%0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e68355 %T Analyzing Satellite Imagery to Target Tuberculosis Control Interventions in Densely Urbanized Areas of Kigali, Rwanda: Cross-Sectional Pilot Study %A Faccin,Mauro %A Geenen,Caspar %A Happaerts,Michiel %A Ombelet,Sien %A Migambi,Patrick %A André,Emmanuel %K tuberculosis %K Rwanda %K satellite image %K TB %K PCR testing %K PCR %K questionnaire %K satellite %K active case-finding %K diagnostic %K urban %K Africa %K TB screening %K ACF %K polymerase chain reaction %D 2025 %7 24.4.2025 %9 %J JMIR Public Health Surveill %G English %X 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. %R 10.2196/68355 %U https://publichealth.jmir.org/2025/1/e68355 %U https://doi.org/10.2196/68355 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e66872 %T The Association Between Cultural Tightness and COVID-19 Vaccine Confidence From 28 Countries: Cross-Sectional Study %A Wang,Qiang %A Bolio,Ana %A Lin,Leesa %K COVID-19 %K vaccine confidence %K social norms %K global %K cultural tightness %D 2025 %7 24.4.2025 %9 %J JMIR Public Health Surveill %G English %X 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 (β=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 (β=−0.54, 95% CI −0.67 to −0.37; P<.001) and 2022 (β=−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. %R 10.2196/66872 %U https://publichealth.jmir.org/2025/1/e66872 %U https://doi.org/10.2196/66872 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e65844 %T Exploring 97 Years of Aedes aegypti as the Vector for Dengue, Yellow Fever, Zika, and Chikungunya (Diptera: Culicidae): Scientometric Analysis %A Cheong,Yoon Ling %A Mohd Ghazali,Sumarni %A Mat Hashim,Mohd Hazilas %A Che Ibrahim,Mohd Khairuddin %A Amran,Afzufira %A Tiunh,Tsye Yih %A Lim,Hui Li %A Cheah,Yong Kang %A Gill,Balvinder Singh %A Lim,Kuang Hock %+ Biomedical Museum Unit, Special Resource Centre, Institute for Medical Research, National Institutes of Health, Ministry of Health Malaysia, Jalan Pahang, Kuala Lumpur, 50588, Malaysia, 60 326162666 ext 2810, cheongyl@moh.gov.my %K relative growth rate %K vector control %K collaboration index %K bibliometric %K Aedes aegypti %K Scopus %K co-occurrence %K author %K dengue %K Zika %D 2025 %7 23.4.2025 %9 Original Paper %J Interact J Med Res %G English %X 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. %M 40267478 %R 10.2196/65844 %U https://www.i-jmr.org/2025/1/e65844 %U https://doi.org/10.2196/65844 %U http://www.ncbi.nlm.nih.gov/pubmed/40267478 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59467 %T CoVimmune COVID-19 Immunity Calculator: Web Application Development and Validation Study %A Slotkin,Rebecca %A Kyriakides,Tassos C %A Yu,Vinni %A Chen,Xien %A Kundu,Anupam %A Gupta,Shaili %K COVID-19 %K immunity %K neutralizing antibody %K immunoglobulin G %K vaccine hesitancy %K vaccine timing %K patient-centered care %K web application %K vaccination %K SARS-CoV-2 %D 2025 %7 22.4.2025 %9 %J JMIR Form Res %G English %X Background: This study illustrates the development of a simple web-based application, which demonstrates the relationship between serum anti-SARS-CoV-2 S1/receptor-binding domain immunoglobulin G (IgG) and anti-SARS-CoV-2 neutralizing antibody (nAb) half-maximal inhibitory concentration (IC50) titers in a vaccinated US adult population and compares them to prior data on nAb titers at different time points after vaccination. Objective: The objective of this study is to create an easily accessible calculator that uses the results of commercially available anti-SARS-CoV-2 serum IgG to approximate the underlying ability to neutralize SARS-CoV-2. Methods: Our web-based application leveraged two previously published datasets. One dataset demonstrated a robust correlation between nAb and serum IgG. The other dataset measured nAb titers at specific time periods over a year-long interval following a messenger RNA vaccination primary series and booster vaccine dose. Clinical factors that were statistically significant on a forward linear regression model examining the prediction of nAb from serum IgG were incorporated in the application tool. Results: By combining the datasets described above, we developed a publicly available web-based application that allows users to enter a serum IgG value and determine their estimated nAb titer. The application contextualizes the estimated nAb titer with the theoretical distance from the corresponding vaccine-mediated antibody protection. Using the clinical variables that had a significant impact on how well IgG values predict nAb titers, this application allows for a patient-centered, nAb titer prediction. Conclusions: This application offers an example of how we might bring the advances made in scientific research on protective antibodies post-SARS-CoV-2 vaccination into the clinical sphere with practical tools. %R 10.2196/59467 %U https://formative.jmir.org/2025/1/e59467 %U https://doi.org/10.2196/59467 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e69113 %T Impact of Acute Respiratory Infections on Medical Absenteeism Among Military Personnel: Retrospective Cohort Study %A M,Premikha %A Goh,Jit Khong %A Ng,Jing Qiang %A Mutalib,Adeliza %A Lim,Huai Yang %K respiratory infections %K military %K epidemiology %K public health %K surveillance %D 2025 %7 18.4.2025 %9 %J JMIR Form Res %G English %X 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. %R 10.2196/69113 %U https://formative.jmir.org/2025/1/e69113 %U https://doi.org/10.2196/69113 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e56877 %T Assessing COVID-19 Mortality in Serbia’s Capital: Model-Based Analysis of Excess Deaths %A Cvijanovic,Dane %A Grubor,Nikola %A Rajovic,Nina %A Vucevic,Mira %A Miltenovic,Svetlana %A Laban,Marija %A Mostic,Tatjana %A Tasic,Radica %A Matejic,Bojana %A Milic,Natasa %K COVID-19 %K COVID-19 impact %K SARS-Cov-2 %K coronavirus %K respiratory %K infectious disease %K pulmonary %K pandemic %K excess mortality %K death rate %K death toll %K centralized health care %K urban %K Serbia %K dense population %K public health %K surveillance %D 2025 %7 17.4.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Concerns have been raised about discrepancies in COVID-19 mortality data, particularly between preliminary and final datasets of vital statistics in Serbia. In the original preliminary dataset, released daily during the ongoing pandemic, there was an underestimation of deaths in contrast to those reported in the subsequently released yearly dataset of vital statistics. Objective: This study aimed to assess the accuracy of the final mortality dataset and justify its use in further analyses. In addition, we quantified the relative impact of COVID-19 on the death rate in the Serbian capital’s population. In the process, we aimed to explore whether any evidence of cause-of-death misattribution existed in the final published datasets. Methods: Data were sourced from the electronic databases of the Statistical Office of the Republic of Serbia. The dataset included yearly recorded deaths and the causes of death of all citizens currently living in the territory of Belgrade, the capital of the Republic of Serbia, from 2015 to 2021. Standardization and modeling techniques were utilized to quantify the direct impact of COVID-19 and to estimate excess deaths. To account for year-to-year trends, we used a mixed-effects hierarchical Poisson generalized linear regression model to predict mortality for 2020 and 2021. The model was fitted to the mortality data observed from 2015 to 2019 and used to generate mortality predictions for 2020 and 2021. Actual death rates were then compared to the obtained predictions and used to generate excess mortality estimates. Results: The total number of excess deaths, calculated from model estimates, was 3175 deaths (99% CI 1715-4094) for 2020 and 8321 deaths (99% CI 6975-9197) for 2021. The ratio of estimated excess deaths to reported COVID-19 deaths was 1.07. The estimated increase in mortality during 2020 and 2021 was 12.93% (99% CI 15.74%-17.33%) and 39.32% (99% CI 35.91%-39.32%) from the expected values, respectively. Those aged 0‐19 years experienced an average decrease in mortality of 22.43% and 23.71% during 2020 and 2021, respectively. For those aged up to 39 years, there was a slight increase in mortality (4.72%) during 2020. However, in 2021, even those aged 20‐39 years had an estimated increase in mortality of 32.95%. For people aged 60‐79 years, there was an estimated increase in mortality of 16.95% and 38.50% in 2020 and 2021, respectively. For those aged >80 years, the increase was estimated at 11.50% and 34.14% in 2020 and 2021, respectively. The model-predicted deaths matched the non-COVID-19 deaths recorded in the territory of Belgrade. This concordance between the predicted and recorded non-COVID-19 deaths provides evidence that the cause-of-death misattribution did not occur in the territory of Belgrade. Conclusions: The finalized mortality dataset for Belgrade can be safely used in COVID-19 impact analysis. Belgrade experienced a significant increase in mortality during 2020 and 2021, with most of the excess mortality attributable to SARS-CoV-2. Concerns about increased mortality from causes other than COVID-19 in Belgrade seem misplaced as their impact appears negligible. %R 10.2196/56877 %U https://publichealth.jmir.org/2025/1/e56877 %U https://doi.org/10.2196/56877 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58436 %T Improving Health and Well-Being of People With Post–COVID-19 Consequences in South Africa: Situation Analysis and Pilot Intervention Design %A Glover,Nicole Audrey %A Sathar,Farzana %A Mokome,Pride %A Mathabela,Nkululeko %A Taleni,Sipokazi %A van Blydenstein,Sarah Alexandra %A Mekota,Anna-Maria %A Charalambous,Salome %A Rachow,Andrea %A Ivanova,Olena %K post–COVID-19 %K rehabilitation %K support %K quality of life %K group care %K well-being %K South Africa %K COVID-19 %K situation analysis %K pilot %K intervention %K context-adapted %K physical health %K mental health %K cross-sectional %K mixed method %K questionnaire %K in-depth %K interviews %K survey %K focus group %K quantitative %K qualitative %K support group %K hospital %K patients %K health care workers %K health worker %D 2025 %7 10.4.2025 %9 %J JMIR Form Res %G English %X Background: Multisystemic complications post–COVID-19 infection are increasingly described in the literature, yet guidance on the management remains limited. Objectives: This study aimed to assess the needs, preferences, challenges, and existing interventions for individuals with post–COVID-19 symptoms. Based on this, we aimed to develop a context-adapted intervention to improve the overall health and well-being of individuals with post–COVID-19 complications. Methods: We conducted a cross-sectional mixed-methods situation analysis assessing the needs, preferences, challenges, and existing interventions for patients with post–COVID-19 symptoms. We collected data through questionnaires, semistructured in-depth interviews, and focus group discussions (FGDs) from individuals diagnosed with COVID-19 within the previous 18-month period and health care providers who managed patients with COVID-19 in both inpatient and outpatient settings. Quantitative data were summarized using descriptive statistics, qualitative data were transcribed, and deductive analysis focused on suggestions for future interventions. Findings guided the development of a group intervention. Results: We conducted 60 questionnaires, 13 interviews, and 3 FGDs. Questionnaires showed limited knowledge of post–COVID-19 complications at 26.7% (16/60). Of those who received any rehabilitation for COVID-19 (19/60, 31.7%), 94.7% (18/19) found it helpful for their recovery. Just over half (23/41, 56%) of those who did not receive rehabilitation reported that they would have liked to. The majority viewed rehabilitation as an important adjunct to post–COVID-19 care (56/60, 93.3%) and that support groups would be helpful (53/60, 88.3%). Qualitative results highlighted the need for mental health support, structured post–COVID-19 follow-up, and financial aid in post–COVID-19 care. Based on the insights from the situation analysis, the theory of change framework, and existing post–COVID-19 evidence, we designed and conducted a pilot support group and rehabilitation intervention for individuals with post–COVID-19 complications. Our main objective was to assess the change in physical and psychological well-being pre- and postintervention. The intervention included 8 weekly themed group sessions supplemented by home tasks. Effectiveness of the intervention was evaluated by questionnaires pre- and postintervention on post–COVID-19 symptoms, quality of life with the EuroQoL 5-Dimension 5-Level, short Warwick-Edinburgh Mental Wellbeing Scale, and physical function by spirometry and 1-minute sit-to-stand test. We also assessed the feasibility and acceptability of the intervention by questionnaires and semistructured in-depth interviews. The intervention outcome analysis is yet to be conducted. Conclusions: Insights from patients and health care providers on the characteristics of post–COVID-19 complications helped guide the development of a context-adapted intervention program with potential to improve health and well-being post–COVID-19. %R 10.2196/58436 %U https://formative.jmir.org/2025/1/e58436 %U https://doi.org/10.2196/58436 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e60484 %T Opportunities and Challenges Surrounding the Use of Wearable Sensor Bracelets for Infectious Disease Detection During Hajj: Qualitative Interview Study %A Maddah,Noha %A Verma,Arpana %A Ainsworth,John %+ Division of Informatics Imaging and Data Sciences, School of Health Sciences, Faculty of Biology, Medicine and Health, Manchester Academic Health Science Centre, Centre for Health Informatics, The University of Manchester, Vaughn House, Manchester, M13 9GB, United Kingdom, 44 1612757675, noha.maddah@postgrad.manchester.ac.uk %K wearable sensor %K unified theory of acceptance and use of technology %K task-technology fit %K hajj %K presymptomatic detection %K infectious diseases %K artificial intelligence %D 2025 %7 8.4.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Wearable sensor bracelets have gained interest for their ability to detect symptomatic and presymptomatic infections through alterations in physiological indicators. Nevertheless, the use of these devices for public health surveillance among attendees of large-scale events such as hajj, the Islamic religious mass gathering held in Saudi Arabia, is currently in a nascent phase. Objective: This study aimed to explore hajj stakeholders’ perspectives on the use of wearable sensor bracelets for disease detection. Methods: We conducted a qualitative, theoretically informed, interview-based study from March 2022 to October 2023 involving a diverse sample of hajj stakeholders, including technology experts, health care providers, and hajj service providers. The study was guided by the task-technology fit model and the unified theory of acceptance and use of technology to provide a comprehensive understanding of the factors influencing the acceptance and use of the technology. Semistructured in-depth interviews were used to capture perspectives on using wearable sensor bracelets for infectious disease detection during hajj. Thematic analysis of interview transcripts was conducted. Results: A total of 14 individuals were interviewed. In total, 4 main themes and 13 subthemes emerged from the study, highlighting crucial challenges, considerations, recommendations, and opportunities in the use of wearable sensor bracelets for the presymptomatic detection of infectious diseases during hajj. Implementing wearable sensor bracelets for disease detection during hajj faces obstacles from multiple perspectives, encompassing users, implementing stakeholders, and technological factors. Hajj stakeholders were concerned about the substantial financial and operational barriers. The motivation of implementing stakeholders and users is essential for the acceptance and uptake of devices during hajj. Successful integration of wearables into the hajj surveillance system depends on several factors, including infrastructure, device features, suitable use cases, training, and a smooth organizational integration process. Conclusions: This study provides valuable insights into the potential opportunities and challenges of adopting wearable sensor bracelets for disease detection during hajj. It offers essential factors to consider and important suggestions to enhance comprehension and ensure the effective implementation of this technology. %M 40198912 %R 10.2196/60484 %U https://formative.jmir.org/2025/1/e60484 %U https://doi.org/10.2196/60484 %U http://www.ncbi.nlm.nih.gov/pubmed/40198912 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e66350 %T Epidemiological Characteristics of Intestinal Protozoal Infections and Their Risk Factors in Malaysia: Systematic Review and Meta-Analysis Protocol %A Mizan,Nor Shazlina %A Al-Talib,Hassanain %A Wang,Seok Mui %+ Department of Medical Microbiology and Parasitology, Faculty of Medicine, Universiti Teknologi MARA, Jalan Hospital, Sungai Buloh, 47000, Malaysia, 60 179131562, hassanain@uitm.edu.my %K intestinal protozoa %K infection %K gastroenteritis %K epidemiology %K parasite %K risk factor %K Malaysia %K contamination %K diarrhea %K outbreak %K socioeconomic %K sanitation %K systematic review %K meta-analysis %K protocol %K observational %K PRISMA %D 2025 %7 4.4.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Intestinal protozoal infections caused by Entamoeba histolytica, Giardia lamblia, and Cryptosporidium parvum are prevalent in Malaysia. They cause severe diarrheal diseases with symptoms such as bloody stools, abdominal pain, stomach discomfort, and bloating. These infection outbreaks have been reported in diverse socioeconomic backgrounds and geographical regions usually during the rainy season or in areas with poor sanitation. Despite the importance of these infections, data on its overall prevalence, risk factors, and diagnostic methods remain limited. Objective: The aim of this study is to systematically review and synthesize evidence on the risk factors, prevalence, and detection methods for intestinal protozoal infections in Malaysia, offering insights that are applicable to other tropical and low-income regions. Methods: Studies on intestinal protozoal infections among Malaysian patients published after January 2010 up to November 2024 will be eligible for inclusion. The eligibility criteria include studies investigating infections caused by E. histolytica, G. lamblia, and C. parvum using validated diagnostic methods such as microscopy, molecular techniques, or immunoassays. Case reports, reviews, and studies without original data will be excluded. Comprehensive database searches will be conducted in PubMed/MEDLINE, Scopus, ProQuest, Web of Science, Google Scholar, and the Cochrane Library. The reference lists of selected papers are also checked. A standardized data extraction form will be used to record study characteristics, outcomes, and associated variables. Risk of bias will be assessed using the Joanna Briggs Institute tools and Newcastle-Ottawa Scale approach. Data synthesis will utilize a random effects model to estimate pooled prevalence and identify risk factors associated with these infections. Subgroup analyses will examine variations by geographic region and diagnostic method. Statistical heterogeneity will be assessed using I2 statistic and meta-regression. Publication bias will be assessed using Egger and Begg funnel plot test. The results are reported in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Results: This systematic review was funded in June 2024. Database searches were started in July 2024, and we identified 1652 papers as of December 2024 for screening. Completion of study screening is anticipated by May 2025, with data extraction and analysis expected to conclude by December 2025. Conclusions: Our study will address critical knowledge gaps in the epidemiology and risk factors of intestinal protozoal infections in Malaysia. Study limitations include potential bias in study selection, heterogeneity in diagnostic methods, and differences in the reporting quality of the included studies. Our findings will provide valuable insights into the prevalence of these infections, the associated risk factors, and the diagnostic techniques employed, which should strengthen public health measures, improve diagnostic procedures, and guide future research to reduce the prevalence of intestinal protozoal infections in Malaysia. Trial Registration: PROSPERO (International Prospective Registry of Systematic Reviews) registration CRD42023456199; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023456199 International Registered Report Identifier (IRRID): DERR1-10.2196/66350 %M 40184188 %R 10.2196/66350 %U https://www.researchprotocols.org/2025/1/e66350 %U https://doi.org/10.2196/66350 %U http://www.ncbi.nlm.nih.gov/pubmed/40184188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e54650 %T Infoveillance of COVID-19 Infections in Dentistry Using Platform X: Descriptive Study %A Al-Mansoori,Alghalia %A Al Hayk,Ola %A Qassmi,Sharifa %A Aziz,Sarah M %A Haouari,Fatima %A Chivese,Tawanda %A Tamimi,Faleh %A Daud,Alaa %+ College of Dental Medicine, QU Health, Qatar University, Al Tarfa St, Doha, 2713, Qatar, 974 77193993, adaud@qu.edu.qa %K COVID-19 %K dentistry %K infection %K patient %K infoveillance %K platform X %K Twitter %D 2025 %7 3.4.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The effect of the COVID-19 pandemic on the well-being of dental professionals and patients has been difficult to track and quantify. X (formerly known as Twitter) proved to be a useful infoveillance tool for tracing the impact of the COVID-19 pandemic worldwide. Objective: This study aims to investigate the use of X to track COVID-19 infections and deaths associated with dental practices. Methods: English Tweets reporting infections or deaths associated with the dental practice were collected from January 1, 2020, to March 31, 2021. Tweets were searched manually using the X Pro search engine (previously known as TweetDeck [X Corp], Twitter Inc, and TweetDeck Ltd) and automatically using a tweet crawler on the X Academic Research application programming interface. Queries included keywords on infection or death of dental staff and patients caused by COVID-19. Tweets registering events on infection or death of dentists, dental staff, and patients as part of their conversation were included. Results: A total of 5641 eligible tweets were retrieved. Of which 1583 (28.1%) were deemed relevant after applying the inclusion and exclusion criteria. Of the relevant tweets, 311 (19.6%) described infections at dental practices, where 1168 (86.9%) infection cases were reported among dentists, 134 (9.9%) dental staff, and 41 (3.1%) patients. The majority of reported infections occurred in the United States, India, and Canada, affecting individuals aged 20-51 years. Among the 600 documented deaths, 253 (42.2%) were dentists, 22 (3.7%) were dental staff, and 7 (1.2%) were patients. The countries with the highest number of deaths were the United States, Pakistan, and India, with an affected age range of 23-83 years. Conclusions: The data suggest that analyses of X information in populations of affected areas may provide useful information regarding the impact of a pandemic on the dental profession and demonstrate a correlation with suspected and confirmed infection or death cases. Platform X shows potential as an early predictor for disease spread. However, further research is required to confirm its validity. %M 40179381 %R 10.2196/54650 %U https://www.jmir.org/2025/1/e54650 %U https://doi.org/10.2196/54650 %U http://www.ncbi.nlm.nih.gov/pubmed/40179381 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e69048 %T Balancing Human Mobility and Health Care Coverage in Sentinel Surveillance of Brazilian Indigenous Areas: Mathematical Optimization Approach %A Oliveira,Juliane Fonseca %A Vasconcelos,Adriano O %A Alencar,Andrêza L %A Cunha,Maria Célia S L %A Marcilio,Izabel %A Barral-Netto,Manoel %A P Ramos,Pablo Ivan %K representative sentinel surveillance %K early pathogen detection %K indigenous health %K human mobility %K surveillance network optimization %K infectious disease surveillance %K public health strategy %K Brazil %D 2025 %7 1.4.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Optimizing sentinel surveillance site allocation for early pathogen detection remains a challenge, particularly in ensuring coverage of vulnerable and underserved populations. Objective: This study evaluates the current respiratory pathogen surveillance network in Brazil and proposes an optimized sentinel site distribution that balances Indigenous population coverage and national human mobility patterns. Methods: We compiled Indigenous Special Health District (Portuguese: Distrito Sanitário Especial Indígena [DSEI]) locations from the Brazilian Ministry of Health and estimated national mobility routes by using the Ford-Fulkerson algorithm, incorporating air, road, and water transportation data. To optimize sentinel site selection, we implemented a linear optimization algorithm that maximizes (1) Indigenous region representation and (2) human mobility coverage. We validated our approach by comparing results with Brazil’s current influenza sentinel network and analyzing the health attraction index from the Brazilian Institute of Geography and Statistics to assess the feasibility and potential benefits of our optimized surveillance network. Results: The current Brazilian network includes 199 municipalities, representing 3.6% (199/5570) of the country’s cities. The optimized sentinel site design, while keeping the same number of municipalities, ensures 100% coverage of all 34 DSEI regions while rearranging 108 (54.3%) of the 199 cities from the existing flu sentinel system. This would result in a more representative sentinel network, addressing gaps in 9 of 34 previously uncovered DSEI regions, which span 750,515 km² and have a population of 1.11 million. Mobility coverage would improve by 16.8 percentage points, from 52.4% (4,598,416 paths out of 8,780,046 total paths) to 69.2% (6,078,747 paths out of 8,780,046 total paths). Additionally, all newly selected cities serve as hubs for medium- or high-complexity health care, ensuring feasibility for pathogen surveillance. Conclusions: The proposed framework optimizes sentinel site allocation to enhance disease surveillance and early detection. By maximizing DSEI coverage and integrating human mobility patterns, this approach provides a more effective and equitable surveillance network, which would particularly benefit underserved Indigenous regions. %R 10.2196/69048 %U https://publichealth.jmir.org/2025/1/e69048 %U https://doi.org/10.2196/69048 %0 Journal Article %@ 2819-2044 %I JMIR Publications %V 3 %N %P e69542 %T Assessing the Influence of Seasonal and Climatic Variations on Livestock Tick Incidence in Tehran Province, Iran: Cross-Sectional Study %A Abbasi,Ebrahim %+ Department of Medical Entomology and Vector Control, School of Health, Shiraz University of Medical Sciences, Zand Street, JGHF+XFG, Shiraz, 3761833650, Iran, 98 9124338389, abbasie.ebrahim@gmail.com %K impact of climate %K seasonal change %K frequency %K livestock %K ticks %K Tehran %D 2025 %7 31.3.2025 %9 Original Paper %J JMIRx Bio %G English %X 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. %R 10.2196/69542 %U https://bio.jmirx.org/2025/1/e69542 %U https://doi.org/10.2196/69542 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e67487 %T Vaccine Hesitancy and Associated Factors Among Caregivers of Children With Special Health Care Needs in the COVID-19 Era in China: Cross-Sectional Study %A Li,Mingyan %A Sun,Changxuan %A Ji,Chai %A Gao,Meiying %A Wang,Xia %A Yao,Dan %A Guo,Junxia %A Sun,Lidan %A Rafay,Abdul %A George,Antonita Shereen %A Muhandiramge,Sanduni Hasara Samararathna Samararathna %A Bai,Guannan %K COVID-19 %K caregivers %K children with special health care needs %K vaccination hesitancy %K decision-making %D 2025 %7 26.3.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Immunization is a cost-effective way to prevent infectious diseases in children, but parental hesitancy leads to low vaccination rates, leaving children at risk. Caregivers of children with special health care needs are more hesitant about vaccines than those of healthy children. Objective: The aim of the study is to investigate the changes in caregivers’ vaccination hesitation of children with special health care needs before, during, and after the COVID-19 pandemic in China and to identify associated factors for caregivers’ attitudes toward National Immunization Program (NIP) and non-NIP vaccines. Methods: We included 7770 caregivers of children with special health care needs (median age 7.0, IQR 2.4-24.1 months) who visited the Vaccination Consultation Clinic at Children’s Hospital, Zhejiang University School of Medicine (Hangzhou, China) from May 2017 to May 2023. General and clinical information was extracted from the immunization evaluation system for children with special health care needs and medical records. We compared the differences in caregivers’ willingness and hesitation for vaccinating their children across the 3 stages of the COVID-19 pandemic using chi-square tests. Multinomial logistic regression models were used to identify independent variables that were associated with caregivers’ willingness and hesitation toward NIP and non-NIP vaccines. Results: There is a statistically significant difference in caregivers’ vaccine hesitancy before, during, and after the COVID-19 pandemic (P<.05). During the COVID-19 pandemic, the percentages of choosing NIP, alternative non-NIP, and non-NIP vaccines are highest (n=1428, 26%, n=3148, 57.4%, and n=3442, 62.7%, respectively) than those at other 2 stages. In comparison, caregivers’ hesitation toward NIP and non-NIP vaccines is lowest (n=911, 16.6% and n=2045, 37.3%, respectively). Despite the stages of the COVID-19 pandemic, multiple factors, including children’s age and sex, parents’ educational level, comorbidities, and history of allergy, were significantly associated with caregivers’ attitude toward NIP and non-NIP vaccines (P<.05). The profiles of risk factors for hesitancy toward NIP and non-NIP vaccines are different, as indicated by the results from the logistic regression models. Conclusions: This study demonstrated that caregivers’ willingness to vaccinate their children with special health care needs with NIP and non-NIP vaccines was highest during the COVID-19 pandemic in China, and their hesitancy was lowest. Additionally, we have identified multiple factors associated with caregivers’ willingness and hesitancy to vaccinate their children. These findings provide evidence-based support for developing personalized health education strategies. %R 10.2196/67487 %U https://publichealth.jmir.org/2025/1/e67487 %U https://doi.org/10.2196/67487 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69506 %T Physiological Sensors Equipped in Wearable Devices for Management of Long COVID Persisting Symptoms: Scoping Review %A Kukreti,Shikha %A Lu,Meng-Ting %A Yeh,Chun-Yin %A Ko,Nai-Ying %+ Department of Nursing, College of Medicine, National Cheng Kung University, No.1, Dasyue Rd, East District, Tainan City, 701, Taiwan, 886 062353535, konaiying@gmail.com %K wearable devices %K long COVID %K physiological sensors %K review %K COVID %K COVID-19 %D 2025 %7 26.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Wearable technology has evolved in managing COVID-19, offering early monitoring of key physiological parameters. However, the role of wearables in tracking and managing long COVID is less understood and requires further exploration of their potential. Objective: This review assessed the application and effectiveness of wearable devices in managing long COVID symptoms, focusing on commonly used sensors and their potential for improving long-term patient care. Methods: A literature search was conducted across databases including PubMed, Embase, Web of Science, and Cochrane Central, adhering to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) reporting guidelines. The search was updated regularly throughout 2024. Abstract and full-text screening and selection were facilitated using Rayyan software developed by Qatar Computing Research Institute. Quality appraisal was conducted using the Joanna Briggs Institute (JBI) critical appraisal tool to ensure the methodological rigor of the included studies. Data were extracted on study characteristics, wearable devices, sensors used, and monitored physiological parameters, and the results were synthesized in a narrative format. Results: A total of 1186 articles were identified, and after duplicate removal and screening, 15 studies were initially included, with 11 studies meeting the criteria for final data synthesis. The included studies varied in design, ranging from observational to interventional trials, and involved sample sizes from 3 to 17,667 participants across different countries. In total, 10 different wearable devices were used to monitor long COVID symptoms, capturing key metrics such as heart rate variability, body temperature, sleep, and physical activity. Smartwatches were the most used wearable devices and fitness trackers with electrocardiography and photoplethysmography sensors were used to monitor heart rate, oxygen saturation, and respiratory rate. Of the 10 devices, 4 were Food and Drug Administration–approved, emphasizing the reliability and validation of the physiological data collected. Studies were primarily conducted in the United States and Europe, reflecting significant regional research interest in wearable technology for long COVID management. Conclusions: This review highlights the potential of wearable technology in providing continuous and personalized monitoring for long COVID patients. Although wearables show promise in tracking persistent symptoms, further research is needed to improve usability, validate long-term efficacy, and enhance patient engagement. %M 40137051 %R 10.2196/69506 %U https://www.jmir.org/2025/1/e69506 %U https://doi.org/10.2196/69506 %U http://www.ncbi.nlm.nih.gov/pubmed/40137051 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e65789 %T Clinical Safety of Pudilan Xiaoyan Oral Liquid for the Treatment of Upper Respiratory Tract Infection in the Real World: Protocol for a Prospective, Observational, Registry Study %A Wang,Mengmeng %A Wang,Lianxin %A Liu,Fumei %A Chen,Renbo %A Wang,Zhifei %A Cui,Xin %A Li,Yuanyuan %A Xie,Yanming %+ Institute of Basic Research in Clinical Medicine, China Academy of Chinese Medical Sciences, No.16, Nanxiao Street, Dongzhimen, Dongcheng District, Beijing, 100700, China, 86 13911112416, ktzu2018@163.com %K Pudilan Xiaoyan oral liquid %K PDL %K upper respiratory tract infection %K URTI %K registry %K adverse drug reaction %D 2025 %7 21.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Pudilan Xiaoyan oral liquid (PDL) is a proprietary Chinese medicine preparation widely used for upper respiratory tract infection, known for its significant therapeutic effects. However, the safety profiles reported in several observational studies vary, and these studies primarily focus on efficacy rather than specifically addressing safety concerns, thus representing inadequate safety monitoring. Objective: This study aimed to investigate the incidence of adverse drug reactions (ADRs) associated with PDL and explore the factors contributing to these reactions. Methods: The study is a prospective, observational, multicenter, hospital-based surveillance study. A total of 17 hospitals from China are involved. The study is expected to enroll a large sample of 10,000 patients aged between 18 and 80 years with upper respiratory tract infection who were prescribed PDL. The patients’ data, including demographics, medical history, diagnostic information, medication details, adverse events, and laboratory test results, will be monitored. The occurrence of ADRs will be recorded. The primary outcome is the incidence of ADR. Secondary outcomes are the ratio of patients whose body temperature return to the normal range (cases of body temperature normalization and the duration for achieving normal body temperature within a 3-day period will be documented) and changes in liver and kidney function (occurrence of drug-induced liver injury and acute kidney injury). Descriptive analyses will be performed for the primary and secondary outcomes. A cohort, nested, case-control study design will be used. If one patient has an ADR, then 4 patients without ADRs will be matched as the control group according to gender, age within 5 years, drug batch, and other factors, at a ratio of 1∶4 to compare the symptoms related to ADRs. The differences of ADR incidence among the possible influencing factors will be compared separately to find the factors with large differences. Then, synthetic minority oversampling technique and group least absolute shrinkage and selection operator methods will be used to identify factors influencing the occurrence of ADRs. Finally, propensity scoring methods will be used to control for confounding variables. The progress of each subcenter will be closely monitored, and the incidence of ADR will be systematically calculated. Furthermore, the characteristics and influencing factors of ADR will be analyzed, along with an investigation into its geographical distribution. Results: The study began on July 17, 2019. Due to the limited number of eligible patients, missed follow-ups, and the huge clinical burden caused by public health events in 2019, the final case will be enrolled on August 30, 2025. Conclusions: This study will obtain safety results of PDL in the real world and provide guidance on the clinical safety of traditional Chinese medicine formulations. Trial Registration: ClinicalTrials.gov NCT04031651; https://clinicaltrials.gov/study/NCT04031651 International Registered Report Identifier (IRRID): DERR1-10.2196/65789 %M 40117581 %R 10.2196/65789 %U https://www.researchprotocols.org/2025/1/e65789 %U https://doi.org/10.2196/65789 %U http://www.ncbi.nlm.nih.gov/pubmed/40117581 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e59971 %T Meeting Global Health Needs via Infectious Disease Forecasting: Development of a Reliable Data-Driven Framework %A Keshavamurthy,Ravikiran %A Pazdernik,Karl T %A Ham,Colby %A Dixon,Samuel %A Erwin,Samantha %A Charles,Lauren E %K disease forecasting %K machine learning %K deep learning %K epidemiology %K One Health %K decision-making %K data visualization %D 2025 %7 21.3.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Infectious diseases (IDs) have a significant detrimental impact on global health. Timely and accurate ID forecasting can result in more informed implementation of control measures and prevention policies. Objective: To meet the operational decision-making needs of real-world circumstances, we aimed to build a standardized, reliable, and trustworthy ID forecasting pipeline and visualization dashboard that is generalizable across a wide range of modeling techniques, IDs, and global locations. Methods: We forecasted 6 diverse, zoonotic diseases (brucellosis, campylobacteriosis, Middle East respiratory syndrome, Q fever, tick-borne encephalitis, and tularemia) across 4 continents and 8 countries. We included a wide range of statistical, machine learning, and deep learning models (n=9) and trained them on a multitude of features (average n=2326) within the One Health landscape, including demography, landscape, climate, and socioeconomic factors. The pipeline and dashboard were created in consideration of crucial operational metrics—prediction accuracy, computational efficiency, spatiotemporal generalizability, uncertainty quantification, and interpretability—which are essential to strategic data-driven decisions. Results: While no single best model was suitable for all disease, region, and country combinations, our ensemble technique selects the best-performing model for each given scenario to achieve the closest prediction. For new or emerging diseases in a region, the ensemble model can predict how the disease may behave in the new region using a pretrained model from a similar region with a history of that disease. The data visualization dashboard provides a clean interface of important analytical metrics, such as ID temporal patterns, forecasts, prediction uncertainties, and model feature importance across all geographic locations and disease combinations. Conclusions: As the need for real-time, operational ID forecasting capabilities increases, this standardized and automated platform for data collection, analysis, and reporting is a major step forward in enabling evidence-based public health decisions and policies for the prevention and mitigation of future ID outbreaks. %R 10.2196/59971 %U https://publichealth.jmir.org/2025/1/e59971 %U https://doi.org/10.2196/59971 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e57905 %T Comparative Evaluation of Effectiveness of Standard of Care Alone and in Combination With Homoeopathic Treatment in COVID-19–Related Rhino-Orbito-Cerebral Mucormycosis (ROCM): Protocol for a Single Blind, Randomized Controlled Trial %A Kaur,Harleen %A Sachdeva,Jyoti %A Bawaskar,Ramesh %A Goyal,Twinkle %+ , Central Council for Research in Homeopathy, 61-65, Institutional Area, Opp. ‘D’ Block, Janak Puri, New Delhi, 110058, India, 91 011 28525523, dr.harleenkaur@gmail.com %K Rhino-orbital-cerebral mucormycosis, randomized controlled trial, homoeopathy, fungus, CE-MRI PNS mucormycosis %K India %K medical care %K mortality rate %K conventional therapy %K ethical %K mortality %K survival %K recovery %K homoeopathic medicines %K management %D 2025 %7 19.3.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Rhino-orbital-cerebral mucormycosis (ROCM) is the most common (45%-74%) mucormycosis in India. With contemporary medical care, ROCM has a mortality rate of 40%-50% and 70% of survivors are left with residual defects. Recently, several cases of mucormycosis in people with COVID-19 have been increasingly reported worldwide, from India, due to immune dysregulation caused by SARS-CoV-2. To reduce the high mortality rate and residual defect in most survivors under the guidelines of the Ministry of AYUSH, the Government of India recommended homoeopathy as an add-on therapy to maximize the effectiveness of standard treatment in conventional therapy. Objective: This study aimed to evaluate the role of existing homoeopathic treatment as an adjuvant therapy in patients with COVID-19–related ROCM and enhancing the survival of the patients hospitalized due to COVID-19 infection and to access the initial treatment response and duration required for significant or complete recovery in patients receiving adjuvant treatment. Methods: This superiority, randomized controlled clinical trial would include two parallel comparator groups A and B. Group A would be the experimental group and would receive homoeopathic treatment along with the standard line of treatment as per investigational medicinal product (IMP) and group B would be the control arm and would receive standard line of treatment as per IMP along with identical placebo. Allocation would be 1:1 through randomization. Based on the inclusion and exclusion criteria, 36 participants per arm would be screened. Participants would be assessed clinically twice a day and magnetic resonance imagery or endoscopy cum-biopsy would be assessed on days 1, 14, and 28. Laboratory investigations may vary as per demand of disease conditions. Results: In India, the COVID-19 pandemic, particularly during the second wave, resulted in a surge of mucormycosis cases among patients with COVID-19. At the time this protocol was being developed, there was a significant spike in mucormycosis cases in India, particularly in Mumbai (June 2021). However, by the time the Central Council for Research in Homoeopathy obtained the necessary approvals and ethical clearance for the study, the incidence of mucormycosis had drastically declined (September 2021). As a result, the study was not initiated and registered. The authors feel it is their ethical responsibility to share the reviewed protocol with the medical community as a reference for future work. Conclusions: This study aims to evaluate the role of existing homoeopathic medicines as an adjuvant therapy in managing COVID-19–related ROCM, potentially contributing to the use of homoeopathy as an evidence-based medical approach. The protocol can also serve as a valuable resource for clinicians and researchers addressing mucormycosis cases unrelated to COVID-19, particularly in immunocompromised patients. It would help ensure preparedness, whether or not sufficient evidence is available, in the event of a future health emergency. International Registered Report Identifier (IRRID): PRR1-10.2196/57905 %M 40106813 %R 10.2196/57905 %U https://www.researchprotocols.org/2025/1/e57905 %U https://doi.org/10.2196/57905 %U http://www.ncbi.nlm.nih.gov/pubmed/40106813 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e51524 %T Targeted Behavior Change Communication Using a Mobile Health Platform to Increase Uptake of Long-Lasting Insecticidal Nets Among Pregnant Women in Tanzania: Hati Salama “Secure Voucher” Study Cluster Randomized Controlled Trial %A Vey,Trinity %A Kinnicutt,Eleonora %A Day,Andrew G %A West,Nicola %A Sleeth,Jessica %A Nchimbi,Kenneth Bernard %A Yeates,Karen %+ Department of Medicine, Queen's University, 99 University Avenue, Kingston, ON, K7L 3N6, Canada, 1 613 533 2000, 16tv7@queensu.ca %K malaria prevention %K pregnant %K mHealth %K mobile health %K short message service %K behaviour change communication %K long-lasting insecticidal nets %K protozoan infections %K parasitic diseases %K vector borne diseases %K randomized controlled trial %K morbidity %K mortality %K intervention %D 2025 %7 19.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Malaria remains a significant cause of maternal and neonate morbidity and mortality in sub-Saharan Africa. Long-lasting insecticidal nets (LLINs) represent an important component of malaria prevention and can decrease the adverse health outcomes associated with malaria infection during pregnancy. Voucher programs have been successfully implemented for a variety of initiatives across sub-Saharan Africa, including the distribution of subsidized LLINs in Tanzania. However, mobile messaging for behavior change communication (BCC), in combination with an e-voucher program, has not been explored for malaria prevention. Objective: This study aimed to assess the efficacy of mobile messaging in increasing the redemption of e-vouchers for LLINs for pregnant women and adolescents in Tanzania. Methods: This study was a blinded, 2-arm, cluster randomized controlled trial implemented in 100 antenatal health facilities in Tanzania (both urban and rural settings), with 50 clusters in both intervention and control groups. Clusters were antenatal clinics with e-voucher capabilities, with randomization stratified such that 25 urban and 25 rural clinics were randomized to each arm. Participants were pregnant females aged 13 years or older. Participants in both intervention and control groups were issued e-vouchers on their mobile phones that could be redeemed for LLINs at registered retailers within a 14-day redemption period. Participants in the intervention group received targeted BCC messages about the importance of malaria prevention and LLIN use during pregnancy, while participants in the control group did not receive BCC messages. Analyses were by intention to treat. The primary outcome was the redemption rate of e-vouchers for LLINs from retailers. Outcome measures pertain to clinic sites and individual participant-level data. Results: The study enrolled 5449 participants; the analysis included 2708 participants in the intervention arm and 2740 participants in the control arm (49 clusters in each group analyzed). There was no significant difference in the raw redemption rate of e-vouchers between pregnant participants in the intervention group (70%) and the control group (67%). Younger participants were less likely to redeem e-vouchers. Conclusions: The use of a BCC mobile messaging intervention did not result in a significant increase in LLIN uptake for pregnant individuals. However, the study shows that e-voucher distribution through nurses in antenatal clinics in partnership with local retailers is feasible on a large scale. Consideration of women and adolescents who are low-income and live in rural areas is needed for future interventions leveraging e-vouchers or mHealth technology in low-resource settings. Trial Registration: ClinicalTrials.gov NCT02561624; https://clinicaltrials.gov/ct2/show/NCT02561624 %M 40106816 %R 10.2196/51524 %U https://www.jmir.org/2025/1/e51524 %U https://doi.org/10.2196/51524 %U http://www.ncbi.nlm.nih.gov/pubmed/40106816 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e65147 %T Factors Associated With the Availability of Virtual Consultations in Primary Care Across 20 Countries: Cross-Sectional Study %A Kerr,Gabriele %A Greenfield,Geva %A Li,Edmond %A Beaney,Thomas %A Hayhoe,Benedict W J %A Car,Josip %A Clavería,Ana %A Collins,Claire %A Gusso,Gustavo %A Hoffman,Robert D %A Jimenez,Geronimo %A Koskela,Tuomas H %A Laranjo,Liliana %A Lingner,Heidrun %A Memarian,Ensieh %A Nessler,Katarzyna %A Petek,Davorina %A Tsopra,Rosy %A Majeed,Azeem %A Neves,Ana Luisa %+ Department of Primary Care and Public Health, Imperial College London, White City Campus, 90 Wood Lane, London, W12 0BZ, United Kingdom, 44 20 7594 9826, gk916@ic.ac.uk %K digital health %K primary care %K telemedicine %K virtual consultation %K healthcare delivery %K online consultation %K primary care physician %K upper-middle income %K upper-middle income countries %K high-income countries %K online survey %K chi-squared test %K remote healthcare %K video consultation %K chat consultation %K telephone consultations %K digital technology %K virtual care %K teleconsultation %K telehealth %K remote consultation %D 2025 %7 19.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual consultations represent a notable change in health care delivery following the COVID-19 pandemic. Understanding the dynamics of virtual consultations is critical in assessing health care system resilience and adaptability in times of crisis. Objective: This study aimed to describe the availability and hours of use of telephone, video, and human chat consultations before and during the COVID-19 pandemic period, and identify factors associated with their availability. Methods: Primary care physicians (PCPs) from 20 upper-middle– and high-income countries completed a cross-sectional web-based survey in 2020. Factors associated with availability were investigated using chi-square tests and effect size (ES) estimates calculated using Cramer V. Results: A total of 1370 PCPs were included in this study (85.4% of the total sample of 1605). Telephone consultations were the most frequently available type of virtual consultations before and during the pandemic (73.1% and 90.4%, respectively). Significant increases in availability and use were observed during the pandemic for all the types of virtual consultations. The largest absolute increase in availability was observed for video consultations (39.5%), followed by telephone (17.3%) and chat (8.6%; all P<.001). The largest increase in use was observed for telephone consultations (+11 hours per week, P<.001). Digital maturity of the practice was weakly associated with availability of video consultations both before (ES 0.2) and during (ES 0.2) the pandemic (P<.001 for both), and with chat consultations before the pandemic only (ES 0.1, P=.001). Greater availability of video and chat consultations was found in PCPs who had completed digital health training, both before and during the pandemic (P<.001 for all). There was significant country-level variation in the use and availabilities of the technologies between both time periods. The association between country and the availability of telephone consultations changed from strong (ES 0.5, P<.001) to weak (ES 0.2, P=.03), while the relationship between country and video consultations changed from moderate (ES 0.3, P<.001) to strong (ES 0.5, P<.001). Conclusions: Our study demonstrates the transformative impact of the COVID-19 pandemic on the availability of virtual consultations globally, and how practice-level factors, predominantly digital maturity, digital health training, and country, were associated with the availability of virtual consultations. Further exploration of drivers of availability, particularly at the national level, is needed to ensure sustained and effective implementation of virtual consultations. International Registered Report Identifier (IRRID): RR2-10.2196/30099 %M 40105882 %R 10.2196/65147 %U https://www.jmir.org/2025/1/e65147 %U https://doi.org/10.2196/65147 %U http://www.ncbi.nlm.nih.gov/pubmed/40105882 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60831 %T Prevalence of Antibiotic Prescribing for Acute Respiratory Tract Infection in Telehealth Versus Face-to-Face Consultations: Cross-Sectional Analysis of General Practice Registrars’ Clinical Practice %A Gao,Yu %A Magin,Parker %A Tapley,Amanda %A Holliday,Elizabeth %A Dizon,Jason %A Fisher,Katie %A van Driel,Mieke %A Davis,Joshua S %A Davey,Andrew %A Ralston,Anna %A Fielding,Alison %A Moad,Dominica %A Mulquiney,Katie %A Clarke,Lisa %A Turner,Alexandria %+ General Practice Clinical Unit, Faculty of Medicine, The University of Queensland, Level 8, Health Sciences Building, Royal Brisbane & Women’s Hospital, Herston, 4029, Australia, 61 3 9698 0655, alex.turner@racgp.org.au %K antimicrobial resistance %K antibiotics stewardship %K telehealth %K general practice %K registrars %K acute respiratory tract infection %K antibiotics %K prescription %K respiratory tract infection %K RTIs %K Australia %K consultations %K teleconsultation %K teleconsult %K bronchitis %K sore throat %K acute otitis %K sinusitis %K in-consultation %K upper respiratory tract infection %D 2025 %7 13.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Antimicrobial resistance is a global threat. Australia has high antibiotic prescribing rates with the majority of antibiotics prescribed by general practitioners (GPs) for self-limiting acute respiratory tract infection (ARTIs). Australian GP trainees’ (registrars’) prescribing for ARTIs may have been affected by the introduction of remunerated telehealth consultations in 2020. Understanding of the impact of telehealth on antibiotic stewardship may inform registrar educational programs. Objective: This study aimed to compare the prevalence of antibiotic prescribing by GP registrars in telehealth versus face-to-face (F2F) consultations for common cold (upper respiratory tract infection [URTI]), bronchitis, sore throat, acute otitis media, and sinusitis. Methods: A cross-sectional analysis of data from the Registrar Clinical Encounters in Training (ReCEnT) study, a multicenter inception cohort study of registrars’ in-consultation clinical and educational experiences. Analysis used univariable and multivariable logistic regression using 2020-2023 ReCEnT data. The outcome variable was “antibiotic prescribed” for new presentations of URTI, acute sore throat, acute bronchitis, acute sinusitis, and acute otitis media. The study factor was consultation type (telehealth or F2F). Results: A total of 2392 registrars participated (response rate=93.4%). The proportions of diagnoses that were managed via telehealth were 25% (5283/21384) overall, 19% (641/3327) for acute sore throat, 29% (3733/12773) for URTI, 21% (364/1772), for acute bronchitis, 4.1% (72/1758) for acute otitis media, and 27% (473/1754) for acute sinusitis. Antibiotics were prescribed for 51% (1685/3327) of sore throat diagnoses, 6.9% (880/12773) of URTI diagnoses, 64% (1140/1772) of bronchitis diagnoses, 61% (1067/1754) of sinusitis diagnoses, and 73% (1278/1758) of otitis media diagnoses. On multivariable analysis, antibiotics were less often prescribed in telehealth than F2F consultations for sore throat (adjusted odds ratio [OR] 0.69, 95% CI 0.55-0.86; P=.001), URTI (adjusted OR 0.64, 95% CI 0.51-0.81; P<.001), and otitis media (adjusted OR 0.47, 95% CI 0.26-0.84; P=.01). There were no significant differences for acute bronchitis (adjusted OR 1.07, 95% CI 0.79-1.45; P=.66) or acute sinusitis (adjusted OR 1, 95% CI 0.76-1.32; P=.99). Conclusions: GP registrars are less likely to prescribe antibiotics for sore throat, URTI, and otitis media when seeing patients by telehealth versus F2F. Understanding the reason for this difference is essential to help guide educational efforts aimed at decreasing antibiotic prescribing by GPs for conditions such as ARTIs where they are of little to no benefit. There was no evidence in this study that telehealth consultations were associated with greater registrar antibiotic prescribing for ARTIs. Therefore, there is no deleterious effect on antibiotic stewardship. %M 40080812 %R 10.2196/60831 %U https://www.jmir.org/2025/1/e60831 %U https://doi.org/10.2196/60831 %U http://www.ncbi.nlm.nih.gov/pubmed/40080812 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e52972 %T COVID-19 Testing Equity in New York City During the First 2 Years of the Pandemic: Demographic Analysis of Free Testing Data %A Rosenfeld,Daniel %A Brennan,Sean %A Wallach,Andrew %A Long,Theodore %A Keeley,Chris %A Kurien,Sarah Joseph %K COVID-19 testing %K health disparities %K equity in testing %K New York City %K socioeconomic factors %K testing accessibility %K health care inequalities %K demographic analysis %K COVID-19 mortality %K coronavirus %K SARS-CoV-2 %K pandemic %K equitable testing %K cost %K poor neighborhood %K resources %D 2025 %7 13.3.2025 %9 %J JMIR Public Health Surveill %G English %X Background: COVID-19 has caused over 46,000 deaths in New York City, with a disproportional impact on certain communities. As part of the COVID-19 response, the city has directly administered over 6 million COVID-19 tests (in addition to millions of indirectly administered tests not covered in this analysis) at no cost to individuals, resulting in nearly half a million positive results. Given that the prevalence of testing, throughout the pandemic, has tended to be higher in more affluent areas, these tests were targeted to areas with fewer resources. Objective: This study aimed to evaluate the impact of New York City’s COVID-19 testing program; specifically, we aimed to review its ability to provide equitable testing in economically, geographically, and demographically diverse populations. Of note, in addition to the brick-and-mortar testing sites evaluated herein, this program conducted 2.1 million tests through mobile units to further address testing inequity. Methods: Testing data were collected from the in-house Microsoft SQL Server Management Studio 18 Clarity database, representing 6,347,533 total tests and 449,721 positive test results. These tests were conducted at 48 hospital system locations. Per capita testing rates by zip code tabulation area (ZCTA) and COVID-19 positivity rates by ZCTA were used as dependent variables in separate regressions. Median income, median age, the percentage of English-speaking individuals, and the percentage of people of color were used as independent demographic variables to analyze testing patterns across several intersecting identities. Negative binomial regressions were run in a Jupyter Notebook using Python. Results: Per capita testing inversely correlated with median income geographically. The overall pseudo r2 value was 0.1101 when comparing hospital system tests by ZCTA against the selected variables. The number of tests significantly increased as median income fell (SE 1.00000155; P<.001). No other variables correlated at a significant level with the number of tests (all P values were >.05). When considering positive test results by ZCTA, the number of positive test results also significantly increased as median income fell (SE 1.57e–6; P<.001) and as the percentage of female residents fell (SE 0.957; P=.001). The number of positive test results by ZCTA rose at a significant level alongside the percentage of English-only speakers (SE 0.271; P=.03). Conclusions: New York City’s COVID-19 testing program was able to improve equity through the provision of no-cost testing, which focused on areas of the city that were disproportionately impacted by COVID-19 and had fewer resources. By detecting higher numbers of positive test results in resource-poor neighborhoods, New York City was able to deploy additional resources, such as those for contact tracing and isolation and quarantine support (eg, free food delivery and free hotel stays), early during the COVID-19 pandemic. Equitable deployment of testing is feasible and should be considered early in future epidemics or pandemics. %R 10.2196/52972 %U https://publichealth.jmir.org/2025/1/e52972 %U https://doi.org/10.2196/52972 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e69068 %T Diagnostic Performance of Artificial Intelligence–Based Methods for Tuberculosis Detection: Systematic Review %A Hansun,Seng %A Argha,Ahmadreza %A Bakhshayeshi,Ivan %A Wicaksana,Arya %A Alinejad-Rokny,Hamid %A Fox,Greg J %A Liaw,Siaw-Teng %A Celler,Branko G %A Marks,Guy B %+ School of Clinical Medicine, South West Sydney, UNSW Medicine & Health, UNSW Sydney, High Street, Kensington, NSW, Sydney, 2052, Australia, 61 456541224, s.hansun@unsw.edu.au %K AI %K artificial intelligence %K deep learning %K diagnostic performance %K machine learning %K PRISMA %K Preferred Reporting Items for Systematic Reviews and Meta-Analysis %K QUADAS-2 %K Quality Assessment of Diagnostic Accuracy Studies version 2 %K systematic literature review %K tuberculosis detection %D 2025 %7 7.3.2025 %9 Review %J J Med Internet Res %G English %X Background: Tuberculosis (TB) remains a significant health concern, contributing to the highest mortality among infectious diseases worldwide. However, none of the various TB diagnostic tools introduced is deemed sufficient on its own for the diagnostic pathway, so various artificial intelligence (AI)–based methods have been developed to address this issue. Objective: We aimed to provide a comprehensive evaluation of AI-based algorithms for TB detection across various data modalities. Methods: Following PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) 2020 guidelines, we conducted a systematic review to synthesize current knowledge on this topic. Our search across 3 major databases (Scopus, PubMed, Association for Computing Machinery [ACM] Digital Library) yielded 1146 records, of which we included 152 (13.3%) studies in our analysis. QUADAS-2 (Quality Assessment of Diagnostic Accuracy Studies version 2) was performed for the risk-of-bias assessment of all included studies. Results: Radiographic biomarkers (n=129, 84.9%) and deep learning (DL; n=122, 80.3%) approaches were predominantly used, with convolutional neural networks (CNNs) using Visual Geometry Group (VGG)-16 (n=37, 24.3%), ResNet-50 (n=33, 21.7%), and DenseNet-121 (n=19, 12.5%) architectures being the most common DL approach. The majority of studies focused on model development (n=143, 94.1%) and used a single modality approach (n=141, 92.8%). AI methods demonstrated good performance in all studies: mean accuracy=91.93% (SD 8.10%, 95% CI 90.52%-93.33%; median 93.59%, IQR 88.33%-98.32%), mean area under the curve (AUC)=93.48% (SD 7.51%, 95% CI 91.90%-95.06%; median 95.28%, IQR 91%-99%), mean sensitivity=92.77% (SD 7.48%, 95% CI 91.38%-94.15%; median 94.05% IQR 89%-98.87%), and mean specificity=92.39% (SD 9.4%, 95% CI 90.30%-94.49%; median 95.38%, IQR 89.42%-99.19%). AI performance across different biomarker types showed mean accuracies of 92.45% (SD 7.83%), 89.03% (SD 8.49%), and 84.21% (SD 0%); mean AUCs of 94.47% (SD 7.32%), 88.45% (SD 8.33%), and 88.61% (SD 5.9%); mean sensitivities of 93.8% (SD 6.27%), 88.41% (SD 10.24%), and 93% (SD 0%); and mean specificities of 94.2% (SD 6.63%), 85.89% (SD 14.66%), and 95% (SD 0%) for radiographic, molecular/biochemical, and physiological types, respectively. AI performance across various reference standards showed mean accuracies of 91.44% (SD 7.3%), 93.16% (SD 6.44%), and 88.98% (SD 9.77%); mean AUCs of 90.95% (SD 7.58%), 94.89% (SD 5.18%), and 92.61% (SD 6.01%); mean sensitivities of 91.76% (SD 7.02%), 93.73% (SD 6.67%), and 91.34% (SD 7.71%); and mean specificities of 86.56% (SD 12.8%), 93.69% (SD 8.45%), and 92.7% (SD 6.54%) for bacteriological, human reader, and combined reference standards, respectively. The transfer learning (TL) approach showed increasing popularity (n=89, 58.6%). Notably, only 1 (0.7%) study conducted domain-shift analysis for TB detection. Conclusions: Findings from this review underscore the considerable promise of AI-based methods in the realm of TB detection. Future research endeavors should prioritize conducting domain-shift analyses to better simulate real-world scenarios in TB detection. Trial Registration: PROSPERO CRD42023453611; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023453611 %M 40053773 %R 10.2196/69068 %U https://www.jmir.org/2025/1/e69068 %U https://doi.org/10.2196/69068 %U http://www.ncbi.nlm.nih.gov/pubmed/40053773 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e54543 %T Exploring Psychological Trends in Populations With Chronic Obstructive Pulmonary Disease During COVID-19 and Beyond: Large-Scale Longitudinal Twitter Mining Study %A Zhang,Chunyan %A Wang,Ting %A Dong,Caixia %A Dai,Duwei %A Zhou,Linyun %A Li,Zongfang %A Xu,Songhua %+ School of Electrical Engineering, Xi'an Jiaotong University, No. 28, Xianning West Road, Xi'an, 710049, China, 86 13289346632, wang.ting@xjtu.edu.cn %K COVID-19 %K chronic obstructive pulmonary disease (COPD) %K psychological trends %K Twitter %K data mining %K deep learning %D 2025 %7 5.3.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Chronic obstructive pulmonary disease (COPD) ranks among the leading causes of global mortality, and COVID-19 has intensified its challenges. Beyond the evident physical effects, the long-term psychological effects of COVID-19 are not fully understood. Objective: This study aims to unveil the long-term psychological trends and patterns in populations with COPD throughout the COVID-19 pandemic and beyond via large-scale Twitter mining. Methods: A 2-stage deep learning framework was designed in this study. The first stage involved a data retrieval procedure to identify COPD and non-COPD users and to collect their daily tweets. In the second stage, a data mining procedure leveraged various deep learning algorithms to extract demographic characteristics, hashtags, topics, and sentiments from the collected tweets. Based on these data, multiple analytical methods, namely, odds ratio (OR), difference-in-difference, and emotion pattern methods, were used to examine the psychological effects. Results: A cohort of 15,347 COPD users was identified from the data that we collected in the Twitter database, comprising over 2.5 billion tweets, spanning from January 2020 to June 2023. The attentiveness toward COPD was significantly affected by gender, age, and occupation; it was lower in females (OR 0.91, 95% CI 0.87-0.94; P<.001) than in males, higher in adults aged 40 years and older (OR 7.23, 95% CI 6.95-7.52; P<.001) than in those younger than 40 years, and higher in individuals with lower socioeconomic status (OR 1.66, 95% CI 1.60-1.72; P<.001) than in those with higher socioeconomic status. Across the study duration, COPD users showed decreasing concerns for COVID-19 and increasing health-related concerns. After the middle phase of COVID-19 (July 2021), a distinct decrease in sentiments among COPD users contrasted sharply with the upward trend among non-COPD users. Notably, in the post-COVID era (June 2023), COPD users showed reduced levels of joy and trust and increased levels of fear compared to their levels of joy and trust in the middle phase of COVID-19. Moreover, males, older adults, and individuals with lower socioeconomic status showed heightened fear compared to their counterparts. Conclusions: Our data analysis results suggest that populations with COPD experienced heightened mental stress in the post-COVID era. This underscores the importance of developing tailored interventions and support systems that account for diverse population characteristics. %M 40053739 %R 10.2196/54543 %U https://www.jmir.org/2025/1/e54543 %U https://doi.org/10.2196/54543 %U http://www.ncbi.nlm.nih.gov/pubmed/40053739 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 6 %N %P e57719 %T Predicting Escalation of Care for Childhood Pneumonia Using Machine Learning: Retrospective Analysis and Model Development %A Serin,Oguzhan %A Akbasli,Izzet Turkalp %A Cetin,Sena Bocutcu %A Koseoglu,Busra %A Deveci,Ahmet Fatih %A Ugur,Muhsin Zahid %A Ozsurekci,Yasemin %K childhood pneumonia %K community-acquired pneumonia %K machine learning %K clinical decision support system %K prognostic care decision %D 2025 %7 4.3.2025 %9 %J JMIRx Med %G English %X Background: Pneumonia is a leading cause of mortality in children aged <5 years. While machine learning (ML) has been applied to pneumonia diagnostics, few studies have focused on predicting the need for escalation of care in pediatric cases. This study aims to develop an ML-based clinical decision support tool for predicting the need for escalation of care in community-acquired pneumonia cases. Objective: The primary objective was to develop a robust predictive tool to help primary care physicians determine where and how a case should be managed. Methods: Data from 437 children with community-acquired pneumonia, collected before the COVID-19 pandemic, were retrospectively analyzed. Pediatricians encoded key clinical features from unstructured medical records based on Integrated Management of Childhood Illness guidelines. After preprocessing with Synthetic Minority Oversampling Technique–Tomek to handle imbalanced data, feature selection was performed using Shapley additive explanations values. The model was optimized through hyperparameter tuning and ensembling. The primary outcome was the level of care severity, defined as the need for referral to a tertiary care unit for intensive care or respiratory support. Results: A total of 437 cases were analyzed, and the optimized models predicted the need for transfer to a higher level of care with an accuracy of 77% to 88%, achieving an area under the receiver operator characteristic curve of 0.88 and an area under the precision-recall curve of 0.96. Shapley additive explanations value analysis identified hypoxia, respiratory distress, age, weight-for-age z score, and complaint duration as the most important clinical predictors independent of laboratory diagnostics. Conclusions: This study demonstrates the feasibility of applying ML techniques to create a prognostic care decision tool for childhood pneumonia. It provides early identification of cases requiring escalation of care by combining foundational clinical skills with data science methods. %R 10.2196/57719 %U https://xmed.jmir.org/2025/1/e57719 %U https://doi.org/10.2196/57719 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e68400 %T Mpox Prevention Self-Efficacy and Associated Factors Among Men Who Have Sex With Men in China: Large Cross-Sectional Study %A Gao,Quyige %A Liu,Shangbin %A Tuerxunjiang,Muzaibaier %A Xu,Huifang %A Zhang,Jiechen %A Xu,Gang %A Chen,Jianyu %A Cai,Yong %A Hu,Fan %A Wang,Ying %K mpox %K self-efficacy %K men who have sex with men %K MSM %K monkeypox %K cross-sectional study %K mpox prevention self-efficacy scale %D 2025 %7 28.2.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Self-efficacy in mpox (formerly known as monkeypox) prevention plays a pivotal role in promoting preventive behaviors by fostering a sense of control and motivation, especially among men who have sex with men (MSM), the population most affected by mpox in many countries. Objective: This study aims to assess the mpox prevention self-efficacy among MSM in China and identify factors influencing it, using a validated mpox prevention self-efficacy scale. Methods: From October 2023 to March 2024, a nationwide cross-sectional study was conducted among MSM (aged ≥18 years) across 6 geographic regions in China using a snowball sampling method. The recruited participants (effective response rate=2403/2481, 96.9%) were asked to complete an anonymous questionnaire designed based on prior knowledge of mpox and social cognitive theory. The mpox prevention self-efficacy scale was evaluated for construct validity using exploratory factor analysis and confirmatory factor analysis, and its reliability was assessed using the Cronbach α coefficient. Univariate and multivariable logistic regression analyses were used to examine the factors associated with mpox prevention self-efficacy among MSM. Results: A total of 2403 MSM participants were included, with a mean age of 29 (IQR 19‐39) years. Of these, 1228 (51.1%) were aged 25‐34 years, 1888 (78.6%) held a college degree or higher, and 2035 (84.7%) were unmarried. The median mpox prevention self-efficacy score was 23 (IQR 18‐28). Exploratory factor analysis retained 6 items of the mpox prevention self-efficacy scale. Confirmatory factor analysis confirmed a strong model fit (χ²₅=32.1, n=1225; P<.001; comparative fit index=0.991; root mean square error of approximation=0.067; standardized root mean square residual=0.02; goodness-of-fit index=0.992; normed fit index=0.990; incremental fit index=0.991; Tucker-Lewis index=0.974), with all indices within acceptable ranges. The scale demonstrated good internal consistency, with a Cronbach α of 0.859. The positive factors associated with mpox prevention self-efficacy were mpox-related knowledge (OR 1.107, 95% CI 1.070‐1.146), perceived risk awareness (OR 1.338, 95% CI 1.132‐1.583), and mpox risk perception (OR 1.154, 95% CI 1.066‐1.250), while the negative factor was age, with individuals aged 25 years and older exhibiting lower self-efficacy in mpox prevention (25‐34 years: OR 0.789, 95% CI 0.642‐0.970; 35‐44 years: OR 0.572, 95% CI 0.444‐0.736; 45 years and older: OR 0.569, 95% CI 0.394‐0.823). Conclusions: These findings highlight the critical role of targeted interventions to enhance mpox prevention self-efficacy, particularly through increasing knowledge, perceived risk awareness, and risk perception. Such interventions are especially important for middle-aged and older MSM, who may experience a decline in self-efficacy. Strengthening self-efficacy in these areas is essential for promoting sustained preventive behaviors, improving mental well-being, and contributing to more effective mpox prevention and control within the MSM community. %R 10.2196/68400 %U https://publichealth.jmir.org/2025/1/e68400 %U https://doi.org/10.2196/68400 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e58582 %T The Utilization of Electronic Consultations (eConsults) to Address Emerging Questions Related to Long COVID-19 in Ontario, Canada: Mixed Methods Analysis %A Singh,Jatinderpreet %A Quon,Michael %A Goulet,Danica %A Keely,Erin %A Liddy,Clare %K COVID-19 %K long COVID %K eConsult %K consultation %K Canada %K mixed methods analysis %K diagnosis %K primary care %K electronic consultation %K COVID specialist %K specialist %K patient %K assessment %K COVID-19 vaccination %K vaccination %K symptom %K medical education %K web-based consultation %K teleconsultation %K web-based consultations %D 2025 %7 28.2.2025 %9 %J JMIR Hum Factors %G English %X Background: Long COVID is an often debilitating condition affecting millions of people. Its diverse clinical presentations make effective diagnosis and management at the primary care level difficult, while specialist services for long COVID face extensive wait times. An electronic consultation (eConsult) program in Ontario developed a long COVID specialist group to allow primary care providers (PCPs) prompt access to specialist advice for patients with long COVID. Objective: This study aims to assess patterns of service use, response times, impact, and clinical content of eConsult cases submitted to an eConsult long COVID specialist group in Ontario. Methods: This study is a mixed methods analysis of eConsults submitted by PCPs to the long COVID specialist group of 2 eConsult services (Champlain eConsult BASE and Ontario eConsult) between June 1, 2021, and July 31, 2022. Data sources included the use data collected automatically by the services, responses to a mandatory closeout survey, and the content of PCP questions and specialist responses (Champlain eConsult BASE service only). Clinical questions or responses were analyzed using 2 validated taxonomies. Descriptive statistics were used for survey responses and use data. Results: A total of 40 PCPs submitted 47 eConsults through Champlain eConsult BASE and 197 PCPs submitted 228 cases through Ontario eConsult. The median specialist response time was 0.6 (IQR 0.19-2.36; mean 1.7, SD 2.29) days. The 5 most common symptoms of long COVID were fatigue (14/47, 30%), dyspnea (7/47, 15%), cough (6/47, 13%), altered sense of smell (ie, anosmia and parosmia; 6/47, 13%), and cognitive changes (6/47, 13%). The five main question categories asked by PCPs were: (1) management of chronic symptoms of COVID-19, (2) need for additional work-up or follow-up testing, (3) community resources to support or manage patients with long COVID, (4) diagnostic clarification, and (5) guidance regarding COVID-19 vaccination. Conclusions: The long COVID groups provided rapid access to a multispecialty service that facilitated the avoidance of unnecessary face-to-face referrals. An assessment of eConsults highlighted 5 common question types, providing insight into potential gaps in knowledge among PCPs that could help guide medical education and policy. %R 10.2196/58582 %U https://humanfactors.jmir.org/2025/1/e58582 %U https://doi.org/10.2196/58582 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e45367 %T Global Evidence on the Sustainability of Telemedicine in Outpatient and Primary Care During the First 2 Years of the COVID-19 Pandemic: Scoping Review Using the Nonadoption, Abandonment, Scale-Up, Spread, and Sustainability (NASSS) Framework %A Valdes,Daniela %A Shanker,Ankit %A Hijazi,Ghofran %A Mensah,Daniel Opoku %A Bockarie,Tahir %A Lazar,Ioana %A Ibrahim,Siti Aishah %A Zolfagharinia,Hamid %A Procter,Rob %A Spencer,Rachel %A Dale,Jeremy %A Paule,Armina %A Medlin,Liam Jonathon %A Tharuvara Kallottil,Keerthana %+ Department of Computer Science, University of Warwick, 6 Lord Bhattacharyya Way, Coventry, CV4 7AL, United Kingdom, 44 7943058485, daniela.valdes@warwick.ac.uk %K pandemic %K primary care %K outpatients %K telemedicine %K ambulatory care %K global health %K patient experience %K NASSS %K clinician-patient relationship %K health inequalities %K gray literature %K PRISMA %D 2025 %7 28.2.2025 %9 Review %J Interact J Med Res %G English %X Background: The rapid implementation of telemedicine during the early stages of the COVID-19 pandemic raises questions about the sustainability of this intervention at the global level. Objective: This research examines the patient experience, health inequalities, and clinician-patient relationship in telemedicine during the COVID-19 pandemic’s first 2 years, aiming to identify sustainability factors. Methods: This study was based on a prepublished protocol using the Joanna Briggs Institute (JBI) methodology for scoping reviews. We included academic and gray literature published between March 2020 and March 2022 according to these criteria: (1) population (any group); (2) concepts (patient experience, clinician-patient relationship, health inequalities); (3) context (telemedicine in primary and outpatient care); (4) excluding studies pertaining to surgery, oncology, and (inpatient) psychiatry. We searched Ovid Medline/PubMed (January 1, 2022), Web of Science (March 19, 2022), Google/Google Scholar (February and March 2022), and others. The risk of bias was not assessed as per guidance. We used an analysis table for the studies and color-coded tabular mapping against a health care technology adoption framework to identify sustainability (using double-blind extraction). Results: Of the 134 studies that met our criteria, 49.3% (66/134) reported no specific population group. Regarding the concepts, 41.8% (56/134) combined 2 of the concepts studied. The context analysis identified that 56.0% (75/134) of the studies referred to, according to the definition in the United Kingdom, an outpatient (ambulatory care) setting, and 34.3% (46/134) referred to primary care. The patient experience analysis reflected positive satisfaction and sustained access during lockdowns. The clinician-patient relationship impacts were nuanced, affecting interaction and encounter quality. When mapping to the nonadoption, abandonment, scale-up, spread, and sustainability (NASSS) framework, 81.3% (109/134) of the studies referenced the innovation’s sustainability. Although positive overall, there were some concerns about sustainability based on quality, eHealth literacy, and access to health care for vulnerable migrants and the uninsured. Conclusions: We identified confusion between the concepts of patient experience and patient satisfaction; therefore, future research could focus on established frameworks to qualify the patient experience across the whole pathway and not just the remote encounter. As expected, our research found mainly descriptive analyses, so there is a need for more robust evidence methods identifying impacts of changes in treatment pathways. This study illustrates modern methods to decolonize academic research by using gray literature extracts in other languages. We acknowledge that the use of Google to identify gray literature at the global level and in other languages has implications on reproducibility. We did not consider synchronous text-based communication. Trial Registration: Open Science Framework 4z5ut; https://osf.io/4z5ut/ %M 40053716 %R 10.2196/45367 %U https://www.i-jmr.org/2025/1/e45367 %U https://doi.org/10.2196/45367 %U http://www.ncbi.nlm.nih.gov/pubmed/40053716 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e67050 %T Impact of Primary Health Care Data Quality on Infectious Disease Surveillance in Brazil: Case Study %A Florentino,Pilar Tavares Veras %A Bertoldo Junior,Juracy %A Barbosa,George Caique Gouveia %A Cerqueira-Silva,Thiago %A Oliveira,Vinicius de Araújo %A Garcia,Marcio Henrique de Oliveira %A Penna,Gerson Oliveira %A Boaventura,Viviane %A Ramos,Pablo Ivan Pereira %A Barral-Netto,Manoel %A Marcilio,Izabel %K primary health care %K data quality %K infectious disease surveillance %K Brazil %K early warning system %D 2025 %7 21.2.2025 %9 %J JMIR Public Health Surveill %G English %X Background: The increase in emerging and re-emerging infectious disease outbreaks underscores the need for robust early warning systems (EWSs) to guide mitigation and response measures. Administrative health care databases provide valuable epidemiological insights without imposing additional burdens on health services. However, these datasets are primarily collected for operational use, making data quality assessment essential to ensure an accurate interpretation of epidemiological analysis. This study focuses on the development and implementation of a data quality index (DQI) for surveillance integrated into an EWS for influenza-like illness (ILI) outbreaks using Brazil’s a nationwide Primary Health Care (PHC) dataset. Objective: We aimed to evaluate the impact of data completeness and timeliness on the performance of an EWS for ILI outbreaks and establish optimal thresholds for a suitable DQI, thereby improving the accuracy of outbreak detection and supporting public health surveillance. Methods: A composite DQI was established to measure the completeness and timeliness of PHC data from the Brazilian National Information System on Primary Health Care. Completeness was defined as the proportion of weeks within an 8-week rolling window with any register of encounters. Timeliness was calculated as the interval between the date of encounter and its corresponding registry in the information system. The backfilled PHC dataset served as the gold standard to evaluate the impact of varying data quality levels from the weekly updated real-time PHC dataset on the EWS for ILI outbreaks across 5570 Brazilian municipalities from October 10, 2023, to March 10, 2024. Results: During the study period, the backfilled dataset recorded 198,335,762 ILI-related encounters, averaging 8,623,294 encounters per week. The EWS detected a median of 4 (IQR 2‐5) ILI outbreak warnings per municipality using the backfilled dataset. Using the real-time dataset, 12,538 (65%) warnings were concordant with the backfilled dataset. Our analysis revealed that 100% completeness yielded 76.7% concordant warnings, while 80% timeliness resulted in at least 50% concordant warnings. These thresholds were considered optimal for a suitable DQI. Restricting the analysis to municipalities with a suitable DQI increased concordant warnings to 80.4%. A median of 71% (IQR 54%-71.9%) of municipalities met the suitable DQI threshold weekly. Municipalities with ≥60% of weeks achieving a suitable DQI demonstrated the highest concordance between backfilled and real-time datasets, with those achieving ≥80% of weeks showing 82.3% concordance. Conclusions: Our findings highlight the critical role of data quality in improving the EWS’ performance based on PHC data for detecting ILI outbreaks. The proposed framework for real-time DQI monitoring is a practical approach and can be adapted to other surveillance systems, providing insights for similar implementations. We demonstrate that optimal completeness and timeliness of data significantly impact the EWS’ ability to detect ILI outbreaks. Continuous monitoring and improvement of data quality should remain a priority to strengthen the reliability and effectiveness of surveillance systems. %R 10.2196/67050 %U https://publichealth.jmir.org/2025/1/e67050 %U https://doi.org/10.2196/67050 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e64914 %T Characterizing US Spatial Connectivity and Implications for Geographical Disease Dynamics and Metapopulation Modeling: Longitudinal Observational Study %A Pullano,Giulia %A Alvarez-Zuzek,Lucila Gisele %A Colizza,Vittoria %A Bansal,Shweta %K geographical disease dynamics %K spatial connectivity %K mobility data %K metapopulation modeling %K COVID-19 %K human mobility %K infectious diseases %K social distancing %K epidemic %K mobile apps %K SafeGraph %K SARS-CoV-2 %K coronavirus %K pandemic %K spatio-temporal %K US %K public health %K mobile health %K mHealth %K digital health %K health informatics %D 2025 %7 18.2.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Human mobility is expected to be a critical factor in the geographic diffusion of infectious diseases, and this assumption led to the implementation of social distancing policies during the early fight against the COVID-19 emergency in the United States. Yet, because of substantial data gaps in the past, what still eludes our understanding are the following questions: (1) How does mobility contribute to the spread of infection within the United States at local, regional, and national scales? (2) How do seasonality and shifts in behavior affect mobility over time? (3) At what geographic level is mobility homogeneous across the United States? Objective: This study aimed to address the questions that are critical for developing accurate transmission models, predicting the spatial propagation of disease across scales, and understanding the optimal geographical and temporal scale for the implementation of control policies. Methods: We analyzed high-resolution mobility data from mobile app usage from SafeGraph Inc, mapping daily connectivity between the US counties to grasp spatial clustering and temporal stability. Integrating this into a spatially explicit transmission model, we replicated SARS-CoV-2’s first wave invasion, assessing mobility’s spatiotemporal impact on disease predictions. Results: Analysis from 2019 to 2021 showed that mobility patterns remained stable, except for a decline in April 2020 due to lockdowns, which reduced daily movements from 45 million to approximately 25 million nationwide. Despite this reduction, intercounty connectivity remained seasonally stable, largely unaffected during the early COVID-19 phase, with a median Spearman coefficient of 0.62 (SD 0.01) between daily connectivity and gravity networks. We identified 104 geographic clusters of US counties with strong internal mobility connectivity and weaker links to counties outside these clusters. These clusters were stable over time, largely overlapping state boundaries (normalized mutual information=0.82) and demonstrating high temporal stability (normalized mutual information=0.95). Our findings suggest that intercounty connectivity is relatively static and homogeneous at the substate level. Furthermore, while county-level, daily mobility data best captures disease invasion, static mobility data aggregated to the cluster level also effectively models spatial diffusion. Conclusions: Our work demonstrates that intercounty mobility was negligibly affected outside the lockdown period in April 2020, explaining the broad spatial distribution of COVID-19 outbreaks in the United States during the early phase of the pandemic. Such geographically dispersed outbreaks place a significant strain on national public health resources and necessitate complex metapopulation modeling approaches for predicting disease dynamics and control design. We thus inform the design of such metapopulation models to balance high disease predictability with low data requirements. %R 10.2196/64914 %U https://publichealth.jmir.org/2025/1/e64914 %U https://doi.org/10.2196/64914 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e62802 %T Increasing COVID-19 Testing and Vaccination Uptake in the Take Care Texas Community-Based Randomized Trial: Adaptive Geospatial Analysis %A Zhang,Kehe %A Hunyadi,Jocelyn V %A de Oliveira Otto,Marcia C %A Lee,Miryoung %A Zhang,Zitong %A Ramphul,Ryan %A Yamal,Jose-Miguel %A Yaseen,Ashraf %A Morrison,Alanna C %A Sharma,Shreela %A Rahbar,Mohammad Hossein %A Zhang,Xu %A Linder,Stephen %A Marko,Dritana %A Roy,Rachel White %A Banerjee,Deborah %A Guajardo,Esmeralda %A Crum,Michelle %A Reininger,Belinda %A Fernandez,Maria E %A Bauer,Cici %K COVID-19 testing %K COVID-19 vaccination %K study design %K community-based interventions %K geospatial analysis %K public health %K social determinants of health %K data dashboard %D 2025 %7 11.2.2025 %9 %J JMIR Form Res %G English %X 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. %R 10.2196/62802 %U https://formative.jmir.org/2025/1/e62802 %U https://doi.org/10.2196/62802 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 11 %N %P e64780 %T Virtual Reality Simulation for Undergraduate Nursing Students for Care of Patients With Infectious Diseases: Mixed Methods Study %A Chang,Wen %A Lin,Chun-Chih %A Crilly,Julia %A Lee,Hui-Ling %A Chen,Li-Chin %A Han,Chin-Yen %+ Department of Nursing, Chang Gung University of Science and Technology, 261, Wenhua 1st Road, Guishan Dist., Taoyuan City, 33303, Taiwan, 886 3 2118999 ext 3417, cyhan@mail.cgust.edu.tw %K virtual reality %K infection control %K learning motivation %K learning attitudes %K nursing education %D 2025 %7 11.2.2025 %9 Original Paper %J JMIR Med Educ %G English %X 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 (β=.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. %M 39933166 %R 10.2196/64780 %U https://mededu.jmir.org/2025/1/e64780 %U https://doi.org/10.2196/64780 %U http://www.ncbi.nlm.nih.gov/pubmed/39933166 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e54156 %T Understanding Providers’ Attitude Toward AI in India’s Informal Health Care Sector: Survey Study %A Kumar,Sumeet %A Rayal,Snehil %A Bommaraju,Raghuram %A Varasala,Navya Pratyusha %A Papineni,Sirisha %A Deo,Sarang %K artificial intelligence %K tuberculosis %K health care providers %K cross-sectional studies %K trust %K x-rays %K India %D 2025 %7 10.2.2025 %9 %J JMIR Form Res %G English %X Background: Tuberculosis (TB) is a major global health concern, causing 1.5 million deaths in 2020. Diagnostic tests for TB are often inaccurate, expensive, and inaccessible, making chest x-rays augmented with artificial intelligence (AI) a promising solution. However, whether providers are willing to adopt AI is not apparent. Objective: The study seeks to understand the attitude of Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homoeopathy (AYUSH) and informal health care providers, who we jointly call AIPs, toward adopting AI for TB diagnosis. We chose to study these providers as they are the first point of contact for a majority of TB patients in India. Methods: We conducted a cross-sectional survey of 406 AIPs across the states of Jharkhand (162 participants) and Gujarat (244 participants) in India. We designed the survey questionnaire to assess the AIPs’ confidence in treating presumptive TB patients, their trust in local radiologists’ reading of the chest x-ray images, their beliefs regarding the diagnostic capabilities of AI, and their willingness to adopt AI for TB diagnosis. Results: We found that 93.7% (270/288) of AIPs believed that AI could improve the accuracy of TB diagnosis, and for those who believed in AI, 71.9% (194/270) were willing to try AI. Among all AIPs, 69.4% (200/288) were willing to try AI. However, we found significant differences in AIPs’ willingness to try AI across the 2 states. Specifically, in Gujarat, a state with better and more accessible health care infrastructure, 73.4% (155/211) were willing to try AI, and in Jharkhand, 58.4% (45/77) were willing to try AI. Moreover, AIPs in Gujarat who showed higher trust in the local radiologists were less likely to try AI (odds ratio [OR] 0.15, 95% CI 0.03‐0.69; P=.02). In contrast, in Jharkhand, those who showed higher trust in the local radiologists were more likely to try AI (OR 2.11, 95% CI 0.9‐4.93; P=.09). Conclusions: While most AIPs believed in the potential benefits of AI-based TB diagnoses, many did not intend to try AI, indicating that the expected benefits of AI measured in terms of technological superiority may not directly translate to impact on the ground. Improving beliefs among AIPs with poor access to radiology services or those who are less confident of diagnosing TB is likely to result in a greater impact of AI on the ground. Additionally, tailored interventions addressing regional and infrastructural differences may facilitate AI adoption in India’s informal health care sector. %R 10.2196/54156 %U https://formative.jmir.org/2025/1/e54156 %U https://doi.org/10.2196/54156 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 13 %N %P e63881 %T InfectA-Chat, an Arabic Large Language Model for Infectious Diseases: Comparative Analysis %A Selcuk,Yesim %A Kim,Eunhui %A Ahn,Insung %+ , Department of Data-Centric Problem Solving Research, Korea Institute of Science and Technology Information, 245 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea, 82 42 869 1053, isahn@kisti.re.kr %K large language model %K Arabic large language models %K AceGPT %K multilingual large language model %K infectious disease monitoring %K public health %D 2025 %7 10.2.2025 %9 Original Paper %J JMIR Med Inform %G English %X Background: Infectious diseases have consistently been a significant concern in public health, requiring proactive measures to safeguard societal well-being. In this regard, regular monitoring activities play a crucial role in mitigating the adverse effects of diseases on society. To monitor disease trends, various organizations, such as the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC), collect diverse surveillance data and make them publicly accessible. However, these platforms primarily present surveillance data in English, which creates language barriers for non–English-speaking individuals and global public health efforts to accurately observe disease trends. This challenge is particularly noticeable in regions such as the Middle East, where specific infectious diseases, such as Middle East respiratory syndrome coronavirus (MERS-CoV), have seen a dramatic increase. For such regions, it is essential to develop tools that can overcome language barriers and reach more individuals to alleviate the negative impacts of these diseases. Objective: This study aims to address these issues; therefore, we propose InfectA-Chat, a cutting-edge large language model (LLM) specifically designed for the Arabic language but also incorporating English for question and answer (Q&A) tasks. InfectA-Chat leverages its deep understanding of the language to provide users with information on the latest trends in infectious diseases based on their queries. Methods: This comprehensive study was achieved by instruction tuning the AceGPT-7B and AceGPT-7B-Chat models on a Q&A task, using a dataset of 55,400 Arabic and English domain–specific instruction–following data. The performance of these fine-tuned models was evaluated using 2770 domain-specific Arabic and English instruction–following data, using the GPT-4 evaluation method. A comparative analysis was then performed against Arabic LLMs and state-of-the-art models, including AceGPT-13B-Chat, Jais-13B-Chat, Gemini, GPT-3.5, and GPT-4. Furthermore, to ensure the model had access to the latest information on infectious diseases by regularly updating the data without additional fine-tuning, we used the retrieval-augmented generation (RAG) method. Results: InfectA-Chat demonstrated good performance in answering questions about infectious diseases by the GPT-4 evaluation method. Our comparative analysis revealed that it outperforms the AceGPT-7B-Chat and InfectA-Chat (based on AceGPT-7B) models by a margin of 43.52%. It also surpassed other Arabic LLMs such as AceGPT-13B-Chat and Jais-13B-Chat by 48.61%. Among the state-of-the-art models, InfectA-Chat achieved a leading performance of 23.78%, competing closely with the GPT-4 model. Furthermore, the RAG method in InfectA-Chat significantly improved document retrieval accuracy. Notably, RAG retrieved more accurate documents based on queries when the top-k parameter value was increased. Conclusions: Our findings highlight the shortcomings of general Arabic LLMs in providing up-to-date information about infectious diseases. With this study, we aim to empower individuals and public health efforts by offering a bilingual Q&A system for infectious disease monitoring. %M 39928922 %R 10.2196/63881 %U https://medinform.jmir.org/2025/1/e63881 %U https://doi.org/10.2196/63881 %U http://www.ncbi.nlm.nih.gov/pubmed/39928922 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e60467 %T Interpreting the Influence of Using Blood Donor Residual Samples for SARS-CoV-2 Seroprevalence Studies in Japan: Cross-Sectional Survey Study %A Kinoshita,Ryo %A Miyamoto,Sho %A Suzuki,Tadaki %A Suzuki,Motoi %A Yoneoka,Daisuke %K SARS-CoV-2 %K COVID-19 %K seroprevalence %K blood donor %K selection bias %K healthy donor effect %K coronavirus %K pandemic %K Japan %K cross-sectional study %K residual blood %K epidemiology %K blood donation %K web-based %K logistic regression %K social economic %K comorbidity %K COVID-19 vaccination %K public health %D 2025 %7 10.2.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Residual blood donor samples are commonly used in SARS-CoV-2 seroepidemiological studies; however their use may introduce bias due to the healthy donor effect, wherein blood donors are generally healthier than the general population. This potential bias is critical for accurately interpreting seroepidemiological data, as blood donors might not fully represent broader population-level infection rates.Objective: This study aims to assess the potential bias in SARS-CoV-2 seroprevalence estimates derived from blood donor samples in Japan by examining the association between blood donation history and COVID-19 diagnosis. By quantifying the healthy donor effect, we seek to refine the interpretation of SARS-CoV-2 seroepidemiological studies using residual blood donor samples.Methods: We conducted a web-based survey from December 14 to 28, 2023, recruiting 10,781 Japanese residents aged 16‐69, stratified by demographic factors to match national representation. Participants provided information on demographics, socioeconomic status, COVID-19 vaccination history, comorbidities, and blood donation experience. A logistic regression model adjusting for confounders such as age, sex, education, occupation, comorbidities, and vaccination status, was used to estimate the odds of COVID-19 diagnosis among blood donors compared to nondonors.Results: Of the 10,781 participants, 3583 (33.2%) reported a history of COVID-19 diagnosis, and 5015 (46.5%) indicated they had donated blood at least once in their lifetime, and 1128 (10.5%) donated within the last year. Blood donors had mean of 13.5 (SD 43.6) donations and were older, with a mean age of 46.4 (SD 13.9) years, compared to 38.5 (SD 14.1) years for nondonors. Among blood donors, 39.9% had comorbidities (95% CI 38.5‐41.2) compared to 27.9% (95% CI 26.7‐29.0) of nondonors. Blood donors had 1.62 (95% CI: 1.48‐1.78) times higher odds of COVID-19 diagnosis compared to nondonors. The higher diagnosis rate among blood donors likely reflects increased social interactions and health-seeking behaviors, a phenomenon we refer to as the inverse healthy donor effect. This suggests that blood donor samples could overestimate SARS-CoV-2 seroprevalence when generalized to the broader Japanese population.Conclusions: Higher COVID-19 diagnosis rates among blood donors may reflect increased community involvement and health-seeking behaviors, suggesting an inverse healthy donor effect. This pattern indicates that in terms of SARS-CoV-2 infection, blood donors might not represent the healthiest segment of the population. Consequently, seroprevalence studies using blood donor samples could overestimate SARS-CoV-2 infection rates in the general Japanese population. For more accurate public health surveillance, the development of statistical methods to adjust for this bias is recommended. %R 10.2196/60467 %U https://publichealth.jmir.org/2025/1/e60467 %U https://doi.org/10.2196/60467 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e67145 %T Ethical Considerations for Wastewater Surveillance Conducted by the US Department of Defense %A Smith,Hunter Jackson %A Agans,Richard T %A Kowallis,William J %K wastewater %K surveillance %K ethics %K military %K Department of Defense %D 2025 %7 6.2.2025 %9 %J JMIR Public Health Surveill %G English %X The US Department of Defense (DoD) is establishing its wastewater surveillance capacities to support national security objectives and promote the public health and medical readiness of US service members. Wastewater surveillance is an emerging technology that has traditionally been leveraged for detecting infectious diseases. However, its potential future applications could yield a vast and unpredictable amount of information that could be used for a wide variety of both health- and nonhealth-related purposes. The US military also serves an inimitable role for the country and its citizens, and exercises significant levels of control over its service members compared to civilian organizations. Further, its present and potential wastewater surveillance activities may reach far beyond just military installations. These factors raise unique ethical considerations that must be accounted for by leaders and policymakers to ensure the DoD implements a wastewater surveillance network in a manner that is both impactful in supporting public health and appropriate to the scope and population under surveillance. This paper explores important ethical features in conducting wastewater surveillance that are both specific to the DoD experience and applicable to wider public health initiatives. %R 10.2196/67145 %U https://publichealth.jmir.org/2025/1/e67145 %U https://doi.org/10.2196/67145 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e65439 %T Consistency of Daily Number of Reported COVID-19 Cases in 191 Countries From 2020 to 2022: Comparative Analysis of 2 Major Data Sources %A Liu,Han %A Zong,Huiying %A Yang,Yang %A Schwebel,David C %A Xie,Bin %A Ning,Peishan %A Rao,Zhenzhen %A Li,Li %A Hu,Guoqing %K COVID-19 %K pandemic %K data consistency %K World Health Organization %K data quality %D 2025 %7 6.2.2025 %9 %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic represents one of the most challenging public health emergencies in recent world history, causing about 7.07 million deaths globally by September 24, 2024. Accurate, timely, and consistent data are critical for early response to situations like the COVID-19 pandemic. Objective: This study aimed to evaluate consistency of daily reported COVID-19 cases in 191 countries from the Johns Hopkins University Center for Systems Science and Engineering (JHU CSSE) and the World Health Organization (WHO) dashboards during 2020‐2022. Methods: We retrieved data concerning new daily COVID-19 cases in 191 countries covered by both data sources from January 22, 2020, to December 31, 2022. The ratios of numbers of daily reported cases from the 2 sources were calculated to measure data consistency. We performed simple linear regression to examine significant changes in the ratio of numbers of daily reported cases during the study period. Results: Of 191 WHO member countries, only 60 displayed excellent data consistency in the number of daily reported COVID-19 cases between the WHO and JHU CSSE dashboards (mean ratio 0.9-1.1). Data consistency changed greatly across the 191 countries from 2020 to 2022 and differed across 4 types of countries, categorized by income. Data inconsistency between the 2 data sources generally decreased slightly over time, both for the 191 countries combined and within the 4 types of income-defined countries. The absolute relative difference between the 2 data sources increased in 84 countries, particularly for Malta (R2=0.25), Montenegro (R2=0.30), and the United States (R2=0.29), but it decreased significantly in 40 countries. Conclusions: The inconsistency between the 2 data sources warrants further research. Construction of public health surveillance and data collection systems for public health emergencies like the COVID-19 pandemic should be strengthened in the future. %R 10.2196/65439 %U https://publichealth.jmir.org/2025/1/e65439 %U https://doi.org/10.2196/65439 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e58779 %T An Easy and Quick Risk-Stratified Early Forewarning Model for Septic Shock in the Intensive Care Unit: Development, Validation, and Interpretation Study %A Liu,Guanghao %A Zheng,Shixiang %A He,Jun %A Zhang,Zi-Mei %A Wu,Ruoqiong %A Yu,Yingying %A Fu,Hao %A Han,Li %A Zhu,Haibo %A Xu,Yichang %A Shao,Huaguo %A Yan,Haidan %A Chen,Ting %A Shen,Xiaopei %+ Department of Bioinformatics, School of Medical Technology and Engineering, Fujian Medical University, 1 Xue Yuan Road, University Town, Fuzhou, 350122, China, 86 17366882017, xshen@fjmu.edu.cn %K septic shock %K early forewarning %K risk stratification %K machine learning %D 2025 %7 6.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Septic shock (SS) is a syndrome with high mortality. Early forewarning and diagnosis of SS, which are critical in reducing mortality, are still challenging in clinical management. Objective: We propose a simple and fast risk-stratified forewarning model for SS to help physicians recognize patients in time. Moreover, further insights can be gained from the application of the model to improve our understanding of SS. Methods: A total of 5125 patients with sepsis from the Medical Information Mart for Intensive Care-IV (MIMIC-IV) database were divided into training, validation, and test sets. In addition, 2180 patients with sepsis from the eICU Collaborative Research Database (eICU) were used as an external validation set. We developed a simplified risk-stratified early forewarning model for SS based on the weight of evidence and logistic regression, which was compared with multi-feature complex models, and clinical characteristics among risk groups were evaluated. Results: Using only vital signs and rapid arterial blood gas test features according to feature importance, we constructed the Septic Shock Risk Predictor (SORP), with an area under the curve (AUC) of 0.9458 in the test set, which is only slightly lower than that of the optimal multi-feature complex model (0.9651). A median forewarning time of 13 hours was calculated for SS patients. 4 distinct risk groups (high, medium, low, and ultralow) were identified by the SORP 6 hours before onset, and the incidence rates of SS in the 4 risk groups in the postonset interval were 88.6% (433/489), 34.5% (262/760), 2.5% (67/2707), and 0.3% (4/1301), respectively. The severity increased significantly with increasing risk in both clinical features and survival. Clustering analysis demonstrated a high similarity of pathophysiological characteristics between the high-risk patients without SS diagnosis (NS_HR) and the SS patients, while a significantly worse overall survival was shown in NS_HR patients. On further exploring the characteristics of the treatment and comorbidities of the NS_HR group, these patients demonstrated a significantly higher incidence of mean blood pressure <65 mmHg, significantly lower vasopressor use and infused volume, and more severe renal dysfunction. The above findings were further validated by multicenter eICU data. Conclusions: The SORP demonstrated accurate forewarning and a reliable risk stratification capability. Among patients forewarned as high risk, similar pathophysiological phenotypes and high mortality were observed in both those subsequently diagnosed as having SS and those without such a diagnosis. NS_HR patients, overlooked by the Sepsis-3 definition, may provide further insights into the pathophysiological processes of SS onset and help to complement its diagnosis and precise management. The importance of precise fluid resuscitation management in SS patients with renal dysfunction is further highlighted. For convenience, an online service for the SORP has been provided. %M 39913913 %R 10.2196/58779 %U https://www.jmir.org/2025/1/e58779 %U https://doi.org/10.2196/58779 %U http://www.ncbi.nlm.nih.gov/pubmed/39913913 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e66072 %T Forecasting the Incidence of Mumps Based on the Baidu Index and Environmental Data in Yunnan, China: Deep Learning Model Study %A Xiong,Xin %A Xiang,Linghui %A Chang,Litao %A Wu,Irene XY %A Deng,Shuzhen %+ Department of School Health, Yunnan Provincial Center for Disease Control and Prevention, No.1177 Xianghe Street, Luolong Street, Chenggong District, Kunming, 650500, China, 86 15096624164, 461447164@qq.com %K mumps %K deep learning %K baidu index %K forecasting %K incidence prediction %K time series analysis %K Yunnan %K China %D 2025 %7 6.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Mumps is a viral respiratory disease characterized by facial swelling and transmitted through respiratory secretions. Despite the availability of an effective vaccine, mumps outbreaks have reemerged globally, including in China, where it remains a significant public health issue. In Yunnan province, China, the incidence of mumps has fluctuated markedly and is higher than that in mainland China, underscoring the need for improved outbreak prediction methods. Traditional surveillance methods, however, may not be sufficient for timely and accurate outbreak prediction. Objective: Our study aims to leverage the Baidu search index, representing search volumes from China’s most popular search engine, along with environmental data to develop a predictive model for mumps incidence in Yunnan province. Methods: We analyzed mumps incidence in Yunnan Province from 2014 to 2023, and used time series data, including mumps incidence, Baidu search index, and environmental factors, from 2016 to 2023, to develop predictive models based on long short-term memory networks. Feature selection was conducted using Pearson correlation analysis, and lag correlations were explored through a distributed nonlinear lag model (DNLM). We constructed four models with different combinations of predictors: (1) model BE, combining the Baidu index and environmental factors data; (2) model IB, combining mumps incidence and Baidu index data; (3) model IE, combining mumps incidence and environmental factors; and (4) model IBE, integrating all 3 data sources. Results: The incidence of mumps in Yunnan showed significant variability, peaking at 37.5 per 100,000 population in 2019. From 2014 to 2023, the proportion of female patients ranged from 41.3% in 2015 to 45.7% in 2020, consistently lower than that of male patients. After excluding variables with a Pearson correlation coefficient of <0.10 or P values of <.05, we included 3 Baidu index search term groups (disease name, symptoms, and treatment) and 6 environmental factors (maximum temperature, minimum temperature, sulfur dioxide, carbon monoxide, particulate matter with a diameter of 2.5 µm or less, and particulate matter with a diameter of 10 µm or less) for model development. DNLM analysis revealed that the relative risks consistently increased with rising Baidu index values, while nonlinear associations between temperature and mumps incidence were observed. Among the 4 models, model IBE exhibited the best performance, achieving the coefficient of determination of 0.72, with mean absolute error, mean absolute percentage error, and root-mean-square error values of 0.33, 15.9%, and 0.43, respectively, in the test set. Conclusions: Our study developed model IBE to predict the incidence of mumps in Yunnan province, offering a potential tool for early detection of mumps outbreaks. The performance of model IBE underscores the potential of integrating search engine data and environmental factors to enhance mumps incidence forecasting. This approach offers a promising tool for improving public health surveillance and enabling rapid responses to mumps outbreaks. %M 39913179 %R 10.2196/66072 %U https://www.jmir.org/2025/1/e66072 %U https://doi.org/10.2196/66072 %U http://www.ncbi.nlm.nih.gov/pubmed/39913179 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63910 %T Public Health Messaging on Twitter During the COVID-19 Pandemic: Observational Study %A Rao,Ashwin %A Sabri,Nazanin %A Guo,Siyi %A Raschid,Louiqa %A Lerman,Kristina %+ Information Sciences Institute, University of Southern California, 4676 Admiralty Way STE 1001, Marina del Rey, CA, 90292, United States, 1 2135050363, mohanrao@usc.edu %K public health %K public health messaging %K COVID-19 %K Twitter %K emotions %K moral foundations %K polarization %D 2025 %7 5.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective communication is crucial during health crises, and social media has become a prominent platform for public health experts (PHEs) to share information and engage with the public. At the same time, social media also provides a platform for pseudoexperts who may spread contrarian views. Despite the importance of social media, key elements of communication, such as the use of moral or emotional language and messaging strategy, particularly during the emergency phase of the COVID-19 pandemic, have not been explored. Objective: This study aimed to analyze how PHEs and pseudoexperts communicated with the public during the emergency phase of the COVID-19 pandemic. We focused on the emotional and moral language used in their messages on various COVID-19 pandemic–related topics. We also analyzed their interactions with political elites and the public’s engagement with PHEs to gain a deeper understanding of their influence on public discourse. Methods: For this observational study, we gathered a dataset of >539,000 original posts or reposts from 489 PHEs and 356 pseudoexperts on Twitter (subsequently rebranded X) from January 2020 to January 2021, along with the replies to the original posts from the PHEs. We identified the key issues that PHEs and pseudoexperts prioritized. We also determined the emotional and moral language in both the original posts and the replies. This allows us to characterize priorities for PHEs and pseudoexperts as well as differences in messaging strategy between these 2 groups. We also evaluated the influence of PHEs’ language and strategy on the public response. Results: Our analyses revealed that PHEs focused more on masking, health care, education, and vaccines, whereas pseudoexperts discussed therapeutics and lockdowns more frequently (P<.001). PHEs typically used positive emotional language across all issues (P<.001), expressing optimism and joy. Pseudoexperts often used negative emotions of pessimism and disgust, while limiting positive emotional language to origins and therapeutics (P<.001). Along the dimensions of moral language, PHEs and pseudoexperts differed on care versus harm and authority versus subversion across different issues. Negative emotional and moral language tends to boost engagement in COVID-19 discussions across all issues. However, the use of positive language by PHEs increases the use of positive language in the public responses. PHEs act as liberal partisans: they express more positive affect in their posts directed at liberals and more negative affect in their posts directed at conservative elites. In contrast, pseudoexperts act as conservative partisans. These results provide nuanced insights into the elements that have polarized the COVID-19 discourse. Conclusions: Understanding the nature of the public response to PHEs’ messages on social media is essential for refining communication strategies during health crises. Our findings underscore the importance of using moral-emotional language strategically to reduce polarization and build trust. %M 39908546 %R 10.2196/63910 %U https://www.jmir.org/2025/1/e63910 %U https://doi.org/10.2196/63910 %U http://www.ncbi.nlm.nih.gov/pubmed/39908546 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e63377 %T Problems and Barriers Related to the Use of AI-Based Clinical Decision Support Systems: Interview Study %A Giebel,Godwin Denk %A Raszke,Pascal %A Nowak,Hartmuth %A Palmowski,Lars %A Adamzik,Michael %A Heinz,Philipp %A Tokic,Marianne %A Timmesfeld,Nina %A Brunkhorst,Frank %A Wasem,Jürgen %A Blase,Nikola %+ Institute for Healthcare Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, Essen, Germany, 49 201 18 331, godwin.giebel@medman.uni-due.de %K decision support %K artificial intelligence %K machine learning %K clinical decision support system %K digitalization %K health care %K technology %K innovation %K semistructured interview %K qualitative %K quality assurance %K web-based %K digital health %K health informatics %D 2025 %7 3.2.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Digitalization is currently revolutionizing health care worldwide. A promising technology in this context is artificial intelligence (AI). The application of AI can support health care providers in their daily work in various ways. The integration of AI is particularly promising in clinical decision support systems (CDSSs). While the opportunities of this technology are numerous, the problems should not be overlooked. Objective: This study aimed to identify challenges and barriers in the context of AI-based CDSSs from the perspectives of experts across various disciplines. Methods: Semistructured expert interviews were conducted with different stakeholders. These included representatives of patients, physicians and caregivers, developers of AI-based CDSSs, researchers (studying AI in health care and social and health law), quality management and quality assurance representatives, a representative of an ethics committee, a representative of a health insurance fund, and medical product consultants. The interviews took place on the web and were recorded, transcribed, and subsequently subjected to a qualitative content analysis based on the method by Kuckartz. The analysis was conducted using MAXQDA software. Initially, the problems were separated into “general,” “development,” and “clinical use.” Finally, a workshop within the project consortium served to systematize the identified problems. Results: A total of 15 expert interviews were conducted, and 309 expert statements with reference to problems and barriers in the context of AI-based CDSSs were identified. These emerged in 7 problem categories: technology (46/309, 14.9%), data (59/309, 19.1%), user (102/309, 33%), studies (17/309, 5.5%), ethics (20/309, 6.5%), law (33/309, 10.7%), and general (32/309, 10.4%). The problem categories were further divided into problem areas, which in turn comprised the respective problems. Conclusions: A large number of problems and barriers were identified in the context of AI-based CDSSs. These can be systematized according to the point at which they occur (“general,” “development,” and “clinical use”) or according to the problem category (“technology,” “data,” “user,” “studies,” “ethics,” “law,” and “general”). The problems identified in this work should be further investigated. They can be used as a basis for deriving solutions to optimize development, acceptance, and use of AI-based CDSSs. International Registered Report Identifier (IRRID): RR2-10.2196/preprints.62704 %M 39899342 %R 10.2196/63377 %U https://www.jmir.org/2025/1/e63377 %U https://doi.org/10.2196/63377 %U http://www.ncbi.nlm.nih.gov/pubmed/39899342 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e62704 %T User-Oriented Requirements for Artificial Intelligence–Based Clinical Decision Support Systems in Sepsis: Protocol for a Multimethod Research Project %A Raszke,Pascal %A Giebel,Godwin Denk %A Abels,Carina %A Wasem,Jürgen %A Adamzik,Michael %A Nowak,Hartmuth %A Palmowski,Lars %A Heinz,Philipp %A Mreyen,Silke %A Timmesfeld,Nina %A Tokic,Marianne %A Brunkhorst,Frank Martin %A Blase,Nikola %+ Institute for Health Care Management and Research, University of Duisburg-Essen, Thea-Leymann-Str. 9, Essen, 45127, Germany, 49 201 183 4395, Pascal.Raszke@medman.uni-due.de %K medical informatics %K artificial intelligence %K machine learning %K computational intelligence %K clinical decision support systems %K CDSS %K decision support %K sepsis %K bloodstream infection %D 2025 %7 30.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Artificial intelligence (AI)–based clinical decision support systems (CDSS) have been developed for several diseases. However, despite the potential to improve the quality of care and thereby positively impact patient-relevant outcomes, the majority of AI-based CDSS have not been adopted in standard care. Possible reasons for this include barriers in the implementation and a nonuser-oriented development approach, resulting in reduced user acceptance. Objective: This research project has 2 objectives. First, problems and corresponding solutions that hinder or support the development and implementation of AI-based CDSS are identified. Second, the research project aims to increase user acceptance by creating a user-oriented requirement profile, using the example of sepsis. Methods: The research project is based on a multimethod approach combining (1) a scoping review, (2) focus groups with physicians and professional caregivers, and (3) semistructured interviews with relevant stakeholders. The research modules mentioned provide the basis for the development of a (4) survey, including a discrete choice experiment (DCE) with physicians. A minimum of 6667 physicians with expertise in the clinical picture of sepsis are contacted for this purpose. The survey is followed by the development of a requirement profile for AI-based CDSS and the derivation of policy recommendations for action, which are evaluated in a (5) expert roundtable discussion. Results: The multimethod research project started in November 2022. It provides an overview of the barriers and corresponding solutions related to the development and implementation of AI-based CDSS. Using sepsis as an example, a user-oriented requirement profile for AI-based CDSS is developed. The scoping review has been concluded and the qualitative modules have been subjected to analysis. The start of the survey, including the DCE, was at the end of July 2024. Conclusions: The results of the research project represent the first attempt to create a comprehensive user-oriented requirement profile for the development of sepsis-specific AI-based CDSS. In addition, general recommendations are derived, in order to reduce barriers in the development and implementation of AI-based CDSS. The findings of this research project have the potential to facilitate the integration of AI-based CDSS into standard care in the long term. International Registered Report Identifier (IRRID): DERR1-10.2196/62704 %M 39883929 %R 10.2196/62704 %U https://www.researchprotocols.org/2025/1/e62704 %U https://doi.org/10.2196/62704 %U http://www.ncbi.nlm.nih.gov/pubmed/39883929 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e63053 %T Epidemiological Features, Clinical Symptoms, and Environmental Risk Factors for Notifiable Japanese Encephalitis in Taiwan From 2008 to 2020: Retrospective Study %A Lin,Fu-Huang %A Chou,Yu-Ching %A Hsieh,Chi-Jeng %A Yu,Chia-Peng %K epidemiology %K Japanese encephalitis virus %K domestic %K environmental factor %K retrospective study %D 2025 %7 28.1.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Japanese encephalitis (JE) is a zoonotic parasitic disease caused by the Japanese encephalitis virus (JEV), and may cause fever, nausea, headache, or meningitis. It is currently unclear whether the epidemiological characteristics of the JEV have been affected by the extreme climatic conditions that have been observed in recent years. Objective: This study aimed to examine the epidemiological characteristics, trends, and potential risk factors of JE in Taiwan from 2008 to 2020. Specifically, the study focused on gender, age, season, residential area, clinical manifestations, high-risk areas, and the impact of environmental and climate factors. Methods: This study reviewed publicly available annual summary data on reported JE cases in the Taiwan Centers for Diseases Control between 2008 and 2020. Results: This study collected 309 confirmed domestic patients and 4 patients with imported JE. There was an increasing trend in the incidence of JE, 0.69‐1.57 cases per 1,000,000 people, peaking in 2018. Case fatality rate was 7.7% (24/313). Comparing sex, age, season, and place of residence, the incidence rate was highest in males, 40‐ to 59-year-old patients, summer, and the Eastern region, with 1.89, 3.27, 1.25, and 12.2 cases per million people, respectively. The average coverage rate of the JE vaccine for children in Taiwan is 94.9%. Additionally, the major clinical manifestations of the cases included fever, unconsciousness, headache, stiff necks, psychological symptoms, vomiting, and meningitis. The major occurrence places of JE included paddy fields, pig farms, pigeon farms, poultry farms, and ponds. For air pollution factors, linear regression analysis showed that SO2 (ppb) concentration was positively associated with JE cases (β=2.184, P=.02), but O3 (ppb) concentration was negatively associated with them (β=−0.157, P=.01). For climate factors, relative humidity (%) was positively associated with JE cases (β=.380, P=.02). Conclusions: This study is the first to report confirmed cases of JE from the surveillance data of the Taiwan Centers for Diseases Control between 2008 and 2020. It identified residence, season, and age as risk factors for JE in Taiwan. Air pollution and climatic factors also influenced the rise in JE cases. This study confirmed that JE remains a prevalent infectious disease in Taiwan, with its epidemic gradually increasing in severity. These findings empower clinicians and health care providers to make informed decisions, guiding their care and resource allocation for patients with JE, a disease that significantly impacts the health and well-being of the Taiwanese population. %R 10.2196/63053 %U https://publichealth.jmir.org/2025/1/e63053 %U https://doi.org/10.2196/63053 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e59845 %T Effectiveness of Frequent Point-of-Care Molecular COVID-19 Surveillance in a Rural Workplace: Nonrandomized Controlled Clinical Trial Among Miners %A Sood,Akshay %A “Cotton” Jarrell,William %A Shore,Xin W %A Sosa,Nestor %A Parada,Alisha %A Edwardson,Nicholas %A Yingling,Alexandra V %A Amirkabirian,Teah %A Cheng,Qiuying %A Hurwitz,Ivy %A Cook,Linda S %A Leng,Shuguang %A Myers,Orrin B %A Perkins,Douglas J %K point-of-care %K seroprevalence %K SARS-CoV-2 %K coronavirus %K COVID-19 %K surveillance %K rural workplace %K miners %K infectious disease %K pandemic %K antigen testing %K midnasal swabs %K public health %D 2025 %7 27.1.2025 %9 %J JMIR Public Health Surveill %G English %X 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 %R 10.2196/59845 %U https://publichealth.jmir.org/2025/1/e59845 %U https://doi.org/10.2196/59845 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e58981 %T Methods to Adjust for Confounding in Test-Negative Design COVID-19 Effectiveness Studies: Simulation Study %A Rowley,Elizabeth AK %A Mitchell,Patrick K %A Yang,Duck-Hye %A Lewis,Ned %A Dixon,Brian E %A Vazquez-Benitez,Gabriela %A Fadel,William F %A Essien,Inih J %A Naleway,Allison L %A Stenehjem,Edward %A Ong,Toan C %A Gaglani,Manjusha %A Natarajan,Karthik %A Embi,Peter %A Wiegand,Ryan E %A Link-Gelles,Ruth %A Tenforde,Mark W %A Fireman,Bruce %+ , Westat, 1600 Research Blvd, Rockville, MD, 20850, United States, 1 301 251 1500, ELIZABETHROWLEY@WESTAT.COM %K disease risk score %K propensity score %K vaccine effectiveness %K COVID-19 %K simulation study %K usefulness %K comorbidity %K assessment %D 2025 %7 27.1.2025 %9 Original Paper %J JMIR Form Res %G English %X Background: Real-world COVID-19 vaccine effectiveness (VE) studies are investigating exposures of increasing complexity accounting for time since vaccination. These studies require methods that adjust for the confounding that arises when morbidities and demographics are associated with vaccination and the risk of outcome events. Methods based on propensity scores (PS) are well-suited to this when the exposure is dichotomous, but present challenges when the exposure is multinomial. Objective: This simulation study aimed to investigate alternative methods to adjust for confounding in VE studies that have a test-negative design. Methods: Adjustment for a disease risk score (DRS) is compared with multivariable logistic regression. Both stratification on the DRS and direct covariate adjustment of the DRS are examined. Multivariable logistic regression with all the covariates and with a limited subset of key covariates is considered. The performance of VE estimators is evaluated across a multinomial vaccination exposure in simulated datasets. Results: Bias in VE estimates from multivariable models ranged from –5.3% to 6.1% across 4 levels of vaccination. Standard errors of VE estimates were unbiased, and 95% coverage probabilities were attained in most scenarios. The lowest coverage in the multivariable scenarios was 93.7% (95% CI 92.2%-95.2%) and occurred in the multivariable model with key covariates, while the highest coverage in the multivariable scenarios was 95.3% (95% CI 94.0%-96.6%) and occurred in the multivariable model with all covariates. Bias in VE estimates from DRS-adjusted models was low, ranging from –2.2% to 4.2%. However, the DRS-adjusted models underestimated the standard errors of VE estimates, with coverage sometimes below the 95% level. The lowest coverage in the DRS scenarios was 87.8% (95% CI 85.8%-89.8%) and occurred in the direct adjustment for the DRS model. The highest coverage in the DRS scenarios was 94.8% (95% CI 93.4%-96.2%) and occurred in the model that stratified on DRS. Although variation in the performance of VE estimates occurred across modeling strategies, variation in performance was also present across exposure groups. Conclusions: Overall, models using a DRS to adjust for confounding performed adequately but not as well as the multivariable models that adjusted for covariates individually. %M 39869907 %R 10.2196/58981 %U https://formative.jmir.org/2025/1/e58981 %U https://doi.org/10.2196/58981 %U http://www.ncbi.nlm.nih.gov/pubmed/39869907 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e59606 %T Occupational Infections Among Workers in Europe: Protocol for a Scoping Review %A Dini,Guglielmo %A Curti,Stefania %A Rahmani,Alborz %A Durando,Paolo %A Mattioli,Stefano %+ Occupational Medicine Unit, IRCCS Ospedale Policlinico San Martino, L.go R. Benzi 10, Building n. 3., Genoa, 16132, Italy, 1 010 3537472, guglielmo.dini@unige.it %K infection %K work-related %K biological hazard %K narrative synthesis %K Europe %K occupational infection %K worker %K scoping review %K infectious %K prevention and control %K occupational health %K epidemiology %K burden of disease %K phenomenon %D 2025 %7 24.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X 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 specific 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 %M 39855637 %R 10.2196/59606 %U https://www.researchprotocols.org/2025/1/e59606 %U https://doi.org/10.2196/59606 %U http://www.ncbi.nlm.nih.gov/pubmed/39855637 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e60669 %T Clinical Characteristics of Virologically Confirmed Respiratory Syncytial Virus in English Primary Care: Protocol for an Observational Study of Acute Respiratory Infection %A Hoang,Uy %A Agrawal,Utkarsh %A Ordóñez-Mena,José Manuel %A Marcum,Zachary %A Radin,Jennifer %A Araujo,Andre %A Panozzo,Catherine A %A Balogh,Orsolya %A Desai,Mihir %A Eltayeb,Ahreej %A Lu,Tianyi %A Nicodemo,Catia %A Gu,Xinchun %A Goudie,Rosalind %A Fan,Xuejuan %A Button,Elizabeth %A Smylie,Jessica %A Joy,Mark %A Jamie,Gavin %A Elson,William %A Byford,Rachel %A Madia,Joan %A Anand,Sneha %A Ferreira,Filipa %A Petrou,Stavros %A Martin,David %A de Lusignan,Simon %+ Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Well Walton Road, Oxford, OX2 6ED, United Kingdom, 44 01865289344, simon.delusignan@phc.ox.ac.uk %K infectious diseases %K primary care %K sentinel surveillance %K point-of-care system %K virologically %K respiratory syncytial virus %K acute respiratory infection %K clinical characteristics %K community dwelling %K adult %K vaccination %K programme %K united kingdom %K incidence %K elderly %D 2025 %7 22.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: There are gaps in our understanding of the clinical characteristics and disease burden of the respiratory syncytial virus (RSV) among community-dwelling adults. This is in part due to a lack of routine testing at the point of care. More data would enhance our assessment of the need for an RSV vaccination program for adults in the United Kingdom. Objective: This study aimed to implement point-of-care-testing (POCT) in primary care to describe the incidence, clinical presentation, risk factors, and economic burden of RSV among adults presenting with acute respiratory infection. Methods: We are recruiting up to 3600 patients from at least 21 practices across England to participate in the Royal College of General Practitioners Research Surveillance Centre. Practices are selected if they undertake reference virology sampling for the Royal College of General Practitioners Research Surveillance Centre and had previous experience with respiratory illness studies. Any adult, ≥40 years old, presenting with acute respiratory infection with onset ≤10 days, but without RSV within the past 28 days, will be eligible to participate. We will estimate the incidence proportion of RSV, describe the clinical features, and risk factors of patients with RSV infection, and measure the economic burden of RSV infection. Results: A total of 25 practices across different English health administrative regions expressed interest and were recruited to participate. We have created and tested an educational program to deploy POCT for RSV in primary care. In addition to using the POCT device, we provide suggestions about how to integrate POCT into primary care workflow and templates for high-quality data recording of diagnosis, symptoms, and signs. In the 2023-2024 winter RSV detection in the sentinel network grew between October and late November. According to data from the UK Health Security Agency, the peak RSV swab positivity was in International Standards Organization week 48, 2023. Data collection remains ongoing, and results from the subset of practices participating in this study are not yet available. Conclusions: This study will provide data on the RSV incidence in the community as well as rapid information to inform sentinel surveillance and vaccination programs. This information could potentially improve clinical decision-making. International Registered Report Identifier (IRRID): DERR1-10.2196/60669 %M 39841515 %R 10.2196/60669 %U https://www.researchprotocols.org/2025/1/e60669 %U https://doi.org/10.2196/60669 %U http://www.ncbi.nlm.nih.gov/pubmed/39841515 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 12 %N %P e53456 %T Leveraging Smart Telemedicine Technology to Enhance Nursing Care Satisfaction and Revolutionize COVID-19 Care: Prospective Cohort Study %A Chang,You-Lung %A Lin,Chi-Ying %A Hsu,Jiun %A Liao,Sui-Ling %A Yu,Chun-Ti %A Peng,Hung-Chueh %A Chen,Chung-Yu %A Ma,Matthew Huei-Ming %A Hwang,Juey-Jen %K COVID-19 %K telemedicine %K smart home care %K intelligent medical care %K nursing care %K medical care %K remote monitoring %K vital signs %K quarantine %K home-care %K hospital-care %K screening %K treatment %K mHealth %K mobile health %K digital health %K health education %K remote equipment %K smartphone %K video consultation %K remote care %K caregiver %K patient %K quality of care %K medical staff %D 2025 %7 21.1.2025 %9 %J JMIR Hum Factors %G English %X Background: Telemedicine has been utilized in the care of patients with COVID-19, allowing real-time remote monitoring of vital signs. This technology reduces the risk of transmission while providing high-quality care to both self-quarantined patients with mild symptoms and critically ill patients in hospitals. Objective: This study aims to investigate the application of telemedicine technology in the care of patients with COVID-19, specifically focusing on usability, effectiveness, and patient outcomes in both home isolation and hospital ward settings. Methods: The study was conducted between January 2022 and December 2022. More than 800 cases were monitored using the QOCA remote home care system, a telemedicine platform that enables remote monitoring of physiological data—including heart rate, blood pressure, temperature, and oxygen levels—through Internet of Things devices and a 4G-connected tablet. Of these, 27 patients participated in thie study: the QOCA remote home care system was deployed 36 times in the isolation ward and 21 times to those in home isolation. The QOCA remote care system monitored isolated cases through remote care packages and a 4G tablet. Case managers and physicians provided telemedicine appointments and medications. Innovative methods were developed to enhance usage, including online health education, remote care equipment instructions via QR core links, and video consultations for patients without smartphones. Results: A clinical nurse satisfaction survey revealed that most respondents found the content of the remote care package comprehensive and the interface easy to learn. They expressed a desire to continue using the system. The majority also agreed that using the remote care system and package would reduce their workload and that patients and caregivers could easily learn to use the package. While some respondents expressed concerns about network and Bluetooth connectivity, the majority (24/27, 89%) agreed to include the remote device as part of their routine equipment, with an average score of 84.8 points. Conclusions: The integration of telemedicine technology improves the quality of care while reducing the workload and exposure of health care workers to viruses. %R 10.2196/53456 %U https://humanfactors.jmir.org/2025/1/e53456 %U https://doi.org/10.2196/53456 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e63314 %T Identifying Preferred Features of Influenza Vaccination Programs Among Chinese Clinicians Practicing Traditional Chinese Medicine and Western Medicine: Discrete Choice Experiment %A Zhang,Liuren %A Chu,Linchen %A Sundaram,Maria E %A Zhou,Yi %A Sun,Xiu %A Wei,Zheng %A Fu,Chuanxi %K influenza vaccination program %K traditional Chinese medicine %K clinicians %K vaccine %K health care worker %K hospital-acquired %K effectiveness %K antiviral %K cross-sectional study %D 2025 %7 20.1.2025 %9 %J JMIR Public Health Surveill %G English %X Background: Achieving high vaccine coverage among clinicians is crucial to curb the spread of influenza. Traditional Chinese medicine (TCM), rooted in cultural symbols and concepts without direct parallels in modern Western medicine, may influence perspectives on vaccination. Therefore, understanding the preferences of TCM clinicians towards influenza vaccines is of great importance. Objective: To understand preferences for features of influenza vaccination programs and identify the optimal influenza vaccination program among clinicians practicing TCM and Western medicine. Methods: We conducted a discrete choice experiment with a national sample of 3085 Chinese clinicians from various hospital levels (n=1013 practicing TCM) from January to May 2022. Simulations from choice models using the experimental data generated the coefficients of preference and predicted the uptake rate of different influenza vaccination programs. Clinicians were grouped by vaccine preference classification through a latent class analysis. Results: All included attributes significantly influenced clinicians’ preferences for choosing an influenza vaccination program. An approximate hypothetical 60% increase of vaccine uptake could be obtained when the attitude of the workplace changed from “no notice” to “encouraging of vaccination”; there was an approximate hypothetical 35% increase of vaccine uptake when vaccination campaign strategies changed from “individual appointment” to “vaccination in a workplace setting.” In the entire sample, about 30% (946/3085) of clinicians preferred free vaccinations, while 26.5% (819/3085) comprehensively considered all attributes, except vaccination campaign strategies, when making a decision about choosing an influenza vaccination program. Clinicians who practiced TCM, worked in tertiary hospital, or had at least a postgraduate degree exhibited a lower preference for free vaccinations. Clinicians who practiced Western medicine, worked in primary hospital, or had at most a bachelor’s degree had a higher preference for vaccinations in workplace settings. Conclusions: Offering a range of influenza vaccination programs targeting the preferred attributes of different clinician groups could potentially encourage more clinicians, including those practicing TCM, to participate in influenza vaccination programs. %R 10.2196/63314 %U https://publichealth.jmir.org/2025/1/e63314 %U https://doi.org/10.2196/63314 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 13 %N %P e57991 %T Effectiveness of a Mobile Health Intervention (DOT Selfie) in Increasing Treatment Adherence Monitoring and Support for Patients With Tuberculosis in Uganda: Randomized Controlled Trial %A Sekandi,Juliet Nabbuye %A Buregyeya,Esther %A Zalwango,Sarah %A Nakkonde,Damalie %A Kaggwa,Patrick %A Quach,Trang Ho Thu %A Asiimwe,David %A Atuyambe,Lynn %A Dobbin,Kevin %+ Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 100 Foster Road, Athens, GA, 30602, United States, 1 7065425257, jsekandi@uga.edu %K tuberculosis %K digital adherence technologies %K video-observed treatment %K video directly observed treatment %K directly observed therapy %K adherence %K mHealth %K Uganda %K Africa %D 2025 %7 16.1.2025 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Directly observed therapy (DOT) is the standard method for monitoring adherence to tuberculosis (TB) treatment. However, implementing DOT poses challenges for both patients and providers due to limited financial and human resources. Increasing evidence suggests that emerging digital adherence technologies, such as video directly observed therapy (VDOT), can serve as viable alternatives. Objective: This study aims to evaluate the effectiveness of VDOT compared with usual care directly observed therapy (UCDOT). Methods: Between July 2020 and October 2021, we conducted a 2-arm, parallel-group, open-label randomized trial with a 1:1 assignment to receive either the VDOT intervention (n=72) or UCDOT (n=72) for treatment adherence monitoring at public health clinics in Kampala, Uganda. Each group was further stratified to ensure equal numbers of males and females. Eligible patients were aged 18-65 years, had a confirmed diagnosis of TB, and were undergoing daily treatment. The VDOT group was provided with a smartphone equipped with an app, while the UCDOT group followed the routine monitoring practices outlined by the Uganda National TB Program. We tested the hypothesis that VDOT was more effective than UCDOT for monitoring medication adherence. The primary outcome was adherence, defined as having ≥80% of the expected doses observed during the 6-month treatment period. An intention-to-treat analysis was conducted, and multivariable logistic regression was used to estimate the effect of the intervention on adherence monitoring. Adjusted relative risk ratios and their corresponding 95% CIs are presented. Secondary outcomes included treatment completion, loss to follow-up, death, and reasons for missed videos in the intervention group. Results: The intention-to-treat analysis included 142 participants, with 2 excluded due to discontinuation of medication within the first week after enrollment. The median age of participants was 34 (IQR 26-45) years. The median fraction of expected doses observed (FEDO) was significantly higher in the VDOT group compared with the UCDOT group (100, IQR 80-100 vs 30, IQR 10-60, respectively; P<.001). When using a FEDO cutoff of ≥80% to define optimal adherence, 63 of 142 (44%) patients met the threshold, with a significant difference between the VDOT and UCDOT groups (56/71, 79% vs 7/71, 10%, P<.001). After adjusting for confounders, VDOT users were significantly more likely to achieve ≥80% of their expected doses observed compared with UCDOT users (adjusted risk ratio 8.4, 95% CI 4.16-17.0). The most common reasons for failing to submit videos of medication intake were an uncharged phone battery, forgetting to record videos during medication intake, and losing the smartphone. Conclusions: Enhanced VDOT was more effective than UCDOT in increasing adherence monitoring among patients with TB in Uganda. This evidence highlights the potential of digital technologies to improve treatment adherence monitoring and support in high TB burden settings with limited human resources. Trial Registration: ClinicalTrials.gov NCT04134689; http://clinicaltrials.gov/ct2/show/NCT04134689 %M 39715573 %R 10.2196/57991 %U https://mhealth.jmir.org/2025/1/e57991 %U https://doi.org/10.2196/57991 %U http://www.ncbi.nlm.nih.gov/pubmed/39715573 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 14 %N %P e64316 %T Interventions to Maintain HIV/AIDS, Tuberculosis, and Malaria Service Delivery During Public Health Emergencies in Low- and Middle-Income Countries: Protocol for a Systematic Review %A Kabwama,Steven Ndugwa %A Wanyenze,Rhoda K. %A Lindgren,Helena %A Razaz,Neda %A Ssenkusu,John M %A Alfvén,Tobias %+ Department of Global Public Health, Karolinska Institutet, Tomtebodavägen 18A, Solna, Stockholm, 17177, Sweden, 46 707578093, steven.ndugwa.kabwama@ki.se %K service availability %K emergencies %K tuberculosis %K malaria %K systematic reviews %K health services %K emergencies %K HIV %K AIDS %K public health emergency %K low- and middle-income countries %K qualitative reviews %K qualitative %K policies %K communities %K health facilities %K emergency %K implement %K implementation %D 2025 %7 15.1.2025 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although existing disease preparedness and response frameworks provide guidance about strengthening emergency response capacity, little attention is paid to health service continuity during emergency responses. During the 2014 Ebola outbreak, there were 11,325 reported deaths due to the Ebola virus and yet disruption in access to care caused more than 10,000 additional deaths due to measles, HIV/AIDS, tuberculosis, and malaria. Low- and middle-income countries account for the largest disease burden due to HIV, tuberculosis, and malaria and yet previous responses to health emergencies showed that HIV, tuberculosis, and malaria service delivery can be significantly disrupted. To date, there has not been a systematic synthesis of interventions implemented to maintain the delivery of these services during emergencies. Objective: This study aimed to synthesize the interventions implemented to maintain HIV/AIDS, tuberculosis, and malaria services during public health emergencies in low- and middle-income countries. Methods: The systematic review was registered in the international register for prospective systematic reviews. It will include activities undertaken to improve human health either through preventing the occurrence of HIV, tuberculosis, or malaria, reducing the severity among patients, or promoting the restoration of functioning lost as a result of experiencing HIV, tuberculosis, or malaria during health emergencies. These will include policy-level (eg, development of guidelines), health facility–level (eg, service rescheduling), and community-level interventions (eg, community drug distribution). Service delivery will be in terms of improving access, availability, use, and coverage. We will report on any interventions to maintain services along the care cascade for HIV, tuberculosis, or malaria. Peer-reviewed study databases including MEDLINE, Web of Science, Embase, Cochrane, and Global Index Medicus will be searched. Reference lists from global reports on HIV/AIDS, tuberculosis, or malaria will also be searched. We will use the GRADE-CERQual (Grading of Recommendations Assessment, Development, and Evaluation—Confidence in Evidence from Reviews of Qualitative Research) approach to report on the quality of evidence in each paper. The information from the studies will be synthesized at the disease or condition level (HIV/AIDS, tuberculosis, and malaria), implementation level (policy, health facility, and community), and outcomes (improving access, availability, use, or coverage). We will use the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist to report findings and discuss implications for strengthening preparedness and response, as well as strengthening health systems in low- and middle-income countries. Results: The initial search for published literature was conducted between January 2023 and March 2023 and yielded 8119 studies. At the time of publication, synthesis and interpretation of results were being concluded. Final results will be published in 2025. Conclusions: The findings will inform the development of national and global guidance to minimize disruption of services for patients with HIV/AIDS, tuberculosis, and malaria during public health emergencies. Trial Registration: PROSPERO CRD42023408967; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=408967 International Registered Report Identifier (IRRID): PRR1-10.2196/64316 %M 39813677 %R 10.2196/64316 %U https://www.researchprotocols.org/2025/1/e64316 %U https://doi.org/10.2196/64316 %U http://www.ncbi.nlm.nih.gov/pubmed/39813677 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e58862 %T Wastewater Monitoring During the COVID-19 Pandemic in the Veneto Region, Italy: Longitudinal Observational Study %A Ocagli,Honoria %A Zambito,Marco %A Da Re,Filippo %A Groppi,Vanessa %A Zampini,Marco %A Terrini,Alessia %A Rigoli,Franco %A Amoruso,Irene %A Baldovin,Tatjana %A Baldo,Vincenzo %A Russo,Francesca %A Gregori,Dario %K wastewater-based epidemiology %K SARS-CoV-2 %K COVID-19 %K CUSUM %K WBE %K cumulative sum chart %D 2025 %7 14.1.2025 %9 %J JMIR Public Health Surveill %G English %X 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. %R 10.2196/58862 %U https://publichealth.jmir.org/2025/1/e58862 %U https://doi.org/10.2196/58862 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e67627 %T Trends in Mental Health Outcomes of College Students Amid the Pandemic (Roadmap mHealth App): Longitudinal Observational Study %A Jayaraj,Gautham %A Cao,Xiao %A Horwitz,Adam %A Rozwadowski,Michelle %A Shea,Skyla %A Hanauer,Shira N %A Hanauer,David A %A Tewari,Muneesh %A Shedden,Kerby %A Choi,Sung Won %+ Department of Pediatrics, Medical School, University of Michigan, 1200 E Hospital Dr, Medical Professional Building D4115, Ann Arbor, MI, 48109, United States, 1 734 615 5707, sungchoi@med.umich.edu %K mHealth %K college %K student %K mental health %K positive psychology %K flourishing %K COVID-19 %K wellbeing %K mobile phone %K SARS-CoV-2 %K coronavirus %K pandemic %K COVID %K app %K digital health %K smartphone %K eHealth %K telehealth %K telemedicine %K longitudinal %K higher education %K depression %K anxiety %K loneliness %D 2025 %7 9.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: The mental health crisis among college students intensified amid the COVID-19 pandemic, suggesting an urgent need for innovative solutions to support them. Previous efforts to address mental health concerns have been constrained, often due to the underuse or shortage of services. Mobile health (mHealth) technology holds significant potential for providing resilience-building support and enhancing access to mental health care. Objective: This study aimed to examine the trends in mental health and well-being outcomes over 3 years among college students, with an exploratory aim to assess the potential impact of the Roadmap mHealth app on these outcomes. Methods: A fully automated longitudinal observational study was conducted remotely from a large public academic institution in the Midwestern United States, evaluating mental health and well-being outcomes among college students using the Roadmap mHealth app over 3 fall semesters from 2020 to 2022. The study enrolled 2164 college students in Year I, with 1128 and 1033 students returning in Years II and III, respectively. Participants completed various self-reported measures, including the Patient Health Questionnaire-9 for depression, Generalized Anxiety Disorder-7 for anxiety, and additional metrics for coping, flourishing, and loneliness. Results: The findings indicated an evolving trajectory in students’ mental health. In Year I, depression and anxiety levels were higher compared with levels reported between 2014 and 2019, remaining stable into Year II. However, significant decreases were noted by Year III for both depression (Year I mean 7.78, SD 5.65 vs Year III mean 6.21, SD 4.68; t108=–2.90; P=.01) and anxiety (Year I mean 6.61, SD 4.91 vs Year III mean 5.62, SD 4.58; t116=–2.02; P=.046). Problem-focused coping decreased initially from Year I (mean 2.46, SD 0.58) to Year II (mean 2.36, SD 0.60; t1073=–5.87; P<.001), then increased by Year III (mean 2.40, SD 0.63; t706=2.26; P=.02). Emotion-focused (Year I mean 2.33, SD 0.41 vs Year III mean 2.22, SD 0.47; t994=–7.47; P<.001) and avoidant coping (Year I mean 1.76, SD 0.37 vs Year III mean 1.65, SD 0.38; t997=–8.53; P=.02) consistently decreased. Loneliness significantly decreased from Year I (mean 5.79, SD 1.74) to Year III (mean 5.17, SD 1.78; t1013=–10.74; P<.001), accompanied by an increase in flourishing from Year I (mean 63.78, SD 14.76) to Year III (mean 66.98, SD 15.06; t994=7.22; P<.001). Analysis of app usage indicated that the positive piggy bank and gratitude journal were the favored activities. Greater engagement with the app was positively correlated with enhanced flourishing, even after adjusting for demographic and sociobehavioral factors (β=.04, SE .016; t3974=2.17; P=.03). Conclusions: In this study, students’ mental health and well-being improved, with notable reductions in depression, anxiety, and loneliness, associated with an increase in flourishing. The app did not appear to worsen students’ mental health. Based on the usage pattern, it is possible the app enhanced positive psychology-based practices. Future research should explore the efficacy of mHealth interventions through randomized controlled trials to further understand their impact on college students’ mental health outcomes. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID): RR2-10.2196/29561 %M 39787592 %R 10.2196/67627 %U https://www.jmir.org/2025/1/e67627 %U https://doi.org/10.2196/67627 %U http://www.ncbi.nlm.nih.gov/pubmed/39787592 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e60022 %T Strategies to Increase Response Rate and Reduce Nonresponse Bias in Population Health Research: Analysis of a Series of Randomized Controlled Experiments during a Large COVID-19 Study %A Atchison,Christina J %A Gilby,Nicholas %A Pantelidou,Galini %A Clemens,Sam %A Pickering,Kevin %A Chadeau-Hyam,Marc %A Ashby,Deborah %A Barclay,Wendy S %A Cooke,Graham S %A Darzi,Ara %A Riley,Steven %A Donnelly,Christl A %A Ward,Helen %A Elliott,Paul %K study recruitment %K response rate %K population-based research %K COVID-19 %K SARS-CoV-2 %K web-based questionnaires %D 2025 %7 9.1.2025 %9 %J JMIR Public Health Surveill %G English %X Background: High response rates are needed in population-based studies, as nonresponse reduces effective sample size and bias affects accuracy and decreases the generalizability of the study findings. Objective: We tested different strategies to improve response rate and reduce nonresponse bias in a national population–based COVID-19 surveillance program in England, United Kingdom. Methods: Over 19 rounds, a random sample of individuals aged 5 years and older from the general population in England were invited by mail to complete a web-based questionnaire and return a swab for SARS-CoV-2 testing. We carried out several nested randomized controlled experiments to measure the impact on response rates of different interventions, including (1) variations in invitation and reminder letters and SMS text messages and (2) the offer of a conditional monetary incentive to return a swab, reporting absolute changes in response and relative response rate (95% CIs). Results: Monetary incentives increased the response rate (completed swabs returned as a proportion of the number of individuals invited) across all age groups, sex at birth, and area deprivation with the biggest increase among the lowest responders, namely teenagers and young adults and those living in more deprived areas. With no monetary incentive, the response rate was 3.4% in participants aged 18‐22 years, increasing to 8.1% with a £10 (US $12.5) incentive, 11.9% with £20 (US $25.0), and 18.2% with £30 (US $37.5) (relative response rate 2.4 [95% CI 2.0-2.9], 3.5 [95% CI 3.0-4.2], and 5.4 [95% CI 4.4-6.7], respectively). Nonmonetary strategies had a modest, if any, impact on response rate. The largest effect was observed for sending an additional swab reminder (SMS text message or email). For example, those receiving an additional SMS text message were more likely to return a completed swab compared to those receiving the standard email-SMS approach, 73.3% versus 70.2%: percentage difference 3.1% (95% CI 2.2%-4.0%). Conclusions: Conditional monetary incentives improved response rates to a web-based survey, which required the return of a swab test, particularly for younger age groups. Used in a selective way, incentives may be an effective strategy for improving sample response and representativeness in population-based studies. %R 10.2196/60022 %U https://publichealth.jmir.org/2025/1/e60022 %U https://doi.org/10.2196/60022 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 11 %N %P e50058 %T Contribution of Travelers to Plasmodium Vivax Malaria in South West Delhi, India: Cross-Sectional Survey %A Savargaonkar,Deepali %A Srivastava,Bina %A Yadav,Chander Prakash %A Singh,Mrigendra Pal %A Anvikar,Anup %A Sharma,Amit %A Singh,Himmat %A Sinha,Abhinav %K malaria %K Plasmodium vivax %K imported malaria %K population movement %K transmission %K elimination %K India %D 2025 %7 8.1.2025 %9 %J JMIR Public Health Surveill %G English %X Background: India is committed to malaria elimination by the year 2030. According to the classification of malaria endemicity, the National Capital Territory of Delhi falls under category 1, with an annual parasite incidence of <1, and was targeted for elimination by 2022. Among others, population movement across states is one of the key challenges for malaria control, as it can result in imported malaria, thus introducing local transmission in an area nearing elimination. Objective: This descriptive study attempts to assess the contribution of such imported Plasmodium vivax cases to the malaria burden in South West Delhi (SWD). Methods: A cross-sectional study was carried out at the fever clinic of the Indian Council of Medical Research-National Institute of Malaria Research in SWD from January 2017 to December 2019. Demographic and travel history data were recorded for all P vivax confirmed malaria cases diagnosed at the fever clinic. Vector and fever surveys along with reactive case detection were conducted in SWD and Bulandshahr district of Uttar Pradesh, 1 of the 6 geographical sources for a high number of imported malaria cases. Results: A total of 355 P vivax malaria cases were reported during the study period. The proportion of imported cases was 63% (n=222). Of these, 96% (n=213) of cases were from Uttar Pradesh. The distribution of malaria cases revealed that imported cases were significantly associated with travel during the transmission season compared with that in the nontransmission season. Entomological and fever surveys and reactive case detection carried out in areas visited by imported P vivax malaria cases showed the presence of adults and larvae of Anopheles species and P vivax parasitemia. Conclusions: Population movement is a key challenge for malaria elimination. Although additional P vivax infections and vector mosquitoes were detected at places visited by the imported malaria cases, the inability to detect the parasite in mosquitoes and the possibility of relapses associated with P vivax limit the significance of malaria associated with the travel. However, there remains a need to address migration malaria to prevent the introduction and re-establishment of malaria in areas with very low or 0 indigenous cases. %R 10.2196/50058 %U https://publichealth.jmir.org/2025/1/e50058 %U https://doi.org/10.2196/50058 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 14 %N %P e55636 %T Citizen Worry and Adherence in Response to Government Restrictions in Switzerland During the COVID-19 Pandemic: Repeated Cross-Sectional Online Surveys %A Kraege,Vanessa %A Dumans-Louis,Céline %A Maglieri,Céline %A Bochatay,Séverine %A Durand,Marie-Anne %A Garnier,Antoine %A Selby,Kevin %A von Plessen,Christian %+ Department of Internal Medicine, Le Groupement Hospitalier de l’Ouest Lémanique, Chemin du Monastier 10, 1260 Nyon, Switzerland, 41 765567810, celine.dumanslouis@ghol.ch %K COVID-19 pandemic %K citizens %K worry %K anxiety %K communication %K prevention %K adherence %K restrictions %K Switzerland %K cross sectional %K online survey %K survey %K Swiss %K adults %K questionnaire %K social media %K linear regression %K age %K gender %K health literacy %K education %K women %K young people %D 2025 %7 7.1.2025 %9 Original Paper %J Interact J Med Res %G English %X Background: Good communication between health authorities and citizens is crucial for adherence to preventive measures during a pandemic. Crisis communication often appeals to worries about negative consequences for oneself or others. While worry can motivate protective behavior, it can also be overwhelming and lead to irrational choices or become a mental health problem. Also, the levels and consequences of worry can differ between different groups of citizens. Little is known about the evolution of worries during the pandemic and adherence to measures in distinct groups. Objective: This study aimed to evaluate worries in the Swiss population as well as associations between worry levels and citizens’ adherence to government restrictions during different phases of the COVID-19 pandemic. Methods: We carried out an observational study with 4 cross-sectional online surveys of adults in the Canton of Vaud, Switzerland. Questionnaires were distributed through social media and websites during 4 periods: survey 1: April 17 to May 14, 2020; survey 2: May 15 to June 22, 2020; survey 3: October 30 to December 12, 2020; and survey 4: June 18 to December 30, 2021. On visual analog scales from 0 to 100, participants reported worry, self-adherence to pandemic restrictions, and their perceived adherence to others. We used multivariable linear regression, adjusting for age, gender, health literacy, and education to assess associations between self-reported worry, adherence, and study periods. Results: We collected 7106 responses. After excluding 2377 questionnaires (incomplete, age <18 years, residence outside Vaud), 4729 (66.55%) were analyzed (mean age 47, SD 15.6 years, 63.96% women). Mean worry across the 4 periods was 42/100, significantly higher in women (44.25/100, vs 37.98/100; P<.001) and young people (43.77/100 in those aged 18-39 years, vs 41.69/100; P=.005; in those aged 40-64 years and 39.16/100; P=.002; in those aged >64 years). Worries were higher during survey 1 and survey 3 (52.41/100 and 56.32/100 vs 38.93/100, P<.001; and 35.71/100, P<.001) than during survey 2 and survey 4, respectively. This corresponds to pandemic peaks during which federal restrictions were better followed with self-reported adherence of 84.80/100 and 89.59/100 in survey 1 and survey 3 versus 78.69/100 (P<.001) and 78.64/100 (P<.001) in survey 2 and survey 4. A 2.9-point increase in worry score, adjusted for the pandemic period, gender, age, education, and health literacy, was associated with a 10-point increase in personal adherence score (95% CI 2.5-3.2; P<.001). Conclusions: Worries were higher in women, young people, and during the peak of the COVID-19 pandemic. Higher worry levels were associated with increased self-reported adherence to federal restrictions. Authorities should consider population worry levels and population subgroups in the planning and design of pandemic communication. %M 39773986 %R 10.2196/55636 %U https://www.i-jmr.org/2025/1/e55636 %U https://doi.org/10.2196/55636 %U http://www.ncbi.nlm.nih.gov/pubmed/39773986 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 27 %N %P e60446 %T Topic Modeling of Nursing Issues in the Media During 4 Emerging Infectious Disease Epidemics in South Korea: Descriptive Analysis %A Kim,Jungok %A Yun,Eun Kyoung %+ , College of Nursing Science, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul, 02447, Republic of Korea, 82 2 961 2348, ekyun@khu.ac.kr %K topic modeling %K news articles %K nursing issues %K text analysis %K emerging infectious disease %D 2025 %7 6.1.2025 %9 Original Paper %J J Med Internet Res %G English %X Background: Emerging infectious disease disasters receive extensive media coverage and public attention. Nurse burnout and attrition peak during health crises such as pandemics. However, there is limited research on nursing issues related to repeated emerging infectious disease crises over time. Objective: The purpose of this study was to analyze and draw implications from changes in key nursing issues reported by the news media during the outbreaks of severe acute respiratory syndrome (SARS; 2003), influenza A (2009), Middle East respiratory syndrome (MERS; 2015), and COVID-19 (2020) in Korea using topic modeling. Methods: A total of 51,489 news articles were extracted by searching for the keywords “nursing” or “nurse” in the title or body of articles published from April 2003 to May 2021 (during new infectious disease outbreaks) in the open integrated database. The selected news articles were preprocessed then analyzed for text and structure using a 3-step keyword analysis method, latent Dirichlet allocation topic modeling, and keyword network analysis. Results: Among the 51,489 news articles collected with the search terms “nursing” and “nurse,” 17,285 (33.6%) were selected based on the eligibility criteria and used in the final analysis. Using topic modeling, we derived 5 topics each for SARS, influenza A, and MERS and 6 topics for COVID-19. The themes commonly identified through topic modeling and keyword network analysis across the 4 epidemics were “response to emerging infectious diseases in Korea,” “demand for nurses,” “vulnerability in the work environment,” and “roles and responsibilities of nurses.” Although the topic names were the same, the meanings implied by the comprehensive keywords for each epidemic varied depending on the epidemic and the times. Conclusions: Analysis of the identified themes and associated keyword network revealed that issues related to nurse shortages, working conditions, and poor treatment were not unique to the COVID-19 pandemic but rather recurring themes from previous epidemics. Our findings can be used to inform strategies to improve the professional roles, work environment, and treatment of nurses during health crises. Suggestions for future nursing-related policy impact and change research are also provided. %M 39761557 %R 10.2196/60446 %U https://www.jmir.org/2025/1/e60446 %U https://doi.org/10.2196/60446 %U http://www.ncbi.nlm.nih.gov/pubmed/39761557 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 9 %N %P e59230 %T Quantifying the Regional Disproportionality of COVID-19 Spread: Modeling Study %A Sasaki,Kenji %A Ikeda,Yoichi %A Nakano,Takashi %K infectious disease %K COVID-19 %K epidemiology %K public health %K SARS-CoV-2 %K pandemic %K inequality measure %K information theory %K Kullback-Leibler divergence %D 2025 %7 3.1.2025 %9 %J JMIR Form Res %G English %X 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. %R 10.2196/59230 %U https://formative.jmir.org/2025/1/e59230 %U https://doi.org/10.2196/59230 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54734 %T Continued Implementation and Use of a Digital Informal Care Support Platform Before and After COVID-19: Multimethod Study %A Sharma,Nikita %A Wrede,Christian %A Bastoni,Sofia %A Braakman-Jansen,Annemarie %A van Gemert-Pijnen,Lisette %K digital care platform %K eHealth %K implementation %K informal care %K new digital normal %K COVID %K Caren %K consolidated framework %D 2024 %7 31.12.2024 %9 %J JMIR Form Res %G English %X Background: With the growing need of support for informal caregivers (ICs) and care recipients (CRs) during COVID-19, the uptake of digital care collaboration platforms such as Caren increased. Caren is a platform designed to (1) improve communication and coordination between ICs and health care professionals, (2) provide a better overview of the care process, and (3) enhance safe information sharing within the care network. Insights on the impact of COVID-19 on the implementation and use of informal care platforms such as Caren are still lacking. Objective: This study aimed to (1) identify technology developers’ lessons learned from the continued implementation of Caren during COVID-19 and (2) examine pre-post COVID-19 changes in usage behavior and support functionality use of Caren. Methods: A focus group with developers of the Caren platform (N=3) was conducted to extract implementation lessons learned. Focus group data were first analyzed deductively, using the Consolidated Framework for Implementation Research domains (ie, individual characteristics, intervention characteristics, inner setting, and outer setting). Later, inductive analysis of overarching themes was performed. Furthermore, survey data were collected in 2019 (N=11,635) and 2022 (N=5573) among Caren platform users for comparing usage behavior and support functionality use. Data were analyzed using descriptive and inferential statistics. Results: Several lessons from the continued implementation of Caren during COVID-19 were identified. Those included, for example, alternative ways to engage with end users, incorporating automated user support and large-scale communication features, considering the fluctuation of user groups, and addressing data transparency concerns in health care. Quantitative results showed that the number of ICs and CRs who used Caren several times per day increased significantly (P<.001 for ICs and CRs) between 2019 (ICs: 23.8%; CRs: 23.2%) and 2022 (ICs: 35.2%; CRs: 37%), as well as the use of certain support functionalities such as a digital agenda to make and view appointments, a messaging function to receive updates and communicate with formal and informal caregivers, and digital notes to store important information. Conclusions: Our study offers insights into the influence of the COVID-19 pandemic on the usage and implementation of the digital informal care support platform Caren. The study shows how platform developers maintained the implementation during COVID-19 and which support functionalities gained relevance among ICs and CRs throughout the pandemic. The findings can be used to improve the design and implementation of current and future digital platforms to support informal care toward the “new digital normal.” %R 10.2196/54734 %U https://formative.jmir.org/2024/1/e54734 %U https://doi.org/10.2196/54734 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e55376 %T Using Laboratory Test Results for Surveillance During a New Outbreak of Acute Hepatitis in 3-Week- to 5-Year-Old Children in the United Kingdom, the Netherlands, Ireland, and Curaçao: Observational Cohort Study %A Swets,Maaike C %A Kerr,Steven R %A MacKenna,Brian %A Fisher,Louis %A van Wijnen,Merel %A Brandwagt,Diederik %A Schenk,Paul W %A Fraaij,Pieter %A Visser,Leonardus G %A Bacon,Sebastian %A Mehrkar,Amir %A Nichol,Alistair %A Twomey,Patrick %A Matthews,Philippa C %A , %A Semple,Malcolm G %A Groeneveld,Geert H %A Goldacre,Ben %A Jones,Iain %A Baillie,J Kenneth %K pediatric hepatitis %K disease surveillance %K outbreak detection %K pandemic preparedness %K acute hepatitis %K children %K data analytics %K hospital %K laboratory %K all age groups %K pre-pandemic %K United Kingdom %K Netherlands %K Ireland Curacao %K single center %K federated analytics %K pandemic surveillance %K outbreaks %K public health %D 2024 %7 23.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: In March 2022, a concerning rise in cases of unexplained pediatric hepatitis was reported in multiple countries. Cases were defined as acute hepatitis with serum transaminases >500 U/L (aspartate transaminase [AST] or alanine transaminase [ALT]) in children aged 16 years or younger. We explored a simple federated data analytics method to search for evidence of unreported cases using routinely held data. We conducted a pragmatic survey to analyze changes in the proportion of hospitalized children with elevated AST or ALT over time. In addition, we studied the feasibility of using routinely collected clinical laboratory results to detect or follow-up the outbreak of an infectious disease. Objective: We explored a simple federated data analytics method to search for evidence of unreported cases using routinely held data. Methods: We provided hospitals with a simple computational tool to enable laboratories to share nondisclosive summary-level data. Summary statistics for AST and ALT measurements were collected from the last 10 years across all age groups. Measurements were considered elevated if ALT or AST was >200 U/L. The rate of elevated AST or ALT test for 3-week- to 5-year-olds was compared between a period of interest in which cases of hepatitis were reported (December 1, 2021, to August 31, 2022) and a prepandemic baseline period (January 1, 2012, to December 31, 2019). We calculated a z score, which measures the extent to which the rate for elevated ALT or AST was higher or lower in the period of interest compared to a baseline period, for the 3-week- to 5-year-olds. Results: Our approach of sharing a simple software tool for local use enabled rapid, federated data analysis. A total of 34 hospitals in the United Kingdom, the Netherlands, Ireland, and Curaçao were asked to contribute summary data, and 30 (88%) submitted their data. For all locations combined, the rate of elevated AST or ALT measurements in the period of interest was not elevated (z score=−0.46; P=.64). Results from individual regions were discordant, with a higher rate of elevated AST or ALT values in the Netherlands (z score=4.48; P<.001), driven by results from a single center in Utrecht. We did not observe any clear indication of changes in primary care activity or test results in the same period. Conclusions: Hospital laboratories collect large amounts of data on a daily basis that can potentially be of use for disease surveillance, but these are currently not optimally used. Federated analytics using nondisclosive, summary-level laboratory data sharing was successful, safe, and efficient. The approach holds potential as a tool for pandemic surveillance in future outbreaks. Our findings do not indicate the presence of a broader outbreak of mild hepatitis cases among young children, although there was an increase in elevated AST or ALT values locally in the Netherlands. %R 10.2196/55376 %U https://publichealth.jmir.org/2024/1/e55376 %U https://doi.org/10.2196/55376 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e46566 %T Users’ Perceived Service Quality of National Telemedicine Services During the COVID-19 Pandemic in Bangladesh: Cross-Sectional Study %A Khatun,Fatema %A Das,Novel Chandra %A Hoque,Md Rakibul %A Saqeeb,Kazi Nazmus %A Rahman,Monjur %A Park,Kyung Ryul %A Rasheed,Sabrina %A Reidpath,Daniel D %K telemedicine %K COVID-19 %K LMIC %K low- and middle-income countries %K Bangladesh %K service quality %K user satisfaction %K structural equation modeling %K digital health %D 2024 %7 23.12.2024 %9 %J JMIR Hum Factors %G English %X Background: COVID-19 created an opportunity for using teleconsultation as an alternative way of accessing expert medical advice. Bangladesh has seen a 20-fold increase in the use of teleconsultation during the pandemic. Objective: The aim of our study was to assess the influence of service quality and user satisfaction on the intention to use teleconsultation in the future among users of national teleconsultation services during the pandemic. Methods: A cross-sectional survey was conducted in 2020 among users of the national teleconsultation service—Shastho Batayon for acute respiratory infection. A validated mobile health service quality model based on structural equation modeling and confirmatory factor analysis was used to analyze the data with SmartPLS (version 3.0). Results: Among the 2097 study participants, 1646 (78.5%) were male, 1416 (67.5%) were aged 18‐39 years, 1588 (75.7%) were urban residents, 1348 (64.2%) had more than 10 years of schooling, and 1657 (79%) were from middle-income households. From a consumer perspective, the quality of the service platform (β=.946), service interaction (β=.974), and outcome (β=.955) contributed to service quality. Service quality was positively associated with user satisfaction (β=.327; P<.001) and intention to use teleconsultation services (β=.102; P<.001). User satisfaction was positively associated with the intention to use teleconsultation services (β=.311; P<.001). Conclusions: The increase in the use of teleconsultation during the pandemic indicated that such services were potentially used for emergencies. However, the future use of teleconsultation will be dependent on the quality of service and user satisfaction. Our findings are relevant for low-income contexts where teleconsultation services are used to address gaps in service delivery. %R 10.2196/46566 %U https://humanfactors.jmir.org/2024/1/e46566 %U https://doi.org/10.2196/46566 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52713 %T SARS-CoV-2 Infections in a Triad of Primary School Learners (Grades 1-7), Their Parents, and Teachers in KwaZulu-Natal, South Africa: Protocol for a Cross-Sectional and Nested Case-Cohort Study %A Dassaye,Reshmi %A Chetty,Terusha %A Daniels,Brodie %A Gaffoor,Zakir %A Spooner,Elizabeth %A Ramraj,Trisha %A Mthethwa,Ncengani %A Nsibande,Duduzile Faith %A Pillay,Saresha %A Bhana,Arvin %A Magasana,Vuyolwethu %A Reddy,Tarylee %A Mohlabi,Khanya %A Moore,Penelope Linda %A Burgers,Wendy A %A de Oliveira,Tulio %A Msomi,Nokukhanya %A Goga,Ameena %+ HIV and Other Infectious Diseases Research Unit, South African Medical Research Council, Francie van Zijl Drive, Parowvallei, Cape Town, 7505, South Africa, 27 312604486, Reshmi.Dassaye@mrc.ac.za %K COVID-19 %K SARS-CoV-2 %K learners %K seroprevalence %K long COVID %K transmission dynamics %D 2024 %7 19.12.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In low- and middle-income countries (LMICs) such as South Africa, there is paucity of data on SARS-CoV-2 infections among children attending school, including seroprevalence and transmission dynamics. Objective: This pilot study aims to assess (1) the prevalence of self-reported or confirmed SARS-CoV-2 prior infections, COVID-19 symptoms (including long COVID), seroprevalence of SARS-CoV-2 antibodies, and general/mental health, (2) longitudinal changes in SARS-CoV-2 seroprevalence, and (3) SARS-CoV-2 acute infections, immune responses, transmission dynamics, and symptomatic versus asymptomatic contacts in a unique cohort of unvaccinated primary school learners, their parents, teachers, and close contacts in semirural primary school settings. Methods: Learners (grades 1-7) from primary schools in KwaZulu-Natal, South Africa, their parents, and teachers will be invited to enroll into the COVID kids school study (CoKiDSS). CoKiDSS comprises 3 parts: a cross-sectional survey (N=640), a follow-up survey (n=300), and a nested case-cohort substudy. Finger-prick blood and saliva samples will be collected for serological and future testing, respectively, in the cross-sectional (451 learners:147 parents:42 teachers) and follow-up (210 learners:70 parents:20 teachers) surveys. The nested case-cohort substudy will include cases from the cross-sectional survey with confirmed current SARS-CoV-2 infection (n=30) and their close contacts (n=up to 10 per infected participant). Finger-prick blood (from all substudy participants), venous blood (from cases), and nasal swabs (from cases and contacts) will be collected for serological testing, immunological testing, and viral genome sequencing, respectively. Questionnaires covering sociodemographic and general and mental health information, prior and current SARS-CoV-2 symptoms and testing information, vaccination status, preventative behavior, and lifestyle will be administered. Statistical methods will include generalized linear mixed models, intracluster correlation, descriptive analysis, and graphical techniques. Results: A total of 645 participants were enrolled into the cross-sectional survey between May and August 2023. A subset of 300 participants were followed up in the follow-up survey in October 2023. Screening of the participants into the nested case-cohort substudy is planned between November 2023 and September 2024. Data cleanup and analysis for the cross-sectional survey is complete, while those for the follow-up survey and nested case substudy will be completed by the third quarter of 2024. The dissemination and publication of results is anticipated for the fourth quarter of 2024. Conclusions: This study provides data from an LMIC setting on the impact of SARS-CoV-2 on school-attending learners, their parents, and teachers 3 years after the SARS-CoV-2 pandemic was declared and 21-24 months after resumption of normal school attendance. In particular, this study will provide data on the prevalence of self-reported or confirmed SARS-CoV-2 prior infection, prior and current symptoms, seroprevalence, changes in seroprevalence, SARS-CoV-2 transmission, SARS-CoV-2 adaptive immune responses, and symptoms of long COVID and mental health among a triad of learners, their parents, and teachers. International Registered Report Identifier (IRRID): DERR1-10.2196/52713 %M 39700491 %R 10.2196/52713 %U https://www.researchprotocols.org/2024/1/e52713 %U https://doi.org/10.2196/52713 %U http://www.ncbi.nlm.nih.gov/pubmed/39700491 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e65093 %T Hepatitis B Virus Exposure, Seroprotection Status, and Susceptibility in Health Care Workers From Lao People’s Democratic Republic: Cross-Sectional Study %A Virachith,Siriphone %A Phakhounthong,Khanxayaphone %A Khounvisith,Vilaysone %A Mayxay,Mayfong %A Kounnavong,Sengchanh %A Sayasone,Somphou %A Hübschen,Judith M %A Black,Antony P %K hepatitis B %K hepatitis D %K health care workers %K Laos %K prevalence %D 2024 %7 17.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Despite the high prevalence of chronic hepatitis B virus (HBV) infection in adults in Lao People’s Democratic Republic (Lao PDR), Lao health care workers (HCWs) have previously been shown to have low levels of protection against infection. Furthermore, the prevalence of hepatitis D virus (HDV), which increases disease severity in individuals infected with HBV, is not known in Lao PDR. Objective: This study aimed to estimate the exposure and seroprotection against HBV, as well as exposure to HDV, in Lao HCWs from 5 provinces. Methods: In 2020, a total of 666 HCWs aged 20 to 65 years from 5 provinces of Lao PDR were recruited, and their sera were tested by enzyme-linked immunosorbent assay to determine their HBV and HDV coinfection status. Results: HBV exposure, as indicated by the presence of anti–hepatitis B core antibodies, was 40.1% (267/666) overall and significantly higher for HCWs from Oudomxay province (21/31, 67.7%; adjusted odds ratio 3.69, 95% CI 1.68‐8.12; P=.001). The prevalence of hepatitis B surface antigen was 5.4% (36/666) overall and increased with age, from 3.6% (9/248) in those aged ≤30 years to 6.8% (8/118) in those aged ≥50 years. Only 28.7% (191/666) of participants had serological indication of immunization. We could find no evidence for HDV exposure in this study. Conclusions: The study found intermediate hepatitis B surface antigen prevalence among HCWs in Lao PDR, with no evidence of HDV coinfection. Notably, a significant proportion of HCWs remains susceptible to HBV, indicating a substantial gap in seroprotection against the disease. %R 10.2196/65093 %U https://publichealth.jmir.org/2024/1/e65093 %U https://doi.org/10.2196/65093 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e63146 %T 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 %A Nie,Jia %A Huang,Tian %A Sun,Yuhong %A Peng,Zutong %A Dong,Wenlong %A Chen,Jiancheng %A Zheng,Di %A Guo,Fuyin %A Shi,Wenhui %A Ling,Yuewei %A Zhao,Weijia %A Yang,Haijun %A Shui,Tiejun %A Yan,Xiangyu %K hand, foot, and mouth disease %K vaccination %K enterovirus 71 %K COVID-19 %K epidemical trend %K HFMD %K EV71 %D 2024 %7 17.12.2024 %9 %J JMIR Public Health Surveill %G English %X 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. %R 10.2196/63146 %U https://publichealth.jmir.org/2024/1/e63146 %U https://doi.org/10.2196/63146 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58391 %T Effect of Health Literacy on Antiviral Treatment of Hepatitis B: Instrumental Variable Analysis %A Cheng,Hanchao %A Liu,Shiyang %A Wang,Zhitao %A Wu,Qiyou %A Wang,Xin %A Chan,Polin %A Chen,Zhongdan %A Luo,Simon %A Li,Yinghua %A Sun,Jing %K health literacy %K antiviral treatment %K hepatitis B %K China %K instrumental variable %K longitudinal study %D 2024 %7 16.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: China is a country with a high burden of hepatitis B (Hep B) but a low treatment rate. One of the key reasons for the low treatment rate is the inadequate health literacy (HL) of the people, which may affect the awareness and knowledge of Hep B and its treatment, as well as the ability to actively and correctly seek medical resources. Objective: This study analyzed how HL contributed to the scale-up of antiviral treatment of Hep B in China. We expect that the findings of this study could be used to inform resource allocation for health education and other approaches intending to improve the HL of the Chinese population, thus facilitating the nationwide scale-up of Hep B treatment and contributing to the achievement of the 2030 goal of eliminating viral hepatitis as a major public health threat in China. Methods: We used the two-stage least squares regression method and adopted the mobile phone penetration rate as the instrumental variable to estimate the effect of improved HL on the number of 12-month standard Hep B antiviral treatments in China based on the panel data of 31 provinces from 2013 to 2020. Results: In the cross-sectional dimension, the higher the HL, the higher the number of treatments in the provinces in a specific year. In the time series dimension, the number of treatments in a specific province increased with the improvement of HL over time. After controlling the time-invariant inherent attributes of provinces, the instrumental variable estimation with two-stage least squares regression based on the province fixed effect model found that for every 1% increase of HL in each province, the number of treatments increased by 7.15% (0.0715 = e0.0691 – 1; P<.001). Such an increase turned to 5.19% (0.0519 = e0.0506 – 1; P<.001) for the analysis targeting the observation time from 2013 to 2019, as the data of 2020 were removed when the COVID-19 pandemic started. The study found no statistically significant effect of HL on the number of Hep B treatments in the provinces with higher newly reported Hep B incidence and lower gross domestic product per capita. Conclusions: Our findings suggest that improved HL of the population is an important favorable facilitator for the scale-up of Hep B treatment in China. Building awareness and knowledge of Hep B and its treatment can help individuals understand their health status, ensuring a healthier lifestyle and appropriate health care–seeking behaviors and health care service utilization, so that people can be diagnosed and treated timely and appropriately. Enhancing resource allocation to improve the overall HL of the population and sending Hep B–specific messages to the infected people would be a feasible and effective approach to scale-up the treatment of Hep B in low- and middle-income settings with limited resources, and contribute to achieving the 2030 global goal of eliminating viral hepatitis as a major public health threat. %R 10.2196/58391 %U https://publichealth.jmir.org/2024/1/e58391 %U https://doi.org/10.2196/58391 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53522 %T Investigating the Associations Between COVID-19, Long COVID, and Sleep Disturbances: Cross-Sectional Study %A Shao,Heng %A Chen,Hui %A Xu,Kewang %A Gan,Quan %A Chen,Meiling %A Zhao,Yanyu %A Yu,Shun %A Li,Yutong Kelly %A Chen,Lihua %A Cai,Bibo %K COVID-19 %K long COVID %K sleep disturbances %K psychological outcomes %K socioeconomic factors %K cross-sectional study %D 2024 %7 13.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: COVID-19 has not only resulted in acute health issues but also led to persistent symptoms known as long COVID, which have been linked to disruptions in sleep quality. Objective: This study aims to investigate the associations between COVID-19, long COVID, and sleep disturbances, focusing on demographic, socioeconomic, and psychological factors among a Chinese population. Methods: This cross-sectional study included 1062 participants from China. Demographic, socioeconomic, and clinical data were collected through web-based questionnaires. Participants were divided into 2 groups based on COVID-19 infection status: infected and noninfected. Within the infected group, participants were further categorized into those with long COVID and those without long COVID. Noninfected participants were included in the non–long COVID group for comparison. Sleep quality was assessed using the Pittsburgh Sleep Quality Index (PSQI), while depression and anxiety were evaluated using the Patient Health Questionnaire-9 (PHQ-9) and the Generalized Anxiety Disorder-7 (GAD-7) scales, respectively. Multivariable linear regression was conducted to examine the associations between COVID-19, long COVID, and sleep quality, adjusting for demographic and psychosocial factors. Results: COVID-19 infection was confirmed in 857 participants, with 273 of them developing long COVID. No significant sex disparities were observed in infection rates (P=.63). However, a marginal statistical difference was noted in the prevalence of long COVID among females (P=.051). Age was significantly associated with both infection rates (P<.001) and long COVID (P=.001). Participants aged 60‐70 years were particularly vulnerable to both outcomes. Sleep latency was significantly longer in the infected group (mean 1.73, SD 0.83) compared to the uninfected group (mean 1.57, SD 0.78; P=.01), and PSQI scores were higher (mean 8.52, SD 4.10 vs. 7.76, SD 4.31; P=.02). Long COVID participants had significantly worse sleep outcomes across all metrics (P<.001), except for sleep medication use (P=.17). Conclusions: Our findings indicate that long COVID is strongly associated with significant sleep disturbances, while initial COVID-19 infection shows a more moderate association with sleep issues. Long COVID–related sleep disturbances were exacerbated by factors such as age, income, and chronic health conditions. The study highlights the need for targeted interventions that address the multifaceted impacts of long COVID on sleep, especially among vulnerable groups such as older adults and those with lower socioeconomic status. Future research should use longitudinal designs to better establish the temporal relationships and causal pathways between COVID-19 and sleep disturbances. %R 10.2196/53522 %U https://publichealth.jmir.org/2024/1/e53522 %U https://doi.org/10.2196/53522 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e55189 %T Qualitative Evaluation of mHealth Implementation for Infectious Disease Care in Low- and Middle-Income Countries: Narrative Review %A Greenall-Ota,Josephine %A Yapa,H Manisha %A Fox,Greg J %A Negin,Joel %K mHealth %K implementation %K LMIC %K infectious diseases %K Tailored Implementation for Chronic Diseases %K mobile phone %K interventions %K short messaging service %K chronic disease %K narrative review %K implementation %K barrier %K mHealth intervention %K infectious disease %K screening %K community %K design %K health system %K SMS %K app %D 2024 %7 13.12.2024 %9 %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) interventions have the potential to improve health outcomes in low- and middle-income countries (LMICs) by aiding health workers to strengthen service delivery, as well as by helping patients and communities manage and prevent diseases. It is crucial to understand how best to implement mHealth within already burdened health services to maximally improve health outcomes and sustain the intervention in LMICs. Objective: We aimed to identify key barriers to and facilitators of the implementation of mHealth interventions for infectious diseases in LMICs, drawing on a health systems analysis framework. Methods: We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) checklist to select qualitative or mixed methods studies reporting on determinants of already implemented infectious disease mHealth interventions in LMICs. We searched MEDLINE, Embase, PubMed, CINAHL, the Social Sciences Citation Index, and Global Health. We extracted characteristics of the mHealth interventions and implementation experiences, then conducted an analysis of determinants using the Tailored Implementation for Chronic Diseases framework. Results: We identified 10,494 titles for screening, among which 20 studies met our eligibility criteria. Of these, 9 studies examined mHealth smartphone apps and 11 examined SMS text messaging interventions. The interventions addressed HIV (n=7), malaria (n=4), tuberculosis (n=4), pneumonia (n=2), dengue (n=1), human papillomavirus (n=1), COVID-19 (n=1), and respiratory illnesses or childhood infectious diseases (n=2), with 2 studies addressing multiple diseases. Within these studies, 10 interventions were intended for use by health workers and the remainder targeted patients, at-risk individuals, or community members. Access to reliable technological resources, familiarity with technology, and training and support were key determinants of implementation. Additional themes included users forgetting to use the mHealth interventions and mHealth intervention designs affecting ease of use. Conclusions: Acceptance of the intervention and the capacity of existing health care system infrastructure and resources are 2 key factors affecting the implementation of mHealth interventions. Understanding the interaction between mHealth interventions, their implementation, and health systems will improve their uptake in LMICs. %R 10.2196/55189 %U https://mhealth.jmir.org/2024/1/e55189 %U https://doi.org/10.2196/55189 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52997 %T Toxicity on Social Media During the 2022 Mpox Public Health Emergency: Quantitative Study of Topical and Network Dynamics %A Fan,Lizhou %A Li,Lingyao %A Hemphill,Libby %+ School of Information, University of Michigan, 105 S State St, Ann Arbor, MI, 48109, United States, 1 734 763 2285, lizhouf@umich.edu %K social media %K network analysis %K pandemic risk %K health care analytics %K infodemiology %K infoveillance %K health communication %K mpox %D 2024 %7 12.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Toxicity on social media, encompassing behaviors such as harassment, bullying, hate speech, and the dissemination of misinformation, has become a pressing social concern in the digital age. Its prevalence intensifies during periods of social crises and unrest, eroding a sense of safety and community. Such toxic environments can adversely impact the mental well-being of those exposed and further deepen societal divisions and polarization. The 2022 mpox outbreak, initially called “monkeypox” but later renamed to reduce stigma and address societal concerns, provides a relevant context for this issue. Objective: In this study, we conducted a comprehensive analysis of the toxic online discourse surrounding the 2022 mpox outbreak. We aimed to dissect its origins, characterize its nature and content, trace its dissemination patterns, and assess its broader societal implications, with the goal of providing insights that can inform strategies to mitigate such toxicity in future crises. Methods: We collected >1.6 million unique tweets and analyzed them with 5 dimensions: context, extent, content, speaker, and intent. Using topic modeling based on bidirectional encoder representations from transformers and social network community clustering, we delineated the toxic dynamics on Twitter. Results: By categorizing topics, we identified 5 high-level categories in the toxic online discourse on Twitter, including disease (20,281/43,521, 46.6%), health policy and health care (8400/43,521, 19.3%), homophobia (10,402/43,521, 23.9%), politics (2611/43,521, 6%), and racism (1784/43,521, 4.1%). Across these categories, users displayed negativity or controversial views on the mpox outbreak, highlighting the escalating political tensions and the weaponization of stigma during this infodemic. Through the toxicity diffusion networks of mentions (17,437 vertices with 3628 clusters), retweets (59,749 vertices with 3015 clusters), and the top users with the highest in-degree centrality, we found that retweets of toxic content were widespread, while influential users rarely engaged with or countered this toxicity through retweets. Conclusions: Our study introduces a comprehensive workflow that combines topical and network analyses to decode emerging social issues during crises. By tracking topical dynamics, we can track the changing popularity of toxic content on the internet, providing a better understanding of societal challenges. Network dynamics highlight key social media influencers and their intentions, suggesting that engaging with these central figures in toxic discourse can improve crisis communication and guide policy making. %M 39666969 %R 10.2196/52997 %U https://www.jmir.org/2024/1/e52997 %U https://doi.org/10.2196/52997 %U http://www.ncbi.nlm.nih.gov/pubmed/39666969 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57495 %T Elevated Ambient Temperature Associated With Reduced Infectious Disease Test Positivity Rates: Retrospective Observational Analysis of Statewide COVID-19 Testing and Weather Across California Counties %A Kwok,Nicholas Wing-Ping %A Pevnick,Joshua %A Feldman,Keith %K body temperature %K BT %K fever %K febrile %K feverish %K ambient temperature %K environmental factor %K environmental context %K environmental %K environment %K COVID-19 %K SARS-CoV-2 %K coronavirus %K respiratory %K infectious %K pulmonary %K COVID-19 pandemic %K pandemic %K diagnostics %K diagnostic test %K diagnostic testing %K public health surveillance %D 2024 %7 12.12.2024 %9 %J JMIR Public Health Surveill %G English %X Background: From medication usage to the time of day, a number of external factors are known to alter human body temperature (BT), even in the absence of underlying pathology. In select cases, clinical guidance already suggests the consideration of clinical and demographic factors when interpreting BT, such as a decreased threshold for fever as age increases. Recent work has indicated factors impacting BT extend to environmental conditions including ambient temperature. However, the effect sizes of these relationships are often small, and it remains unclear if such relationships result in a meaningful impact on real-world health care practices. Objective: Temperature remains a common element in public health screening efforts. Leveraging the unique testing and reporting infrastructure developed around the COVID-19 pandemic, this paper uses a unique resource of daily-level statewide testing data to assess the relationship between ambient temperatures and positivity rates. As fever was a primary symptom that triggered diagnostic testing for COVID-19, this work hypothesizes that environmentally mediated BT increases would not reflect pathology, leading to decreased COVID-19 test positivity rates as temperature rises. Methods: Statewide COVID-19 polymerase chain reaction testing data curated by the California Department of Public Health were used to obtain the daily number of total tests and positivity rates for all counties across the state. These data were combined with ambient temperature data provided by the National Centers for Environmental Information for a period of 133 days between widespread testing availability and vaccine approval. A mixed-effects beta-regression model was used to estimate daily COVID-19 test positivity rate as a function of ambient temperature, population, and estimates of COVID prevalence, with nested random effects for a day of the week within unique counties across the state. Results: Considering over 19 million tests performed over 4 months and across 45 distinct counties, adjusted model results highlighted a significant negative association between daily ambient temperature and testing positivity rate (P<.001). Results of the model are strengthened as, using the same testing data, this relationship was not present in a sensitivity analysis using random daily temperatures drawn from the range of observed values (P=.52). Conclusions: These results support the underlying hypothesis and demonstrate the relationship between environmental factors and BT can impact an essential public health activity. As health care continues to operate using thresholds of BT as anchor points (ie, ≥100.4 as fever) it is increasingly important to develop approaches to integrate the array of factors known to influence BT measurement. Moreover, as weather data are not often readily available in the same systems as patient data, these findings present a compelling case for future research into when and how environmental context can best be used to improve the interpretation of patient data. %R 10.2196/57495 %U https://publichealth.jmir.org/2024/1/e57495 %U https://doi.org/10.2196/57495 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e58423 %T A Pathological Diagnosis Method for Fever of Unknown Origin Based on Multipath Hierarchical Classification: Model Design and Validation %A Du,Jianchao %A Ding,Junyao %A Wu,Yuan %A Chen,Tianyan %A Lian,Jianqi %A Shi,Lei %A Zhou,Yun %K fever of unknown origin %K FUO %K intelligent diagnosis %K machine learning %K hierarchical classification %K feature selection %K model design %K validation %K diagnostic %K prediction model %D 2024 %7 9.12.2024 %9 %J JMIR Form Res %G English %X Background: Fever of unknown origin (FUO) is a significant challenge for the medical community due to its association with a wide range of diseases, the complexity of diagnosis, and the likelihood of misdiagnosis. Machine learning can extract valuable information from the extensive data of patient indicators, aiding doctors in diagnosing the underlying cause of FUO. Objective: The study aims to design a multipath hierarchical classification algorithm to diagnose FUO due to the hierarchical structure of the etiology of FUO. In addition, to improve the diagnostic performance of the model, a mechanism for feature selection is added to the model. Methods: The case data of patients with FUO admitted to the First Affiliated Hospital of Xi’an Jiaotong University between 2011 and 2020 in China were used as the dataset for model training and validation. The hierarchical structure tree was then characterized according to etiology. The structure included 3 layers, with the top layer representing the FUO, the middle layer dividing the FUO into 5 categories of etiology (bacterial infection, viral infection, other infection, autoimmune diseases, and other noninfection), and the last layer further refining them to 16 etiologies. Finally, ablation experiments were set to determine the optimal structure of the proposed method, and comparison experiments were to verify the diagnostic performance. Results: According to ablation experiments, the model achieved the best performance with an accuracy of 76.08% when the number of middle paths was 3%, and 25% of the features were selected. According to comparison experiments, the proposed model outperformed the comparison methods, both from the perspective of feature selection methods and hierarchical classification methods. Specifically, brucellosis had an accuracy of 100%, and liver abscess, viral infection, and lymphoma all had an accuracy of more than 80%. Conclusions: In this study, a novel multipath feature selection and hierarchical classification model was designed for the diagnosis of FUO and was adequately evaluated quantitatively. Despite some limitations, this model enriches the exploration of FUO in machine learning and assists physicians in their work. %R 10.2196/58423 %U https://formative.jmir.org/2024/1/e58423 %U https://doi.org/10.2196/58423 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e59425 %T Long COVID Discourse in Canada, the United States, and Europe: Topic Modeling and Sentiment Analysis of Twitter Data %A AbuRaed,Ahmed Ghassan Tawfiq %A Prikryl,Emil Azuma %A Carenini,Giuseppe %A Janjua,Naveed Zafar %+ Department of Computer Science, The University of British Colombia, 2366 Main Mall, ICICS Building, Vancouver, BC, V6T 1Z4, Canada, 1 7789294413, ahmed.aburaed@ubc.ca %K long COVID %K topic modeling %K sentiment analysis %K Twitter %K public perception %K social media analysis %K public health %D 2024 %7 9.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media serves as a vast repository of data, offering insights into public perceptions and emotions surrounding significant societal issues. Amid the COVID-19 pandemic, long COVID (formally known as post–COVID-19 condition) has emerged as a chronic health condition, profoundly impacting numerous lives and livelihoods. Given the dynamic nature of long COVID and our evolving understanding of it, effectively capturing people’s sentiments and perceptions through social media becomes increasingly crucial. By harnessing the wealth of data available on social platforms, we can better track the evolving narrative surrounding long COVID and the collective efforts to address this pressing issue. Objective: This study aimed to investigate people’s perceptions and sentiments around long COVID in Canada, the United States, and Europe, by analyzing English-language tweets from these regions using advanced topic modeling and sentiment analysis techniques. Understanding regional differences in public discourse can inform tailored public health strategies. Methods: We analyzed long COVID–related tweets from 2021. Contextualized topic modeling was used to capture word meanings in context, providing coherent and semantically meaningful topics. Sentiment analysis was conducted in a zero-shot manner using Llama 2, a large language model, to classify tweets into positive, negative, or neutral sentiments. The results were interpreted in collaboration with public health experts, comparing the timelines of topics discussed across the 3 regions. This dual approach enabled a comprehensive understanding of the public discourse surrounding long COVID. We used metrics such as normalized pointwise mutual information for coherence and topic diversity for diversity to ensure robust topic modeling results. Results: Topic modeling identified five main topics: (1) long COVID in people including children in the context of vaccination, (2) duration and suffering associated with long COVID, (3) persistent symptoms of long COVID, (4) the need for research on long COVID treatment, and (5) measuring long COVID symptoms. Significant concern was noted across all regions about the duration and suffering associated with long COVID, along with consistent discussions on persistent symptoms and calls for more research and better treatments. In particular, the topic of persistent symptoms was highly prevalent, reflecting ongoing challenges faced by individuals with long COVID. Sentiment analysis showed a mix of positive and negative sentiments, fluctuating with significant events and news related to long COVID. Conclusions: Our study combines natural language processing techniques, including contextualized topic modeling and sentiment analysis, along with domain expert input, to provide detailed insights into public health monitoring and intervention. These findings highlight the importance of tracking public discourse on long COVID to inform public health strategies, address misinformation, and provide support to affected individuals. The use of social media analysis in understanding public health issues is underscored, emphasizing the role of emerging technologies in enhancing public health responses. %M 39652387 %R 10.2196/59425 %U https://www.jmir.org/2024/1/e59425 %U https://doi.org/10.2196/59425 %U http://www.ncbi.nlm.nih.gov/pubmed/39652387 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e60140 %T In the Shadow of Medicine: The Glaring Absence of Occurrence Records of Human-Hosted Biodiversity %A Poncet,Rémy %A Gargominy,Olivier %K human microbiome %K bacterial occurrence data %K public health %K one health %K biodiversity data gap %K medical data integration %K medical data %K microbiome %K bacterial %K bacteria %K biodiversity %K disease prevention %K pathogens %K user-friendly %K bacterial pathogens %D 2024 %7 9.12.2024 %9 %J Online J Public Health Inform %G English %X Microbial diversity is vast, with bacteria playing a crucial role in human health. However, occurrence records (location, date, observer, and host interaction of human-associated bacteria) remain scarce. This lack of information hinders our understanding of human-microbe relationships and disease prevention. In this study, we show that existing solutions such as France’s Système d’Information sur le Patrimoine Naturel framework, can be used to efficiently collect and manage occurrence data on human-associated bacteria. This user-friendly system allows medical personnel to easily share and access data on bacterial pathogens. By adopting similar national infrastructures and treating human-associated bacteria as biodiversity data, we can significantly improve public health management and research, and our understanding of the One Health concept, which emphasizes the interconnectedness of human, animal, and environmental health. %R 10.2196/60140 %U https://ojphi.jmir.org/2024/1/e60140 %U https://doi.org/10.2196/60140 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53218 %T Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Canada: Longitudinal Trend Analysis %A Wu,Scott A %A Soetikno,Alan G %A Ozer,Egon A %A Welch,Sarah B %A Liu,Yingxuan %A Havey,Robert J %A Murphy,Robert L %A Hawkins,Claudia %A Mason,Maryann %A Post,Lori A %A Achenbach,Chad J %A Lundberg,Alexander L %+ Buehler Center for Health Policy and Economics, Robert J Havey, MD Institute for Global Health, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States, 1 3125031706, lori.post@northwestern.edu %K SARS-CoV-2 %K COVID-19 %K Canada %K pandemic %K surveillance %K transmission %K acceleration %K deceleration %K dynamic panel %K generalized method of moments %K GMM %K Arellano-Bond %K 7-day lag %K k %K metrics %K epidemiology %K dynamic %K genomic %K historical context %K outbreak threshold %D 2024 %7 5.12.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: This study provides an update on the status of the COVID-19 pandemic in Canada, building upon our initial analysis conducted in 2020 by incorporating an additional 2 years of data. Objective: This study aims to (1) summarize the status of the pandemic in Canada when the World Health Organization (WHO) declared the end of the public health emergency for the COVID-19 pandemic on May 5, 2023; (2) use dynamic and genomic surveillance methods to describe the history of the pandemic in Canada and situate the window of the WHO declaration within the broader history; and (3) provide historical context for the course of the pandemic in Canada. Methods: This longitudinal study analyzed trends in traditional surveillance data and dynamic panel estimates for COVID-19 transmissions and deaths in Canada from June 2020 to May 2023. We also used sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern. For these sequences, we used Nextclade nomenclature to collect clade designations and Pangolin nomenclature for lineage designations of SARS-CoV-2. We used 1-sided t tests of dynamic panel regression coefficients to measure the persistence of COVID-19 transmissions around the WHO declaration. Finally, we conducted a 1-sided t test for whether provincial and territorial weekly speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. Results: Canada’s speed remained below the outbreak threshold for 8 months by the time of the WHO declaration ending the COVID-19 emergency of international concern. Acceleration and jerk were also low and stable. While the 1-day persistence coefficient remained statistically significant and positive (1.074; P<.001), the 7-day coefficient was negative and small in magnitude (–0.080; P=.02). Furthermore, shift parameters for either of the 2 most recent weeks around May 5, 2023, were negligible (0.003 and 0.018, respectively, with P values of .75 and .31), meaning the clustering effect of new COVID-19 cases had remained stable in the 2 weeks around the WHO declaration. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling 1-sided t test of speed equal to 10 became entirely insignificant from mid-October 2022 onward. Conclusions: While COVID-19 continues to circulate in Canada, the rate of transmission remained well below the threshold of an outbreak for 8 months ahead of the WHO declaration. Both standard and enhanced surveillance metrics confirm that the pandemic had largely ended in Canada by the time of the WHO declaration. These results can inform future public health interventions and strategies in Canada, as well as contribute to the global understanding of the trajectory of the COVID-19 pandemic. %M 39471286 %R 10.2196/53218 %U https://publichealth.jmir.org/2024/1/e53218 %U https://doi.org/10.2196/53218 %U http://www.ncbi.nlm.nih.gov/pubmed/39471286 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48882 %T Individual Characteristics in the Comprehension of Pandemic Video Communication: Randomized Controlled Between-Subjects Design %A Lungu,Daniel Adrian %A Røislien,Jo %A Smeets,Ionica %A Wiig,Siri %A Brønnick,Kolbjørn Kallesten %+ SHARE – Centre for Resilience in Healthcare, Department of Quality and Health Technology, Faculty of Health Sciences, University of Stavanger, PO Box 8600, Stavanger, 4021, Norway, 47 91532327, daniel.a.lungu@uis.no %K video communication %K COVID-19 pandemic %K comprehension %K health literacy %K video %K videos %K health communication %K psychology %K perception %K comprehend %K understanding %K coronavirus disease 2019 %D 2024 %7 4.12.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Video played an important role in health communication throughout the COVID-19 pandemic. It was used to communicate pandemic information to the public, with a variety of formats, presenters, and topics. Evidence regarding the effectiveness of video features is available, while how individual characteristics of recipients influence communication comprehension is still limited. Objective: This study aimed to test 6 individual characteristics and assess their effect on the comprehension of pandemic video communication. Methods: Short health communication videos were presented to a large sample of subjects, receiving questionnaire responses from 1194 participants. Individual characteristics consisted of age, sex, living area, education level, income level, and belief in science. Communication comprehension consisted of both perceived and objective comprehension. The data were analyzed by multiple linear regression. Results: Age had a negative effect on both perceived and objective comprehension—age was negatively associated with comprehension. There were sex differences, with higher perceived comprehension and lower objective comprehension among female than male individuals. Living in an urban or a rural area had no significant effect (all P>.05). The level of education and income had a positive effect on both subjective and objective comprehension. Finally, the belief in science had a positive effect on perceived comprehension (P<.001) but did not have a statistically significant effect on objective comprehension (P=.87). Conclusions: The main differences between those who think they understand pandemic communication and those who comprehend it better are sex (female individuals have a higher perception of having comprehended, while male individuals have higher levels of objective comprehension) and belief in science (higher belief in science leads to higher perceived comprehension, while it does not have any impact on objectively understanding the message conveyed). %M 39631064 %R 10.2196/48882 %U https://www.jmir.org/2024/1/e48882 %U https://doi.org/10.2196/48882 %U http://www.ncbi.nlm.nih.gov/pubmed/39631064 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e64726 %T Strengthening the Backbone: Government-Academic Data Collaborations for Crisis Response %A Yang,Rick %A Yang,Alina %K data infrastructure %K data sharing %K cross-sector collaboration %K government-academic partnerships %K public health %K crisis response %D 2024 %7 28.11.2024 %9 %J JMIR Public Health Surveill %G English %X %R 10.2196/64726 %U https://publichealth.jmir.org/2024/1/e64726 %U https://doi.org/10.2196/64726 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e66479 %T Authors’ Reply to: Strengthening the Backbone: Government-Academic Data Collaborations for Crisis Response %A Lee,Jian-Sin %A Tyler,Allison R B %A Veinot,Tiffany Christine %A Yakel,Elizabeth %K COVID-19 %K crisis response %K cross-sector collaboration %K data infrastructures %K data science %K data sharing %K pandemic %K public health informatics %D 2024 %7 28.11.2024 %9 %J JMIR Public Health Surveill %G English %X %R 10.2196/66479 %U https://publichealth.jmir.org/2024/1/e66479 %U https://doi.org/10.2196/66479 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 5 %N %P e62747 %T Eco-Evolutionary Drivers of Vibrio parahaemolyticus Sequence Type 3 Expansion: Retrospective Machine Learning Approach %A Campbell,Amy Marie %A Hauton,Chris %A van Aerle,Ronny %A Martinez-Urtaza,Jaime %+ Department of Genetics and Microbiology, Autonomous University of Barcelona, Facultat de Biociènces, oficina C3/109, Campus de la UAB, Bellaterra, Barcelona, 08193, Spain, 34 93 581 2729, jaime.martinez.urtaza@uab.cat %K pathogen expansion %K climate change %K machine learning %K ecology %K evolution %K vibrio parahaemolyticus %K sequencing %K sequence type 3 %K VpST3 %K genomics %D 2024 %7 28.11.2024 %9 Original Paper %J JMIR Bioinform Biotech %G English %X 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. %M 39607996 %R 10.2196/62747 %U https://bioinform.jmir.org/2024/1/e62747 %U https://doi.org/10.2196/62747 %U http://www.ncbi.nlm.nih.gov/pubmed/39607996 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56926 %T SARS-CoV-2 Infection Risk by Vaccine Doses and Prior Infections Over 24 Months: ProHEpiC-19 Longitudinal Study %A Torán-Monserrat,Pere %A Lamonja-Vicente,Noemí %A Costa-Garrido,Anna %A Carrasco-Ribelles,Lucía A %A Quirant,Bibiana %A Boigues,Marc %A Molina,Xaviera %A Chacón,Carla %A Dacosta-Aguayo,Rosalia %A Arméstar,Fernando %A Martínez Cáceres,Eva María %A Prado,Julia G %A Violán,Concepción %A , %K SARS-CoV-2 %K COVID-19 %K health care workers %K cohort %K extended Cox models %K coronavirus %K epidemiology %K epidemiological %K risks %K infectious %K respiratory %K longitudinal %K vaccines %K vaccination %K vaccinated %D 2024 %7 22.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: As the vaccination campaign against COVID-19 progresses, it becomes crucial to comprehend the lasting effects of vaccination on safeguarding against new infections or reinfections. Objective: This study aimed to assess the risk of new SARS-CoV-2 infections based on the number of vaccine doses, prior infections, and other clinical characteristics. Methods: We defined a cohort of 800 health care workers in a 24-month study (March 2020 to December 2022) in northern Barcelona to determine new infections by SARS-CoV-2. We used extended Cox models, specifically Andersen-Gill (AG) and Prentice-Williams-Peterson, and we examined the risk of new infections. The AG model incorporated variables such as sex, age, job title, number of chronic conditions, vaccine doses, and prior infections. Additionally, 2 Prentice-Williams-Peterson models were adjusted, one for those individuals with no or 1 infection and another for those with 2 or 3 infections, both with the same covariates as the AG model. Results: The 800 participants (n=605, 75.6% women) received 1, 2, 3, and 4 doses of the vaccine. Compared to those who were unvaccinated, the number of vaccine doses significantly reduced (P<.001) the risk of infection by 66%, 81%, 89%, and 99%, respectively. Unit increase in the number of prior infections reduced the risk of infection by 75% (P<.001). When separating individuals by number of previous infections, risk was significantly reduced for those with no or 1 infection by 61% (P=.02), and by 88%, 93%, and 99% (P<.001) with 1, 2, 3, or 4 doses, respectively. In contrast, for those with 2 or 3 previous infections, the reduction was only significant with the fourth dose, at 98% (P<.001). The number of chronic diseases only increased the risk by 28%‐31% (P<.001) for individuals with 0‐1 previous infections. Conclusions: The study suggests that both prior infections and vaccination status significantly contribute to SARS-CoV-2 immunity, supporting vaccine effectiveness in reducing risk of reinfection for up to 24 months after follow-up from the onset of the pandemic. These insights contribute to our understanding of long-term immunity dynamics and inform strategies for mitigating the impact of COVID-19. Trial Registration: ClinicalTrials.gov NCT04885478; http://clinicaltrials.gov/ct2/show/NCT04885478 %R 10.2196/56926 %U https://publichealth.jmir.org/2024/1/e56926 %U https://doi.org/10.2196/56926 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63376 %T Community Versus Facility-Based Services to Improve the Screening of Active Hepatitis C Virus Infection in Cambodia: The ANRS 12384 CAM-C Cluster Randomized Controlled Trial—Protocol for a Mixed Methods Study %A Mosnier,Emilie %A Ségéral,Olivier %A Neth,Sansothy %A Sagaon-Teyssier,Luis %A Khuon,Dyna %A Phoeung,Chan Leakhena %A Mam,Sovatha %A Chhay,Chhingsrean %A Heang,Kimeang %A Duclos-Vallée,Jean Charles %A Saphonn,Vonthanak %+ Aix Marseille Université, Institut national de la santé et de la recherche médicale (INSERM), Institut de recherche pour le développementIRD, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale (SESSTIM) Aix Marseille Univ,, Aix Marseille Institute of Public Health (ISSPAM), Faculté de Médecine 27 Bd Jean Moulin, Marseille, 13385, France, 33 491324600, emilie.mosnier@gmail.com %K hepatitis C virus %K HCV %K community-based intervention %K cluster randomized controlled trial %K Cambodia %K cost-effectiveness analysis %K qualitative analysis %D 2024 %7 20.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Cambodia, hepatitis C constitutes a significant public health challenge, particularly among older adults (>45 years) for whom prevalence is estimated to be 5%. To facilitate the elimination of hepatitis C among the general population, enhancing access to screening and treatment is imperative. In this regard, the evaluation of community-based screening programs emerges as a crucial step toward improving health care accessibility. Objective: This study aims to assess the comparative efficacy of a community-based versus a facility-based approach in enhancing the uptake of hepatitis C antibody testing among the general population older than 40 years of age in Cambodia. Methods: The CAM-C (Community Versus Facility-Based Services to Improve the Screening of Active Hepatitis C Virus Infection in Cambodia) study uses a cluster-randomized controlled trial design across two Cambodian provinces to compare community-based and facility-based hepatitis testing interventions. Sampling involves a multistage cluster approach, targeting individuals older than 40 years of age due to their higher prevalence and risk of chronic hepatitis complications. This study incorporates a qualitative analysis of acceptability and a cost-effectiveness comparison. Interventions include facility-based testing with subsequent referral and community-based testing with direct in-home assessments. Follow-up for positive cases involves comprehensive management and potential direct-acting antiviral treatment. This study aims to identify a significant increase in testing uptake, requiring the screening of 6000 individuals older than 40 years of age, facilitated by a structured sampling and intervention approach to minimize contamination risks. Results: The final protocol including the quantitative, qualitative, and cost-effectiveness part of the study was registered and was approved in 2019 by the National Ethical Cambodian for Health Research. Inclusions were completed by mid-2024, with analyses starting in May 2024. Conclusions: Using a mixed methods approach that combines a robust methodology (cluster-randomized controlled trial) with a cost-effectiveness analysis and qualitative research, such a study should provide invaluable information to guide the Ministry of Health in its hepatitis C virus screening strategy and move toward elimination. Trial Registration: ClinicalTrials.gov NCT03992313; https://clinicaltrials.gov/study/NCT03992313 International Registered Report Identifier (IRRID): DERR1-10.2196/63376 %M 39566053 %R 10.2196/63376 %U https://www.researchprotocols.org/2024/1/e63376 %U https://doi.org/10.2196/63376 %U http://www.ncbi.nlm.nih.gov/pubmed/39566053 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e63191 %T The Young Adult Centered Healthforce Training (YACHT) Program to Increase HIV Testing and Pre-Exposure Prophylaxis Referrals Among Young Sexual Minority Men in Florida: Protocol for a Type 2 Implementation-Effectiveness Hybrid Trial With a Stepped Wedge Design %A Giguere,Rebecca %A Fernandez,Maria Isabel %A Bauermeister,Jose A %A Balán,Iván C %A Aryal,Subhash %A Cheshure,Andrea %A Green,Sara %A Lin,Willey %A Morgan,Jonathan %A Naar,Sylvie %+ Center for Translational Behavioral Science, College of Medicine, Florida State University, 2010 Levy Ave Building B, Suite B0266, Tallahassee, FL, 32310, United States, 1 850 644 2334, rebecca.giguere@med.fsu.edu %K sexual minority men %K youth %K HIV prevention %K tailored motivational interviewing %K technical assistance %D 2024 %7 20.11.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a high incidence of HIV among young sexual minority men in Florida. Many are unaware of their status due to low testing rates. Counseling, testing, and referral (CTR) services are essential for diagnosis and prevention of HIV and are integral to the Ending the HIV Epidemic (EHE) strategic plan. However, efforts to increase CTR among young sexual minority men have not been successful. Objective: The Young Adult Centered Healthforce Training (YACHT) program promotes developmentally sensitive, culturally appropriate, and evidence-based CTR services for young sexual minority men. This study tests whether the YACHT program increases HIV testing among young sexual minority men and fidelity to evidence-based CTR among testing providers. Methods: Agencies in Florida EHE counties that tested at least 24 young sexual minority men aged 18 to 29 years in 2021 will be invited to participate. The sites (N=42) will be randomized in blocks of 6 to participate in the YACHT program, following a stepped wedge design. Through YACHT, all sites will receive visits from mystery shoppers (MSs), who are trained to evaluate HIV testing services and complete postvisit quality monitoring assessments. Sites will be offered the opportunity to review their MS feedback and to receive tailored motivational interviewing training and evidence-based technical assistance to address areas of need identified through MS assessments. The study will evaluate whether YACHT leads to increased HIV testing by comparing numbers of young sexual minority men testing for HIV before versus after YACHT’s implementation. The Exploration, Preparation, Implementation and Sustainment framework will help understand the barriers to and facilitators of the program’s implementation and sustainment. Results: YACHT was funded in August 2022. Data collection began in June 2023. As of June 2024, 194 MS visits have taken place at 42 sites; 4 (67%) sites from the first block and 1 (33%) site from the second block have engaged with the study. At baseline, sites exhibited the lowest competencies in relationship context, counseling sessions, and safer sex education and the highest competency in privacy and confidentiality. Data collection will continue through May 2027, with results published by the end of 2027. Conclusions: To address the high incidence of HIV among young sexual minority men in Florida, YACHT aims to support testing sites with tailored motivational interviewing training and technical assistance to address needs identified by MS assessments. The program seeks to improve delivery of evidence-based CTR services, thereby increasing HIV testing, counseling, and pre-exposure prophylaxis referrals and reducing HIV incidence among this population. Trial Registration: ClinicalTrials.gov NCT06015581; https://classic.clinicaltrials.gov/ct2/show/NCT06015581 International Registered Report Identifier (IRRID): DERR1-10.2196/63191 %M 39566048 %R 10.2196/63191 %U https://www.researchprotocols.org/2024/1/e63191 %U https://doi.org/10.2196/63191 %U http://www.ncbi.nlm.nih.gov/pubmed/39566048 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 7 %N %P e44580 %T Remote Patient Monitoring at Home in Patients With COVID-19: Narrative Review %A Cornelis,Justien %A Christiaens,Wendy %A de Meester,Christophe %A Mistiaen,Patriek %+ Belgian Health Care Knowledge Centre, Kruidtuinlaan 55, Brussels, 1000, Belgium, 32 475834741, justien.cornelis@kce.fgov.be %K COVID-19 %K coronavirus disease %K telemonitoring %K remote patient monitoring %K review %K pandemic %K at-home monitoring %K implementation %K health care %K patient care %D 2024 %7 19.11.2024 %9 Review %J JMIR Nursing %G English %X 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. %M 39287362 %R 10.2196/44580 %U https://nursing.jmir.org/2024/1/e44580 %U https://doi.org/10.2196/44580 %U http://www.ncbi.nlm.nih.gov/pubmed/39287362 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49123 %T Analysis of Tuberculosis Epidemiological Distribution Characteristics in Fujian Province, China, 2005-2021: Spatial-Temporal Analysis Study %A Yu,Shanshan %A Zhan,Meirong %A Li,Kangguo %A Chen,Qiuping %A Liu,Qiao %A Gavotte,Laurent %A Frutos,Roger %A Chen,Tianmu %K tuberculosis %K TB %K epidemiology %K Fujian Province %K temporal-spatial pattern %K spatial-temporal analysis %K surveillance %K pulmonary tuberculosis %K epidemic status %K detection %D 2024 %7 18.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Tuberculosis (TB) is a chronic infectious disease that harms human health for a long time. TB epidemiological distribution analysis can help governments to control TB in high TB incidence areas. The distribution trend of TB cases varies in different regions. The unbalanced temporal and spatial trends of pulmonary TB (PTB) risk at a fine level in Fujian Province remain unclear. Objective: The purpose was to analyze different distribution characteristics, explore the prevalence of TB in this region, and provide a scientific basis for further guidance of TB control work in Fujian Province, China. Methods: Prefectural-level and county-level notified PTB case data were collected in Fujian Province. A joinpoint regression model was constructed to analyze the unbalanced temporal patterns of PTB notification rates from 2005 to 2021 at prefecture-level city scales. The spatial clustering analysis and spatial autocorrelation analysis were performed to assess the inequality of the locations of PTB cases. Demographical characteristics were explored by the method of descriptive analysis. Results: TB cases reported in Fujian showed an overall downward trend from 2005 to 2021 (in 2005: n=32,728 and in 2021: n=15,155). TB case numbers showed obvious seasonal changes. The majority of TB cases were middle-aged and older adult male patients (45 years and older; n=150,201, 42.6%). Most of the TB cases were farmers (n=166,186, 47.1%), followed by houseworkers and the unemployed (n=48,828, 13.8%) and workers (n=34,482, 9.8%). Etiologically positive TB cases continue to be the main source of TB cases (n=159,702, 45.3%). Spatially, the reported TB cases were mainly distributed in cities in southeastern Fujian, especially at the county level. TB case numbers showed 2 spatial groups; cases within each group shared similar case characteristics. In terms of geographical distribution, TB showed obvious spatial correlation, and local areas showed high aggregation. Conclusions: The TB incidence trend decreased annually in Fujian Province. TB cases distributed commonly in the male population, middle-aged and older people, and farmers. Etiologically positive cases are still the main source of Mycobacterium tuberculosis infection. TB incidence is higher in the cities with a developed economy and large population in the southeast. TB control should be strengthened in these populations and areas, such as via early screening of cases and management of confirmed cases. %R 10.2196/49123 %U https://publichealth.jmir.org/2024/1/e49123 %U https://doi.org/10.2196/49123 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e62887 %T Competence and Training Needs in Infectious Disease Emergency Response Among Chinese Nurses: Cross-Sectional Study %A Zhang,Dandan %A Chen,Yong-Jun %A Cui,Tianxin %A Zhang,Jianzhong %A Chen,Si-Ying %A Zhang,Yin-Ping %K competence %K preparedness %K infectious disease emergency %K Chinese %K nurse %K cross-sectional study %K COVID-19 %K pandemic %K public health %K health crises %K emergency response %K emergency preparedness %K medical institution %K health care worker %K linear regression %D 2024 %7 18.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: In recent years, the frequent outbreaks of infectious diseases and insufficient emergency response capabilities, particularly issues exposed during the COVID-19 pandemic, have underscored the critical role of nurses in addressing public health crises. It is currently necessary to investigate the emergency preparedness of nursing personnel following the COVID-19 pandemic completely liberalized, aiming to identify weaknesses and optimize response strategies. Objective: This study aimed to assess the emergency response competence of nurses, identify their specific training needs, and explore the various elements that impact their emergency response competence. Methods: Using a multistage stratified sampling method, 5 provinces from different geographical locations nationwide were initially randomly selected using random number tables. Subsequently, within each province, 2 tertiary hospitals, 4 secondary hospitals, and 10 primary hospitals were randomly selected for the survey. The random selection and stratification of the hospitals took into account various aspects such as geographical locations, different levels, scale, and number of nurses. This study involved 80 hospitals (including 10 tertiary hospitals, 20 secondary hospitals, and 50 primary hospitals), where nurses from different departments, specialties, and age groups anonymously completed a questionnaire on infectious disease emergency response capabilities. Results: This study involved 2055 participants representing various health care institutions. The nurses’ mean score in infectious disease emergency response competence was 141.75 (SD 20.09), indicating a moderate to above-average level. Nearly one-fifth (n=397, 19.32%) of nurses have experience in responding to infectious disease emergencies; however, they acknowledge a lack of insufficient drills (n=615,29.93%) and training (n=502,24.43%). Notably, 1874 (91.19%) nurses expressed a willingness to undergo further training. Multiple linear regression analysis indicated that significant factors affecting infectious disease emergency response competence included the highest degree, frequency of drills and training, and the willingness to undertake further training (B=−11.455, 7.344, 11.639, 14.432, 10.255, 7.364, and −11.216; all P<.05). Notably, a higher frequency of participation in drills and training sessions correlated with better outcomes (P<.001 or P<.05). Nurses holding a master degree or higher demonstrated significantly lower competence scores in responding to infectious diseases compared with nurses with a diploma or associate degree (P=.001). Approximately 1644 (80%) of the nurses preferred training lasting from 3 days to 1 week, with scenario simulations and emergency drills considered the most popular training methods. Conclusions: These findings highlight the potential and need for nurses with infectious disease emergency response competence. Frequent drills and training will significantly enhance response competence; however, a lack of practical experience in higher education may have a negative impact on emergency performance. The study emphasizes the critical need for personalized training to boost nurses’ abilities, especially through short-term, intensive methods and simulation drills. Further training and tailored plans are essential to improve nurses’ overall proficiency and ensure effective responses to infectious disease emergencies. %R 10.2196/62887 %U https://publichealth.jmir.org/2024/1/e62887 %U https://doi.org/10.2196/62887 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e55562 %T Reducing the Number of Intrusive Memories of Work-Related Traumatic Events in Frontline Health Care Staff During the COVID-19 Pandemic: Case Series %A Kubickova,Veronika %A Steel,Craig %A Moulds,Michelle L %A Kanstrup,Marie %A Beer,Sally %A Darwent,Melanie %A Keating,Liza %A Holmes,Emily A %A Iyadurai,Lalitha %+ Oxford Institute of Clinical Psychology Training and Research, Oxford Health NHS Foundation Trust, Isis Education Centre, Warneford Hospital, Oxford, OX3 7JX, United Kingdom, 44 1865226366, craig.steel@hmc.ox.ac.uk %K intrusive memories %K digital intervention %K psychological trauma %K remote delivery %K health care staff %K COVID-19 %K case series %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Frontline health care staff are frequently exposed to traumatic events as part of their work. Although this study commenced before the emergence of COVID-19, levels of exposure were heightened by the pandemic. Many health care staff members report intrusive memories of such events, which can elicit distress, affect functioning, and be associated with posttraumatic stress disorder symptoms in the long term. We need evidence-based interventions that are brief, preventative, nonstigmatizing, suitable for the working lives of frontline health care staff, and effective for repeated trauma exposure. A brief, guided imagery-competing task intervention involving a trauma reminder cue and Tetris gameplay may hold promise in this regard, given evidence that it can prevent and reduce the number of intrusive memories following trauma across various settings. Objective: This case series aims to investigate the impact of a brief imagery-competing task intervention on the number of intrusive memories, general functioning, and symptoms of posttraumatic stress, anxiety, and depression, and examine the feasibility and acceptability of the intervention for UK National Health Service frontline health care staff. The intervention was delivered with guidance from a clinical psychologist. Methods: We recruited 12 clinical staff from the UK National Health Service, specifically from emergency departments, the intensive care unit, and the ambulance service. We evaluated the intervention using an AB single-case experimental design, where the baseline (A) was the monitoring-only phase and the postintervention (B) period was the time after the intervention was first administered. Methods were adapted once the COVID-19 pandemic began. Results: There was a decrease (59%) in the mean number of intrusive memories per day from baseline (mean 1.29, SD 0.94) to postintervention (mean 0.54, SD 0.51). There was a statistically significant reduction in the number of intrusive memories from baseline to postintervention, as shown by an aggregated omnibus analysis with a small effect size (τ-U=–0.38; P<.001). Depression, anxiety, and posttraumatic stress symptoms all significantly reduced from preintervention to postintervention. Participants also reported improvements in functioning based on both quantitative and qualitative measures. The intervention was feasible to deliver and rated as acceptable by participants. Conclusions: These preliminary findings suggest that this brief therapist-guided imagery-competing task intervention offers a potential approach to mitigating the impact of work-related traumatic events in frontline health care staff, both during a pandemic and beyond. Randomized controlled trials will be an important next step. %M 39556801 %R 10.2196/55562 %U https://humanfactors.jmir.org/2024/1/e55562 %U https://doi.org/10.2196/55562 %U http://www.ncbi.nlm.nih.gov/pubmed/39556801 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e57476 %T Use of Digital Tools in Arbovirus Surveillance: Scoping Review %A Melo,Carolina Lopes %A Mageste,Larissa Rangel %A Guaraldo,Lusiele %A Paula,Daniela Polessa %A Wakimoto,Mayumi Duarte %+ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Rio de Janeiro, 21040-900, Brazil, 55 2138659110, mayumi.wakimoto@ini.fiocruz.br %K arbovirus infections %K dengue %K zika virus %K chikungunya fever %K public health surveillance %K digital tool %K technology %D 2024 %7 18.11.2024 %9 Review %J J Med Internet Res %G English %X Background: The development of technology and information systems has led to important changes in public health surveillance. Objective: This scoping review aimed to assess the available evidence and gather information about the use of digital tools for arbovirus (dengue virus [DENV], zika virus [ZIKV], and chikungunya virus [CHIKV]) surveillance. Methods: The databases used were MEDLINE, SCIELO, LILACS, SCOPUS, Web of Science, and EMBASE. The inclusion criterion was defined as studies that described the use of digital tools in arbovirus surveillance. The exclusion criteria were defined as follows: letters, editorials, reviews, case reports, series of cases, descriptive epidemiological studies, laboratory and vaccine studies, economic evaluation studies, and studies that did not clearly describe the use of digital tools in surveillance. Results were evaluated in the following steps: monitoring of outbreaks or epidemics, tracking of cases, identification of rumors, decision-making by health agencies, communication (cases and bulletins), and dissemination of information to society). Results: Of the 2227 studies retrieved based on screening by title, abstract, and full-text reading, 68 (3%) studies were included. The most frequent digital tools used in arbovirus surveillance were apps (n=24, 35%) and Twitter, currently called X (n=22, 32%). These were mostly used to support the traditional surveillance system, strengthening aspects such as information timeliness, acceptability, flexibility, monitoring of outbreaks or epidemics, detection and tracking of cases, and simplicity. The use of apps to disseminate information to society (P=.02), communicate (cases and bulletins; P=.01), and simplicity (P=.03) and the use of Twitter to identify rumors (P=.008) were statistically relevant in evaluating scores. This scoping review had some limitations related to the choice of DENV, ZIKV, and CHIKV as arboviruses, due to their clinical and epidemiological importance. Conclusions: In the contemporary scenario, it is no longer possible to ignore the use of web data or social media as a complementary strategy to health surveillance. However, it is important that efforts be combined to develop new methods that can ensure the quality of information and the adoption of systematic measures to maintain the integrity and reliability of digital tools’ data, considering ethical aspects. %M 39556803 %R 10.2196/57476 %U https://www.jmir.org/2024/1/e57476 %U https://doi.org/10.2196/57476 %U http://www.ncbi.nlm.nih.gov/pubmed/39556803 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e56675 %T Association Between X/Twitter and Prescribing Behavior During the COVID-19 Pandemic: Retrospective Ecological Study %A Helgeson,Scott A %A Mudgalkar,Rohan M %A Jacobs,Keith A %A Lee,Augustine S %A Sanghavi,Devang %A Moreno Franco,Pablo %A Brooks,Ian S %A , %+ Department of Pulmonary and Critical Care Medicine, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, United States, 1 9049532000, helgeson.scott@mayo.edu %K social media %K infodemic %K COVID-19 %K healthcare utilization %K misinformation %K disinformation %K Twitter %K hydroxychloroquine %K X %K drugs %K pharmacy %K pharmacology %K pharmacotherapy %K pharmaceuticals %K medication %K prescription %K sentiment %K SARS-CoV-2 %K pandemic %K respiratory %K infectious %D 2024 %7 18.11.2024 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Social media has become a vital tool for health care providers to quickly share information. However, its lack of content curation and expertise poses risks of misinformation and premature dissemination of unvalidated data, potentially leading to widespread harmful effects due to the rapid and large-scale spread of incorrect information. Objective: We aim to determine whether social media had an undue association with the prescribing behavior of hydroxychloroquine, using the COVID-19 pandemic as the setting. Methods: In this retrospective study, we gathered the use of hydroxychloroquine in 48 hospitals in the United States between January and December 2020. Social media data from X/Twitter was collected using Brandwatch, a commercial aggregator with access to X/Twitter’s data, and focused on mentions of “hydroxychloroquine” and “Plaquenil.” Tweets were categorized by sentiment (positive, negative, or neutral) using Brandwatch’s sentiment analysis tool, with results classified by date. Hydroxychloroquine prescription data from the National COVID Cohort Collaborative for 2020 was used. Granger causality and linear regression models were used to examine relationships between X/Twitter mentions and prescription trends, using optimum time lags determined via vector auto-regression. Results: A total of 581,748 patients with confirmed COVID-19 were identified. The median daily number of positive COVID-19 cases was 1318.5 (IQR 1005.75-1940.3). Before the first confirmed COVID-19 case, hydroxychloroquine was prescribed at a median rate of 559 (IQR 339.25-728.25) new prescriptions per day. A day-of-the-week effect was noted in both prescriptions and case counts. During the pandemic in 2020, hydroxychloroquine prescriptions increased significantly, with a median of 685.5 (IQR 459.75-897.25) per day, representing a 22.6% rise from baseline. The peak occurred on April 2, 2020, with 3411 prescriptions, a 397.6% increase. Hydroxychloroquine mentions on X/Twitter peaked at 254,770 per day on April 5, 2020, compared to a baseline of 9124 mentions per day before January 21, 2020. During this study’s period, 3,823,595 total tweets were recorded, with 10.09% (n=386,115) positive, 37.87% (n=1,448,030) negative, and 52.03% (n=1,989,450) neutral sentiments. A 1-day lag was identified as the optimal time for causal association between tweets and hydroxychloroquine prescriptions. Univariate analysis showed significant associations across all sentiment types, with the largest impact from positive tweets. Multivariate analysis revealed only neutral and negative tweets significantly affected next-day prescription rates. Conclusions: During the first year of the COVID-19 pandemic, there was a significant association between X/Twitter mentions and the number of prescriptions of hydroxychloroquine. This study showed that X/Twitter has an association with the prescribing behavior of hydroxychloroquine. Clinicians need to be vigilant about their potential unconscious exposure to social media as a source of medical knowledge, and health systems and organizations need to be more diligent in identifying expertise, source, and quality of evidence when shared on social media platforms. %M 39556417 %R 10.2196/56675 %U https://infodemiology.jmir.org/2024/1/e56675 %U https://doi.org/10.2196/56675 %U http://www.ncbi.nlm.nih.gov/pubmed/39556417 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57798 %T Public Preference and Priorities for Including Vaccines in China’s National Immunization Program: Discrete Choice Experiment %A Zhang,Lingli %A Li,Xin %A Chen,Jiali %A Wang,Xiaoye %A Sun,Yuyang %K discrete choice experiment %K national immunization program %K vaccines %K vaccination %K immunization %K public preferences %K China %K mixed logit model %K heterogeneity %K varicella %K public health %K infectious diseases %D 2024 %7 14.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Several important vaccines, such as the Haemophilus influenzae type b vaccine, rotavirus vaccine, pneumococcal conjugate vaccine, and influenza vaccine, have not been included in China’s National Immunization Program (NIP) due to a prolonged absence of updates and limited resources. Public engagement could identify concerns that require attention and foster trust to ensure continuous support for immunization. Objective: This study aimed to identify public preferences for vaccine inclusion in the NIP and to determine the desired vaccine funding priorities in the Chinese population. Methods: A dual-response discrete choice experiment was utilized to estimate the relative importance of 6 attributes, including incidence of vaccine-preventable diseases, mortality of vaccine-preventable diseases, vaccine effectiveness, vaccine cost, vaccinated group, and vaccine coverage. Participants were recruited through the Wenjuanxing platform using a census-based quota sample of the nationwide population aged 18 years and older. A mixed logit model was used to estimate the coefficient of attribute preferences and predict the selection probability. Subgroups and interaction effects were analyzed to examine the heterogeneity in preferences. Results: In total, 1258 participants completed the survey, of which 880 were involved in the main analysis and 1166 in the sensitivity analysis. The relative importance and model estimates of 2 attributes, vaccine cost and vaccination group, varied between the unforced- and forced-choice settings. All 6 vaccine attributes significantly influenced the preferences for vaccine inclusion, with vaccine effectiveness and coverage as the most important factors, followed by the vaccinated group and mortality of vaccine-preventable diseases in the unforced-choice settings. The top vaccines recommended for China’s NIP included the varicella vaccine, Haemophilus influenzae type b vaccine, enterovirus 71 vaccine, and influenza vaccine for preschoolers and school-aged children. The current analysis also revealed distinct preference patterns among different subgroups, such as gender, age, education, and income. The interaction analysis indicated that the region and health status of participants contribute to preference heterogeneity. Conclusions: Public preferences for including vaccines in the NIP were primarily influenced by vaccine effectiveness and coverage. The varicella vaccine should be prioritized for inclusion in the NIP. The public preferences could provide valuable insights when incorporating new vaccines in the NIP. %R 10.2196/57798 %U https://publichealth.jmir.org/2024/1/e57798 %U https://doi.org/10.2196/57798 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e62759 %T Development of an Integrated Surveillance System to Improve Preparedness for Arbovirus Outbreaks in a Dengue Endemic Setting: Descriptive Study %A Leandro,André %A Maciel-de-Freitas,Rafael %K surveillance %K Aedes aegypti %K vector control %K transmission risk %K dengue fever %D 2024 %7 14.11.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Dengue fever, transmitted by Aedes aegypti and Aedes albopictus mosquitoes, poses a significant public health challenge in tropical and subtropical regions. Dengue surveillance involves monitoring the incidence, distribution, and trends of infections through systematic data collection, analysis, interpretation, and dissemination. It supports public health decision-making, guiding interventions like vector control, vaccination campaigns, and public education. Objective: Herein, we report the development of a surveillance system already in use to support public health managers against dengue transmission in Foz do Iguaçu, a dengue-endemic Brazilian city located in the Triple Border with Argentina and Paraguay. Methods: We present data encompassing the fieldwork organization of more than 100 health agents; epidemiological and entomological data were gathered from November 2022 to April 2024, totalizing 18 months of data collection. Results: By registering health agents, we were able to provide support for those facing issues to fill their daily milestone of inspecting 16 traps per working day. We filtered dengue transmission in the city by patient age, gender, and reporting units, as well as according to dengue virus serotype. The entomological indices presented a strong seasonal pattern, as expected. Several longtime established routines in Foz do Iguaçu have been directly impacted by the adoption of Vigilância Integrada com Tecnologia (VITEC). Conclusions: The implementation of VITEC has enabled more efficient and accurate diagnostics of local transmission risk, leading to a better understanding of operational activity patterns and risks. Lately, local public health managers can easily identify hot spots of dengue transmission and optimize interventions toward those highly sensitive areas. %R 10.2196/62759 %U https://publichealth.jmir.org/2024/1/e62759 %U https://doi.org/10.2196/62759 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53340 %T Survey of Citizens’ Preferences for Combined Contact Tracing App Features During a Pandemic: Conjoint Analysis %A Bito,Seiji %A Hayashi,Yachie %A Fujita,Takanori %A Takahashi,Ikuo %A Arai,Hiromi %A Yonemura,Shigeto %+ National Hospital Organization Tokyo Medical Center, 2-5-1 Higashigaoka, Meguro-ku, Tokyo, 1528602, Japan, 81 334113130, bitoseiji@gmail.com %K digital contact tracing apps %K infectious disease %K conjoint analysis %K user attitudes %K public preferences %K citizen values %K attitude to health %K COVID-19 %K contact tracing %K privacy %K questionnaires %D 2024 %7 14.11.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the COVID-19 pandemic, an increased need for novel solutions such as digital contact tracing apps to mitigate virus spread became apparent. These apps have the potential to enhance public health initiatives through timely contact tracing and infection rate reduction. However, public and academic scrutiny has emerged around the adoption and use of these apps due to privacy concerns. Objective: This study aims to investigate public attitudes and preferences for contact tracing apps, specifically in Japan, using conjoint analysis to examine what specifications the public values most in such apps. By offering a nuanced understanding of the values that citizens prioritize, this study can help balance public health benefits and data privacy standards when designing contact tracing apps and serve as reference data for discussions on legal development and social consensus formation in the future. Methods: A cross-sectional, web-based questionnaire survey was conducted to determine how various factors related to the development and integration of infectious disease apps affect the public’s intention to use such apps. Individuals were recruited anonymously by a survey company. All respondents were asked to indicate their preferences for a combination of basic attributes and infectious disease app features for conjoint analysis. The respondents were randomly divided into 2 groups: one responded to a scenario where the government was assumed to be the entity dealing with infectious disease apps (ie, the government cluster), and the other responded to a scenario where a commercial company was assumed to be this entity (ie, the business cluster). Samples of 500 respondents from each randomly selected group were used as target data. Results: For the government cluster, the most important attribute in scenario A was distributor rights (42.557), followed by public benefits (29.458), personal health benefits (22.725), and profit sharing (5.260). For the business cluster, the most important attribute was distributor rights (45.870), followed by public benefits (32.896), personal health benefits (13.994), and profit sharing (7.240). Hence, personal health benefits tend to be more important in encouraging active app use than personal financial benefits. However, the factor that increased motivation for app use the most was the public health benefits of cutting infections by half. Further, concern about the use of personal data collected by the app for any secondary purpose was a negative incentive, which was more significant toward app use compared to the other 3 factors. Conclusions: The findings suggest that potential app users are positively motivated not only by personal health benefits but also by contributing to public health. Thus, a combined approach can be taken to increase app use. %M 39541579 %R 10.2196/53340 %U https://publichealth.jmir.org/2024/1/e53340 %U https://doi.org/10.2196/53340 %U http://www.ncbi.nlm.nih.gov/pubmed/39541579 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49708 %T Designing and Validating a Survey for National-Level Data During the COVID-19 Pandemic in Sri Lanka: Cross-Sectional Mobile Phone Surveys %A Phadnis,Rachael %A Perera,Udara %A Lea,Veronica %A Davlin,Stacy %A Lee,Juliette %A Siesel,Casey %A Abeygunathilaka,Dhanushka %A Wickramasinghe,S C %+ Centers for Disease Control and Prevention Foundation, 600 Peachtree St NE, #1000, Atlanta, GA, 30308, United States, 1 320 248 7430, rachaelphadnis@gmail.com %K pilot study %K mobile phone survey %K survey methodology %K COVID-19 %K data collection %K national survey %K pandemic %K population-based study %K Sri Lanka %K middle-income countries %K low-income countries %K vaccine acceptability %K vaccine %K COVID-19 vaccination %D 2024 %7 8.11.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 39514850 %R 10.2196/49708 %U https://formative.jmir.org/2024/1/e49708 %U https://doi.org/10.2196/49708 %U http://www.ncbi.nlm.nih.gov/pubmed/39514850 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e62641 %T Early Warning Systems for Acute Respiratory Infections: Scoping Review of Global Evidence %A Patel,Atushi %A Maruthananth,Kevin %A Matharu,Neha %A Pinto,Andrew D %A Hosseini,Banafshe %+ Upstream Lab, MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada, 1 416 864 6060 ext 76148, benita.hosseini@unityhealth.to %K early warning systems %K acute respiratory infections %K early detection systems %D 2024 %7 7.11.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Early warning systems (EWSs) are tools that integrate clinical observations to identify patterns indicating increased risks of clinical deterioration, thus facilitating timely and appropriate interventions. EWSs can mitigate the impact of global infectious diseases by enhancing information exchange, monitoring, and early detection. Objective: We aimed to evaluate the effectiveness of EWSs in acute respiratory infections (ARIs) through a scoping review of EWSs developed, described, and implemented for detecting novel, exotic, and re-emerging ARIs. Methods: We searched Ovid MEDLINE ALL, Embase, Cochrane Library (Wiley), and CINAHL (Ebsco). The search was conducted on October 03, 2023. Studies that implemented EWSs for the detection of acute respiratory illnesses were included. Covidence was used for citation management, and a modified Critical Appraisal Skills Programme (CASP) checklist was used for quality assessment. Results: From 5838 initial articles, 29 met the inclusion criteria for this review. Twelve studies evaluated the use of EWSs within community settings, ranging from rural community reporting networks to urban online participatory surveillance platforms. Five studies focused on EWSs that used data from hospitalization and emergency department visits. These systems leveraged clinical and admission data to effectively detect and manage local outbreaks of respiratory infections. Two studies focused on the effectiveness of existing surveillance systems, assessing their adaptability and responsiveness to emerging threats and how they could be improved based on past performance. Four studies highlighted the integration of machine learning models to improve the predictive accuracy of EWSs. Three studies explored the applications of national EWSs in different health care settings and emphasized their potential in predicting clinical deterioration and facilitating early intervention. Lastly, 3 studies addressed the use of surveillance systems in aged-care facilities, highlighting the unique challenges and needs of monitoring and responding to health threats in environments housing vulnerable populations. The CASP tool revealed that most studies were relevant, reliable, and of high value (score 6: 11/29, 38%; score 5: 9/29, 31%). The common limitations included result generalizability, selection bias, and small sample size for model validation. Conclusions: This scoping review confirms the critical role of EWSs in enhancing public health responses to respiratory infections. Although the effectiveness of these systems is evident, challenges related to generalizability and varying methodologies suggest a need for continued innovation and standardization in EWS development. %M 39510516 %R 10.2196/62641 %U https://publichealth.jmir.org/2024/1/e62641 %U https://doi.org/10.2196/62641 %U http://www.ncbi.nlm.nih.gov/pubmed/39510516 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58413 %T Development and Validation of Deep Learning–Based Infectivity Prediction in Pulmonary Tuberculosis Through Chest Radiography: Retrospective Study %A Chung,Wou young %A Yoon,Jinsik %A Yoon,Dukyong %A Kim,Songsoo %A Kim,Yujeong %A Park,Ji Eun %A Kang,Young Ae %+ Department of Internal Medicine, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 1954, mdkang@yuhs.ac %K pulmonary tuberculosis %K chest radiography %K artificial intelligence %K tuberculosis %K TB %K smear %K smear test %K culture test %K diagnosis %K treatment %K deep learning %K CXR %K PTB %K management %K cost effective %K asymptomatic infection %K diagnostic tools %K infectivity %K AI tool %K cohort %D 2024 %7 7.11.2024 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 39509691 %R 10.2196/58413 %U https://www.jmir.org/2024/1/e58413 %U https://doi.org/10.2196/58413 %U http://www.ncbi.nlm.nih.gov/pubmed/39509691 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e64270 %T Digital Contact Tracing Implementation Among Leaders and Health Care Workers in a Pediatric Hospital During the COVID-19 Pandemic: Qualitative Interview Study %A O'Dwyer,Brynn %A Jaana,Mirou %A Hui,Charles %A Chreim,Samia %A Ellis,Jennifer %+ Telfer School of Management, University of Ottawa, 55 Laurier Ave E, Ottawa, ON, K1N 6N5, Canada, 1 6135625731 ext 3400, jaana@telfer.uottawa.ca %K COVID-19 %K surveillance %K technology %K digital contact tracing %K qualitative %K hospitals %K Reach, Effectiveness, Adoption, Implementation, and Maintenance framework %K RE-AIM %D 2024 %7 5.11.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Health systems had to rapidly implement infection control strategies to sustain their workforces during the COVID-19 pandemic. Various outbreak response tools, such as digital contact tracing (DCT), have been developed to monitor exposures and symptoms of health care workers (HCWs). Limited research evidence exists on the experiences with these technologies and the impacts of DCT innovations from the perspective of stakeholders in health care environments. Objective: This study aims to identify the factors influencing the adoption of DCT, highlight variations in perspectives across 3 key stakeholder groups concerning the impact of DCT, and provide benchmarking evidence for future pandemic preparedness. Methods: Guided by the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework, we conducted an exploratory qualitative study to investigate the implementation and impact of DCT at the Children’s Hospital of Eastern Ontario between December 2022 and April 2023. We conducted 21 semistructured interviews with key stakeholders, including health care administrators (6/21, 29%), occupational health and safety specialists (8/21, 38%), and HCWs (7/21, 33%). Stakeholders were asked about the factors influencing engagement with the DCT tool, organizational-level uptake, the implementation process, long-term use and sustainability of DCT, and unintended consequences. Verbatim transcripts were subject to thematic analysis using NVivo (QSR International). Results: The implementation of DCT was viable and well received. End users indicated that their engagement with the DCT tool was facilitated by its perceived ease of use and the ability to gain awareness of probable COVID-19 exposures; however, risk assessment consequences and access concerns were reported as barriers (reach). Participants commonly agreed that the DCT technology had a positive influence on the hospital’s capacity to meet the demands of COVID-19 (effectiveness). Implementors and occupational specialists referred to negative staffing impacts and the loss of nuanced information as unintended consequences (effectiveness). Safety-focused communication strategies and having a DCT tool that was human-centered were crucial factors driving staff adoption of the technology. Conversely, adoption was challenged by the misaligned delivery of the DCT tool with HCWs’ standard practices, alongside the evolving perceived threat of COVID-19. Stakeholders collectively agreed on the viability of DCT and its applicability to infectious disease practices (maintenance). Conclusions: Hospital stakeholders were highly satisfied with DCT technology and it was perceived as feasible, efficient, and having a positive impact on organizational safety. Challenges related to the alignment and delivery of DCT, alongside the evolving perspectives on COVID-19, posed obstacles to continued adoption by HCWs. Our findings contribute to evidence-based practices and present benchmarks that can inform preparedness for future pandemics and infectious disease outbreaks and help other organizations implement similar technologies. %M 39499919 %R 10.2196/64270 %U https://publichealth.jmir.org/2024/1/e64270 %U https://doi.org/10.2196/64270 %U http://www.ncbi.nlm.nih.gov/pubmed/39499919 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56989 %T Association Between Sociodemographic Factors and Vaccine Acceptance for Influenza and SARS-CoV-2 in South Korea: Nationwide Cross-Sectional Study %A Hong,Seohyun %A Son,Yejun %A Lee,Myeongcheol %A Lee,Jun Hyuk %A Park,Jaeyu %A Lee,Hayeon %A Dragioti,Elena %A Fond,Guillaume %A Boyer,Laurent %A López Sánchez,Guillermo Felipe %A Smith,Lee %A Tully,Mark A %A Rahmati,Masoud %A Choi,Yong Sung %A Lee,Young Joo %A Yeo,Seung Geun %A Woo,Selin %A Yon,Dong Keon %K COVID-19 %K influenza %K South Korea %K vaccination %K vaccinations %K COVID-19 vaccine %K COVID-19 vaccination %K SARS-CoV-2 %K SARS-CoV-2 vaccine %K pandemic %K SARS-CoV-2 vaccination %K vaccine %K vaccine hesitancy %D 2024 %7 1.11.2024 %9 %J JMIR Public Health Surveill %G English %X 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. %R 10.2196/56989 %U https://publichealth.jmir.org/2024/1/e56989 %U https://doi.org/10.2196/56989 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56390 %T An Online Tailored COVID-19 Vaccination Decision Aid for Dutch Citizens: Development, Dissemination, and Use %A Preuhs,Katharina %A Bussink-Voorend,Daphne %A van Keulen,Hilde M %A Wildeman,Ilona %A Hautvast,Jeannine %A Hulscher,Marlies %A van Empelen,Pepijn %+ Netherlands Organization for Applied Scientific Research (TNO), Expertise Group Child Health, PO Box 2215, Leiden, 2301 CE, Netherlands, 31 615597505, katharina.preuhs@tno.nl %K COVID-19 %K COVID-19 vaccination %K informed decision-making %K user-centered design %K low literacy %K eHealth %K tailored decision aid %D 2024 %7 30.10.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Since December 2019, COVID-19 led to a pandemic causing many hospitalizations and deaths. Vaccinations were developed and introduced to control viral transmission. In the Dutch context, the decision to accept vaccination is not mandatory. An informed decision is based on sufficient and reliable information, in line with one’s attitudes and values, and with consideration of pros and cons. To support people in informed decision-making, we developed an online COVID-19 vaccination decision aid (DA). Objective: This article aims to describe the development, dissemination, and use of the DA. Methods: Building on a previously developed DA, the COVID-19 vaccination DA was developed in 3 phases following a user-centered design approach: (1) definition phase, (2) concept testing, and (3) prototype testing. End users, individuals with low literacy, and experts (with relevant expertise on medical, behavioral, and low literacy aspects) were involved in the iterative development, design, and testing, with their feedback forming the basis for adaptations to the DA. Results: The DA was developed within 14 weeks. The DA consists of 3 modules, namely, Provide Information, Support Decision-Making, and Facilitate Actions Following a Decision. These modules are translated into various information tiles and diverse functionalities such as a knowledge test, a value clarification tool using a decisional balance, and a communication tool. The DA was disseminated for use in May 2021. Users varied greatly regarding age, gender, and location in the Netherlands. Conclusions: This paper elaborates on the development of the COVID-19 vaccination DA in a brief period and its dissemination for use among Dutch adults in the Netherlands. The evaluation of use showed that we were able to reach a large proportion and variety of people throughout the Netherlands. %M 39475719 %R 10.2196/56390 %U https://formative.jmir.org/2024/1/e56390 %U https://doi.org/10.2196/56390 %U http://www.ncbi.nlm.nih.gov/pubmed/39475719 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e54578 %T Contact Tracing Different Age Groups During the COVID-19 Pandemic: Retrospective Study From South-West Germany %A Dyer,Christopher Michael %A Negoescu,Alexandra-Teodora %A Borchert,Matthias %A Harter,Christoph %A Kühn,Anne %A Dambach,Peter %A Marx,Michael %+ Rhein-Neckar District and Heidelberg City Public Health Authority, Kurfürsten-Anlage 38 - 40, Heidelberg, 69115, Germany, 49 6201 522 2949, C.Dyer@Rhein-Neckar-Kreis.de %K COVID-19 %K SARS-CoV-2 %K pandemic %K quarantine %K contact tracing %K contact tracing effectiveness %K demographics %K mortality %K case fatality %K public health surveillance %K public health systems %D 2024 %7 29.10.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Contact tracing was implemented in many countries during the COVID-19 pandemic to prevent disease spread, reduce mortality, and avoid overburdening health care systems. In several countries, including Germany, new systems were needed to trace potentially infected individuals. Objective: Using data collected in the Rhine-Neckar and Heidelberg (RNK/HD) districts in southwest Germany (population: 706,974), this study examines the overall effectiveness and efficiency of contact tracing in different age groups and stages of the pandemic. Methods: From January 27, 2020, to April 30, 2022, the RNK/HD Health Authority collected data on COVID-19 infections, quarantines, and deaths. Data on infection, quarantine, and death was grouped by age (young: 0-19 years; adult: 20-65 years; and senior citizens: >65 years) and pandemic phase (infectious wave plus subsequent lull periods) and analyzed for proportion, risk, and relative risk (RR). The overall effectiveness and efficiency of contact tracing were determined by calculating quarantine sensitivity (proportion of the infected population captured in quarantine), positive predictive value (PPV; proportion of the quarantined population that was infected), and the weighted Fβ-score (combined predictive performance). Results: Of 706,974 persons living in RNK/HD during the study period, 192,175 (27.2%) tested positive for SARS-CoV-2, 74,810 (10.4%) were quarantined, and 932 (0.132%) died following infection. Compared with adults, the RR of infection was lower among senior citizens (0.401, 95% CI 0.395-0.407) and while initially lower for young people, was ultimately higher for young people across all 5 phases (first-phase RR 0.502, 95% CI 0.438-0.575; all phases RR 1.35, 95% CI 1.34-1.36). Of 932 COVID-19–associated deaths during the study period, 852 were senior citizens (91.4%), with no deaths reported among young people. Relative to adults, senior citizens had the lowest risk of quarantine (RR 0.436, 95% CI 0.424-0.448), while young people had the highest RR (2.94, 95% CI 2.90-2.98). The predictive performance of contact tracing was highest during the second and third phases of the pandemic (Fβ-score=0.272 and 0.338, respectively). In the second phase of the pandemic, 5810 of 16,814 COVID-19 infections were captured within a total quarantine population of 39,687 (sensitivity 34.6%; PPV 14.6%). In the third phase of the pandemic, 3492 of 8803 infections were captured within a total quarantine population of 16,462 (sensitivity 39.7%; PPV 21.2%). Conclusions: The use of quarantine aligned with increasing risks of COVID-19 infection and death. High levels of quarantine sensitivity before the introduction of the vaccine show how contact tracing systems became increasingly effective at capturing and quarantining the infected population. High levels of PPV and Fβ-scores indicate, moreover, that contact tracing became more efficient at identifying infected individuals. Additional analysis of transmission pathways is needed to evaluate the application of quarantine in relation to infection and death risks within specific age groups. %M 39471373 %R 10.2196/54578 %U https://ojphi.jmir.org/2024/1/e54578 %U https://doi.org/10.2196/54578 %U http://www.ncbi.nlm.nih.gov/pubmed/39471373 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e62657 %T Developing National Information Systems to Monitor COVID-19 Vaccination: A Global Observational Study %A Brooks,Donald J %A Kim,Carolyn Inae %A Mboussou,Franck Fortune %A Danovaro-Holliday,M Carolina %K COVID-19 %K COVID-19 vaccine %K immunization information system %K vaccination monitoring %K vaccine %K monitoring and evaluation %D 2024 %7 25.10.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Strong information systems are essential for safe and effective immunization programs. The COVID-19 vaccine rollout presented all immunization information systems (IIS) with challenging demands—requiring in-depth vaccine implementation data at all health system levels in real time. The system development approaches taken by countries were heterogeneous, with some countries opting to adapt existing systems and others implementing new ones. Objective: Using data reported by Member States to the World Health Organization (WHO), we aim to develop a global understanding of (1) the types of IIS used to monitor COVID-19 vaccination implemented in 2021 and (2) the approaches taken by countries to develop these systems. Methods: We conducted a descriptive analysis of data reported through a supplemental questionnaire of the WHO/United Nations Children's Emergency Fund (UNICEF) Joint Reporting Form on Immunization, collecting data for 2021 on (1) the use of and developmental approaches taken for 7 IIS functions (appointments, aggregate reporting, individual-level reporting, reminders, home-based records, safety surveillance, and stock management), and (2) modifications needed for digital health frameworks to permit COVID-19 vaccination monitoring. Results: In total, 188 of 194 WHO Member States responded to the supplemental questionnaire, with 155 reporting on the IIS-related questions. Among those reporting, for each of the 7 IIS functions explored, greater than 85% of responding countries reported that the system was in place for COVID-19 vaccines. Among responding countries, “aggregate reporting system” was the system most frequently reported as being in place (n=116, 98.3%), while “reminder system” was the least (n=77, 89%). Among the countries reporting using a system, whether an existing system was adapted for COVID-19 vaccines or a new one was developed varied by system. Additionally, two-thirds (n=127, 67.6%) of countries reported establishing at least one new system, ranging from 72% (n=42) in high-income countries (HICs) to 62% (n=16) in low-income countries. Concurrently, 55.3% (n=104) of countries reported adapting at least one system already in place for COVID-19 vaccines, with 62% (n=36) of HICs reporting this compared to about 53% for other income groups. Of those reporting developing new systems, for each of the systems explored, more than 85% of countries reported that they intended to keep new systems specific to COVID-19 vaccines. Further, 147 of the 188 (78.2%) Member States responding to the supplemental questionnaire responded to the digital health frameworks question. Lastly, 31% (n=46) of responding countries reported needing to adapt them for COVID-19 vaccination systems. HICs had a higher percentage. Conclusions: Nearly all countries have adapted existing or developed new IIS to monitor COVID-19 vaccination. The approaches varied, notably by income group. Reflection is needed on how to sustain the investments made in IIS during the pandemic. Continued support for IIS is critical, given their essential role in program monitoring and performance. %R 10.2196/62657 %U https://publichealth.jmir.org/2024/1/e62657 %U https://doi.org/10.2196/62657 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58257 %T Online Media Use and COVID-19 Vaccination in Real-World Personal Networks: Quantitative Study %A Oană,Iulian %A Hâncean,Marian-Gabriel %A Perc,Matjaž %A Lerner,Jürgen %A Mihăilă,Bianca-Elena %A Geantă,Marius %A Molina,José Luis %A Tincă,Isabela %A Espina,Carolina %+ Department of Sociology, University of Bucharest, Panduri 90-92, Bucharest, 050663, Romania, 40 305 97 30 ext 021, iulian.oana@sas.unibuc.ro %K vaccine hesitancy %K online media %K social media %K assortative mixing %K personal network analysis %K social network analysis %K Romania %K vaccination %K health information %K COVID-19 %D 2024 %7 25.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Most studies assessing the impact of online media and social media use on COVID-19 vaccine hesitancy predominantly rely on survey data, which often fail to capture the clustering of health opinions and behaviors within real-world networks. In contrast, research using social network analysis aims to uncover the diverse communities and discourse themes related to vaccine support and hesitancy within social media platforms. Despite these advancements, there is a gap in the literature on how a person’s social circle affects vaccine acceptance, wherein an important part of social influence stems from offline interactions. Objective: We aimed to examine how online media consumption influences vaccination decisions within real-world social networks by analyzing unique quantitative network data collected from Romania, an Eastern European state and member of the European Union. Methods: We conducted 83 face-to-face interviews with participants from a living lab in Lerești, a small rural community in Romania, using a personal network analysis framework. This approach involved gathering data on both the respondents and individuals within their social circles (referred to as alters). After excluding cases with missing data, our analysis proceeded with 73% (61/83) of the complete personal networks. To examine the hierarchical structure of alters nested within ego networks, we used a mixed multilevel logistic regression model with random intercepts. The model aimed to predict vaccination status among alters, with the focal independent variable being the respondents’ preferred source of health and prevention information. This variable was categorized into 3 types: traditional media, online media (including social media), and a combination of both, with traditional media as the reference category. Results: In this study, we analyzed 61 personal networks, encompassing between 15 and 25 alters each, totaling 1280 alters with valid data across all variables of interest. Our primary findings indicate that alters within personal networks, whose respondents rely solely on online media for health information, exhibit lower vaccination rates (odds ratio [OR] 0.37, 95% CI 0.15-0.92; P=.03). Conversely, the transition from exclusive traditional media use to a combination of both traditional and online media does not significantly impact vaccination rate odds (OR 0.75, 95% CI 0.32-1.78; P=.52). In addition, our analysis revealed that alters in personal networks of respondents who received the vaccine are more likely to have received the vaccine themselves (OR 3.75, 95% CI 1.79-7.85; P<.001). Conclusions: Real-world networks combine diverse human interactions and attributes along with consequences on health opinions and behaviors. As individuals’ vaccination status is influenced by how their social alters use online media and vaccination behavior, further insights are needed to create tailored communication campaigns and interventions regarding vaccination in areas with low levels of digital health literacy and vaccination rates, as Romania exposes. %M 39454189 %R 10.2196/58257 %U https://www.jmir.org/2024/1/e58257 %U https://doi.org/10.2196/58257 %U http://www.ncbi.nlm.nih.gov/pubmed/39454189 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53409 %T Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Sub-Saharan Africa: Longitudinal Trend Analysis %A Lundberg,Alexander L %A Soetikno,Alan G %A Wu,Scott A %A Ozer,Egon A %A Welch,Sarah B %A Mason,Maryann %A Murphy,Robert L %A Hawkins,Claudia %A Liu,Yingxuan %A Moss,Charles B %A Havey,Robert J %A Achenbach,Chad J %A Post,Lori A %+ Buehler Center for Health Policy and Economics, Robert J Havey, MD Institute for Global Health, Northwestern University, 420 E. Superior, Chicago, IL, 60611, United States, 1 312 503 1706, lori.post@northwestern.edu %K SARS-CoV-2 %K COVID-19 %K sub-Saharan Africa %K pandemic %K surveillance %K public health %K COVID-19 transmission %K speed %K acceleration %K deceleration %K jerk %K dynamic panel %K generalized method of moments %K Arellano-Bond %D 2024 %7 23.10.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: This study updates the initial COVID-19 pandemic surveillance in sub-Saharan Africa (SSA) from 2020 by providing 2 additional years of data for the region. Objective: First, we aimed to measure whether there was an expansion or contraction in the pandemic in SSA when the World Health Organization (WHO) declared an end to the public health emergency for the COVID-19 pandemic on May 5, 2023. Second, we used dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we aimed to provide historical context for the course of the pandemic in SSA. Methods: In addition to updates of traditional surveillance data and dynamic panel estimates from the original study by Post et al (2021), this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and used Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t-test to assess whether regional weekly speed was greater than an outbreak threshold of 10. We ran the test iteratively with a rolling 6-month window of data across the sample period. Results: Speed for the region remained well below the outbreak threshold before and after the WHO declaration. Acceleration and jerk were also low and stable. The 7-day persistence coefficient remained somewhat large (1.11) and statistically significant. However, both shift parameters for the weeks around the WHO declaration were negative, meaning the clustering effect of new COVID-19 cases had become recently smaller. From November 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t-test of speed equal to 10 was insignificant for the entire sample period. Conclusions: While COVID-19 continues to circulate in SSA, the region never reached outbreak status, and the weekly transmission rate remained below 1 case per 100,000 population for well over 1 year ahead of the WHO declaration. COVID-19 is endemic in the region and no longer reaches the threshold for its classification as a pandemic. Both standard and enhanced surveillance metrics confirm that the pandemic ended in SSA by the time the WHO made its declaration. %M 39013111 %R 10.2196/53409 %U https://publichealth.jmir.org/2024/1/e53409 %U https://doi.org/10.2196/53409 %U http://www.ncbi.nlm.nih.gov/pubmed/39013111 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58720 %T Toward a Clinical Decision Support System for Monitoring Therapeutic Antituberculosis Medical Drugs in Tanzania (Project TuberXpert): Protocol for an Algorithm' Development and Implementation %A Thoma,Yann %A Cathignol,Annie E %A Pétermann,Yuan J %A Sariko,Margaretha L %A Said,Bibie %A Csajka,Chantal %A Guidi,Monia %A Mpagama,Stellah G %+ School of Engineering and Management Vaud, HES-SO University of Applied Sciences and Arts Western Switzerland, route de Cheseaux 1, Yverdon-les-Bains, 1401, Switzerland, 41 245576273, yann.thoma@heig-vd.ch %K TDM %K therapeutic drug monitoring %K pharmacometrics %K tuberculosis %K model-informed precision dosing software %K clinical pharmacology %K clinical decision support system %K Tanzania %K mobile phone %D 2024 %7 21.10.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The end tuberculosis (TB) strategy requires a novel patient treatment approach contrary to the one-size-fits-all model. It is well known that each patient’s physiology is different and leads to various rates of drug elimination. Therapeutic drug monitoring (TDM) offers a way to manage drug dosage adaptation but requires trained pharmacologists, which is scarce in resource-limited settings. Objective: We will develop an automated clinical decision support system (CDSS) to help practitioners with the dosage adaptation of rifampicin, one of the essential medical drugs targeting TB, that is known for large pharmacokinetic variability and frequent suboptimal blood exposure. Such an advanced system will encourage the spread of a dosage-individualization culture, including among practitioners not specialized in pharmacology. Thus, the objectives of this project are to (1) develop the appropriate population pharmacokinetic (popPK) model for rifampicin for Tanzanian patients, (2) optimize the reporting of relevant information to practitioners for drug dosage adjustment, (3) automate the delivery of the report in line with the measurement of drug concentration, and (4) validate and implement the final system in the field. Methods: A total of 3 teams will combine their efforts to deliver the first automated TDM CDSS for TB. A cross-sectional study will be conducted to define the best way to display information to clinicians. In parallel, a rifampicin popPK model will be developed taking advantage of the published literature, complemented with data provided by existing literature data from the Pan-African Consortium for the Evaluation of Antituberculosis Antibiotics (panACEA), and samples collected within this project. A decision tree will be designed and implemented as a CDSS, and an automated report generation will be developed and validated through selected case studies. Expert pharmacologists will validate the CDSS, and finally, field implementation in Tanzania will occur, coupled with a prospective study to assess clinicians’ adherence to the CDSS recommendations. Results: The TuberXpert project started in November 2022. In July 2024, the clinical study in Tanzania was completed with the enrollment of 50 patients to gather the required data to build a popPK model for rifampicin, together with a qualitative study defining the report design, as well as the CDSS general architecture definition. Conclusions: At the end of the TuberXpert project, Tanzania will possess a new tool to help the practitioners with the adaptation of drug dosage targeting complicated TB cases (TB or HIV, TB or diabetes mellitus, and TB or malnutrition). This automated system will be validated and used in the field and will be proposed to other countries affected by endemic TB. In addition, this approach will serve as proof of concept regarding the feasibility and suitability of CDSS-assisted TDM for further anti-TB drugs in TB-burdened areas deprived of TDM experts, including second-line treatments considered important to monitor. International Registered Report Identifier (IRRID): DERR1-10.2196/58720 %M 39432902 %R 10.2196/58720 %U https://www.researchprotocols.org/2024/1/e58720 %U https://doi.org/10.2196/58720 %U http://www.ncbi.nlm.nih.gov/pubmed/39432902 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50184 %T Mobile Phone Syndromic Surveillance for Respiratory Conditions in an Emergency (COVID-19) Context in Colombia: Representative Survey Design %A Vecino-Ortiz,Andres I %A Guzman-Tordecilla,Deivis Nicolas %A Maniar,Vidhi %A Agudelo-Londoño,Sandra %A Franco-Suarez,Oscar %A Aya Pastrana,Nathaly %A Rodríguez-Patarroyo,Mariana %A Mejía-Rocha,Marino %A Cardona,Jaime %A Chavez Chamorro,Mariangela %A Gibson,Dustin %+ Health Systems Program, International Health Department, Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe Street, Baltimore, MD, 21205, United States, 1 410 955 3934, andres.vecino@gmail.com %K mobile phone surveys %K syndromic surveillance %K COVID-19 %K public health surveillance %K IVR %K interactive voice response %K survey %K surveys %K voice response %K syndromic %K surveillance %K respiratory %K pandemic %K SARS-CoV-2 %K feasibility %K data collection %K public health %K emergency %K outbreak %K mobile phone %D 2024 %7 17.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Syndromic surveillance for respiratory infections such as COVID-19 is a crucial part of the public health surveillance toolkit as it allows decision makers to detect and prepare for new waves of the disease in advance. However, it is labor-intensive, costly, and increases exposure to survey personnel. This study assesses the feasibility of conducting a mobile phone–based respiratory syndromic surveillance program in a middle-income country during a public health emergency, providing data to support the inclusion of this method in the standard infection control protocols at the population level. Objective: This study aims to assess the feasibility of a national active syndromic surveillance system for COVID-19 disease in Colombia. Methods: In total, 2 pilots of syndromic mobile phone surveys (MPSs) were deployed using interactive voice response technology in Colombia (367 complete surveys in March 2022 and 451 complete surveys in April and May 2022). Respondents aged 18 years and older were sampled using random digit dialing, and after obtaining consent, they were sent a 10-minute survey with modules on sociodemographic status, respiratory symptoms, past exposure to COVID-19 infection and vaccination status, preferences about COVID-19 vaccination, and information source for COVID-19. Pilot 1 used a nationally representative sample while pilot 2 used quota sampling to yield representative results at the regional level. In this work, we assessed the performance characteristics of the survey pilots and compared the demographic information collected with a nationally representative household survey. Results: For both pilots, contact rates were between 1% and 2%, while participation rates were above 80%. The results revealed that younger, female, and higher educated participants were more likely to participate in the syndromic survey. Survey rates as well as demographics, COVID-19 vaccination status, and prevalence of respiratory symptoms are reported for both pilots. We found that respondents of the MPSs are more likely to be younger and female. Conclusions: In a COVID-19 pandemic setting, using an interactive voice response MPS to conduct syndromic surveillance may be a transformational, low-risk, and feasible method to detect outbreaks. This evaluation expects to provide a path forward to the inclusion of MPSs as a traditional surveillance method. %M 39418077 %R 10.2196/50184 %U https://www.jmir.org/2024/1/e50184 %U https://doi.org/10.2196/50184 %U http://www.ncbi.nlm.nih.gov/pubmed/39418077 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50846 %T Protective Effect of Allergen Immunotherapy in Patients With Allergic Rhinitis and Asthma Against COVID-19 Infection: Observational, Nationwide, and Multicenter Study %A Qin,Rundong %A Feng,Yan %A Zhang,Huanping %A Zhao,Beibei %A Lei,Wei %A Sun,Hongying %A Zhi,Lili %A Zheng,Zhongsheng %A Wang,Siqin %A Yu,Yafeng %A Jiang,Shengxue %A Liu,Changshan %A Ma,Xingkai %A Ma,Hui %A Wang,Huiying %A Lin,Hang %A He,Qiaojie %A Wu,Lingying %A Zhai,Yingying %A Lu,Honglue %A Chen,Shi %A Ma,Yan %A Jin,Xiaohong %A Deng,Shan %A Zhong,Nanshan %A Chen,Ruchong %A Li,Jing %K allergen immunotherapy %K COVID-19 %K antiviral effect %K allergic rhinitis %K asthma %K viral infection %K allergic disease %K trajectory %K questionnaire-based survey %K clinical evidence %D 2024 %7 16.10.2024 %9 %J JMIR Public Health Surveill %G English %X 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. %R 10.2196/50846 %U https://publichealth.jmir.org/2024/1/e50846 %U https://doi.org/10.2196/50846 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e59762 %T Assessing the Impact of Frailty on Infection Risk in Older Adults: Prospective Observational Cohort Study %A Yang,Ya %A Che,Kechun %A Deng,Jiayan %A Tang,Xinming %A Jing,Wenyuan %A He,Xiuping %A Yang,Jiacheng %A Zhang,Wenya %A Yin,Mingjuan %A Pan,Congcong %A Huang,Xiaoling %A Zhang,Zewu %A Ni,Jindong %K community elderly %K frailty %K infectious diseases %K infectious disease %K older %K China %K questionnaire %K survey %K cohort %K COVID-19 %K infection %K chi-square %K longitudinal analysis %K age-related chronic disease %K chronic disease %K chronic diseases %D 2024 %7 16.10.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Infectious diseases are among the leading causes of death and disability and are recognized as a major cause of health loss globally. At the same time, frailty as a geriatric syndrome is a rapidly growing major public health problem. However, few studies have investigated the incidence and risk of infectious diseases in frail older people. Thus, research on frailty and infectious diseases is urgently needed. Objective: The purpose of this study was to evaluate the association between frailty and infectious diseases among older adults aged 65 years and older. Methods: In this prospective observational cohort study, we have analyzed the infectious disease prevalence outcomes of older adults aged 65 years and older who participated in frailty epidemiological surveys from March 1, 2018, to March 2023 in Dalang Town, Dongguan City, and from March 1, 2020, to March 2023 in Guancheng Street, Dongguan City. This study has an annual on-site follow-up. Incidence data for infectious diseases were collected through the Chinese Disease Control and Prevention Information System—Infectious Disease Monitoring and Public Health Emergency Monitoring System. A project-developed frailty assessment scale was used to assess the frailty status of study participants. We compared the incidence rate ratios (IRR) of each disease across frailty status, age, and gender to determine the associations among frailty, gender, age, and infectious diseases. Cox proportional hazards regression was conducted to identify the effect of frailty on the risk of demographic factors and frailty on the risk of infectious diseases, with estimations of the hazard ratio and 95% CI. Results: A total of 235 cases of 12 infectious diseases were reported during the study period, with an incidence of 906.21/100,000 person-years in the frailty group. In the same age group, the risk of infection was higher in men than women. Frail older adults had a hazard ratio for infectious diseases of 1.50 (95% CI 1.14‐1.97) compared with healthy older adults. We obtained the same result after sensitivity analyses. For respiratory tract–transmitted diseases (IRR 1.97, 95% CI 1.44‐2.71) and gastrointestinal tract–transmitted diseases (IRR 3.67, 95% CI 1.39‐10.74), frail older adults are at risk. Whereas no significant association was found for blood-borne, sexually transmitted, and contact-transmitted diseases (IRR 0.76, 95% CI 0.37‐1.45). Conclusions: Our study provides additional evidence that frailty components are significantly associated with infectious diseases. Health care professionals must pay more attention to frailty in infectious disease prevention and control. %R 10.2196/59762 %U https://publichealth.jmir.org/2024/1/e59762 %U https://doi.org/10.2196/59762 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57242 %T COVID-19 Vaccine Preferences in General Populations in Canada, Germany, the United Kingdom, and the United States: Discrete Choice Experiment %A Salisbury,David %A Lazarus,Jeffrey V %A Waite,Nancy %A Lehmann,Clara %A Sri Bhashyam,Sumitra %A de la Cruz,Marie %A Hahn,Beth %A Rousculp,Matthew D %A Bonanni,Paolo %+ Novavax, Inc, 700 Quince Orchard Road, Gaithersburg, MD, 20878, United States, 1 9192740660, bhahn@Novavax.com %K COVID-19 %K discrete choice experiment %K vaccine hesitancy %K vaccine side effects %K SARS-CoV-2 %K COVID vaccination %K immunization %K preference elicitation %K informed decision-making %K antivaccine %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite strong evidence supporting COVID-19 vaccine efficacy and safety, a proportion of the population remains hesitant to receive immunization. Discrete choice experiments (DCEs) can help assess preferences and decision-making drivers. Objective: We aim to (1) elicit preferences for COVID-19 vaccines in Canada, Germany, the United Kingdom, and the United States; (2) understand which vaccine attributes people there value; and (3) gain insight into the choices that different population subgroups make regarding COVID-19 vaccines. Methods: Participants in the 2019nCoV-408 study were aged ≥18 years; self-reported antivaccinationists were excluded. A DCE with a series of 2 hypothetical vaccine options was embedded into a survey to determine participant treatment preferences (primary objective). Survey questions covered vaccine preference, previous COVID-19 experiences, and demographics, which were summarized using descriptive statistics to understand the study participants’ backgrounds. In the DCE, participants were provided choice pairs: 1 set with and 1 without an “opt-out” option. Each participant viewed 11 unique vaccine profiles. Vaccine attributes consisted of type (messenger RNA or protein), level of protection against any or severe COVID-19, risk of side effects (common and serious), and potential coadministration of COVID-19 and influenza vaccines. Attribute level selections were included for protection and safety (degree of effectiveness and side effect risk, respectively). Participants were stratified by vaccination status (unvaccinated, or partially or fully vaccinated) and disease risk group (high-risk or non–high-risk). A conditional logit model was used to analyze DCE data to estimate preferences of vaccine attributes, with the percentage relative importance calculated to allow for its ranking. Each model was run twice to account for sets with and without the opt-out options. Results: The mean age of participants (N=2000) was 48 (SD 18.8) years, and 51.25% (1025/2000) were male. The DCE revealed that the most important COVID-19 vaccine attributes were protection against severe COVID-19 or any severity of COVID-19 and common side effects. Protection against severe COVID-19 was the most important attribute for fully vaccinated participants, which significantly differed from the unvaccinated or partially vaccinated subgroup (relative importance 34.8% vs 30.6%; P=.049). Avoiding serious vaccine side effects was a significantly higher priority for the unvaccinated or partially versus fully vaccinated subgroup (relative importance 10.7% vs 8.2%; P=.044). Attributes with significant differences in the relative importance between the high-risk versus non–high-risk subgroups were protection against severe COVID-19 (38.2% vs 31.5%; P<.000), avoiding common vaccine side effects (12% vs 20.5%; P<.000), and avoiding serious vaccine side effects (9.7% vs 7.5%; P=.002). Conclusions: This DCE identified COVID-19 vaccine attributes, such as protection against severe COVID-19, that may influence preference and drive choice and can inform vaccine strategies. The high ranking of common and serious vaccine side effects suggests that, when the efficacy of 2 vaccines is comparable, safety is a key decision-making factor. %M 39412841 %R 10.2196/57242 %U https://publichealth.jmir.org/2024/1/e57242 %U https://doi.org/10.2196/57242 %U http://www.ncbi.nlm.nih.gov/pubmed/39412841 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49871 %T Spatiotemporal Cluster Detection for COVID-19 Outbreak Surveillance: Descriptive Analysis Study %A Martonik,Rachel %A Oleson,Caitlin %A Marder,Ellyn %+ Deloitte, 1919 North Lynn Street, Arlington, VA, 22209, United States, 1 7032039550, rachel.martonik@gmail.com %K COVID-19 %K cluster detection %K disease outbreaks %K surveillance %K SaTScan %K space-time surveillance %K spatiotemporal %K United States %K outbreak %K outbreaks %K pandemic %K real-time surveillance %K detection %K tool %K tools %K effectiveness %K public health %K intervention %K interventions %K community settings %K outbreak detection %D 2024 %7 16.10.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the peak of the winter 2020-2021 surge, the number of weekly reported COVID-19 outbreaks in Washington State was 231; the majority occurred in high-priority settings such as workplaces, community settings, and schools. The Washington State Department of Health used automated address matching to identify clusters at health care facilities. No other systematic, statewide outbreak detection methods were in place. This was a gap given the high volume of cases, which delayed investigations and decreased data completeness, potentially leading to undetected outbreaks. We initiated statewide cluster detection using SaTScan, implementing a space-time permutation model to identify COVID-19 clusters for investigation. Objective: To improve outbreak detection, the Washington State Department of Health initiated a systematic cluster detection model to identify timely and actionable COVID-19 clusters for local health jurisdiction (LHJ) investigation and resource prioritization. This report details the model’s implementation and the assessment of the tool’s effectiveness. Methods: In total, 6 LHJs participated in a pilot to test model parameters including analysis type, geographic aggregation, cluster radius, and data lag. Parameters were determined through heuristic criteria to detect clusters early when they are smaller, making interventions more feasible. This study reviews all clusters detected after statewide implementation from July 17 to December 17, 2021. The clusters were analyzed by LHJ population and disease incidence. Clusters were compared with reported outbreaks. Results: A weekly, LHJ-specific retrospective space-time permutation model identified 2874 new clusters during this period. While the weekly analysis included case data from the prior 3 weeks, 58.25% (n=1674) of all clusters identified were timely—having occurred within 1 week of the analysis and early enough for intervention to prevent further transmission. There were 2874 reported outbreaks during this same period. Of those, 363 (12.63%) matched to at least one SaTScan cluster. The most frequent settings among reported and matched outbreaks were schools and youth programs (n=825, 28.71% and n=108, 29.8%), workplaces (n=617, 21.46% and n=56, 15%), and long-term care facilities (n=541, 18.82% and n=99, 27.3%). Settings with the highest percentage of clusters that matched outbreaks were community settings (16/72, 22%) and congregate housing (44/212, 20.8%). The model identified approximately one-third (119/363, 32.8%) of matched outbreaks before cases were associated with the outbreak event in our surveillance system. Conclusions: Our goal was to routinely and systematically identify timely and actionable COVID-19 clusters statewide. Regardless of population or incidence, the model identified reasonably sized, timely clusters statewide, meeting the objective. Among some high-priority settings subject to public health interventions throughout the pandemic, such as schools and community settings, the model identified clusters that were matched to reported outbreaks. In workplaces, another high-priority setting, results suggest the model might be able to identify outbreaks sooner than existing outbreak detection methods. %M 39412839 %R 10.2196/49871 %U https://publichealth.jmir.org/2024/1/e49871 %U https://doi.org/10.2196/49871 %U http://www.ncbi.nlm.nih.gov/pubmed/39412839 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 5 %N %P e48629 %T Identification of COVID-19–Associated Hepatitis in Children as an Emerging Complication in the Wake of SARS-CoV-2 Infections: Ambispective Observational Study %A Rawat,Sumit Kumar %A Asati,Ajit Anand %A Mishra,Nitu %A Jain,Ashish %A Ratho,Radha Kanta %K COVID-19 %K coronavirus %K SARS-CoV-2 %K liver %K hepatic %K hepatitis %K child %K children %K pediatric %K pediatrics %K retrospective %K observational %K jaundice %K youth %K inflammatory %K inflammation %D 2024 %7 11.10.2024 %9 %J JMIRx Med %G English %X Background: Although the pediatric population has largely remained free of severe COVID-19 symptoms, in some cases, SARS-CoV-2 infection has been associated with complications such as multiple inflammatory syndrome in children (MIS-C). We identified another a unique form of hepatitis occurring subsequent to asymptomatic SARS-CoV-2 infection, designated by us as COVID-19–associated hepatitis in children (CAH-C), in a subset of children who presented with hepatitis. Objective: Our study describes the clinical presentations, temporal association, and viral parameters of the CAH-C cases and compares them to those of MIS-C cases or other known forms of hepatitis in children. Methods: In an ambispective (retrospective and follow-up) observational study, records from April to July 2021 were reviewed for all children aged ≤14 years who were previously healthy and presented with a sudden onset of hepatitis, elevated transaminases, and nonobstructive jaundice. After performing all routine tests, those lacking marked inflammatory responses and without evidence of (1) other known causes of acute hepatitis or previous underlying liver disease and (2) multisystem involvement were classified as having CAH-C. Their characteristics were compared to those of children with MIS-C or other known forms of hepatitis. Results: Among the 5539 children tested for SARS-CoV-2, a total of 475 (8.6%) tested positive and 47 (0.8%) presented with hepatitis. Among the 47 children with hepatitis, 37 (79%) had features of CAH-C: having symptoms of hepatitis only, without protracted illness (mean length of stay 5 d), and an uneventful recovery following supportive treatment. In contrast, the remaining 10 (21%) had features of MIS-C–associated hepatitis: multiple system involvement; protracted illness (mean length of stay 8 d); and requiring admission to critical care, with a mortality rate of 30% (3/10). Conclusions: Our data suggest that CAH-C might be one of the new clinical complications associated with the emergence of newer variants of concern of SARS-CoV-2, which often result in changing presentations. Our findings should facilitate its early identification and thorough workup and aid its differentiation from other emerging syndromes in children, which would help initiate appropriate measures, enable better resource prioritization, and thus limit adversities. %R 10.2196/48629 %U https://xmed.jmir.org/2024/1/e48629 %U https://doi.org/10.2196/48629 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 5 %N %P e58018 %T Comparison of the Neutralization Power of Sotrovimab Against SARS-CoV-2 Variants: Development of a Rapid Computational Method %A Ashoor,Dana %A Marzouq,Maryam %A Fathallah,M-Dahmani %+ Department of Life Sciences, Health Biotechnology Program - King Fahad Chair for Health Biotechnology, College of Graduate Studies, Arabian Gulf University, Road 2904 Building 293, Manama, 329, Bahrain, 973 17239875, danana@agu.edu.bh %K in silico %K anti–SARS-CoV-2 %K neutralizing antibody %K Sotrovimab %K S309 %K variants %K SARS-CoV-2 %K Omicron %K subvariants %K computational method %K monoclonal %K amino acid %K protein %K mutation %D 2024 %7 10.10.2024 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: The rapid evolution of SARS-CoV-2 imposed a huge challenge on disease control. Immune evasion caused by genetic variations of the SARS-CoV-2 spike protein’s immunogenic epitopes affects the efficiency of monoclonal antibody–based therapy of COVID-19. Therefore, a rapid method is needed to evaluate the efficacy of the available monoclonal antibodies against the new emerging variants or potential novel variants. Objective: The aim of this study is to develop a rapid computational method to evaluate the neutralization power of anti–SARS-CoV-2 monoclonal antibodies against new SARS-CoV-2 variants and other potential new mutations. Methods: The amino acid sequence of the extracellular domain of the spike proteins of the severe acute respiratory syndrome coronavirus (GenBank accession number YP_009825051.1) and SARS-CoV-2 (GenBank accession number YP_009724390.1) were used to create computational 3D models for the native spike proteins. Specific mutations were introduced to the curated sequence to generate the different variant spike models. The neutralization potential of sotrovimab (S309) against these variants was evaluated based on its molecular interactions and Gibbs free energy in comparison to a reference model after molecular replacement of the reference receptor-binding domain with the variant’s receptor-binding domain. Results: Our results show a loss in the binding affinity of the neutralizing antibody S309 with both SARS-CoV and SARS-CoV-2. The binding affinity of S309 was greater to the Alpha, Beta, Gamma, and Kappa variants than to the original Wuhan strain of SARS-CoV-2. However, S309 showed a substantially decreased binding affinity to the Delta and Omicron variants. Based on the mutational profile of Omicron subvariants, our data describe the effect of the G339H and G339D mutations and their role in escaping antibody neutralization, which is in line with published clinical reports. Conclusions: This method is rapid, applicable, and of interest to adapt the use of therapeutic antibodies to the treatment of emerging variants. It could be applied to antibody-based treatment of other viral infections. %M 39388246 %R 10.2196/58018 %U https://bioinform.jmir.org/2024/1/e58018 %U https://doi.org/10.2196/58018 %U http://www.ncbi.nlm.nih.gov/pubmed/39388246 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e47370 %T Changes in the Epidemiological Features of Influenza After the COVID-19 Pandemic in China, the United States, and Australia: Updated Surveillance Data for Influenza Activity %A Jiang,Mingyue %A Jia,Mengmeng %A Wang,Qing %A Sun,Yanxia %A Xu,Yunshao %A Dai,Peixi %A Yang,Weizhong %A Feng,Luzhao %+ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31 Beiji Tower, Dongcheng District, Beijing, 100730, China, 86 10 65120716, fengluzhao@cams.cn %K influenza %K seasonal variation %K COVID-19 pandemic %K stringency index %D 2024 %7 9.10.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: There has been a global decrease in seasonal influenza activity since the onset of the COVID-19 pandemic. Objective: We aimed to describe influenza activity during the 2021/2022 season and compare it to the trends from 2012 to 2023. We also explored the influence of social and public health prevention measures during the COVID-19 pandemic on influenza activity. Methods: We obtained influenza data from January 1, 2012, to February 5, 2023, from publicly available platforms for China, the United States, and Australia. Mitigation measures were evaluated per the stringency index, a composite index with 9 measures. A general additive model was used to assess the stringency index and the influenza positivity rate correlation, and the deviance explained was calculated. Results: We used over 200,000 influenza surveillance data. Influenza activity remained low in the United States and Australia during the 2021/2022 season. However, it increased in the United States with a positive rate of 26.2% in the 49th week of 2022. During the 2021/2022 season, influenza activity significantly increased compared with the previous year in southern and northern China, with peak positivity rates of 28.1% and 35.1% in the second week of 2022, respectively. After the COVID-19 pandemic, the dominant influenza virus genotype in China was type B/Victoria, during the 2021/2022 season, and accounted for >98% (24,541/24,908 in the South and 20,543/20,634 in the North) of all cases. Influenza virus type B/Yamagata was not detected in all these areas after the COVID-19 pandemic. Several measures individually significantly influence local influenza activity, except for influenza type B in Australia. When combined with all the measures, the deviance explained values for influenza A and B were 87.4% (P<.05 for measures of close public transport and restrictions on international travel) and 77.6% in southern China and 83.4% (P<.05 for measures of school closing and close public transport) and 81.4% in northern China, respectively. In the United States, the association was relatively stronger, with deviance-explained values of 98.6% for influenza A and 99.1% (P<.05 for measures of restrictions on international travel and public information campaign) for influenza B. There were no discernible effects on influenza B activity in Australia between 2020 and 2022 due to the incredibly low positive rate of influenza B. Additionally, the deviance explained values were 95.8% (P<.05 for measures of restrictions on gathering size and restrictions on international travel) for influenza A and 72.7% for influenza B. Conclusions: Influenza activity has increased gradually since 2021. Mitigation measures for COVID-19 showed correlations with influenza activity, mainly driven by the early stage of the pandemic. During late 2021 and 2022, the influence of mitigation management for COVID-19 seemingly decreased gradually, as the activity of influenza increased compared to the 2020/2021 season. %M 39382955 %R 10.2196/47370 %U https://www.i-jmr.org/2024/1/e47370 %U https://doi.org/10.2196/47370 %U http://www.ncbi.nlm.nih.gov/pubmed/39382955 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e55208 %T Influenza-Like Illness in Lesotho From July 2020 to July 2021: Population-Based Participatory Surveillance Results %A Greenleaf,Abigail R %A Francis,Sarah %A Zou,Jungang %A Farley,Shannon M %A Lekhela,Tšepang %A Asiimwe,Fred %A Chen,Qixuan %K surveillance %K participatory surveillance %K influenza-like illness %K COVID-19 %K cell phone %K sub-Saharan Africa %K population-based %K Lesotho %K SARS-CoV-2 %K technology %K epidemiology %K adult %K data collection %K innovation %K mobile phone %K cellphone %D 2024 %7 8.10.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Participatory surveillance involves at-risk populations reporting their symptoms using technology. In Lesotho, a landlocked country of 2 million people in Southern Africa, laboratory and case-based COVID-19 surveillance systems were complemented by a participatory surveillance system called “LeCellPHIA” (Lesotho Cell Phone Population-Based HIV Impact Assessment Survey). Objective: This report describes the person, place, and time characteristics of influenza-like illness (ILI) in Lesotho from July 15, 2020, to July 15, 2021, and reports the risk ratio of ILI by key demographic variables. Methods: LeCellPHIA employed interviewers to call participants weekly to inquire about ILI. The average weekly incidence rate for the year-long period was created using a Quasi-Poisson model, which accounted for overdispersion. To identify factors associated with an increased risk of ILI, we conducted a weekly data analysis by fitting a multilevel Poisson regression model, which accounted for 3 levels of clustering. Results: The overall response rate for the year of data collection was 75%, which resulted in 122,985 weekly reports from 1776 participants. ILI trends from LeCellPHIA mirrored COVID-19 testing data trends, with an epidemic peak in mid to late January 2021. Overall, any ILI symptoms (eg, fever, dry cough, and shortness of breath) were reported at an average weekly rate of 879 per 100,000 (95% CI 782‐988) persons at risk. Compared to persons in the youngest age group (15‐19 years), all older age groups had an elevated risk of ILI, with the highest risk of ILI in the oldest age group (≥60 years; risk ratio 2.6, 95% CI 1.7‐3.8). Weekly data were shared in near real time with the National COVID-19 Secretariat and other stakeholders to monitor ILI trends, identify and respond to increases in reports of ILI, and inform policies and practices designed to reduce COVID-19 transmission in Lesotho. Conclusions: LeCellPHIA, an innovative and cost-effective system, could be replicated in countries where cell phone ownership is high but internet use is not yet high enough for a web- or app-based surveilance system. %R 10.2196/55208 %U https://publichealth.jmir.org/2024/1/e55208 %U https://doi.org/10.2196/55208 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e59274 %T Association Between Ursodeoxycholic Acid and Clinical Outcomes in Patients With COVID-19 Infection: Population-Based Cohort Study %A Lee,Hyunjun %A Kim,Min Gul %A Yeom,Sang Woo %A Noh,Sang Jae %A Jeong,Cho Yun %A Kim,Min Ji %A Kang,Min Gu %A Ko,Ji Hoon %A Park,Su Cheol %A Kweon,Hyeok Tae %A Sim,Sang Il %A Lee,Hyun %A You,Yeon Seok %A Kim,Jong Seung %+ Department of Medical Informatics, Department of Otorhinolaryngology, Jeonbuk National University School of Medicine and Hospital, 20 Geonji-ro, Deokjin-gu, Jeonju-si, Jeonbuk-do, Jeonju, 54907, Republic of Korea, 82 +82 63 250 2792, kjsjdk@gmail.com %K Covid 19 %K COVID-19 %K ursodeoxycholic acid %K population-based cohort study %K SARS-CoV-2 %K Coronavirus %K pandemic %K population-based %K retrospective cohort study %K propensity score %K UDCA %K public health %K common data model %K clinical %K severity %D 2024 %7 7.10.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Several studies have investigated the relationship between ursodeoxycholic acid (UDCA) and COVID-19 infection. However, complex and conflicting results have generated confusion in the application of these results. Objective: We aimed to investigate whether the association between UDCA and COVID-19 infection can also be demonstrated through the analysis of a large-scale cohort. Methods: This retrospective study used local and nationwide cohorts, namely, the Jeonbuk National University Hospital into the Observational Medical Outcomes Partnership common data model cohort (JBUH CDM) and the Korean National Health Insurance Service claim–based database (NHIS). We investigated UDCA intake and its relationship with COVID-19 susceptibility and severity using validated propensity score matching. Results: Regarding COVID-19 susceptibility, the adjusted hazard ratio (aHR) value of the UDCA intake was significantly lowered to 0.71 in the case of the JBUH CDM (95% CI 0.52-0.98) and was significantly lowered to 0.93 (95% CI 0.90-0.96) in the case of the NHIS. Regarding COVID-19 severity, the UDCA intake was found to be significantly lowered to 0.21 (95% CI 0.09-0.46) in the case of JBUH CDM. Furthermore, the aHR value was significantly lowered to 0.77 in the case of NHIS (95% CI 0.62-0.95). Conclusions: Using a large-scale local and nationwide cohort, we confirmed that UDCA intake was significantly associated with reductions in COVID-19 susceptibility and severity. These trends remained consistent regardless of the UDCA dosage. This suggests the potential of UDCA as a preventive and therapeutic agent for COVID-19 infection. %M 39139026 %R 10.2196/59274 %U https://publichealth.jmir.org/2024/1/e59274 %U https://doi.org/10.2196/59274 %U http://www.ncbi.nlm.nih.gov/pubmed/39139026 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47879 %T Evaluation of Machine Learning to Detect Influenza Using Wearable Sensor Data and Patient-Reported Symptoms: Cohort Study %A Farooq,Kamran %A Lim,Melody %A Dennison-Hall,Lawrence %A Janson,Finn %A Olszewska,Aspen Hazel %A Ahmad Zabidi,Muhammad Mamduh %A Haratym-Rojek,Anna %A Narowski,Karol %A Clinch,Barry %A Prunotto,Marco %A Chawla,Devika %A Hunter,Victoria %A Ukachukwu,Vincent %+ Roche Data & Analytics Chapter (Data Science), Wurmisweg, Kaiseraugst, 4303, Switzerland, 41 616881111, kamran.farooq@roche.com %K influenza %K influenza-like illness %K wearable sensor %K person-generated health care data %K machine learning %D 2024 %7 4.10.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Machine learning offers quantitative pattern recognition analysis of wearable device data and has the potential to detect illness onset and monitor influenza-like illness (ILI) in patients who are infected. Objective: This study aims to evaluate the ability of machine-learning algorithms to distinguish between participants who are influenza positive and influenza negative in a cohort of symptomatic patients with ILI using wearable sensor (activity) data and self-reported symptom data during the latent and early symptomatic periods of ILI. Methods: This prospective observational cohort study used the extreme gradient boosting (XGBoost) classifier to determine whether a participant was influenza positive or negative based on 3 models using symptom-only data, activity-only data, and combined symptom and activity data. Data were collected from the Home Testing of Respiratory Illness (HTRI) study and FluStudy2020, both conducted between December 2019 and October 2020. The model was developed using the FluStudy2020 data and tested on the HTRI data. Analyses included participants in these studies with an at-home influenza diagnostic test result. Fitbit (Google LLC) devices were used to measure participants’ steps, heart rate, and sleep parameters. Participants detailed their ILI symptoms, health care–seeking behaviors, and quality of life. Model performance was assessed by area under the curve (AUC), balanced accuracy, recall (sensitivity), specificity, precision (positive predictive value), negative predictive value, and weighted harmonic mean of precision and recall (F2) score. Results: An influenza diagnostic test result was available for 953 and 925 participants in HTRI and FluStudy2020, respectively, of whom 848 (89%) and 840 (90.8%) had activity data. For the training and validation sets, the highest performing model was trained on the combined symptom and activity data (training AUC=0.77; validation AUC=0.74) versus symptom-only (training AUC=0.73; validation AUC=0.72) and activity-only (training AUC=0.68; validation AUC=0.65) data. For the FluStudy2020 test set, the performance of the model trained on combined symptom and activity data was closely aligned with that of the symptom-only model (combined symptom and activity test AUC=0.74; symptom-only test AUC=0.74). These results were validated using independent HTRI data (combined symptom and activity evaluation AUC=0.75; symptom-only evaluation AUC=0.74). The top features guiding influenza detection were cough; mean resting heart rate during main sleep; fever; total minutes in bed for the combined model; and fever, cough, and sore throat for the symptom-only model. Conclusions: Machine-learning algorithms had moderate accuracy in detecting influenza, suggesting that previous findings from research-grade sensors tested in highly controlled experimental settings may not easily translate to scalable commercial-grade sensors. In the future, more advanced wearable sensors may improve their performance in the early detection and discrimination of viral respiratory infections. %M 39365646 %R 10.2196/47879 %U https://www.jmir.org/2024/1/e47879 %U https://doi.org/10.2196/47879 %U http://www.ncbi.nlm.nih.gov/pubmed/39365646 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e62863 %T Association Between Climatic Factors and Varicella Incidence in Wuxi, East China, 2010-2019: Surveillance Study %A Zhang,Kehong %A Shen,Ganglei %A Yuan,Yue %A Shi,Chao %+ President Office, Wuxi Hospital Affiliated to Nanjing University of Chinese Medicine, Room 707, Building 5, Number 8 Zhongnan West Road, Wuxi, 214071, China, 86 051088859999 ext 17003, 1358599249@qq.com %K varicella %K meteorological factors %K Generalized Additive Model %K Segmented Linear Regression Model %K China %K meteorology %K regression %K statistics %K surveillance %D 2024 %7 2.10.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Varicella is a common infectious disease and a growing public health concern in China, with increasing outbreaks in Wuxi. Analyzing the correlation between climate factors and varicella incidence in Wuxi is crucial for guiding public health prevention efforts. Objective: This study examines the impact of meteorological variables on varicella incidence in Wuxi, eastern China, from 2010 to 2019, offering insights for public health interventions. Methods: We collected daily meteorological data and varicella case records from January 1, 2010, to December 31, 2019, in Wuxi, China. Generalized cross-validation identified optimal lag days by selecting those with the lowest score. The relationship between meteorological factors and varicella incidence was analyzed using Poisson generalized additive models and segmented linear regression. Subgroup analyses were conducted by gender and age. Results: The study encompassed 64,086 varicella cases. Varicella incidence in Wuxi city displayed a bimodal annual pattern, with peak occurrences from November to January of the following year and lower peaks from May to June. Several meteorological factors influencing varicella risk were identified. A decrease of 1°C when temperatures were ≤20°C corresponded to a 1.99% increase in varicella risk (95% CI 1.57-2.42, P<.001). Additionally, a decrease of 1°C below 22.38°C in ground temperature was associated with a 1.36% increase in varicella risk (95% CI 0.96-1.75, P<.001). Each 1 mm increase in precipitation above 4.88 mm was associated with a 1.62% increase in varicella incidence (95% CI 0.93-2.30, P<.001). A 1% rise in relative humidity above 57.18% increased varicella risk by 2.05% (95% CI 1.26-2.84, P<.001). An increase in air pressure of 1 hPa below 1011.277 hPa was associated with a 1.75% rise in varicella risk (95% CI 0.75-2.77, P<.001). As wind speed and evaporation increased, varicella risk decreased linearly with a 16-day lag. Varicella risk was higher with sunshine durations exceeding 1.825 hours, with a 14-day lag, increasing by 1.30% for each additional hour of sunshine (95% CI 0.62-2.00, P=.006). Subgroup analyses revealed that teenagers and children under 17 years of age faced higher varicella risks associated with temperature, average ground temperature, precipitation, relative humidity, and air pressure. Adults aged 18-64 years experienced increased risk with longer sunshine durations. Additionally, males showed higher varicella risks related to ground temperature and air pressure compared with females. However, no significant gender differences were observed regarding varicella risks associated with temperature (male: P<.001; female P<.001), precipitation (male: P=.001; female: P=.06), and sunshine duration (male: P=.53; female: P=.04). Conclusions: Our preliminary findings highlight the interplay between varicella outbreaks in Wuxi city and meteorological factors. These insights provide valuable support for developing policies aimed at reducing varicella risks through informed public health measures. %M 39228304 %R 10.2196/62863 %U https://publichealth.jmir.org/2024/1/e62863 %U https://doi.org/10.2196/62863 %U http://www.ncbi.nlm.nih.gov/pubmed/39228304 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e55697 %T Associations Between Acute COVID-19 Symptom Profiles and Long COVID Prevalence: Population-Based Cross-Sectional Study %A Hirschtick,Jana L %A Slocum,Elizabeth %A Xie,Yanmei %A Power,Laura E %A Elliott,Michael R %A Orellana,Robert C %A Fleischer,Nancy L %K SARS-CoV-2 %K COVID-19 %K post-acute COVID-19 syndrome %K epidemiology %K surveillance %D 2024 %7 1.10.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Growing evidence suggests that severe acute COVID-19 illness increases the risk of long COVID (also known as post–COVID-19 condition). However, few studies have examined associations between acute symptoms and long COVID onset. Objective: This study aimed to examine associations between acute COVID-19 symptom profiles and long COVID prevalence using a population-based sample. Methods: We used a dual mode (phone and web-based) population-based probability survey of adults with polymerase chain reaction–confirmed SARS-CoV-2 between June 2020 and May 2022 in the Michigan Disease Surveillance System to examine (1) how acute COVID-19 symptoms cluster together using latent class analysis, (2) sociodemographic and clinical predictors of symptom clusters using multinomial logistic regression accounting for classification uncertainties, and (3) associations between symptom clusters and long COVID prevalence using modified Poisson regression. Results: In our sample (n=4169), 15.9% (n=693) had long COVID, defined as new or worsening symptoms at least 90 days post SARS-CoV-2 infection. We identified 6 acute COVID-19 symptom clusters resulting from the latent class analysis, with flu-like symptoms (24.7%) and fever (23.6%) being the most prevalent in our sample, followed by nasal congestion (16.4%), multi-symptomatic (14.5%), predominance of fatigue (10.8%), and predominance of shortness of breath (10%) clusters. Long COVID prevalence was highest in the multi-symptomatic (39.7%) and predominance of shortness of breath (22.4%) clusters, followed by the flu-like symptom (15.8%), predominance of fatigue (14.5%), fever (6.4%), and nasal congestion (5.6%) clusters. After adjustment, females (vs males) had greater odds of membership in the multi-symptomatic, flu-like symptom, and predominance of fatigue clusters, while adults who were Hispanic or another race or ethnicity (vs non-Hispanic White) had greater odds of membership in the multi-symptomatic cluster. Compared with the nasal congestion cluster, the multi-symptomatic cluster had the highest prevalence of long COVID (adjusted prevalence ratio [aPR] 6.1, 95% CI 4.3‐8.7), followed by the predominance of shortness of breath (aPR 3.7, 95% CI 2.5‐5.5), flu-like symptom (aPR 2.8, 95% CI 1.9‐4.0), and predominance of fatigue (aPR 2.2, 95% CI 1.5‐3.3) clusters. Conclusions: Researchers and clinicians should consider acute COVID-19 symptom profiles when evaluating subsequent risk of long COVID, including potential mechanistic pathways in a research context, and proactively screen high-risk patients during the provision of clinical care. %R 10.2196/55697 %U https://publichealth.jmir.org/2024/1/e55697 %U https://doi.org/10.2196/55697 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57596 %T Long-Term Post–COVID-19 Health and Psychosocial Effects and Coping Resources Among Survivors of Severe and Critical COVID-19 in Central and Eastern Europe: Protocol for an International Qualitative Study %A Alexandrova-Karamanova,Anna %A Lauri Korajlija,Anita %A Halama,Peter %A Baban,Adriana %+ Department of Psychology, Institute for Population and Human Studies, Bulgarian Academy of Sciences, Acad. Georgi Bonchev St., Bl. 6, Fl. 5, Sofia, 1113, Bulgaria, 359 29793043, annaalexandrova@yahoo.com %K COVID-19 survivors %K severe COVID-19 %K COVID-19 hospitalization %K long-term COVID-19 effects %K post–COVID-19 condition %K posttraumatic growth %K coping resources %K qualitative %K international %K Central and Eastern Europe %D 2024 %7 30.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a strong need to determine pandemic and postpandemic challenges and effects at the individual, family, community, and societal levels. Post–COVID-19 health and psychosocial effects have long-lasting impacts on the physical and mental health and quality of life of a large proportion of survivors, especially survivors of severe and critical COVID-19, extending beyond the end of the pandemic. While research has mostly focused on the negative short- and long-term effects of COVID-19, few studies have examined the positive effects of the pandemic, such as posttraumatic growth. It is essential to study both negative and positive long-term post–COVID-19 effects and to acknowledge the role of the resources available to the individual to cope with stress and trauma. This knowledge is especially needed in understudied regions hit hard by the pandemic, such as the region of Central and Eastern Europe. A qualitative approach could provide unique insights into the subjective perspectives of survivors on their experiences with severe COVID-19 disease and its lingering impact on their lives. Objective: The aim of the study is to qualitatively explore the experiences of adult survivors of severe or critical COVID-19 throughout the acute and postacute period in 5 Central and Eastern European countries (Bulgaria, Slovakia, Croatia, Romania, and Poland); gain insight into negative (post–COVID-19 condition and quality of life) and positive (posttraumatic growth) long-term post–COVID effects; and understand the role of survivors’ personal, social, and other coping resources and local sociocultural context and epidemic-related situations. Methods: This is a qualitative thematic analysis study with an experiential reflexive perspective and inductive orientation. The analytical approach involves 2-stage data analysis: national analyses in stage 1 and international analysis in stage 2. Data are collected from adult survivors of severe and critical COVID-19 through in-depth semistructured interviews conducted in the period after hospital discharge. Results: As of the publication of this paper, data collection is complete. The total international sample includes 151 survivors of severe and critical COVID-19: Bulgaria (n=33, 21.8%), Slovakia (n=30, 19.9%), Croatia (n=30, 19.9%), Romania (n=30, 19.9%), and Poland (n=28, 18.5%). National-level qualitative thematic analysis is currently underway, and several papers based on national results have been published. Cross-national analysis has started in 2024. The results will be submitted for publication in the third and fourth quarters of 2024. Conclusions: This research emphasizes the importance of a deeper understanding of the ongoing health and psychosocial challenges survivors face and what helps them cope with these challenges and, in some cases, thrive. It has implications for informing holistic care and improving the health and psychosocial outcomes of survivors of COVID-19 and will be crucial for evaluating the overall impact and multifaceted implications of the pandemic and for informing future pandemic preparedness. International Registered Report Identifier (IRRID): DERR1-10.2196/57596 %M 39348673 %R 10.2196/57596 %U https://www.researchprotocols.org/2024/1/e57596 %U https://doi.org/10.2196/57596 %U http://www.ncbi.nlm.nih.gov/pubmed/39348673 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58584 %T Estimating the Size of Populations at High Risk of Malaria in 2 Operational Districts in Cambodia: Household-Based Survey %A Jacobson,Jerry O %A Doum,Dyna %A Lobo,Neil F %A Sovannaroth,Siv %A Tatarsky,Allison %A McIver,David J %+ Malaria Elimination Initiative, Institute for Global Health Sciences, University of California, San Francisco, 1975 4th Street, San Francisco, CA, 94158, United States, 1 4153533000, davidjmciver@gmail.com %K population size estimate %K malaria %K forest exposure %K Greater Mekong Subregion %K infectious %K epidemiology %K epidemiological %K size %K population %K communicable %K risks %K surveys %K questionnaires %D 2024 %7 27.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Cambodia is targeting the elimination of malaria by 2025. The last remaining pockets of malaria in Cambodia are concentrated among populations exposed to forested areas, but the size of these populations is not well understood. To plan for the procurement and distribution of vector-control tools, chemoprophylaxis, and other commodities for malaria prevention and surveillance, robust estimates of the population at greatest risk are required. Objective: This study aims to estimate the number of forest-exposed individuals residing in Cambodia’s highest-burden operational districts (ODs) in 2 provinces with active malaria transmission. Methods: In April 2023, a multistage, in-person survey was conducted among residents in the 2 ODs in Cambodia with the highest malaria burden: Sen Monorom in Mondulkiri province and Phnom Srouch in Kampong Speu province. In each OD, 10 villages were randomly selected, and 35 households were randomly selected from each village. To estimate the number of individuals at high risk of malaria—defined as residing within 1 km of a forest or traveling at least once per week to the forest—respondents were asked about the distance from their household to the nearest forested area, and their travel patterns to forested areas. To account for mobility (ie, to avoid double-counting), respondents also provided information on overnight stays at other households in the selected villages in the past month. In the 4 selected villages in Sen Monorom OD where Project BITE forest packs (an intervention in the larger research program) had been distributed prior to the survey, respondents were also asked questions to determine if they had received such a pack, to develop smaller scale “multiplier method” estimates of at-risk individuals in each of those villages. Results: In Sen Monorom, 138 households and 872 individuals were enrolled in the survey, and in Phnom Srouch, 163 households and 844 individuals were enrolled. The estimated percentage of female householders was 49.7% (852/1716) across both ODs; the median age was 22 (IQR 12-37) years in Sen Monorom and 24.5 (IQR 16.0-40.5) years in Phnom Srouch (total age range 3-86). Based on mobility-adjusted survey estimates alone, 32% (280/706; 95% CI 19.9-47.2) of residents in Sen Monorom (an estimated 12,133-20,135 individuals) and 36% (68/198; 95% CI 24.5-45.5) of residents in Phnom Srouch (an estimated 1717-2203 individuals), met risk criteria for forest exposure. Between 125 and 186 individuals were estimated to be at risk in each of the 4 villages where the multiplier method could be applied. Conclusions: This study provides estimates of the number of individuals potentially at high risk for malaria infection due to forest exposure in 2 ODs in Cambodia. These estimates can support planning for malaria control and elimination efforts. The straightforward methods of household surveys and multipliers should be feasible for many national malaria control programs. %M 39331420 %R 10.2196/58584 %U https://publichealth.jmir.org/2024/1/e58584 %U https://doi.org/10.2196/58584 %U http://www.ncbi.nlm.nih.gov/pubmed/39331420 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53368 %T COVID-19 Health Impact: A Use Case for Syndromic Surveillance System Monitoring Based on Primary Care Patient Registries in the Netherlands %A Rahmon,Imme %A Bosmans,Mark %A Baliatsas,Christos %A Hooiveld,Mariette %A Marra,Elske %A Dückers,Michel %K SARS-CoV-2 %K epidemic surveillance %K public health %K general practice %K disaster health research %D 2024 %7 26.9.2024 %9 %J JMIR Public Health Surveill %G English %X 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. %R 10.2196/53368 %U https://publichealth.jmir.org/2024/1/e53368 %U https://doi.org/10.2196/53368 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e64286 %T Epidemiological Characteristics and Spatiotemporal Clustering of Pulmonary Tuberculosis Among Students in Southwest China From 2016 to 2022: Analysis of Population-Based Surveillance Data %A Kong,Deliang %A Wu,Chengguo %A Cui,Yimin %A Fan,Jun %A Zhang,Ting %A Zhong,Jiyuan %A Pu,Chuan %K student PTB %K Southwest China %K epidemiology %K visualizing incidence map %K spatial autocorrelation analysis %K spatiotemporal clusters %K pulmonary tuberculosis %D 2024 %7 24.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Pulmonary tuberculosis (PTB), as a respiratory infectious disease, poses significant risks of covert transmission and dissemination. The high aggregation and close contact among students in Chinese schools exacerbate the transmission risk of PTB outbreaks. Objective: This study investigated the epidemiological characteristics, geographic distribution, and spatiotemporal evolution of student PTB in Chongqing, Southwest China, aiming to delineate the incidence risks and clustering patterns of PTB among students. Methods: PTB case data from students monitored and reported in the Tuberculosis Information Management System within the China Information System for Disease Control and Prevention were used for this study. Descriptive analyses were conducted to characterize the epidemiological features of student PTB. Spatial trend surface analysis, global and local spatial autocorrelation analyses, and disease rate mapping were performed using ArcGIS 10.3. SaTScan 9.6 software was used to identify spatiotemporal clusters of PTB cases. Results: From 2016 to 2022, a total of 9920 student TB cases were reported in Chongqing, Southwest China, with an average incidence rate of 24.89/100,000. The incidence of student TB showed an initial increase followed by a decline, yet it remained relatively high. High school students (age: 13‐18 years; 6649/9920, 67.03%) and college students (age: ≥19 years; 2921/9920, 29.45%) accounted for the majority of student PTB cases. Patient identification primarily relied on passive detection, with a high proportion of delayed diagnosis and positive etiological results. COVID-19 prevention measures have had some impact on reducing incidence levels, but the primary factor appears to be the implementation of screening measures, which facilitated earlier case detection. Global spatial autocorrelation analysis indicated Moran I values of >0 for all years except 2018, ranging from 0.1908 to 0.4645 (all P values were <.05), suggesting strong positive spatial clustering of student PTB cases across Chongqing. Local spatial autocorrelation identified 7 high-high clusters, 13 low-low clusters, 5 high-low clusters, and 4 low-high clusters. High-high clusters were predominantly located in the southeast and northeast parts of Chongqing, consistent with spatial trend surface analysis and spatiotemporal clustering results. Spatiotemporal scan analysis revealed 4 statistically significant spatiotemporal clusters, with the most likely cluster in the southeast (relative risk [RR]=2.87, log likelihood ratio [LLR]=574.29, P<.001) and a secondary cluster in the northeast (RR=1.99, LLR=234.67, P<.001), indicating higher reported student TB cases and elevated risks of epidemic spread within these regions. Conclusions: Future efforts should comprehensively enhance prevention and control measures in high-risk areas of PTB in Chongqing to mitigate the incidence risk among students. Additionally, implementing proactive screening strategies and enhancing screening measures are crucial for early identification of student patients to prevent PTB outbreaks in schools. %R 10.2196/64286 %U https://publichealth.jmir.org/2024/1/e64286 %U https://doi.org/10.2196/64286 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54503 %T Assessment of the Effective Sensitivity of SARS-CoV-2 Sample Pooling Based on a Large-Scale Screening Experience: Retrospective Analysis %A Cabrera Alvargonzalez,Jorge J %A Larrañaga,Ana %A Martinez,Javier %A Pérez Castro,Sonia %A Rey Cao,Sonia %A Daviña Nuñez,Carlos %A Del Campo Pérez,Víctor %A Duran Parrondo,Carmen %A Suarez Luque,Silvia %A González Alonso,Elena %A Silva Tojo,Alfredo José %A Porteiro,Jacobo %A Regueiro,Benito %+ Microbiology Department, Complexo Hospitalario Universitario de Vigo, Servicio Galego de Saude, Estrada de Clara Campoamor, 341, Vigo, 36312, Spain, 34 986811111, jorge.julio.cabrera.alvargonzalez@sergas.es %K pooling %K sensitivity %K SARS-CoV-2 %K PCR %K saliva %K screening %K surveillance %K COVID-19 %K nonsymptomatic %K transmission control %D 2024 %7 24.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The development of new large-scale saliva pooling detection strategies can significantly enhance testing capacity and frequency for asymptomatic individuals, which is crucial for containing SARS-CoV-2. Objective: This study aims to implement and scale-up a SARS-CoV-2 screening method using pooled saliva samples to control the virus in critical areas and assess its effectiveness in detecting asymptomatic infections. Methods: Between August 2020 and February 2022, our laboratory received a total of 928,357 samples. Participants collected at least 1 mL of saliva using a self-sampling kit and registered their samples via a smartphone app. All samples were directly processed using AutoMate 2550 for preanalytical steps and then transferred to Microlab STAR, managed with the HAMILTON Pooling software for pooling. The standard pool preset size was 20 samples but was adjusted to 5 when the prevalence exceeded 2% in any group. Real-time polymerase chain reaction (RT-PCR) was conducted using the Allplex SARS-CoV-2 Assay until July 2021, followed by the Allplex SARS-CoV-2 FluA/FluB/RSV assay for the remainder of the study period. Results: Of the 928,357 samples received, 887,926 (95.64%) were fully processed into 56,126 pools. Of these pools, 4863 tested positive, detecting 5720 asymptomatic infections. This allowed for a comprehensive analysis of pooling’s impact on RT-PCR sensitivity and false-negative rate (FNR), including data on positive samples per pool (PPP). We defined Ctref as the minimum cycle threshold (Ct) of each data set from a sample or pool and compared these Ctref results from pooled samples with those of the individual tests (ΔCtP). We then examined their deviation from the expected offset due to dilution [ΔΔCtP = ΔCtP – log2]. In this work, the ΔCtP and ΔΔCtP were 2.23 versus 3.33 and –0.89 versus 0.23, respectively, comparing global results with results for pools with 1 positive sample per pool. Therefore, depending on the number of genes used in the test and the size of the pool, we can evaluate the FNR and effective sensitivity (1 – FNR) of the test configuration. In our scenario, with a maximum of 20 samples per pool and 3 target genes, statistical observations indicated an effective sensitivity exceeding 99%. From an economic perspective, the focus is on pooling efficiency, measured by the effective number of persons that can be tested with 1 test, referred to as persons per test (PPT). In this study, the global PPT was 8.66, reflecting savings of over 20 million euros (US $22 million) based on our reagent prices. Conclusions: Our results demonstrate that, as expected, pooling reduces the sensitivity of RT-PCR. However, with the appropriate pool size and the use of multiple target genes, effective sensitivity can remain above 99%. Saliva pooling may be a valuable tool for screening and surveillance in asymptomatic individuals and can aid in controlling SARS-CoV-2 transmission. Further studies are needed to assess the effectiveness of these strategies for SARS-CoV-2 and their application to other microorganisms or biomarkers detected by PCR. %M 39316785 %R 10.2196/54503 %U https://publichealth.jmir.org/2024/1/e54503 %U https://doi.org/10.2196/54503 %U http://www.ncbi.nlm.nih.gov/pubmed/39316785 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54861 %T Kinetics of Viral Shedding for Outbreak Surveillance of Emerging Infectious Diseases: Modeling Approach to SARS-CoV-2 Alpha and Omicron Infection %A Lin,Ting-Yu %A Yen,Amy Ming-Fang %A Chen,Sam Li-Sheng %A Hsu,Chen-Yang %A Lai,Chao-Chih %A Luh,Dih-Ling %A Yeh,Yen-Po %A Chen,Tony Hsiu-Hsi %+ Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Room 533, No 17, Xu-Zhou Road, Taipei, 100, Taiwan, 886 233668033, chenlin@ntu.edu.tw %K COVID-19 %K PCR testing %K Ct values %K viral load %K kinetics of viral shedding %K emerging infectious disease %K SARS-CoV-2 variants %K infection surveillance %D 2024 %7 19.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Previous studies have highlighted the importance of viral shedding using cycle threshold (Ct) values obtained via reverse transcription polymerase chain reaction to understand the epidemic trajectories of SARS-CoV-2 infections. However, it is rare to elucidate the transition kinetics of Ct values from the asymptomatic or presymptomatic phase to the symptomatic phase before recovery using individual repeated Ct values. Objective: This study proposes a novel Ct-enshrined compartment model to provide a series of quantitative measures for delineating the full trajectories of the dynamics of viral load from infection until recovery. Methods: This Ct-enshrined compartment model was constructed by leveraging Ct-classified states within and between presymptomatic and symptomatic compartments before recovery or death among people with infections. A series of recovery indices were developed to assess the net kinetic movement of Ct-up toward and Ct-down off recovery. The model was applied to (1) a small-scale community-acquired Alpha variant outbreak under the “zero-COVID-19” policy without vaccines in May 2021 and (2) a large-scale community-acquired Omicron variant outbreak with high booster vaccination rates following the lifting of the “zero-COVID-19” policy in April 2022 in Taiwan. The model used Bayesian Markov chain Monte Carlo methods with the Metropolis-Hastings algorithm for parameter estimation. Sensitivity analyses were conducted by varying Ct cutoff values to assess the robustness of the model. Results: The kinetic indicators revealed a marked difference in viral shedding dynamics between the Alpha and Omicron variants. The Alpha variant exhibited slower viral shedding and lower recovery rates, but the Omicron variant demonstrated swifter viral shedding and higher recovery rates. Specifically, the Alpha variant showed gradual Ct-up transitions and moderate recovery rates, yielding a presymptomatic recovery index slightly higher than 1 (1.10), whereas the Omicron variant had remarkable Ct-up transitions and significantly higher asymptomatic recovery rates, resulting in a presymptomatic recovery index much higher than 1 (152.5). Sensitivity analysis confirmed the robustness of the chosen Ct values of 18 and 25 across different recovery phases. Regarding the impact of vaccination, individuals without booster vaccination had a 19% higher presymptomatic incidence rate compared to those with booster vaccination. Breakthrough infections in boosted individuals initially showed similar Ct-up transition rates but higher rates in later stages compared to nonboosted individuals. Overall, booster vaccination improved recovery rates, particularly during the symptomatic phase, although recovery rates for persistent asymptomatic infection were similar regardless of vaccination status once the Ct level exceeded 25. Conclusions: The study provides new insights into dynamic Ct transitions, with the notable finding that Ct-up transitions toward recovery outpaced Ct-down and symptom-surfacing transitions during the presymptomatic phase. The Ct-up against Ct-down transition varies with variants and vaccination status. The proposed Ct-enshrined compartment model is useful for the surveillance of emerging infectious diseases in the future to prevent community-acquired outbreaks. %M 39298261 %R 10.2196/54861 %U https://publichealth.jmir.org/2024/1/e54861 %U https://doi.org/10.2196/54861 %U http://www.ncbi.nlm.nih.gov/pubmed/39298261 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e57334 %T Metagenomics in the Diagnosis of Pneumonia: Protocol for a Systematic Review %A Quarton,Samuel %A Livesey,Alana %A Jeff,Charlotte %A Hatton,Christopher %A Scott,Aaron %A Parekh,Dhruv %A Thickett,David %A McNally,Alan %A Sapey,Elizabeth %+ National Institute for Health Research Birmingham Biomedical Research Centre, Institute of Translational Medicine, Birmingham, B15 2TH, United Kingdom, 44 01213712000, s.quarton@bham.ac.uk %K pneumonia %K metagenomics %K CAP %K community-acquired pneumonia %K HAP %K hospital-acquired pneumonia %K VAP %K ventilator-associated pneumonia %K diagnosis %K respiratory tract infection %K systematic review %D 2024 %7 18.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Causative pathogens are currently identified in only a minority of pneumonia cases, which affects antimicrobial stewardship. Metagenomic next-generation sequencing (mNGS) has potential to enhance pathogen detection due to its sensitivity and broad applicability. However, while studies have shown improved sensitivity compared with conventional microbiological methods for pneumonia diagnosis, it remains unclear whether this can translate into clinical benefit. Most existing studies focus on patients who are ventilated, readily allowing for analysis of bronchoalveolar lavage fluid (BALF). The impact of sample type on the use of metagenomic analysis remains poorly defined. Similarly, previous studies rarely differentiate between the types of pneumonia involved—community-acquired pneumonia (CAP), hospital-acquired pneumonia (HAP), or ventilator-associated pneumonia (VAP)—which have different clinical profiles. Objective: This study aims to determine the clinical use of mNGS in CAP, HAP, and VAP, compared with traditional microbiological methods. Methods: We aim to review all studies (excluding case reports of a series of fewer than 10 people) of adult patients with suspected or confirmed pneumonia that compare metagenomic analysis with traditional microbiology techniques, including culture, antigen-based testing, and polymerase chain reaction–based assays. Relevant studies will be identified through systematic searches of the Embase, MEDLINE, Scopus, and Cochrane CENTRAL databases. Screening of titles, abstracts, and subsequent review of eligible full texts will be done by 2 separate reviewers (SQ and 1 of AL, CJ, or CH), with a third clinician (ES) providing adjudication in case of disagreement. Our focus is on the clinical use of metagenomics for patients with CAP, HAP, and VAP. Data extracted will focus on clinically important outcomes—pathogen positivity rate, laboratory turnaround time, impact on clinical decision-making, length of stay, and 30-day mortality. Subgroup analyses will be performed based on the type of pneumonia (CAP, HAP, or VAP) and sample type used. The risk of bias will be assessed using the QUADAS-2 tool for diagnostic accuracy studies. Outcome data will be combined in a random-effects meta-analysis, and where this is not possible, a narrative synthesis will be undertaken. Results: The searches were completed with the assistance of a medical librarian on January 13, 2024, returning 5750 records. Screening and data extraction are anticipated to be completed by September 2024. Conclusions: Despite significant promise, the impact of metagenomic analysis on clinical pathways remains unclear. Furthermore, it is unclear whether the use of this technique will alter depending on whether the pneumonia is a CAP, HAP, or VAP or the sample type that is collected. This systematic review will assess the current evidence base to support the benefit of clinical outcomes for metagenomic analysis, depending on the setting of pneumonia diagnosis or specimen type used. It will identify areas where further research is needed to advance this methodology into routine care. Trial Registration: PROSPERO CRD42023488096; https://tinyurl.com/3suy7cma International Registered Report Identifier (IRRID): DERR1-10.2196/57334 %M 39293053 %R 10.2196/57334 %U https://www.researchprotocols.org/2024/1/e57334 %U https://doi.org/10.2196/57334 %U http://www.ncbi.nlm.nih.gov/pubmed/39293053 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e58704 %T From Fax to Secure File Transfer Protocol: The 25-Year Evolution of Real-Time Syndromic Surveillance in England %A Elliot,Alex J %A Hughes,Helen E %A Harcourt,Sally E %A Smith,Sue %A Loveridge,Paul %A Morbey,Roger A %A Bains,Amardeep %A Edeghere,Obaghe %A Jones,Natalia R %A Todkill,Daniel %A Smith,Gillian E %+ Real-time Syndromic Surveillance Team, UK Health Security Agency, 23 Stephenson Street, Birmingham, B2 4BH, United Kingdom, 44 1212329211, alex.elliot@ukhsa.gov.uk %K epidemiology %K population surveillance %K sentinel surveillance %K public health surveillance %K bioterrorism %K mass gathering %K pandemics %D 2024 %7 17.9.2024 %9 Viewpoint %J J Med Internet Res %G English %X The purpose of syndromic surveillance is to provide early warning of public health incidents, real-time situational awareness during incidents and emergencies, and reassurance of the lack of impact on the population, particularly during mass gatherings. The United Kingdom Health Security Agency (UKHSA) currently coordinates a real-time syndromic surveillance service that encompasses 6 national syndromic surveillance systems reporting on daily health care usage across England. Each working day, UKHSA analyzes syndromic data from over 200,000 daily patient encounters with the National Health Service, monitoring over 140 unique syndromic indicators, risk assessing over 50 daily statistical exceedances, and taking and recommending public health action on these daily. This English syndromic surveillance service had its origins as a small exploratory pilot in a single region of England in 1999 involving a new pilot telehealth service, initially reporting only on “cold or flu” calls. This pilot showed the value of syndromic surveillance in England, providing advanced warning of the start of seasonal influenza activity over existing laboratory-based surveillance systems. Since this initial pilot, a program of real-time syndromic surveillance has evolved from the single-system, -region, -indicator pilot (using manual data transfer methods) to an all-hazard, multisystem, automated national service. The suite of systems now monitors a wide range of syndromes, from acute respiratory illness to diarrhea to cardiac conditions, and is widely used in routine public health surveillance and for monitoring seasonal respiratory disease and incidents such as the COVID-19 pandemic. Here, we describe the 25-year evolution of the English syndromic surveillance system, focusing on the expansion and improvements in data sources and data management, the technological and digital enablers, and novel methods of data analytics and visualization. %M 39288377 %R 10.2196/58704 %U https://www.jmir.org/2024/1/e58704 %U https://doi.org/10.2196/58704 %U http://www.ncbi.nlm.nih.gov/pubmed/39288377 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55290 %T 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 %A O'Connor,Suji Y %A Mationg,Mary Lorraine %A Kelly,Matthew J %A Williams,Gail M %A Clements,Archie CA %A Sripa,Banchob %A Sayasone,Somphou %A Khieu,Virak %A Wangdi,Kinley %A Stewart,Donald E %A Tangkawattana,Sirikachorn %A Suwannatrai,Apiporn T %A Savathdy,Vanthanom %A Khieu,Visal %A Odermatt,Peter %A Gordon,Catherine A %A Wannachart,Sangduan %A McManus,Donald P %A Gray,Darren J %+ National Centre for Epidemiology and Population Health, Australian National University, 62 Mills Road, Acton, 2601, Australia, 61 026125 2378, suji.oconnor@anu.edu.au %K attitude %K child %K health education %K helminths %K knowledge %K practices %K Opisthorchis viverrini %K randomized controlled trial %K schools %K Ascaris lumbricoides %K Trichuris trichiura %K hookworm %K Magic Glasses %D 2024 %7 16.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 39283663 %R 10.2196/55290 %U https://www.researchprotocols.org/2024/1/e55290 %U https://doi.org/10.2196/55290 %U http://www.ncbi.nlm.nih.gov/pubmed/39283663 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52490 %T Using AI to Differentiate Mpox From Common Skin Lesions in a Sexual Health Clinic: Algorithm Development and Validation Study %A Soe,Nyi Nyi %A Yu,Zhen %A Latt,Phyu Mon %A Lee,David %A Samra,Ranjit Singh %A Ge,Zongyuan %A Rahman,Rashidur %A Sun,Jiajun %A Ong,Jason J %A Fairley,Christopher K %A Zhang,Lei %+ Artificial Intelligence and Modelling in Epidemiology Program, Melbourne Sexual Health Centre, Alfred Health, 580 Swanston Street, Carlton, Melbourne, Australia, 61 0433452013, Lei.Zhang1@monash.edu %K mpox %K sexually transmitted infections %K artificial intelligence %K deep learning %K skin lesion %D 2024 %7 13.9.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The 2022 global outbreak of mpox has significantly impacted health facilities, and necessitated additional infection prevention and control measures and alterations to clinic processes. Early identification of suspected mpox cases will assist in mitigating these impacts. Objective: We aimed to develop and evaluate an artificial intelligence (AI)–based tool to differentiate mpox lesion images from other skin lesions seen in a sexual health clinic. Methods: We used a data set with 2200 images, that included mpox and non-mpox lesions images, collected from Melbourne Sexual Health Centre and web resources. We adopted deep learning approaches which involved 6 different deep learning architectures to train our AI models. We subsequently evaluated the performance of each model using a hold-out data set and an external validation data set to determine the optimal model for differentiating between mpox and non-mpox lesions. Results: The DenseNet-121 model outperformed other models with an overall area under the receiver operating characteristic curve (AUC) of 0.928, an accuracy of 0.848, a precision of 0.942, a recall of 0.742, and an F1-score of 0.834. Implementation of a region of interest approach significantly improved the performance of all models, with the AUC for the DenseNet-121 model increasing to 0.982. This approach resulted in an increase in the correct classification of mpox images from 79% (55/70) to 94% (66/70). The effectiveness of this approach was further validated by a visual analysis with gradient-weighted class activation mapping, demonstrating a reduction in false detection within the background of lesion images. On the external validation data set, ResNet-18 and DenseNet-121 achieved the highest performance. ResNet-18 achieved an AUC of 0.990 and an accuracy of 0.947, and DenseNet-121 achieved an AUC of 0.982 and an accuracy of 0.926. Conclusions: Our study demonstrated it was possible to use an AI-based image recognition algorithm to accurately differentiate between mpox and common skin lesions. Our findings provide a foundation for future investigations aimed at refining the algorithm and establishing the place of such technology in a sexual health clinic. %M 39269753 %R 10.2196/52490 %U https://www.jmir.org/2024/1/e52490 %U https://doi.org/10.2196/52490 %U http://www.ncbi.nlm.nih.gov/pubmed/39269753 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e64373 %T Transgender-Specific Differentiated HIV Service Delivery Models in the South African Public Primary Health Care System (Jabula Uzibone): Protocol for an Implementation Study %A Poteat,Tonia %A Bothma,Rutendo %A Maposa,Innocent %A Hendrickson,Cheryl %A Meyer-Rath,Gesine %A Hill,Naomi %A Pettifor,Audrey %A Imrie,John %+ Duke University School of Nursing, 307 Trent Drive, Durham, NC, 27710, United States, 1 919 684 9303, tonia.poteat@duke.edu %K HIV prevention %K HIV care %K pre-exposure prophylaxis %K antiretroviral therapy %K gender affirmation %K transgender health %D 2024 %7 13.9.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Almost 60% of transgender people in South Africa are living with HIV. Ending the HIV epidemic will require that transgender people successfully access HIV prevention and treatment. However, transgender people often avoid health services due to facility-based stigma and lack of availability of gender-affirming care. Transgender-specific differentiated service delivery (TG-DSD) may improve engagement and facilitate progress toward HIV elimination. Wits RHI, a renowned South African research institute, established 4 TG-DSD demonstration sites in 2019, with funding from the US Agency for International Development. These sites offer unique opportunities to evaluate the implementation of TG-DSD and test their effectiveness. Objective: The Jabula Uzibone study seeks to assess the implementation, effectiveness, and cost of TG-DSD for viral suppression and prevention-effective adherence. Methods: The Jabula Uzibone study collects baseline and 12-month observation checklists at 8 sites and 6 (12.5%) key informant interviews per site at 4 TG-DSD and 4 standard sites (n=48). We seek to enroll ≥600 transgender clients, 50% at TG-DSD and 50% at standard sites: 67% clients with HIV and 33% clients without HIV per site type. Participants complete interviewer-administered surveys quarterly, and blood is drawn at baseline and 12 months for HIV RNA levels among participants with HIV and tenofovir levels among participants on pre-exposure prophylaxis. A subset of 30 participants per site type will complete in-depth interviews at baseline and 12 months: 15 participants will be living with HIV and 15 participants will be HIV negative. Qualitative analyses will explore aspects of implementation; regression models will compare viral suppression and prevention-effective adherence by site type. Structural equation modeling will test for mediation by stigma and gender affirmation. Microcosting approaches will estimate the cost per service user served and per service user successfully treated at TG-DSD sites relative to standard sites, as well as the budget needed for a broader implementation of TG-DSD. Results: Funded by the US National Institutes of Mental Health in April 2022, the study was approved by the Human Research Ethics Committee at University of Witwatersrand in June 2022 and the Duke University Health System Institutional Review Board in June 2023. Enrollment began in January 2024. As of July 31, 2024, a total of 593 transgender participants have been enrolled: 348 are living with HIV and 245 are HIV negative. We anticipate baseline enrollment will be complete by August 31, 2024, and the final study visit will take place no later than August 2025. Conclusions: Jabula Uzibone will provide data to inform HIV policies and practices in South Africa and generate the first evidence for implementation of TG-DSD in sub-Saharan Africa. Study findings may inform the use of TG-DSD strategies to increase care engagement and advance global progress toward HIV elimination goals. International Registered Report Identifier (IRRID): DERR1-10.2196/64373 %M 39269745 %R 10.2196/64373 %U https://www.researchprotocols.org/2024/1/e64373 %U https://doi.org/10.2196/64373 %U http://www.ncbi.nlm.nih.gov/pubmed/39269745 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51237 %T Patient Engagement With and Perceptions of the COVIDA Project, a Volunteer-Led Telemonitoring and Teleorientation Service for COVID-19 Community Management: Mixed Methods Study %A Escobar-Agreda,Stefan %A Silva-Valencia,Javier %A Soto-Becerra,Percy %A Reategui-Rivera,C Mahony %A De la Cruz-Torralva,Kelly %A Chahuara-Rojas,Max %A Hernandez-Iriarte,Bruno %A Espinoza-Herrera,Daniel Hector %A Delgado,Carlos Alberto %A Matassini,Silvana %A Vargas-Herrera,Javier %A Rojas-Mezarina,Leonardo %+ Unidad de Telesalud, Facultad de Medicina, Universidad Nacional Mayor de San Marcos, Grau Avenue, 775, Lima, 15001, Peru, 51 619 7000 ext 4650, jvargash@unmsm.edu.pe %K telemonitoring %K volunteers %K engagement %K COVID-19 %K Peru %K telehealth %K perceptions %D 2024 %7 13.9.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: During the pandemic in Peru, the COVIDA (Collaboration Network of Volunteer Brigade Members for the Investigation, Detection, and Primary Management of Community Cases Affected by COVID-19) project proposed an innovative way to provide telemonitoring and teleorientation to COVID-19 patients, led by health care student volunteers. However, it has not been described how this interaction is perceived from the patient’s perspective and which factors increase their engagement with this service. Objective: The aim of this study is to describe the perceptions of patients about COVIDA and identify factors associated with their engagement with this service. Methods: A mixed methods study was conducted to evaluate perceptions of patients that participated in the COVIDA project. This telehealth intervention organized by the National University of San Marcos was implemented in Peru from August to December 2020. The service involved daily phone calls by volunteer students to monitor registered COVID-19 patients until the completion of the 14th day of the illness or if a warning sign was identified. The volunteers also provided teleorientation to address the patients’ needs and concerns. Quantitative analysis was performed to describe the characteristics of the patients and to assess the factors related to their engagement with the service, which was defined by the percentage of participants who completed the follow-up according to their individual schedule. Qualitative analysis through semistructured interviews evaluated the patients’ perceptions of the service regarding the aspects of communication, interaction, and technology. Results: Of the 770 patients enrolled in COVIDA, 422 (55.7%) were female; the median age was 39 (IQR 28-52) years. During the monitoring, 380 patients (49.4%) developed symptoms, and 471 (61.2%) showed warning signs of COVID-19. The overall median for engagement was 93% (IQR 35.7%-100%). Among those patients who did not develop warning signs, engagement was associated with the presence of symptoms (OR 3.04, 95% CI 2.22-4.17), a positive COVID-19 test at the start of follow-up (OR 1.97, 95% CI 1.48-2.61), and the presence of comorbidities (OR 1.83, 95% CI 1.29-2.59). Patients reported that the volunteers provided clear and valuable information and emotional support. Communication via phone calls took place smoothly and without interruptions. Conclusions: COVIDA represents a well-accepted and well-perceived alternative model for student volunteers to provide telemonitoring, teleorientation, and emotional support to patients with COVID-19 in the context of overwhelmed demand for health care services. The deployment of this kind of intervention should be prioritized among patients with symptoms and comorbidities, as they show more engagement with these services. %M 39269741 %R 10.2196/51237 %U https://formative.jmir.org/2024/1/e51237 %U https://doi.org/10.2196/51237 %U http://www.ncbi.nlm.nih.gov/pubmed/39269741 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56398 %T Health Care Resource Use and Total Mortality After Hospital Admission for Severe COVID-19 Infections During the Initial Pandemic Wave in France: Descriptive Study %A Dziadzko,Mikhail %A Belhassen,Manon %A Van Ganse,Eric %A Heritier,Fabrice %A Berard,Marjorie %A Marant-Micallef,Claire %A Aubrun,Frederic %+ Hospices Civils de Lyon, Hôpital de la Croix Rousse, Département d’Anesthésie-Réanimation, Douleur, 103 Grande rue de la Croix Rousse, Lyon, 69004, France, 33 4 26 10 93 25, mikhail.dziadzko@chu-lyon.fr %K claims data %K COVID-19 infection %K France %K health care resource utilizationuse %K hospitalization %K mortality %K Post-Acute COVID-19 Syndrome %K PACS %K analysis %K COVID-19 %K health care %K infection %K infections %K pandemic %K descriptive study %K resource use %K outpatient care %K retrospective %K cohort study %K women %K female %K females %K population-based %D 2024 %7 11.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Little is known about post–hospital health care resource use (HRU) of patients admitted for severe COVID-19, specifically for the care of patients with postacute COVID-19 syndrome (PACS). Objective: A list of HRU domains and items potentially related to PACS was defined, and potential PACS-related HRU (PPRH) was compared between the pre– and post–COVID-19 periods, to identify new outpatient care likely related to PACS. Methods: A retrospective cohort study was conducted with the French National Health System claims data (SNDS). All patients hospitalized for COVID-19 between February 1, 2020, and June 30, 2020 were described and investigated for 6 months, using discharge date as index date. Patients who died during index stay or within 30 days after discharge were excluded. PPRH was assessed over the 5 months from day 31 after index date to end of follow-up, that is, for the post–COVID-19 period. For each patient, a pre–COVID-19 period was defined that covered the same calendar time in 2019, and pre–COVID-19 PPRH was assessed. Post- or pre- ratios (PP ratios) of the percentage of users were computed with their 95% CIs, and PP ratios>1.2 were considered as “major HRU change.” Results: The final study population included 68,822 patients (median age 64.8 years, 47% women, median follow-up duration 179.3 days). Altogether, 23% of the patients admitted due to severe COVID-19 died during the hospital stay or within the 6 months following discharge. A total of 8 HRU domains were selected to study PPRH: medical visits, technical procedures, dispensed medications, biological analyses, oxygen therapy, rehabilitation, rehospitalizations, and nurse visits. PPRs showed novel outpatient care in all domains and in most items, without specificity, with the highest ratios observed for the care of thoracic conditions. Conclusions: Patients hospitalized for severe COVID-19 during the initial pandemic wave had high morbi-mortality. The analysis of HRU domains and items most likely to be related to PACS showed that new care was commonly initiated after discharge but with no specificity, potentially suggesting that any impact of PACS was part of the overall high HRU of this population after hospital discharge. These purely descriptive results need to be completed with methods for controlling for confusion bias through subgroup analyses. Trial Registration: ClinicalTrials.gov NCT05073328; https://clinicaltrials.gov/ct2/show/NCT05073328 %M 39259961 %R 10.2196/56398 %U https://publichealth.jmir.org/2024/1/e56398 %U https://doi.org/10.2196/56398 %U http://www.ncbi.nlm.nih.gov/pubmed/39259961 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56044 %T 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 %A Luchman,Joseph %A Bennett,Morgane %A Kranzler,Elissa %A Tuskeviciute,Rugile %A Vega,Ronald %A Denison,Benjamin %A Trigger,Sarah %A Nighbor,Tyler %A Vines,Monica %A Hoffman,Leah %+ Fors Marsh, 4250 N. Fairfax Drive, Ste 520, Arlington, VA, 22201, United States, 1 5718583800, jluchman@forsmarsh.com %K COVID-19 %K COVID-19 vaccination %K vaccine %K United States %K segmentation %K latent class cluster analysis %K vaccines %K vaccination %K segmentation analysis %K estimation %K validation %K attitude %K attitudes %K belief %K beliefs %K behavior %K behaviors %K sociodemographic %K nonintender %K nonintenders %K waiter %K waiters %K confident %K confidents %K social distancing %K bivariate %K regression analysis %K survey %K respondent %K respondents %D 2024 %7 10.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 39255032 %R 10.2196/56044 %U https://publichealth.jmir.org/2024/1/e56044 %U https://doi.org/10.2196/56044 %U http://www.ncbi.nlm.nih.gov/pubmed/39255032 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e55613 %T Digital Gamification Tool (Let’s Control Flu) to Increase Vaccination Coverage Rates: Proposal for Algorithm Development %A Lopes,Henrique %A Baptista-Leite,Ricardo %A Hermenegildo,Catarina %A Atun,Rifat %+ NOVA Center for Global Health, NOVA Information Management School, Universidade Nova de Lisboa, Campus de Campolide, Lisbon, 1070-312, Portugal, 351 962499020, hlopes@novaims.unl.pt %K influenza %K gamification %K public health policies %K vaccination coverage rates %K health promotion %D 2024 %7 10.9.2024 %9 Proposal %J JMIR Res Protoc %G English %X Background: Influenza represents a critical public health challenge, disproportionately affecting at-risk populations, including older adults and those with chronic conditions, often compounded by socioeconomic factors. Innovative strategies, such as gamification, are essential for augmenting risk communication and community engagement efforts to address this threat. Objective: This study aims to introduce the “Let’s Control Flu” (LCF) tool, a gamified, interactive platform aimed at simulating the impact of various public health policies (PHPs) on influenza vaccination coverage rates and health outcomes. The tool aligns with the World Health Organization’s goal of achieving a 75% influenza vaccination rate by 2030, facilitating strategic decision-making to enhance vaccination uptake. Methods: The LCF tool integrates a selection of 13 PHPs from an initial set proposed in another study, targeting specific population groups to evaluate 7 key health outcomes. A prioritization mechanism accounts for societal resistance and the synergistic effects of PHPs, projecting the potential policy impacts from 2022 to 2031. This methodology enables users to assess how PHPs could influence public health strategies within distinct target groups. Results: The LCF project began in February 2021 and is scheduled to end in December 2024. The model creation phase and its application to the pilot country, Sweden, took place between May 2021 and May 2023, with subsequent application to other European countries. The pilot phase demonstrated the tool’s potential, indicating a promising increase in the national influenza vaccination coverage rate, with uniform improvements across all targeted demographic groups. These initial findings highlight the tool’s capacity to model the effects of PHPs on improving vaccination rates and mitigating the health impact of influenza. Conclusions: By incorporating gamification into the analysis of PHPs, the LCF tool offers an innovative and accessible approach to supporting health decision makers and patient advocacy groups. It enhances the comprehension of policy impacts, promoting more effective influenza prevention and control strategies. This paper underscores the critical need for adaptable and engaging tools in PHP planning and implementation. International Registered Report Identifier (IRRID): RR1-10.2196/55613 %M 39255031 %R 10.2196/55613 %U https://www.researchprotocols.org/2024/1/e55613 %U https://doi.org/10.2196/55613 %U http://www.ncbi.nlm.nih.gov/pubmed/39255031 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e59237 %T Exploring the Birthday Week Effect on Hand, Foot, and Mouth Disease in Yunnan Province, China, From 2008 to 2022: Surveillance Data Analysis %A Jiang,Pei %A Yan,Xiangyu %A Cai,Tongjian %A Huang,Longxin %A Liu,Zhenzhong %A Hao,Linhui %A Huang,Tian %A Yang,Haijun %A Xu,Min %A Shi,Wenhui %A Shui,Tiejun %K hand, foot, and mouth disease %K birthday week effect %K infants %K children %K China %K surveillance %K HFMD %D 2024 %7 9.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Hand, foot, and mouth disease (HFMD) is a notable infectious disease predominantly affecting infants and children worldwide. Previous studies on HFMD have primarily focused on natural patterns, such as seasonality, but research on the influence of important social time points is lacking. Several studies have indicated correlations between birthdays and certain disease outcomes. Objective: This study aimed to explore the association between birthdays and HFMD. Methods: Surveillance data on HFMD from 2008 to 2022 in Yunnan Province, China, were collected. We defined the period from 6 days before the birthday to the exact birthday as the “birthday week.” The effect of the birthday week was measured by the proportion of cases occurring during this period, termed the “birthday week proportion.” We conducted subgroup analyses to present the birthday week proportions across sexes, age groups, months of birth, and reporting years. Additionally, we used a modified Poisson regression model to identify conditional subgroups more likely to contract HFMD during the birthday week. Results: Among the 973,410 cases in total, 116,976 (12.02%) occurred during the birthday week, which is 6.27 times the average weekly proportion (7/365, 1.92%). While the birthday week proportions were similar between male and female individuals (68,849/564,725, 12.19% vs 48,127/408,685, 11.78%; χ21=153.25, P<.001), significant differences were observed among different age groups (χ23=47,145, P<.001) and months of birth (χ211=16,942, P<.001). Compared to other age groups, infants aged 0‐1 year had the highest birthday week proportion (30,539/90,709, 33.67%), which is 17.57 times the average weekly proportion. Compared to other months, patients born from April to July and from October to December, the peak months of the HFMD epidemic, had higher birthday week proportions. Additionally, a decreasing trend in birthday week proportions from 2008 to 2022 was observed, dropping from 33.74% (3914/11,600) to 2.77% (2254/81,372; Cochran-Armitage trend test: Z=−102.53, P<.001). The results of the modified Poisson regression model further supported the subgroup analyses findings. Compared with children aged >7 years, infants aged 0‐1 year were more likely to contract HFMD during the birthday week (relative risk 1.182, 95% CI 1.177‐1.185; P<.001). Those born during peak epidemic months exhibited a higher propensity for contracting HFMD during their birthday week. Compared with January, the highest relative risk was observed in May (1.087, 95% CI 1.084‐1.090; P<.001). Conclusions: This study identified a novel “birthday week effect” of HFMD, particularly notable for infants approaching their first birthday and those born during peak epidemic months. Improvements in surveillance quality may explain the declining trend of the birthday week effect over the years. Higher exposure risk during the birthday period and potential biological mechanisms might also account for this phenomenon. Raising public awareness of the heightened risk during the birthday week could benefit HFMD prevention and control. %R 10.2196/59237 %U https://publichealth.jmir.org/2024/1/e59237 %U https://doi.org/10.2196/59237 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54750 %T Wastewater Surveillance Pilot at US Military Installations: Cost Model Analysis %A Sanjak,Jaleal S %A McAuley,Erin M %A Raybern,Justin %A Pinkham,Richard %A Tarnowski,Jacob %A Miko,Nicole %A Rasmussen,Bridgette %A Manalo,Christian J %A Goodson,Michael %A Stamps,Blake %A Necciai,Bryan %A Sozhamannan,Shanmuga %A Maier,Ezekiel J %K wastewater surveillance %K cost analysis %K military health %K public health %K sanitation %K sanitary %K water %K wastewater %K surveillance %K environment %K environmental %K cost %K costs %K economic %K economics %K finance %K financial %K pathogen %K pathogens %K biosurveillance %D 2024 %7 6.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic highlighted the need for pathogen surveillance systems to augment both early warning and outbreak monitoring/control efforts. Community wastewater samples provide a rapid and accurate source of environmental surveillance data to complement direct patient sampling. Due to its global presence and critical missions, the US military is a leader in global pandemic preparedness efforts. Clinical testing for COVID-19 on US Air Force (USAF) bases (AFBs) was effective but costly with respect to direct monetary costs and indirect costs due to lost time. To remain operating at peak capacity, such bases sought a more passive surveillance option and piloted wastewater surveillance (WWS) at 17 AFBs to demonstrate feasibility, safety, utility, and cost-effectiveness from May 2021 to January 2022. Objective: We model the costs of a wastewater program for pathogens of public health concern within the specific context of US military installations using assumptions based on the results of the USAF and Joint Program Executive Office for Chemical, Biological, Radiological and Nuclear Defense pilot program. The objective was to determine the cost of deploying WWS to all AFBs relative to clinical swab testing surveillance regimes. Methods: A WWS cost projection model was built based on subject matter expert input and actual costs incurred during the WWS pilot program at USAF AFBs. Several SARS-CoV-2 circulation scenarios were considered, and the costs of both WWS and clinical swab testing were projected. Analysis was conducted to determine the break-even point and how a reduction in swab testing could unlock funds to enable WWS to occur in parallel. Results: Our model confirmed that WWS is complementary and highly cost-effective when compared to existing alternative forms of biosurveillance. We found that the cost of WWS was between US $10.5-$18.5 million less expensive annually in direct costs as compared to clinical swab testing surveillance. When the indirect cost of lost work was incorporated, including lost work associated with required clinical swab testing, we estimated that over two-thirds of clinical swab testing could be maintained with no additional costs upon implementation of WWS. Conclusions: Our results support the adoption of WWS across US military installations as part of a more comprehensive and early warning system that will enable adaptive monitoring during disease outbreaks in a more cost-effective manner than swab testing alone. %R 10.2196/54750 %U https://publichealth.jmir.org/2024/1/e54750 %U https://doi.org/10.2196/54750 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e59449 %T Epidemiological Survey of Enterovirus Infections in Taiwan From 2011 to 2020: Retrospective Study %A Liu,Fang-Chen %A Chen,Bao-Chung %A Huang,Yao-Ching %A Huang,Shi-Hao %A Chung,Ren Jei %A Yu,Pi-Ching %A Yu,Chia-Peng %K epidemiology %K enterovirus %K domestic %K cluster %K sporadic %K retrospective %K Taiwan %D 2024 %7 5.9.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Young children are susceptible to enterovirus (EV) infections, which cause significant morbidity in this age group. Objective: This study investigated the characteristics of virus strains and the epidemiology of EVs circulating among young children in Taiwan from 2011 to 2020. Methods: Children diagnosed with EV infections from 2011 to 2020 were identified from the routine national health insurance data monitoring disease system, real-time outbreak and disease surveillance system, national laboratory surveillance system, and Statistics of Communicable Diseases and Surveillance Report, a data set (secondary data) of the Taiwan Centers for Disease and Control. Four primary outcomes were identified: epidemic features, characteristics of sporadic and cluster cases of EV infections, and main cluster institutions. Results: From 2011 to 2020, between 10 and 7600 person-times visited the hospitals for EV infections on an outpatient basis daily. Based on 2011 to 2020 emergency department EV infection surveillance data, the permillage of EV visits throughout the year ranged from 0.07‰ and 25.45‰. After typing by immunofluorescence assays, the dominant type was coxsackie A virus (CVA; 8844/12,829, 68.9%), with most constituting types CVA10 (n=2972), CVA2 (n=1404), CVA6 (n=1308), CVA4 (n=1243), CVA16 (n=875), and CVA5 (n=680); coxsackie B virus CVB (n=819); echovirus (n=508); EV-A71 (n=1694); and EV-D68 (n=10). There were statistically significant differences (P<.001) in case numbers of EV infections among EV strains from 2011 to 2020. Cases in 2012 had 15.088 times the odds of being EV-A71, cases in 2014 had 2.103 times the odds of being CVA, cases in 2015 had 1.569 times the odds of being echovirus, and cases in 2018 had 2.274 times the odds of being CVB as cases in other years. From 2011 to 2020, in an epidemic analysis of EV clusters, 57 EV clusters were reported. Clusters that tested positive included 53 (53/57, 93%) CVA cases (the major causes were CVA6, n=32, and CVA10, n=8). Populous institutions had the highest proportion (7 of 10) of EV clusters. Conclusion: This study is the first report of sporadic and cluster cases of EV infections from surveillance data (Taiwan Centers for Disease and Control, 2011‐2020). This information will be useful for policy makers and clinical experts to direct prevention and control activities to EV infections that cause the most severe illness and greatest burden to the Taiwanese. %R 10.2196/59449 %U https://publichealth.jmir.org/2024/1/e59449 %U https://doi.org/10.2196/59449 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e59848 %T An Evidence-Based Serious Game App for Public Education on Antibiotic Use and Resistance: Randomized Controlled Trial %A Huang,Zhilian %A Ow,Jing Teng %A Tang,Wern Ee %A Chow,Angela %+ Department of Preventive and Population Medicine, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308322, Singapore, 65 6256 6011, zhilian_huang@ttsh.com.sg %K serious game application %K randomized controlled trial %K antimicrobial resistance %K antibiotic use %K public education %K mobile phone %D 2024 %7 5.9.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: The misuse and overuse of antibiotics accelerate the development of antimicrobial resistance (AMR). Serious games, any form of games that serve a greater purpose other than entertainment, could augment public education above ongoing health promotion efforts. Hence, we developed an evidence-based educational serious game app—SteWARdS Antibiotic Defence—to educate players on good antibiotic use practices and AMR through a game quest comprising 3 minigames and interaction with the nonplayer characters. Objective: We aimed to evaluate the effectiveness of the SteWARdS Antibiotic Defence app in improving the knowledge of, attitude toward, and perceptions (KAP) of appropriate antibiotic use and AMR among the public in Singapore. Methods: We conducted a 2-arm parallel randomized controlled trial, recruiting visitors aged 18-65 years from 2 polyclinics in Singapore. Intervention group participants had to download the SteWARdS Antibiotic Defence app (available only in English and on the Android platform) on their smartphones and complete the quest in the app. Participants took half a day to 2 weeks to complete the quest. The control group received no intervention. Knowledge questions on antibiotic use and AMR (11 binary questions) were self-administered at baseline, immediately after the intervention, and 6-10 weeks post intervention, while attitudes and perception questions (14 three-point Likert-scale questions) were self-administered at baseline and 6-10 weeks post intervention. We also collected participants’ feedback on app usage. Results: Participants (n=348; intervention: n=142, control: n=206) had a mean age of 36.9 years. Intervention group participants showed a statistically significant improvement in mean knowledge score (effect size: 0.58 [95% CI 0.28-0.87]) compared with controls after accounting for age, educational level, and exposure to advertisements on antibiotics and AMR. Intervention participants also showed a statistically significant improvement in mean attitude-perception scores (effect size: 0.98 (95% CI 0.44-1.52)) after adjusting for marital status and race. A majority of participants agreed that the “SteWARdS Antibiotic Defence” app improved their awareness on antibiotic use (135/142, 95.1%) and AMR (136/142, 95.8%). About 73.9% (105/142) of the participants agreed that the app is easy to use, 70.4% (100/142) agreed that the app was enjoyable, and 85.2% (121/142) would recommend the app to others. Conclusions: Our educational serious game app improves participants’ KAP on appropriate antibiotic use and AMR. Public education apps should be engaging, educational, easy to use, and have an attractive user interface. Future research should assess the effectiveness of interventions in facilitating long-term knowledge retention and long-lasting behavioral change. Trial Registration: ClinicalTrials.gov NCT05445414; https://clinicaltrials.gov/ct2/show/NCT05445414 International Registered Report Identifier (IRRID): RR2-10.2196/45833 %M 39235853 %R 10.2196/59848 %U https://games.jmir.org/2024/1/e59848 %U https://doi.org/10.2196/59848 %U http://www.ncbi.nlm.nih.gov/pubmed/39235853 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e60021 %T Investigation of Mother-to-Child Transmission of Hepatitis B in Yinchuan, China: Cross-Sectional Survey Study %A Gu,Jie %A Xu,Yiyuan %A Yuan,Jiao %A Chen,Yuxiang %A Luo,Jingxia %A Guo,Cui %A Zhang,Guanbin %+ Department of Laboratory Medicine, Fujian Medical University, 1 Xuefu North Road, University Town, Minhou County, Fuzhou, 350122, China, 86 13811332083, gbzhang@capitalbio.com %K hepatitis B virus %K mother-to-child transmission %K antiviral therapy %K immunization failure %K cord blood %D 2024 %7 4.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Hepatitis B poses a significant global public health challenge, with mother-to-child transmission (MTCT) being the primary method of hepatitis B virus (HBV) transmission. The prevalence of HBV infection in China is the highest in Asia, and it carries the greatest burden globally. Objective: This study aims to critically evaluate the existing local strategies for preventing MTCT and the proposed potential enhancements by analyzing the prevalence of hepatitis B among pregnant women and their neonates in Yinchuan. Methods: From January 2017 to December 2021, 37,557 prenatal screening records were collected. Among them, 947 pregnant women who tested positive for hepatitis B surface antigen (HBsAg) near delivery and their 960 neonates were included in an HBV-exposed group, while 29 pregnant women who tested negative and their 30 neonates were included in an HBV-nonexposed group. HBV markers in maternal peripheral blood and neonatal cord blood were analyzed using the least absolute shrinkage and selection operator (LASSO) regression, logistic regression, chi-square test, t-test, and U-test. Additionally, to further evaluate the diagnostic value of HBsAg positivity in cord blood, we conducted an additional follow-up study on 103 infants who tested positive for HBsAg in their cord blood. Results: The prevalence of HBV among pregnant women was 2.5% (947/37,557), with a declining trend every year (χ²4=19.7; P=.001). From 2018 to 2020, only 33.0% (35/106) of eligible pregnant women received antiviral medication treatment. Using LASSO regression to screen risk factors correlated with HBsAg positivity in cord blood (when log [λ] reached a minimum value of –5.02), 5 variables with nonzero coefficients were selected, including maternal hepatitis B e-antigen (HBeAg) status, maternal hepatitis B core antibody (HBcAb) status, maternal HBV DNA load, delivery method, and neonatal birth weight. Through univariate and multivariate logistic regression, delivery by cesarean section (adjusted odds ratio [aOR] 0.52, 95% CI 0.31-0.87), maternal HBeAg positivity (aOR 2.05, 95% CI 1.27-3.33), low maternal viral load (aOR 2.69, 95% CI 1.33-5.46), and high maternal viral load (aOR 2.69, 95% CI 1.32-5.51) were found to be strongly associated with cord blood HBsAg positivity. In the additional follow-up study, 61 infants successfully completed the follow-up, and only 2 were found to be infected with HBV. The mothers of both these infants had detectable HBV DNA levels and should have received standard antiviral therapy. The results of the hepatitis B surface antibody (HBsAb) positivity rate and titer test indicated a gradual decline in the immunity of vaccinated infants as the interval after vaccination increased. Conclusions: The clinical relevance of HBV marker detection in cord blood is restricted within the current prevention measures for MTCT. There is an emphasis on the significance of public education regarding hepatitis B and the reinforcement of postnatal follow-up for the prevention of MTCT. %M 39230944 %R 10.2196/60021 %U https://publichealth.jmir.org/2024/1/e60021 %U https://doi.org/10.2196/60021 %U http://www.ncbi.nlm.nih.gov/pubmed/39230944 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53580 %T Impact of Long SARS-CoV-2 Omicron Infection on the Health Care Burden: Comparative Case-Control Study Between Omicron and Pre-Omicron Waves %A Valdivieso-Martinez,Bernardo %A Lopez-Sanchez,Victoria %A Sauri,Inma %A Diaz,Javier %A Calderon,Jose Miguel %A Gas-Lopez,Maria Eugenia %A Lidon,Laura %A Philibert,Juliette %A Lopez-Hontangas,Jose Luis %A Navarro,David %A Cuenca,Llanos %A Forner,Maria Jose %A Redon,Josep %+ Hospital Clínico de la Comunidad Valenciana (INCLIVA) Research Institute, University of Valencia, Menendez y Pelayo, 4, Valencia, 46010, Spain, 34 658909676, josep.redon@uv.es %K Omicron %K long COVID %K post–COVID-19 %K diagnostics %K primary care %K specialist %K emergency department %K hospitalization %D 2024 %7 3.9.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Following the initial acute phase of COVID-19, health care resource use has escalated among individuals with SARS-CoV-2 infection. Objective: This study aimed to compare new diagnoses of long COVID and the demand for health services in the general population after the Omicron wave with those observed during the pre-Omicron waves, using similar assessment protocols for both periods and to analyze the influence of vaccination. Methods: This matched retrospective case-control study included patients of both sexes diagnosed with acute SARS-CoV-2 infection using reverse transcription polymerase chain reaction or antigen tests in the hospital microbiology laboratory during the pandemic period regardless of whether the patients were hospitalized. We included patients of all ages from 2 health care departments that cover 604,000 subjects. The population was stratified into 2 groups, youths (<18 years) and adults (≥18 years). Patients were followed-up for 6 months after SARS-CoV-2 infection. Previous vaccination, new diagnoses, and the use of health care resources were recorded. Patients were compared with controls selected using a prospective score matched for age, sex, and the Charlson index. Results: A total of 41,577 patients with a history of prior COVID-19 infection were included, alongside an equivalent number of controls. This cohort encompassed 33,249 (80%) adults aged ≥18 years and 8328 (20%) youths aged <18 years. Our analysis identified 40 new diagnoses during the observation period. The incidence rate per 100 patients over a 6-month period was 27.2 for vaccinated and 25.1 for unvaccinated adults (P=.09), while among youths, the corresponding rates were 25.7 for vaccinated and 36.7 for unvaccinated individuals (P<.001). Overall, the incidence of new diagnoses was notably higher in patients compared to matched controls. Additionally, vaccinated patients exhibited a reduced incidence of new diagnoses, particularly among women (P<.001) and younger patients (P<.001) irrespective of the number of vaccine doses administered and the duration since the last dose. Furthermore, an increase in the use of health care resources was observed in both adult and youth groups, albeit with lower figures noted in vaccinated individuals. In the comparative analysis between the pre-Omicron and Omicron waves, the incidence of new diagnoses was higher in the former; however, distinct patterns of diagnosis were evident. Specifically, depressed mood (P=.03), anosmia (P=.003), hair loss (P<.001), dyspnea (<0.001), chest pain (P=.04), dysmenorrhea (P<.001), myalgia (P=.011), weakness (P<.001), and tachycardia (P=.015) were more common in the pre-Omicron period. Similarly, health care resource use, encompassing primary care, specialist, and emergency services, was more pronounced in the pre-Omicron wave. Conclusions: The rise in new diagnoses following SARS-CoV-2 infection warrants attention due to its potential implications for health systems, which may necessitate the allocation of supplementary resources. The absence of vaccination protection presents a challenge to the health care system. %M 39226091 %R 10.2196/53580 %U https://publichealth.jmir.org/2024/1/e53580 %U https://doi.org/10.2196/53580 %U http://www.ncbi.nlm.nih.gov/pubmed/39226091 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52666 %T Changes in Infectious Disease–Specific Health Literacy in the Post–COVID-19 Pandemic Period: Two-Round Cross-Sectional Survey Study %A Zhao,Yusui %A Xu,Yue %A Yao,Dingming %A Wu,Qingqing %A Chen,Heni %A Hu,Xiujing %A Huang,Yu %A Zhang,Xuehai %K survey %K infectious disease–specific health literacy %K COVID-19 %K health education %K factors %K postpandemic %D 2024 %7 30.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Infectious disease–specific health literacy (IDSHL) is a crucial factor in the development of infectious diseases. It plays a significant role not only in mitigating the resurgence of infectious diseases but also in effectively averting the emergence of novel infections such as COVID-19. During the 3 years of the COVID-19 pandemic, China primarily adopted nonpharmaceutical interventions, advocating for people to avoid crowded places and wear masks to prevent the spread of COVID-19. Consequently, there has been a dearth of research concerning IDSHL and its corresponding focal points for health education. Objective: This study aimed to (1) evaluate the changes in IDSHL scores between 2019 (before the COVID-19 pandemic) and 2022 (the postepidemic period of COVID-19) and (2) explore the risk factors affecting IDSHL using a multivariate logistic regression analysis. Methods: This study used 2-round cross-sectional surveys, conducted in 2019 and 2022, respectively, in 30 counties in Zhejiang Province, China. Multiple-stage stratified random sampling was used to select households, and a Kish grid was used to identify participants. An identical standardized questionnaire consisting of 12 closed-ended questions was used to measure IDSHL scores before and after the COVID-19 pandemic (2019 and 2022). Standard descriptive statistics, chi-square tests, t tests, and multivariate logistic regression analyses were used to analyze the data. Results: The 2-round cross-sectional surveys conducted in 2019 and 2022 yielded, out of 19,366 and 19,221 total questionnaires, 19,257 (99.44% response rate) and 18,857 (98.11% response rate) valid questionnaires, respectively. The correct response rate for the respiratory infectious diseases question “When coughing or sneezing, which of the following is correct?” increased from 29.10% in 2019 to 37.92% in 2022 (χ²1=332.625; P<.001). The correct response rate for the nonrespiratory infectious diseases question “In which of the following ways can hepatitis B be transmitted to others?” decreased from 64.28% to 59.67% (χ²1=86.059; P<.001). In terms of IDSHL scores, a comparison between 2022 and 2019 revealed notable statistical differences in the overall scores (t1=10.829; P<.001) and across the 3 dimensions of knowledge (t1=8.840; P<.001), behavior (t1=16.170; P<.001), and skills (t1=9.115; P<.001). With regard to the questions, all but 4 exhibited statistical differences (P<.001). Multivariate logistic regression analyses indicated that the 2022 year group had a higher likelihood of possessing acquired IDSHL than the 2019 group (odds ratio 1.323, 95% CI 1.264‐1.385; P<.001). Conclusions: When conducting health education, it is imperative to enhance efforts in nonrespiratory infectious disease health education, as well as respiratory infectious diseases such as COVID-19. Health education interventions should prioritize ethnic minority populations with a poor self-health status and low education. %R 10.2196/52666 %U https://publichealth.jmir.org/2024/1/e52666 %U https://doi.org/10.2196/52666 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52089 %T Profile and Determinants for Complications of Imported Malaria in 5 Chinese Provinces From 2014 to 2021: Retrospective Analysis %A Liu,Bowen %A Zhang,Tao %A Wang,Duoquan %A Xia,Shang %A Li,Weidong %A Zhang,Xiaoxi %A Wang,Shuxun %A Guo,Xiao-Kui %A Zhou,Xiao-Nong %A Li,Shizhu %K imported malaria %K epidemiological characteristics %K complications %K influencing factors %K China %D 2024 %7 30.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: In 2021, the World Health Organization officially declared the People’s Republic of China as malaria-free. However, despite this milestone achievement, the continued occurrence of severe and fatal cases of imported malaria in China, due to globalization and increased international communication, remains a significant public health concern. Objective: The aim of this study was to elucidate the epidemiological characteristics of imported malaria in 5 Chinese provinces from 2014 to 2021 and to identify the factors that influence complications in imported malaria cases. The findings will provide a basis for enhancing prevention and control measures, thereby consolidating China’s achievements in malaria elimination. Methods: A case-based retrospective study was performed, using surveillance data collected from the representative provinces of China from 2014 to 2021. Epidemiological characteristics were analyzed using descriptive statistics. Logistic regression was used to identify the factors influencing the occurrence of complications. Results: A total of 5559 malaria cases were included during the study period. The predominant species was Plasmodium falciparum (3940/5559, 70.9%), followed by Plasmodium ovale (1054/5559, 19%), Plasmodium vivax (407/5559, 7.3%), Plasmodium malariae (157/5559, 2.8%), and 1 case of Plasmodium knowlesi. Most of the cases were male (5343/5559, 96.1%). The complication rates for P falciparum and P ovale were 11.4% and 3.3%, respectively. Multivariate logistic regression analysis of the relevant factors of malaria complications revealed potential protective factors, including a previous infection by Plasmodium (P<.001; odds ratio [OR] 0.512, 95% CI 0.422‐0.621), and risk factors, including increased age (P=.004; OR 1.014, 95% CI 1.004‐1.024), misdiagnosis at the first clinical visit (P<.001; OR 3.553, 95% CI 2.886‐4.375), and the time interval from onset to treatment (P=.001; OR 1.026, 95% CI 1.011‐1.042). Subgroup analyses identified risk factors associated with P falciparum, which include advanced age (P=.004; OR 1.015, 95% CI 1.005‐1.026), initial misdiagnosis during the first clinical visit (P<.001; OR 3.549, 95% CI 2.827‐4.455), the time interval from onset to treatment (P<.001; OR 1.043, 95% CI 1.022‐1.063), and a delay of more than 3 days from the first treatment to diagnosis (P<.001; OR 2.403, 95% CI 1.823‐3.164). Additionally, the risk factors pertaining to P ovale involve misdiagnosis at the initial clinical visit (P=.01; OR 2.901, 95% CI 1.336‐6.298), the time interval from onset to treatment (P=.002; OR 1.095, 95% CI 1.033‐1.160), and the duration from the initial treatment to diagnosis (P=.43; OR 1.032, 95% CI 0.953‐1.118). Previous infections can prevent the progression of both P falciparum and P ovale. Conclusions: This study showed that the increasing proportion of P ovale in recent years should not be ignored. Furthermore, there is a need to improve diagnostic awareness, enhance the capacity of medical institutions, and provide health education for high-risk groups. %R 10.2196/52089 %U https://publichealth.jmir.org/2024/1/e52089 %U https://doi.org/10.2196/52089 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54874 %T Characteristics, Influence, Prevention, and Control Measures of the Mpox Infodemic: Scoping Review of Infodemiology Studies %A Yan,XiangYu %A Li,Zhuo %A Cao,Chunxia %A Huang,Longxin %A Li,Yongjie %A Meng,Xiangbin %A Zhang,Bo %A Yu,Maohe %A Huang,Tian %A Chen,Jiancheng %A Li,Wei %A Hao,Linhui %A Huang,Dongsheng %A Yi,Bin %A Zhang,Ming %A Zha,Shun %A Yang,Haijun %A Yao,Jian %A Qian,Pengjiang %A Leung,Chun Kai %A Fan,Haojun %A Jiang,Pei %A Shui,Tiejun %+ Yunnan Center for Disease Control and Prevention, Xianghe Street #1177, Chenggong District, Kunming, 650050, China, 86 13987165649, shuitiejunynjkedu@163.com %K mpox %K infodemic %K infodemiology %K information search volume %K content topic %K digital health %D 2024 %7 30.8.2024 %9 Review %J J Med Internet Res %G English %X Background: The mpox pandemic has caused widespread public concern around the world. The spread of misinformation through the internet and social media could lead to an infodemic that poses challenges to mpox control. Objective: This review aims to summarize mpox-related infodemiology studies to determine the characteristics, influence, prevention, and control measures of the mpox infodemic and propose prospects for future research. Methods: The scoping review was conducted based on a structured 5-step methodological framework. A comprehensive search for mpox-related infodemiology studies was performed using PubMed, Web of Science, Embase, and Scopus, with searches completed by April 30, 2024. After study selection and data extraction, the main topics of the mpox infodemic were categorized and summarized in 4 aspects, including a trend analysis of online information search volume, content topics of mpox-related online posts and comments, emotional and sentiment characteristics of online content, and prevention and control measures for the mpox infodemic. Results: A total of 1607 articles were retrieved from the databases according to the keywords, and 61 studies were included in the final analysis. After the World Health Organization’s declaration of an mpox public health emergency of international concern in July 2022, the number of related studies began growing rapidly. Google was the most widely used search engine platform (9/61, 15%), and Twitter was the most used social media app (32/61, 52%) for researchers. Researchers from 33 countries were concerned about mpox infodemic–related topics. Among them, the top 3 countries for article publication were the United States (27 studies), India (9 studies), and the United Kingdom (7 studies). Studies of online information search trends showed that mpox-related online search volume skyrocketed at the beginning of the mpox outbreak, especially when the World Health Organization provided important declarations. There was a large amount of misinformation with negative sentiment and discriminatory and hostile content against gay, bisexual, and other men who have sex with men. Given the characteristics of the mpox infodemic, the studies provided several positive prevention and control measures, including the timely and active publishing of professional, high-quality, and easy-to-understand information online; strengthening surveillance and early warning for the infodemic based on internet data; and taking measures to protect key populations from the harm of the mpox infodemic. Conclusions: This comprehensive summary of evidence from previous mpox infodemiology studies is valuable for understanding the characteristics of the mpox infodemic and for formulating prevention and control measures. It is essential for researchers and policy makers to establish prediction and early warning approaches and targeted intervention methods for dealing with the mpox infodemic in the future. %M 39213025 %R 10.2196/54874 %U https://www.jmir.org/2024/1/e54874 %U https://doi.org/10.2196/54874 %U http://www.ncbi.nlm.nih.gov/pubmed/39213025 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e40801 %T Telemedicine Research Trends in 2001-2022 and Research Cooperation Between China and Other Countries Before and After the COVID-19 Pandemic: Bibliometric Analysis %A Feng,Hanlin %A Kurata,Karin %A Cao,Jianfei %A Itsuki,Kageyama %A Niwa,Makoto %A Aoyama,Atsushi %A Kodama,Kota %+ Medical Data Science Lab, Hoshi University, 2-4-41 Ebara, Shinagawa-Ku, Tokyo, 142-8501, Japan, 81 337861011, kodama.kota@hoshi.ac.jp %K telemedicine %K telehealth %K coauthorship analysis %K network analysis %K bibliometric analysis %K co-occurrence analysis %D 2024 %7 30.8.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Advancements in technology have overcome geographical barriers, making telemedicine, which offers remote emergency services, healthcare, and medication guidance, increasingly popular. COVID-19 restrictions amplified its global importance by bridging distances. Objective: This study aimed to analyze Chinese and global literature data, present new global telemedicine research trends, and clarify the development potential, collaborations, and deficiencies in China's telemedicine research. Methods: We conducted bibliometrics and network analyses on relevant documents from the Web of Science database from 2001 to 2022. Data collection was completed on October 30, 2023. Considering COVID-19’s impact, 2020 was used as a baseline, dividing the data into 2 periods: 2001-2019 and 2020-2022. The development potential was determined based on publication trends. An international coauthorship network analysis identified collaboration statuses and potential. Co-occurrence analysis was conducted for China and the world. Results: We identified 25,333 telemedicine-related research papers published between 2001 and 2022, with a substantial increase during the COVID-19 period (2020-2022), particularly in China (1.93-fold increase), moving its global publication rank from tenth to sixth. The United States, the United Kingdom, and Australia contributed 62.96% of the literature, far ahead of China’s 3.90%. Globally, telemedicine research increased significantly post-2020. Between 2001 and 2019, the United States and Australia were central in coauthor networks; post-2020, the United States remained the largest node. Network hubs included the United States, the United Kingdom, Australia, and Canada. Keyword co-occurrence analysis revealed 5 global clusters from 2001 to 2019 (system technology, health care applications, mobile health, mental health, and electronic health) and 2020 to 2022 (COVID-19, children’s mental health, artificial intelligence, digital health, and rehabilitation of middle-aged and older adults). In China, the research trends aligned with global patterns, with rapid growth post-2020. From 2001 to 2019, China cooperated closely with Indonesia, India, Japan, Taiwan, and South Korea. From 2020 to 2022, cooperation expanded to Japan, Singapore, Malaysia, and South Korea, as well as Saudi Arabia, Egypt, South Africa, Ghana, Lebanon, and other African and Middle Eastern countries. Chinese keyword co-occurrence analysis showed focus areas in system technology, health care applications, mobile health, big data analysis, and electronic health (2001-2019) and COVID-19, artificial intelligence, digital health, and mental health (2020-2022). Although psychology research increased, studies on children’s mental health and middle-aged and older adults’ rehabilitation were limited. Conclusions: We identified the latest trends in telemedicine research, demonstrating its significant potential in China and providing directions for future development and collaborations in telemedicine research. %M 39213010 %R 10.2196/40801 %U https://www.i-jmr.org/2024/1/e40801 %U https://doi.org/10.2196/40801 %U http://www.ncbi.nlm.nih.gov/pubmed/39213010 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52318 %T Surveillance Metrics and History of the COVID-19 Pandemic in Central Asia: Updated Epidemiological Assessment %A Lundberg,Alexander L %A Ozer,Egon A %A Wu,Scott A %A Soetikno,Alan G %A Welch,Sarah B %A Liu,Yingxuan %A Havey,Robert J %A Murphy,Robert L %A Hawkins,Claudia %A Mason,Maryann %A Achenbach,Chad J %A Post,Lori A %+ Buehler Center for Health Policy and Economics, Robert J. Havey, MD Institute for Global Health, Northwestern University, 420 E. Superior St., Chicago, IL, 60611, United States, 1 312 503 1706, alexander.lundberg@northwestern.edu %K SARS-CoV-2 %K COVID-19 %K Central Asia %K pandemic %K surveillance %K public health %K COVID-19 transmission %K speed %K acceleration %K deceleration %K jerk %K dynamic panel %K generalized method of moments %K GMM %K Arellano-Bond %K 7-day lag %K Armenia %K Azerbaijan %K Cyprus %K Faeroe Islands %K Georgia %K Gibraltar %K Kazakhstan %K Kosovo %K Kyrgyzstan %K Macedonia %K Russia %K Tajikistan Turkey %K Turkmenistan %K Uzbekistan %D 2024 %7 28.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: This study updates the COVID-19 pandemic surveillance in Central Asia we conducted during the first year of the pandemic by providing 2 additional years of data for the region. The historical context provided through additional data can inform regional preparedness and early responses to infectious outbreaks of either the SARS-CoV-2 virus or future pathogens in Central Asia. Objective: First, we aim to measure whether there was an expansion or contraction in the pandemic in Central Asia when the World Health Organization (WHO) declared the end of the public health emergency for the COVID-19 pandemic on May 5, 2023. Second, we use dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we aim to provide historical context for the course of the pandemic in Central Asia. Methods: Traditional surveillance metrics, including counts and rates of COVID-19 transmissions and deaths, and enhanced surveillance indicators, including speed, acceleration, jerk, and persistence, were used to measure shifts in the pandemic. To identify the appearance and duration of variants of concern, we used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID). We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t test to determine whether regional speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. Results: Speed for the region had remained below the outbreak threshold for 7 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. Although the 1- and 7-day persistence coefficients remained statistically significant, the coefficients were relatively small in magnitude (0.125 and 0.347, respectively). Furthermore, the shift parameters for either of the 2 most recent weeks around May 5, 2023, were both significant and negative, meaning the clustering effect of new COVID-19 cases became even smaller in the 2 weeks around the WHO declaration. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of speed equal to 10 became entirely insignificant for the first time in March 2023. Conclusions: Although COVID-19 continues to circulate in Central Asia, the rate of transmission remained well below the threshold of an outbreak for 7 months ahead of the WHO declaration. COVID-19 appeared to be endemic in the region and no longer reached the threshold of a pandemic. Both standard and enhanced surveillance metrics suggest the pandemic had ended by the time of the WHO declaration. %M 39013115 %R 10.2196/52318 %U https://publichealth.jmir.org/2024/1/e52318 %U https://doi.org/10.2196/52318 %U http://www.ncbi.nlm.nih.gov/pubmed/39013115 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47465 %T Patient-Reported Experiences of Persistent Post–COVID-19 Conditions After Hospital Discharge During the Second and Third Waves of the Pandemic in Switzerland: Cross-Sectional Questionnaire Study %A Tacchini-Jacquier,Nadine %A Monnay,Sévrine %A Coquoz,Nicolas %A Bonvin,Eric %A Verloo,Henk %+ Department of Nursing, School of Health Sciences, University of Applied Sciences and Arts Western Switzerland (HES-SO), 5, Chemin de l’Agasse, Sion, 1950, Switzerland, 41 78 769 89 90, henk.verloo@hevs.ch %K patient-reported experience measures %K PREMs %K long COVID %K fatigue %K post-traumatic stress disorder %K depression %K anxiety %K SARS-CoV-2 infection %K post-COVID %K COVID-19 %K pandemic %K hospital discharge %K pandemic %D 2024 %7 28.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Hospitalized patients infected with SARS-CoV-2 should recover within a few weeks. However, even those with mild versions can experience symptoms lasting 4 weeks or longer. These post–COVID-19 condition (PCC) comprise various new, returning, or ongoing symptoms that can last for months or years and cause disability. Few studies have investigated PCC using self-reports from discharged patients infected with SARS-CoV-2 to complement clinical and biomarker studies. Objective: This study aimed to investigate self-reported, persistent PCC among patients infected with SARS-CoV-2 who were discharged during the second and third waves of the COVID-19 pandemic. Methods: We designed, pretested, and posted an ad hoc paper questionnaire to all eligible inpatients discharged between October 2020 and April 2021. At 4 months post discharge, we collected data on PCC and scores for the Multidimensional Fatigue Inventory (MFI), the Patient Health Questionnaire-4 (PHQ-4), a Brief Memory Screening Scale (Q3PC), and a posttraumatic stress disorder scale (PCL-5). Descriptive, inferential, and multivariate linear regression statistics assessed PCC symptomatology, associations, and differences regarding sociodemographic characteristics and hospital length of stay (LOS). We examined whether our variables of interest significantly predicted MFI scores. Results: Of the 1993 valid questionnaires returned, 245 were from discharged patients with SARS-CoV-2 (median age 71, IQR 62.7-77 years). Only 28.2% (69/245) of respondents were symptom-free after 4 months. Women had significantly more persistent PCC symptoms than men (P≤.001). Patients with a hospital LOS ≥11 days had more PCC symptoms as well (P<.001)—women had more symptoms and longer LOS. No significant differences were found between age groups (18-64, 65-74, and ≥75 years old; P=.50) or between intensive care units and other hospitalization units (P=.09). Patients self-reported significantly higher PHQ-4 scores during their hospitalization than at 4 months later (P<.001). Three-fourth (187/245, 76.4%) of the respondents reported memory loss and concentration disorders (Q3PC). No significant differences in the median MFI score (56, IQR 1-3, range 50-60]) were associated with sociodemographic variables. Patients with a hospital LOS of ≥11 days had a significantly higher median PCL-5 score (P<.001). Multivariate linear regression allowed us to calculate that the combination of PHQ-4, Q3PC, and PCL-5 scores, adjusted for age, sex, and LOS (of either ≥11 days [median 2 symptoms, IQR 1-5] or <11 days), did not significantly predict MFI scores (R2=0.09; F4,7 =1.5; P=.22; adjusted R2=0.06). Conclusions: The majority of inpatients infected with SARS-CoV-2 presented with PCC 4 months after discharge, with complex clinical pictures. Only one-third of them were symptom-free during that time. Based on our findings, MFI scores were not directly related to self-reported depression, anxiety, or posttraumatic scores adjusted for age, sex, or LOS. Further research is needed to explore PCC and fatigue based on self-reported health experiences of discharged inpatients infected with SARS-CoV-2. %M 39197160 %R 10.2196/47465 %U https://publichealth.jmir.org/2024/1/e47465 %U https://doi.org/10.2196/47465 %U http://www.ncbi.nlm.nih.gov/pubmed/39197160 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52759 %T Association Between COVID-19 and Self-Harm: Nationwide Retrospective Ecological Spatiotemporal Study in Metropolitan France %A Baillet,Maëlle %A Wathelet,Marielle %A Lamer,Antoine %A Frévent,Camille %A Fovet,Thomas %A D'Hondt,Fabien %A Notredame,Charles-Edouard %A Vaiva,Guillaume %A Génin,Michael %K self-harm %K COVID-19 %K spatiotemporal analysis %K ecological regression %K data reuse %D 2024 %7 27.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has not been associated with increases in suicidal behavior at the national, regional, or county level. However, previous studies were not conducted on a finer scale or adjusted for ecological factors. Objective: Our objective was to assess the fine-scale spatiotemporal association between self-harm and COVID-19 hospitalizations, while considering ecological factors. Methods: Using the French national hospital discharge database, we extracted data on hospitalizations for self-harm of patients older than 10 years (from 2019 to 2021) or for COVID-19 (from 2020 to 2021) in metropolitan France. We first calculated monthly standardized incidence ratios (SIRs) for COVID-19 between March 2020 and December 2021, using a Besag, York, and Mollié spatiotemporal model. Next, we entered the SIRs into an ecological regression in order to test the association between hospital admissions for self-harm and those for COVID-19. Lastly, we adjusted for ecological variables with time lags of 0 to 6 months. Results: Compared with a smoothed SIR of ≤1, smoothed SIRs from 1 to 3, from 3 to 4, and greater than 4 for COVID-19 hospital admissions were associated with a subsequent increase in hospital admissions for self-harm, with a time lag of 2 to 4 months, 4 months, and 6 months, respectively. Conclusions: A high SIR for hospital admissions for COVID-19 was a risk factor for hospital admission for self-harm some months after the epidemic peaks. This finding emphasizes the importance of monitoring and seeking to prevent suicide attempts outside the epidemic peak periods. %R 10.2196/52759 %U https://publichealth.jmir.org/2024/1/e52759 %U https://doi.org/10.2196/52759 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47416 %T Geospatial Point-of-Care Testing Strategies for COVID-19 Resilience in Resource-Poor Settings: Rural Cambodia Field Study %A Kost,Gerald Joseph %A Eng,Muyngim %A Zadran,Amanullah %+ Point-of-care Testing Center for Teaching and Research (POCT•CTR), School of Medicine, University of California, Davis, 506 Citadel Drive, Davis, CA, 95616, United States, 1 916 734 2525, geraldkost@gmail.com %K Cambodia %K COVID-19 %K diagnostic portals %K mobile-testing van and clinic %K molecular diagnostics %K point-of-care testing %K POCT %K public health resilience %K rapid antigen test %K RAgT %K SARS-CoV-2 %K Solano and Yolo counties %K California %D 2024 %7 27.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Point-of-care testing (POCT) generates intrinsically fast, inherently spatial, and immediately actionable results. Lessons learned in rural Cambodia and California create a framework for planning and mobilizing POCT with telehealth interventions. Timely diagnosis can help communities assess the spread of highly infectious diseases, mitigate outbreaks, and manage risks. Objective: The aims of this study were to identify the need for POCT in Cambodian border provinces during peak COVID-19 outbreaks and to quantify geospatial gaps in access to diagnostics during community lockdowns. Methods: Data sources comprised focus groups, interactive learners, webinar participants, online contacts, academic experts, public health experts, and officials who determined diagnostic needs and priorities in rural Cambodia during peak COVID-19 outbreaks. We analyzed geographic distances and transit times to testing in border provinces and assessed a high-risk province, Banteay Meanchey, where people crossed borders daily leading to disease spread. We strategized access to rapid antigen testing and molecular diagnostics in the aforementioned province and applied mobile-testing experience among the impacted population. Results: COVID-19 outbreaks were difficult to manage in rural and isolated areas where diagnostics were insufficient to meet needs. The median transit time from border provinces (n=17) to testing sites was 73 (range 1-494) minutes, and in the high-risk Banteay Meanchey Province (n=9 districts), this transit time was 90 (range 10-150) minutes. Within border provinces, maximum versus minimum distances and access times for testing differed significantly (P<.001). Pareto plots revealed geospatial gaps in access to testing for people who are not centrally located. At the time of epidemic peaks in Southeast Asia, mathematical analyses showed that only one available rapid antigen test met the World Health Organization requirement of sensitivity >80%. We observed that in rural Solano and Yolo counties, California, vending machines and public libraries dispensing free COVID-19 test kits 24-7 improved public access to diagnostics. Mobile-testing vans equipped with COVID-19 antigen, reverse transcription polymerase chain reaction, and multiplex influenza A/B testing proved useful for differential diagnosis, public awareness, travel certifications, and telehealth treatment. Conclusions: Rural diagnostic portals implemented in California demonstrated a feasible public health strategy for Cambodia. Automated dispensers and mobile POCT can respond to COVID-19 case surges and enhance preparedness. Point-of-need planning can enhance resilience and assure spatial justice. Public health assets should include higher-quality, lower-cost, readily accessible, and user-friendly POCT, such as self-testing for diagnosis, home molecular tests, distributed border detection for surveillance, and mobile diagnostics vans for quick telehealth treatment. High-risk settings will benefit from the synthesis of geospatially optimized POCT, automated 24-7 test access, and timely diagnosis of asymptomatic and symptomatic patients at points of need now, during new outbreaks, and in future pandemics. %M 39190459 %R 10.2196/47416 %U https://publichealth.jmir.org/2024/1/e47416 %U https://doi.org/10.2196/47416 %U http://www.ncbi.nlm.nih.gov/pubmed/39190459 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e45513 %T The Clinical Severity of COVID-19 Variants of Concern: Retrospective Population-Based Analysis %A Harrigan,Sean P %A Velásquez García,Héctor A %A Abdia,Younathan %A Wilton,James %A Prystajecky,Natalie %A Tyson,John %A Fjell,Chris %A Hoang,Linda %A Kwong,Jeffrey C %A Mishra,Sharmistha %A Wang,Linwei %A Sander,Beate %A Janjua,Naveed Z %A Sbihi,Hind %+ BC Centre for Disease Control, 655 W12th Avenue, Vancouver, BC, V5Z4R4, Canada, 1 604 7071400, hind.sbihi@bccdc.ca %K COVID-19 %K SARS-CoV-2 %K severity %K whole genome sequencing %K WGS %K social determinants of health %K SDOHs %K vaccination %K variants of concern %K VOCs %K Alpha %K Gamma %K Delta %K Omicron %D 2024 %7 27.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: SARS-CoV-2 variants of concern (VOCs) emerged and rapidly replaced the original strain worldwide. The increased transmissibility of these new variants led to increases in infections, hospitalizations, and mortality. However, there is a scarcity of retrospective investigations examining the severity of all the main VOCs in presence of key public health measures and within various social determinants of health (SDOHs). Objective: This study aims to provide a retrospective assessment of the clinical severity of COVID-19 VOCs in the context of heterogenous SDOHs and vaccination rollout. Methods: We used a population-based retrospective cohort design with data from the British Columbia COVID-19 Cohort, a linked provincial surveillance platform. To assess the relative severity (hospitalizations, intensive care unit [ICU] admissions, and deaths) of Gamma, Delta, and Omicron infections during 2021 relative to Alpha, we used inverse probability treatment weighted Cox proportional hazard modeling. We also conducted a subanalysis among unvaccinated individuals, as assessed severity differed across VOCs and SDOHs. Results: We included 91,964 individuals infected with a SARS-CoV-2 VOC (Alpha: n=20,487, 22.28%; Gamma: n=15,223, 16.55%; Delta: n=49,161, 53.46%; and Omicron: n=7093, 7.71%). Delta was associated with the most severe disease in terms of hospitalization, ICU admissions, and deaths (hospitalization: adjusted hazard ratio [aHR] 2.00, 95% CI 1.92-2.08; ICU: aHR 2.05, 95% CI 1.91-2.20; death: aHR 3.70, 95% CI 3.23-4.25 relative to Alpha), followed generally by Gamma and then Omicron and Alpha. The relative severity by VOC remained similar in the unvaccinated individual subanalysis, although the proportion of individuals infected with Delta and Omicron who were hospitalized was 2 times higher in those unvaccinated than in those fully vaccinated. Regarding SDOHs, the proportion of hospitalized individuals was higher in areas with lower income across all VOCs, whereas among Alpha and Gamma infections, 2 VOCs that cocirculated, differential distributions of hospitalizations were found among racially minoritized groups. Conclusions: Our study provides robust severity estimates for all VOCs during the COVID-19 pandemic in British Columbia, Canada. Relative to Alpha, we found Delta to be the most severe, followed by Gamma and Omicron. This study highlights the importance of targeted testing and sequencing to ensure timely detection and accurate estimation of severity in emerging variants. It further sheds light on the importance of vaccination coverage and SDOHs in the context of pandemic preparedness to support the prioritization of allocation for resource-constrained or minoritized groups. %M 39190434 %R 10.2196/45513 %U https://publichealth.jmir.org/2024/1/e45513 %U https://doi.org/10.2196/45513 %U http://www.ncbi.nlm.nih.gov/pubmed/39190434 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54034 %T Acceptance of Social Media Recruitment for Clinical Studies Among Patients With Hepatitis B: Mixed Methods Study %A Willem,Theresa %A Zimmermann,Bettina M %A Matthes,Nina %A Rost,Michael %A Buyx,Alena %+ Institute of History and Ethics in Medicine, TUM School of Medicine and Health, Technical University of Munich, Ismaninger Str. 22, Munich, 81675, Germany, 49 89 4140 4041, bettina.zimmermann@tum.de %K Facebook %K Twitter %K social media %K clinical trial %K enrollment %K health technology acceptance %K ethics %K infectious diseases %K privacy %K data protection %K stigma %K discrimination %D 2024 %7 26.8.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media platforms are increasingly used to recruit patients for clinical studies. Yet, patients’ attitudes regarding social media recruitment are underexplored. Objective: This mixed methods study aims to assess predictors of the acceptance of social media recruitment among patients with hepatitis B, a patient population that is considered particularly vulnerable in this context. Methods: Using a mixed methods approach, the hypotheses for our survey were developed based on a qualitative interview study with 6 patients with hepatitis B and 30 multidisciplinary experts. Thematic analysis was applied to qualitative interview analysis. For the cross-sectional survey, we additionally recruited 195 patients with hepatitis B from 3 clinical centers in Germany. Adult patients capable of judgment with a hepatitis B diagnosis who understood German and visited 1 of the 3 study centers during the data collection period were eligible to participate. Data analysis was conducted using SPSS (version 28; IBM Corp), including descriptive statistics and regression analysis. Results: On the basis of the qualitative interview analysis, we hypothesized that 6 factors were associated with acceptance of social media recruitment: using social media in the context of hepatitis B (hypothesis 1), digital literacy (hypothesis 2), interest in clinical studies (hypothesis 3), trust in nonmedical (hypothesis 4a) and medical (hypothesis 4b) information sources, perceiving the hepatitis B diagnosis as a secret (hypothesis 5a), attitudes toward data privacy in the social media context (hypothesis 5b), and perceived stigma (hypothesis 6). Regression analysis revealed that the higher the social media use for hepatitis B (hypothesis 1), the higher the interest in clinical studies (hypothesis 3), the more trust in nonmedical information sources (hypothesis 4a), and the less secrecy around a hepatitis B diagnosis (hypothesis 5a), the higher the acceptance of social media as a recruitment tool for clinical hepatitis B studies. Conclusions: This mixed methods study provides the first quantitative insights into social media acceptance for clinical study recruitment among patients with hepatitis B. The study was limited to patients with hepatitis B in Germany but sets out to be a reference point for future studies assessing the attitudes toward and acceptance of social media recruitment for clinical studies. Such empirical inquiries can facilitate the work of researchers designing clinical studies as well as ethics review boards in balancing the risks and benefits of social media recruitment in a context-specific manner. %M 39186322 %R 10.2196/54034 %U https://www.jmir.org/2024/1/e54034 %U https://doi.org/10.2196/54034 %U http://www.ncbi.nlm.nih.gov/pubmed/39186322 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53331 %T South Asia’s COVID-19 History and Surveillance: Updated Epidemiological Assessment %A Post,Lori A %A Soetikno,Alan G %A Wu,Scott A %A Hawkins,Claudia %A Mason,Maryann %A Ozer,Egon A %A Murphy,Robert L %A Welch,Sarah B %A Liu,Yingxuan %A Havey,Robert J %A Moss,Charles B %A Achenbach,Chad J %A Lundberg,Alexander L %+ Buehler Center for Health Policy and Economics, Robert J Havey, MD Institute for Global Health, Northwestern University, 420 E Superior St, Chicago, IL, 60611, United States, 1 312 503 1706, lori.post@northwestern.edu %K SARS-CoV-2 %K COVID-19 %K South Asia %K pandemic history %K Bangladesh %K Bhutan %K India %K Maldives %K Nepal %K Pakistan %K Sri Lanka %K surveillance %K speed %K acceleration %K jerk %K dynamic panel data %K generalized method of moments %K GMM %K Arellano-Bond %K 7-day lag %D 2024 %7 26.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: This study updates our findings from the COVID-19 pandemic surveillance we first conducted in South Asia in 2020 with 2 additional years of data for the region. We assess whether COVID-19 had transitioned from pandemic to endemic at the point the World Health Organization (WHO) ended the public health emergency status for COVID-19 on May 5, 2023. Objective: First, we aim to measure whether there was an expansion or contraction in the pandemic in South Asia around the WHO declaration. Second, we use dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we aim to provide historical context for the course of the pandemic in South Asia. Methods: In addition to updating the traditional surveillance data and dynamic panel estimates from our original study, this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t test to determine whether regional weekly speed or transmission rate per 100,000 population was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. Results: Speed for the region had remained below the outbreak threshold for over a year by the time of the WHO declaration. Acceleration and jerk were also low and stable. While the 1-day persistence coefficients remained statistically significant and positive (1.168), the 7-day persistence coefficient was negative (–0.185), suggesting limited cluster effects in which cases on a given day predict cases 7 days forward. Furthermore, the shift parameters for either of the 2 most recent weeks around May 5, 2023, did not indicate any overall change in the persistence measure around the time of the WHO declaration. From December of 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of speed equal to 10 was statistically insignificant across the entire pandemic. Conclusions: While COVID-19 continued to circulate in South Asia, the rate of transmission had remained below the outbreak threshold for well over a year ahead of the WHO declaration. COVID-19 is endemic in the region and no longer reaches the threshold of the pandemic definition. Both standard and enhanced surveillance metrics confirm that the pandemic had ended by the time of the WHO declaration. Prevention policies should be a focus ahead of future pandemics. On that point, policy should emphasize an epidemiological task force with widespread testing and a contact-tracing system. %M 39013116 %R 10.2196/53331 %U https://publichealth.jmir.org/2024/1/e53331 %U https://doi.org/10.2196/53331 %U http://www.ncbi.nlm.nih.gov/pubmed/39013116 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 12 %N %P e53211 %T Using mHealth Technologies for Case Finding in Tuberculosis and Other Infectious Diseases in Africa: Systematic Review %A Mudzengi,Don Lawrence %A Chomutare,Herbert %A Nagudi,Jeniffer %A Ntshiqa,Thobani %A Davis,J Lucian %A Charalambous,Salome %A Velen,Kavindhran %+ The Aurum Institute, 29 Queens Road, Parktown, Johannesburg, 2193, South Africa, 27 833697946, dmudzengi@auruminstitute.org %K mobile health %K mHealth %K design thinking %K tuberculosis %K Ebola %K HIV %K COVID-19 %K infectious diseases %K contact tracing %K mobile phone %D 2024 %7 26.8.2024 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) technologies are increasingly used in contact tracing and case finding, enhancing and replacing traditional methods for managing infectious diseases such as Ebola, tuberculosis, COVID-19, and HIV. However, the variations in their development approaches, implementation scopes, and effectiveness introduce uncertainty regarding their potential to improve public health outcomes. Objective: We conducted this systematic review to explore how mHealth technologies are developed, implemented, and evaluated. We aimed to deepen our understanding of mHealth’s role in contact tracing, enhancing both the implementation and overall health outcomes. Methods: We searched and reviewed studies conducted in Africa focusing on tuberculosis, Ebola, HIV, and COVID-19 and published between 1990 and 2023 using the PubMed, Scopus, Web of Science, and Google Scholar databases. We followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines to review, synthesize, and report the findings from articles that met our criteria. Results: We identified 11,943 articles, but only 19 (0.16%) met our criteria, revealing a large gap in technologies specifically aimed at case finding and contact tracing of infectious diseases. These technologies addressed a broad spectrum of diseases, with a predominant focus on Ebola and tuberculosis. The type of technologies used ranged from mobile data collection platforms and smartphone apps to advanced geographic information systems (GISs) and bidirectional communication systems. Technologies deployed in programmatic settings, often developed using design thinking frameworks, were backed by significant funding and often deployed at a large scale but frequently lacked rigorous evaluations. In contrast, technologies used in research settings, although providing more detailed evaluation of both technical performance and health outcomes, were constrained by scale and insufficient funding. These challenges not only prevented these technologies from being tested on a wider scale but also hindered their ability to provide actionable and generalizable insights that could inform public health policies effectively. Conclusions: Overall, this review underscored a need for organized development approaches and comprehensive evaluations. A significant gap exists between the expansive deployment of mHealth technologies in programmatic settings, which are typically well funded and rigorously developed, and the more robust evaluations necessary to ascertain their effectiveness. Future research should consider integrating the robust evaluations often found in research settings with the scale and developmental rigor of programmatic implementations. By embedding advanced research methodologies within programmatic frameworks at the design thinking stage, mHealth technologies can potentially become technically viable and effectively meet specific contact tracing health outcomes to inform policy effectively. %M 39186366 %R 10.2196/53211 %U https://mhealth.jmir.org/2024/1/e53211 %U https://doi.org/10.2196/53211 %U http://www.ncbi.nlm.nih.gov/pubmed/39186366 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e43173 %T Impact of the COVID-19 Pandemic on Influenza Hospital Admissions and Deaths in Wales: Descriptive National Time Series Analysis %A Alsallakh,Mohammad %A Adeloye,Davies %A Vasileiou,Eleftheria %A Sivakumaran,Shanya %A Akbari,Ashley %A Lyons,Ronan A %A Robertson,Chris %A Rudan,Igor %A Davies,Gwyneth A %A Sheikh,Aziz %K influenza %K hospitalization %K mortality %K COVID-19 pandemic %K nonpharmaceutical interventions %K Wales %K COVID-19 %K community health %K hospital admission %K endemic virus %K public health surveillance %D 2024 %7 21.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic and the ensuing implementation of control measures caused widespread societal disruption. These disruptions may also have affected community transmission and seasonal circulation patterns of endemic respiratory viruses. Objective: We aimed to investigate the impact of COVID-19–related disruption on influenza-related emergency hospital admissions and deaths in Wales in the first 2 years of the pandemic. Methods: A descriptive analysis of influenza activity was conducted using anonymized pathology, hospitalization, and mortality data from the Secure Anonymised Information Linkage Databank in Wales. The annual incidence of emergency hospitalizations and deaths with influenza-specific diagnosis codes between January 1, 2015, and December 31, 2021, was estimated. Case definitions of emergency hospitalization and death required laboratory confirmation with a polymerase chain reaction test. Trends of admissions and deaths were analyzed monthly and yearly. We conducted 2 sensitivity analyses by extending case definitions to include acute respiratory illnesses with a positive influenza test and by limiting admissions to those with influenza as the primary diagnosis. We also examined yearly influenza testing trends to understand changes in testing behavior during the pandemic. Results: We studied a population of 3,235,883 Welsh residents in 2020 with a median age of 42.5 (IQR 22.9–61.0) years. Influenza testing in Wales increased notably in the last 2 months of 2020, and particularly in 2021 to 39,720 per 100,000 people, compared to the prepandemic levels (1343 in 2019). The percentage of influenza admissions matched to an influenza polymerase chain reaction test increased from 74.8% (1890/2526) in 2019 to 85.2% (98/115) in 2021. However, admissions with a positive test per 100,000 population decreased from 17.0 in 2019 to 2.7 and 0.6 in 2020 and 2021, respectively. Similarly, deaths due to influenza with a positive influenza test per 100,000 population decreased from 0.4 in 2019 to 0.0 in 2020 and 2021. Sensitivity analyses showed similar patterns of decreasing influenza admissions and deaths in the first 2 years of the COVID-19 pandemic. Conclusions: Nonpharmaceutical interventions to control COVID-19 were associated with a substantial reduction in the transmission of the influenza virus, with associated substantial reductions in hospital cases and deaths observed. Beyond the pandemic context, consideration should be given to the role of nonpharmaceutical community-driven interventions to reduce the burden of influenza. %R 10.2196/43173 %U https://publichealth.jmir.org/2024/1/e43173 %U https://doi.org/10.2196/43173 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57742 %T Risk Index of Regional Infection Expansion of COVID-19: Moving Direction Entropy Study Using Mobility Data and Its Application to Tokyo %A Ohsawa,Yukio %A Sun,Yi %A Sekiguchi,Kaira %A Kondo,Sae %A Maekawa,Tomohide %A Takita,Morihito %A Tanimoto,Tetsuya %A Kami,Masahiro %+ School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8656, Japan, 81 358417012, ohsawa@sys.t.u-tokyo.ac.jp %K suppressing the spread of infection %K index for risk assessment %K local regions %K diversity of mobility %K mobility data %K moving direction entropy %K MDE %K social network model %K COVID-19 %K influenza %K sexually transmitted diseases %D 2024 %7 21.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Policies, such as stay home, bubbling, and stay with your community, recommending that individuals reduce contact with diverse communities, including families and schools, have been introduced to mitigate the spread of the COVID-19 pandemic. However, these policies are violated if individuals from various communities gather, which is a latent risk in a real society where people move among various unreported communities. Objective: We aimed to create a physical index to assess the possibility of contact between individuals from diverse communities, which serves as an indicator of the potential risk of SARS-CoV-2 spread when considered and combined with existing indices. Methods: Moving direction entropy (MDE), which quantifies the diversity of moving directions of individuals in each local region, is proposed as an index to evaluate a region’s risk of contact of individuals from diverse communities. MDE was computed for each inland municipality in Tokyo using mobility data collected from smartphones before and during the COVID-19 pandemic. To validate the hypothesis that the impact of intercommunity contact on infection expansion becomes larger for a virus with larger infectivity, we compared the correlations of the expansion of infectious diseases with indices, including MDE and the densities of supermarkets, restaurants, etc. In addition, we analyzed the temporal changes in MDE in municipalities. Results: This study had 4 important findings. First, the MDE values for local regions showed significant invariance between different periods according to the Spearman rank correlation coefficient (>0.9). Second, MDE was found to correlate with the rate of infection cases of COVID-19 among local populations in 53 inland regions (average of 0.76 during the period of expansion). The density of restaurants had a similar correlation with COVID-19. The correlation between MDE and the rate of infection was smaller for influenza than for COVID-19, and tended to be even smaller for sexually transmitted diseases (order of infectivity). These findings support the hypothesis. Third, the spread of COVID-19 was accelerated in regions with high-rank MDE values compared to those with high-rank restaurant densities during and after the period of the governmental declaration of emergency (P<.001). Fourth, the MDE values tended to be high and increased during the pandemic period in regions where influx or daytime movement was present. A possible explanation for the third and fourth findings is that policymakers and living people have been overlooking MDE. Conclusions: We recommend monitoring the regional values of MDE to reduce the risk of infection spread. To aid in this monitoring, we present a method to create a heatmap of MDE values, thereby drawing public attention to behaviors that facilitate contact between communities during a highly infectious disease pandemic. %M 39037745 %R 10.2196/57742 %U https://publichealth.jmir.org/2024/1/e57742 %U https://doi.org/10.2196/57742 %U http://www.ncbi.nlm.nih.gov/pubmed/39037745 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e55183 %T The Mediating Role of Human Mobility in Temporal-Lagged Relationships Between Risk Perception and COVID-19 Dynamics in Taiwan: Statistical Modeling for Comparing the Pre-Omicron and Omicron Eras %A Chang,Min-Chien %A Wen,Tzai-Hung %K human mobility %K risk perception %K COVID-19 %K Omicron %K Taiwan %K pandemic %K disease transmission %K pandemic dynamics %K global threats %K infectious disease %K behavioural health %K public health %K surveillance %D 2024 %7 20.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has profoundly impacted all aspects of human life for over 3 years. Understanding the evolution of public risk perception during these periods is crucial. Few studies explore the mechanisms for reducing disease transmission due to risk perception. Thus, we hypothesize that changes in human mobility play a mediating role between risk perception and the progression of the pandemic. Objective: The study aims to explore how various forms of human mobility, including essential, nonessential, and job-related behaviors, mediate the temporal relationships between risk perception and pandemic dynamics. Methods: We used distributed-lag linear structural equation models to compare the mediating impact of human mobility across different virus variant periods. These models examined the temporal dynamics and time-lagged effects among risk perception, changes in mobility, and virus transmission in Taiwan, focusing on two distinct periods: (1) April-August 2021 (pre-Omicron era) and (2) February-September 2022 (Omicron era). Results: In the pre-Omicron era, our findings showed that an increase in public risk perception correlated with significant reductions in COVID-19 cases across various types of mobility within specific time frames. Specifically, we observed a decrease of 5.59 (95% CI −4.35 to −6.83) COVID-19 cases per million individuals after 7 weeks in nonessential mobility, while essential mobility demonstrated a reduction of 10.73 (95% CI −9.6030 to −11.8615) cases after 8 weeks. Additionally, job-related mobility resulted in a decrease of 3.96 (95% CI −3.5039 to −4.4254) cases after 11 weeks. However, during the Omicron era, these effects notably diminished. A reduction of 0.85 (95% CI −1.0046 to −0.6953) cases through nonessential mobility after 10 weeks and a decrease of 0.69 (95% CI −0.7827 to −0.6054) cases through essential mobility after 12 weeks were observed. Conclusions: This study confirms that changes in mobility serve as a mediating factor between heightened risk perception and pandemic mitigation in both pre-Omicron and Omicron periods. This suggests that elevating risk perception is notably effective in impeding virus progression, especially when vaccines are unavailable or their coverage remains limited. Our findings provide significant value for health authorities in devising policies to address the global threats posed by emerging infectious diseases. %R 10.2196/55183 %U https://publichealth.jmir.org/2024/1/e55183 %U https://doi.org/10.2196/55183 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53322 %T Predicting Long COVID in the National COVID Cohort Collaborative Using Super Learner: Cohort Study %A Butzin-Dozier,Zachary %A Ji,Yunwen %A Li,Haodong %A Coyle,Jeremy %A Shi,Junming %A Phillips,Rachael V %A Mertens,Andrew N %A Pirracchio,Romain %A van der Laan,Mark J %A Patel,Rena C %A Colford,John M %A Hubbard,Alan E %A , %+ Division of Biostatistics, University of California Berkeley School of Public Health, 2121 Berkeley Way, Berkeley, CA, 94720, United States, 1 3024376262, zbutzin@berkeley.edu %K long COVID %K COVID-19 %K machine learning %K respiratory %K infectious %K SARS-CoV-2 %K sequelae %K chronic %K long term %K covariate %K covariates %K risk %K risks %K predict %K prediction %K predictions %K predictive %K Super Learner %K ensemble %K stacking %D 2024 %7 15.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Postacute sequelae of COVID-19 (PASC), also known as long COVID, is a broad grouping of a range of long-term symptoms following acute COVID-19. These symptoms can occur across a range of biological systems, leading to challenges in determining risk factors for PASC and the causal etiology of this disorder. An understanding of characteristics that are predictive of future PASC is valuable, as this can inform the identification of high-risk individuals and future preventative efforts. However, current knowledge regarding PASC risk factors is limited. Objective: Using a sample of 55,257 patients (at a ratio of 1 patient with PASC to 4 matched controls) from the National COVID Cohort Collaborative, as part of the National Institutes of Health Long COVID Computational Challenge, we sought to predict individual risk of PASC diagnosis from a curated set of clinically informed covariates. The National COVID Cohort Collaborative includes electronic health records for more than 22 million patients from 84 sites across the United States. Methods: We predicted individual PASC status, given covariate information, using Super Learner (an ensemble machine learning algorithm also known as stacking) to learn the optimal combination of gradient boosting and random forest algorithms to maximize the area under the receiver operator curve. We evaluated variable importance (Shapley values) based on 3 levels: individual features, temporal windows, and clinical domains. We externally validated these findings using a holdout set of randomly selected study sites. Results: We were able to predict individual PASC diagnoses accurately (area under the curve 0.874). The individual features of the length of observation period, number of health care interactions during acute COVID-19, and viral lower respiratory infection were the most predictive of subsequent PASC diagnosis. Temporally, we found that baseline characteristics were the most predictive of future PASC diagnosis, compared with characteristics immediately before, during, or after acute COVID-19. We found that the clinical domains of health care use, demographics or anthropometry, and respiratory factors were the most predictive of PASC diagnosis. Conclusions: The methods outlined here provide an open-source, applied example of using Super Learner to predict PASC status using electronic health record data, which can be replicated across a variety of settings. Across individual predictors and clinical domains, we consistently found that factors related to health care use were the strongest predictors of PASC diagnosis. This indicates that any observational studies using PASC diagnosis as a primary outcome must rigorously account for heterogeneous health care use. Our temporal findings support the hypothesis that clinicians may be able to accurately assess the risk of PASC in patients before acute COVID-19 diagnosis, which could improve early interventions and preventive care. Our findings also highlight the importance of respiratory characteristics in PASC risk assessment. International Registered Report Identifier (IRRID): RR2-10.1101/2023.07.27.23293272 %R 10.2196/53322 %U https://publichealth.jmir.org/2024/1/e53322 %U https://doi.org/10.2196/53322 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e55822 %T Increased Risk of Influenza Infection During Cold Spells in China: National Time Series Study %A Wang,Haitao %A Geng,Mengjie %A Schikowski,Tamara %A Areal,Ashtyn Tracey %A Hu,Kejia %A Li,Wen %A Coelho,Micheline de Sousa Zanotti Stagliorio %A Saldiva,Paulo Hilário Nascimento %A Sun,Wei %A Zhou,Chengchao %A Lu,Liang %A Zhao,Qi %A Ma,Wei %K influenza %K cold spell %K definition %K vulnerable population %K modification effect %K China %D 2024 %7 13.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Studies have reported the adverse effects of cold events on influenza. However, the role of critical factors, such as characteristics of cold spells, and regional variations remain unresolved. Objective: We aimed to systematically evaluate the association between cold spells and influenza incidence in mainland China. Methods: This time series analysis used surveillance data of daily influenza from 325 sites in China in the 2014‐2019 period. A total of 15 definitions of cold spells were adopted based on combinations of temperature thresholds and days of duration. A distributed lag linear model was used to estimate the short-term effects of cold spells on influenza incidence during the cool seasons (November to March), and we further explored the potential impact of cold spell characteristics (ie, intensity, duration, and timing during the season) on the estimated associations. Meta-regressions were used to evaluate the modification effect of city-level socioeconomic indicators. Results: The overall effect of cold spells on influenza incidence increased with the temperature threshold used to define cold spells, whereas the added effects were generally small and not statistically significant. The relative risk of influenza-associated with cold spells was 3.35 (95% CI 2.89‐3.88), and the estimated effects were stronger during the middle period of cool seasons. The health effects of cold spells varied geographically and residents in Jiangnan region were vulnerable groups (relative risk 7.36, 95% CI 5.44‐9.95). The overall effects of cold spells were positively correlated with the urban population density, population size, gross domestic product per capita, and urbanization rate, indicating a sterner response to cold spells in metropolises. Conclusions: Cold spells create a substantial health burden on seasonal influenza in China. Findings on regional and socioeconomic differences in the health effects of cold spells on seasonal influenza may be useful in formulating region-specific public health policies to address the hazardous effects of cold spells. %R 10.2196/55822 %U https://publichealth.jmir.org/2024/1/e55822 %U https://doi.org/10.2196/55822 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57349 %T A Bayesian System to Detect and Track Outbreaks of Influenza-Like Illnesses Including Novel Diseases: Algorithm Development and Validation %A Aronis,John M %A Ye,Ye %A Espino,Jessi %A Hochheiser,Harry %A Michaels,Marian G %A Cooper,Gregory F %+ Department of Biomedical Informatics, University of Pittsburgh, 5607 Baum Blvd, Suite 500, Pittsburgh, PA, 15206-3701, United States, 1 412 624 5100, jma18@pitt.edu %K biosurveillance %K outbreak %K novel disease %K natural language processing %K disease modeling %K Bayesian modeling %K influenza %K influenza-like illnesses %K novel diseases %K public health %K COVID-19 %K SARS-CoV-2 %K coronavirus %K hospital %K hospitals %K emergency department %K patient care %K NLP %K algorithm %K respiratory syncytial %K human metapneumovirus %K parainfluenza %K Pennsylvania %K enterovirus D68 %K surveillance %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background:  The early identification of outbreaks of both known and novel influenza-like illnesses (ILIs) is an important public health problem. Objective:  This study aimed to describe the design and testing of a tool that detects and tracks outbreaks of both known and novel ILIs, such as the SARS-CoV-2 worldwide pandemic, accurately and early. Methods:  This paper describes the ILI Tracker algorithm that first models the daily occurrence of a set of known ILIs in hospital emergency departments in a monitored region using findings extracted from patient care reports using natural language processing. We then show how the algorithm can be extended to detect and track the presence of an unmodeled disease that may represent a novel disease outbreak. Results:  We include results based on modeling diseases like influenza, respiratory syncytial virus, human metapneumovirus, and parainfluenza for 5 emergency departments in Allegheny County, Pennsylvania, from June 1, 2014, to May 31, 2015. We also include the results of detecting the outbreak of an unmodeled disease, which in retrospect was very likely an outbreak of the enterovirus D68 (EV-D68). Conclusions:  The results reported in this paper provide support that ILI Tracker was able to track well the incidence of 4 modeled influenza-like diseases over a 1-year period, relative to laboratory-confirmed cases, and it was computationally efficient in doing so. The system was also able to detect a likely novel outbreak of EV-D68 early in an outbreak that occurred in Allegheny County in 2014 as well as clinically characterize that outbreak disease accurately. %M 38805611 %R 10.2196/57349 %U https://publichealth.jmir.org/2024/1/e57349 %U https://doi.org/10.2196/57349 %U http://www.ncbi.nlm.nih.gov/pubmed/38805611 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e59193 %T Mpox Discourse on Twitter by Sexual Minority Men and Gender-Diverse Individuals: Infodemiological Study Using BERTopic %A Wang,Yunwen %A O’Connor,Karen %A Flores,Ivan %A Berdahl,Carl T %A Urbanowicz,Ryan J %A Stevens,Robin %A Bauermeister,José A %A Gonzalez-Hernandez,Graciela %+ Department of Computational Biomedicine, Cedars-Sinai Medical Center, 700 N San Vicente Blvd, West Hollywood, CA, 90069, United States, 1 310 423 2980, graciela.gonzalezhernandez@csmc.edu %K mpox %K monkeypox %K social media %K sexual minority %K SMMGD %K sexual minority men and gender diverse %K emerging infectious disease %K infectious disease outbreak %K health activism %K health promotion %K health stigma %K stigma prevention %K health equity %K natural language processing %K BERTopic %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The mpox outbreak resulted in 32,063 cases and 58 deaths in the United States and 95,912 cases worldwide from May 2022 to March 2024 according to the US Centers for Disease Control and Prevention (CDC). Like other disease outbreaks (eg, HIV) with perceived community associations, mpox can create the risk of stigma, exacerbate homophobia, and potentially hinder health care access and social equity. However, the existing literature on mpox has limited representation of the perspective of sexual minority men and gender-diverse (SMMGD) individuals. Objective: To fill this gap, this study aimed to synthesize themes of discussions among SMMGD individuals and listen to SMMGD voices for identifying problems in current public health communication surrounding mpox to improve inclusivity, equity, and justice. Methods: We analyzed mpox-related posts (N=8688) posted between October 2020 and September 2022 by 2326 users who self-identified on Twitter/X as SMMGD and were geolocated in the United States. We applied BERTopic (a topic-modeling technique) on the tweets, validated the machine-generated topics through human labeling and annotations, and conducted content analysis of the tweets in each topic. Geographic analysis was performed on the size of the most prominent topic across US states in relation to the University of California, Los Angeles (UCLA) lesbian, gay, and bisexual (LGB) social climate index. Results: BERTopic identified 11 topics, which annotators labeled as mpox health activism (n=2590, 29.81%), mpox vaccination (n=2242, 25.81%), and adverse events (n=85, 0.98%); sarcasm, jokes, and emotional expressions (n=1220, 14.04%); COVID-19 and mpox (n=636, 7.32%); government or public health response (n=532, 6.12%); mpox symptoms (n=238, 2.74%); case reports (n=192, 2.21%); puns on the naming of the virus (ie, mpox; n=75, 0.86%); media publicity (n=59, 0.68%); and mpox in children (n=58, 0.67%). Spearman rank correlation indicated significant negative correlation (ρ=–0.322, P=.03) between the topic size of health activism and the UCLA LGB social climate index at the US state level. Conclusions: Discussions among SMMGD individuals on mpox encompass both utilitarian (eg, vaccine access, case reports, and mpox symptoms) and emotionally charged (ie, promoting awareness, advocating against homophobia, misinformation/disinformation, and health stigma) themes. Mpox health activism is more prevalent in US states with lower LGB social acceptance, suggesting a resilient communicative pattern among SMMGD individuals in the face of public health oppression. Our method for social listening could facilitate future public health efforts, providing a cost-effective way to capture the perspective of impacted populations. This study illuminates SMMGD engagement with the mpox discourse, underscoring the need for more inclusive public health programming. Findings also highlight the social impact of mpox: health stigma. Our findings could inform interventions to optimize the delivery of informational and tangible health resources leveraging computational mixed-method analyses (eg, BERTopic) and big data. %M 39137013 %R 10.2196/59193 %U https://publichealth.jmir.org/2024/1/e59193 %U https://doi.org/10.2196/59193 %U http://www.ncbi.nlm.nih.gov/pubmed/39137013 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54383 %T 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 %A Pongutta,Suladda %A Tangcharoensathien,Viroj %A Leung,Kathy %A Larson,Heidi J %A Lin,Leesa %+ International Health Policy Program, Ministry of Public Health, Muang, , Nonthaburi, , Thailand, 66 25902376, suladda@ihpp.thaigov.net %K social vulnerability Index %K COVID-19 %K protective behavior %K Africa %K Western Pacific %K social vulnerability %K African countries %K Western countries %K predict %K predicts %K prediction %K propensity %K baseline data %K Factor analysis %K polychoric %K varimax rotation %K protective %K behaviour %K behaviours %K preventive %K precautionary %K linear regression %K predictability %K Omicron %K sociodemographic %K media use %K communication %K health risk perception %K socioeconomic %D 2024 %7 13.8.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 39137034 %R 10.2196/54383 %U https://publichealth.jmir.org/2024/1/e54383 %U https://doi.org/10.2196/54383 %U http://www.ncbi.nlm.nih.gov/pubmed/39137034 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50244 %T Association of Fine Particulate Matter and Residential Greenness With Risk of Pulmonary Tuberculosis Retreatment: Population-Based Retrospective Study %A Guo,Tonglei %A Shen,Fei %A Xin,Henan %A Du,Jiang %A Cao,Xuefang %A Feng,Boxuan %A He,Yijun %A Shen,Lingyu %A Di,Yuanzhi %A Chen,Yanxiao %A Li,Zihan %A Jin,Qi %A Li,Hongzhi %A Zhang,Chunming %A Gao,Lei %K tuberculosis %K PM2.5 %K particulate matter %K air pollution %K greenness %K retrospective study %K pulmonary %K retreatment %D 2024 %7 12.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: The evidence on the association of fine particulate matter with an aerodynamic diameter of 2.5 μm or less (PM2.5) with pulmonary tuberculosis (PTB) retreatment is limited. There are no data on whether greenness exposure protects air pollution–related PTB retreatment in patients with prior PTB. Objective: In a population-based retrospective study, we aimed to investigate the influence of PM2.5 and residential greenness on the risk of PTB retreatment. Methods: A total of 26,482 patients with incident PTB, registered in a mandatory web-based reporting system between 2012 and 2019 in Zhengzhou, China, were included in the analysis. The exposure to PM2.5 was assessed based on the China High Air Pollutants dataset, and the level of greenness was estimated using the Normalized Difference Vegetation Index (NDVI) values. The associations of PTB retreatment with exposure to PM2.5 and greenness were evaluated, respectively, considering the local socioeconomic level indicated by the nighttime light index. Results: Among the 26,482 patients (mean age 46.86, SD 19.52 years) with a median follow-up time of 1523 days per patient, 1542 (5.82%) PTB retreatments were observed between 2012 and 2019. Exposure to PM2.5 was observed to be significantly associated with the increased risk of PTB retreatment in fully adjusted models with a hazard ratio of 1.97 (95% CI 1.34‐2.83) per 10 μg/m3 increase in PM2.5. Patients living in the regions with relatively high quartiles of NDVI values had a 45% lower risk of PTB retreatment than those living in the regions with the lowest quartile for the 500 m buffers (hazard ratio 0.55, 95% CI 0.40‐0.77). Such a protective effect of residential greenness was more pronounced among patients living in lower nighttime light areas. The strength of the association between PM2.5 exposure and the risk of PTB retreatment was attenuated by greenness. No significant association was observed between NDVI and the incidence of drug resistance. Conclusions: Long-term exposure to PM2.5 might be a risk factor for PTB retreatment, while an increased level of residential greenness was found to be associated with reduced risks of PTB retreatment. Our results suggest strengthening the control of ambient air pollution and improving residential greenness may contribute to the reduction of PTB retreatment. %R 10.2196/50244 %U https://publichealth.jmir.org/2024/1/e50244 %U https://doi.org/10.2196/50244 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e52363 %T Comparison of Use Rates of Telehealth Services for Substance Use Disorder During and Following COVID-19 Safety Distancing Recommendations: Two Cross-Sectional Surveys %A Pusnik,Adrijana %A Hartzler,Bryan %A Vjorn,Olivia %A Rutkowski,Beth A %A Chaple,Michael %A Becker,Sara %A Freese,Thomas %A Nichols,Maureen %A Molfenter,Todd %K telehealth %K COVID-19 %K substance use disorders %K telephone counseling %K video counseling %D 2024 %7 12.8.2024 %9 %J JMIR Ment Health %G English %X Background: The COVID-19 social distancing guidelines resulted in a dramatic transition to telephone and video technologies to deliver substance use disorder (SUD) treatment. Before COVID-19, the question was “Will telehealth ever take hold for SUD services?” Now that social distancing guidelines have been lifted, the question is “Will telehealth remain a commonly used care modality?” Objective: The principal purpose of this investigation was to examine the extent to which telehealth use in SUD service settings persisted following the lifting of COVID-19 safety distancing recommendations. Additionally, the study aimed to explore practitioners’ perceptions of telehealth convenience and value after its regular implementation during the pandemic. Specifically, the goal of this study was to compare telehealth activity between time intervals: May-August 2020 (during peak COVID-19 safety distancing recommendations) and October-December 2022 (following discontinuation of distancing recommendations). Specifically, we compared (1) telehealth technologies and services, (2) perceived usefulness of telehealth, (3) ease of use of telephone- and video-based telehealth services, and (4) organizational readiness to use telehealth. Methods: An online cross-sectional survey consisting of 108 items was conducted to measure the use of telehealth technologies for delivering a specific set of SUD services in the United States and to explore the perceived readiness for use and satisfaction with telephonic and video services. The survey took approximately 25‐35 minutes to complete and used the same 3 sets of questions and 2 theory-driven scales as in a previous cross-sectional survey conducted in 2020. Six of 10 Regional Addiction Technology Transfer Centers funded by the Substance Abuse and Mental Health Services Administration distributed the survey in their respective regions, collectively spanning 37 states. Responses of administrators and clinicians (hereafter referred to as staff) from this 2022 survey were compared to those obtained in the 2020 survey. Responses in 2020 and 2022 were anonymous and comprised two separate samples; therefore, an accurate longitudinal model could not be analyzed. Results: A total of 375 staff responded to the 2022 survey (vs 457 in 2020). Baseline organizational characteristics of the 2022 sample were similar to those of the 2020 sample. Phone and video telehealth utilization rates remained greater than 50% in 2022 for screening and assessment, case management, peer recovery support services, and regular outpatient services. The perceived usefulness of phone-based telehealth was higher in 2022 than in 2020 (mean difference [MD] −0.23; P=.002), but not for video-based telehealth (MD −0.12; P=.13). Ease of use of video-based telehealth was perceived as higher in 2022 than in 2020 (MD−0.35; P<.001), but no difference was found for phone-based telehealth (MD −0.12; P=.11). From the staff’s perspective, patients had greater readiness for using telehealth via phone than video, but the staff perceived their personal and organizational readiness for using telehealth as greater for video-based than for phone-based telehealth. Conclusions: Despite lower telephone and video use in 2022 for telehealth services than in 2020, both modalities continue to be perceived positively. Future research may further determine the relative cost and clinical effectiveness of video-based services and thereby help to address some sources of the noted challenges to implementation by SUD organizations. %R 10.2196/52363 %U https://mental.jmir.org/2024/1/e52363 %U https://doi.org/10.2196/52363 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e58821 %T Spatiotemporal Changes and Influencing Factors of Hand, Foot, and Mouth Disease in Guangzhou, China, From 2013 to 2022: Retrospective Analysis %A Liu,Jiaojiao %A Wang,Hui %A Zhong,Siyi %A Zhang,Xiao %A Wu,Qilin %A Luo,Haipeng %A Luo,Lei %A Zhang,Zhoubin %K hand, foot, and mouth disease %K spatial analysis %K space-time scan statistics %K geographically and temporally weighted regression %K infectious disease %D 2024 %7 2.8.2024 %9 %J JMIR Public Health Surveill %G English %X 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 (β=−0.016) and average annual income of employees (β=−0.007) were protective factors for HFMD incidence, while the average number of students in each primary school (β=1.416) and kindergarten (β=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. %R 10.2196/58821 %U https://publichealth.jmir.org/2024/1/e58821 %U https://doi.org/10.2196/58821 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46070 %T Factors Associated With the Spatial Distribution of Severe Fever With Thrombocytopenia Syndrome in Zhejiang Province, China: Risk Analysis Based on Maximum Entropy %A Tao,Mingyong %A Liu,Ying %A Ling,Feng %A Ren,Jiangping %A Zhang,Rong %A Shi,Xuguang %A Guo,Song %A Jiang,Jianmin %A Sun,Jimin %K severe fever with thrombocytopenia syndrome %K MaxEnt %K maximum entropy %K tick density %K spatial distribution %K risk factor %K China %D 2024 %7 2.8.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease that was first identified in mainland China in 2009 and has been reported in Zhejiang Province, China, since 2011. However, few studies have focused on the association between ticks, host animals, and SFTS. Objective: In this study, we analyzed the influence of meteorological and environmental factors as well as the influence of ticks and host animals on SFTS. This can serve as a foundational basis for the development of strategic policies aimed at the prevention and control of SFTS. Methods: Data on SFTS incidence, tick density, cattle density, and meteorological and environmental factors were collected and analyzed using a maximum entropy–based model. Results: As of December 2019, 463 laboratory-confirmed SFTS cases were reported in Zhejiang Province. We found that the density of ticks, precipitation in the wettest month, average temperature, elevation, and the normalized difference vegetation index were significantly associated with SFTS spatial distribution. The niche model fitted accurately with good performance in predicting the potential risk areas of SFTS (the average test area under the receiver operating characteristic curve for the replicate runs was 0.803 and the SD was 0.013). The risk of SFTS occurrence increased with an increase in tick density, and the response curve indicated that the risk was greater than 0.5 when tick density exceeded 1.4. The risk of SFTS occurrence decreased with increased precipitation in the wettest month, and the risk was less than 0.5 when precipitation exceeded 224.4 mm. The relationship between elevation and SFTS occurrence showed a reverse V shape, and the risk peaked at approximately 400 m. Conclusions: Tick density, precipitation, and elevation were dominant influencing factors for SFTS, and comprehensive intervention measures should be adjusted according to these factors to reduce SFTS incidence in Zhejiang Province. %R 10.2196/46070 %U https://publichealth.jmir.org/2024/1/e46070 %U https://doi.org/10.2196/46070 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e43022 %T Using a Smartphone-Based Chatbot for Postoperative Care After Intravitreal Injection During the COVID-19 Pandemic: Retrospective Cohort Study %A Wu,Pei-Chang %A Chiang,Wei-Yu %A Lo,Jung %A Lee,Jong-Jer %A Chen,Yung-Jen %A Kuo,Hsi-Kung %A Chiau,Jie-Shin %A Hsu,Shu-Hui %A Chen,Yi-Hao %+ Department of Ophthalmology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, 123, Da-Pi Road, Niao-Sung District, Kaohsiung, 88301, Taiwan, 886 77317123 ext 2801, kaneyhc@gmail.com %K smartphone chatbot %K postoperative care %K intravitreal injection %K age-related macular degeneration %K self-report, endophthalmitis %K COVID-19 %D 2024 %7 2.8.2024 %9 Short Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic period, it was difficult to carry out regular and scheduled follow-up of patients in the outpatient department, especially during lockdown periods. However, early detection of initial infection or other serious conditions is vital for patients after ocular surgery, such as intravitreal injection (IVI) for age-related macular degeneration (AMD). Objective: We evaluated the use of a smartphone-based postoperative care chatbot system (PCCS) with an instant bidirectional feedback system for patients to self-report postoperative symptoms and signs. Methods: During the COVID-19 level 3 epidemic alert in July 2021 in Taiwan, the PCCS alerted the patients to report and grade 6 ocular symptoms and signs associated with ocular inflammation or retinal detachment. Patients used the PCCS for 7 days post surgery to assess their symptoms and signs each day after receiving an alert. Data were automatically collected using a cloud computer system, including symptom grades and messages sent to medical staff for further medical assistance. A user satisfaction questionnaire was administered to the patients on the seventh day post surgery. Results: In total, 185 patients participated in this study. There were 26 (3.03%) reports of symptom grade deterioration (including increased blurred vision, eye swelling, nausea, and floaters or flashes) from 12 (6.5%) patients. We found no difference in the gender of patients who received an early medical consultation. One case of endophthalmitis was reported, wherein an improvement was observed after prompt administration of IVI antibiotics twice. Overall, 87% (n=185) of patients were satisfied or very satisfied with communicating their symptoms instantly through the app; they were willing to use it again and believed that it could improve the quality of care. Seven of the 185 (3.8%) patients had an earlier medical consultation and 1 (0.5%) had endophthalmitis. Conclusions: The chatbot system, designed for self-reporting postoperative symptoms and providing instant bidirectional feedback on smartphones, could be beneficial for enhancing the quality of care in early medical consultations without gender differences among patients with AMD receiving IVI, and achieved satisfactory responses from patients. %M 38643063 %R 10.2196/43022 %U https://formative.jmir.org/2024/1/e43022 %U https://doi.org/10.2196/43022 %U http://www.ncbi.nlm.nih.gov/pubmed/38643063 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e59604 %T Molecular Evolutionary Dynamics of Coxsackievirus A6 Causing Hand, Foot, and Mouth Disease From 2021 to 2023 in China: Genomic Epidemiology Study %A Chen,Yu %A Chen,Shouhang %A Shen,Yuanfang %A Li,Zhi %A Li,Xiaolong %A Zhang,Yaodong %A Zhang,Xiaolong %A Wang,Fang %A Jin,Yuefei %K coxsackievirus A6 %K hand, foot, and mouth disease %K evolution %K molecular epidemiology %K China %K CV-A6 %K HFMD %D 2024 %7 31.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Hand, foot, and mouth disease (HFMD) is a global public health concern, notably within the Asia-Pacific region. Recently, the primary pathogen causing HFMD outbreaks across numerous countries, including China, is coxsackievirus (CV) A6, one of the most prevalent enteroviruses in the world. It is a new variant that has undergone genetic recombination and evolution, which might not only induce modifications in the clinical manifestations of HFMD but also heighten its pathogenicity because of nucleotide mutation accumulation. Objective: The study assessed the epidemiological characteristics of HFMD in China and characterized the molecular epidemiology of the major pathogen (CV-A6) causing HFMD. We attempted to establish the association between disease progression and viral genetic evolution through a molecular epidemiological study. Methods: Surveillance data from the Chinese Center for Disease Control and Prevention from 2021 to 2023 were used to analyze the epidemiological seasons and peaks of HFMD in Henan, China, and capture the results of HFMD pathogen typing. We analyzed the evolutionary characteristics of all full-length CV-A6 sequences in the NCBI database and the isolated sequences in Henan. To characterize the molecular evolution of CV-A6, time-scaled tree and historical population dynamics regarding CV-A6 sequences were estimated. Additionally, we analyzed the isolated strains for mutated or missing amino acid sites compared to the prototype CV-A6 strain. Results: The 2021-2023 epidemic seasons for HFMD in Henan usually lasted from June to August, with peaks around June and July. The monthly case reporting rate during the peak period ranged from 20.7% (4854/23,440) to 35% (12,135/34,706) of the total annual number of cases. Analysis of the pathogen composition of 2850 laboratory-confirmed cases identified 8 enterovirus serotypes, among which CV-A6 accounted for the highest proportion (652/2850, 22.88%). CV-A6 emerged as the major pathogen for HFMD in 2022 (203/732, 27.73%) and 2023 (262/708, 37.01%). We analyzed all CV-A6 full-length sequences in the NCBI database and the evolutionary features of viruses isolated in Henan. In China, the D3 subtype gradually appeared from 2011, and by 2019, all CV-A6 virus strains belonged to the D3 subtype. The VP1 sequences analyzed in Henan showed that its subtypes were consistent with the national subtypes. Furthermore, we analyzed the molecular evolutionary features of CV-A6 using Bayesian phylogeny and found that the most recent common ancestor of CV-A6 D3 dates back to 2006 in China, earlier than the 2011 HFMD outbreak. Moreover, the strains isolated in 2023 had mutations at several amino acid sites compared to the original strain. Conclusions: The CV-A6 virus may have been introduced and circulating covertly within China prior to the large-scale HFMD outbreak. Our laboratory testing data confirmed the fluctuation and periodic patterns of CV-A6 prevalence. Our study provides valuable insights into understanding the evolutionary dynamics of CV-A6. %R 10.2196/59604 %U https://publichealth.jmir.org/2024/1/e59604 %U https://doi.org/10.2196/59604 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56275 %T Key Characteristics and Perception of Different Outbreak Surveillance Systems in Côte d’Ivoire: Cross-Sectional Survey Among Users %A Palmeirim,Marta S %A Houngbedji,Clarisse A %A Barth-Jaeggi,Tanja %A Kouamé,Jean-Pierre Y %A Krouman,Aboubakar %A Coulibaly,Daouda %A Wyss,Kaspar %K outbreak surveillance system %K COVID-19 %K Côte d’Ivoire %K SORMAS %K MAGPI %K DHIS2 %K outbreak surveillance %K key characteristics %K users’ perception %K infectious disease %K infectious diseases %K public health %K disease surveillance %K policy decision %K cross-sectional study %K descriptively analysis %K Policymakers %K health officials %K healthcare system %K Surveillance Outbreak Response Management and Analysis System %K District Health Information Software 2 %K policy makers %K health care system %D 2024 %7 30.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Accurate and timely infectious disease surveillance is pivotal for effective public health responses. An important component of this is the disease surveillance tools used. Understanding views and experiences of users is crucial for informing policy decisions and ensuring the seamless functioning of surveillance systems. Objective: In this study, we aimed to assess the user perceptions of 3 disease surveillance tools used in Côte d’Ivoire, namely, MAGPI, District Health Information Software 2 (DHIS2), and Surveillance Outbreak Response Management and Analysis System (SORMAS), the latter was implemented in 2021 within a pilot scheme. Methods: We conducted interviews and a web-based survey distributed to users of the 3 surveillance tools. The survey assessed users’ views of the surveillance tools’ usefulness, ease of use, feelings toward the tool, conditions that may influence the use, and other characteristics. The descriptive analysis compared responses from SORMAS, MAGPI, and DHIS2 users, providing a comprehensive evaluation of their experiences. Results: Among the 159 respondents who actively use one of the systems, MAGPI was the most widely used surveillance tool among respondents (n=127, 79.9%), followed by DHIS2 (n=108, 67.9%), and SORMAS (n=25, 15.7%). In terms of users’ perceptions, SORMAS, despite its limited implementation, emerged as a tool that allows for data analysis and had the most comprehensive set of functionalities. DHIS2 was appreciated for its frequency of report provision, although users reported occasional IT system failures. MAGPI was recognized for its ease of use but was reported to lack certain functionalities offered by the other surveillance systems. Conclusions: This study offers valuable insights into the perceptions of disease surveillance tools users in Côte d’Ivoire. While all systems were positively regarded, each exhibited strengths and weaknesses addressing different needs and functionalities. Policy makers and health officials can use these findings to enhance existing tools or consider a unified approach for infectious disease surveillance systems. Understanding users’ perspectives allows them to optimize the choice of surveillance tools, ultimately strengthening public health responses in Côte d’Ivoire and potentially serving as a model for other countries facing similar decisions in their health care systems. %R 10.2196/56275 %U https://publichealth.jmir.org/2024/1/e56275 %U https://doi.org/10.2196/56275 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47520 %T COVID-19 Resilience and Risk Reduction Intervention in Rural Populations of Western India: Retrospective Evaluation %A Basu,Saurav %A Desai,Meghana %A Karan,Anup %A Bhardwaj,Surbhi %A Negandhi,Himanshu %A Jadhav,Nitin %A Maske,Amar %A Zodpey,Sanjay %+ Department of Monitoring, Evaluation, and Learning, Bharatiya Jain Sangathana, Shantilal Muttha Foundation, Muttha Chambers II, Senapati Bapat Rd, Pune, 411016, India, 91 9822936922, megs1080@gmail.com %K COVID-19 %K community intervention %K COVID-19 vaccination %K COVID-appropriate behavior %K impact evaluation %K rural health %K community-based intervention %K rural population %K awareness %K disease prevention %K health literacy %K public health %K pandemic %K digital health %K community awareness %K effectiveness %K low- and middle-income countries %K vaccination %K infodemic %D 2024 %7 29.7.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Globally, especially in the low- and middle-income countries (LMICs), rural populations were more susceptible to the negative impact of the COVID-19 pandemic due to lower levels of community awareness, poor hygiene, and health literacy accompanying pre-existing weak public health systems. Consequently, various community-based interventions were engineered in rural regions worldwide to mitigate the COVID-19 pandemic by empowering people to mount both individual and collective public health responses against the pandemic. However, to date, there is paucity of information on the effectiveness of any large-scale community intervention in controlling and mitigating the effects of COVID-19, especially from the perspective of LMICs. Objective: This retrospective impact evaluation study was conducted to evaluate the effect of a large-scale rural community–based intervention, the COVID-Free Village Program (CFVP), on COVID-19 resilience and control in rural populations in Maharashtra, India. Methods: The intervention site was the rural areas of the Pune district where CFVP was implemented from August 2021 to February 2022, while the adjoining district, Satara, represented the control district where the COVID-Free Village Scheme was implemented. Data were collected during April-May 2022 from 3500 sample households in villages across intervention and comparison arms by using the 2-stage stratified random sampling through face-to-face interviews followed by developing a matched sample using propensity score matching methods. Results: The participants in Pune had a significantly higher combined COVID-19 awareness index by 0.43 (95% CI 0.29-0.58) points than those in Satara. Furthermore, the adherence to COVID-appropriate behaviors, including handwashing, was 23% (95% CI 3%-45%) and masking was 17% (0%-38%) higher in Pune compared to those in Satara. The probability of perception of COVID as a serious illness in patients with heart disease was 22% (95% CI 1.036-1.439) higher in Pune compared to that in Satara. The awareness index of COVID-19 variants and preventive measures were also higher in Pune by 0.88 (95% CI 0.674-1.089) points. In the subgroup analysis, when the highest household educational level was restricted to middle school, the awareness about the COVID-control program was 0.69 (95% CI 0.36-1.021) points higher in Pune, while the awareness index of COVID-19 variants and preventive measures was higher by 0.45 (95% CI 0.236-0.671) points. We did not observe any significant changes in the overall COVID-19 vaccination coverage due to CFVP implementation. Furthermore, the number of COVID-19 deaths in both the sampled populations were very low. The probability of observing COVID-19–related stigma or discrimination in Pune was 68% (95% CI 0.133-0.191) lower than that in Satara. Conclusions: CFVP contributed to improved awareness and sustainability of COVID-appropriate behaviors in a large population although there was no evidence of higher COVID-19 vaccination coverage or reduction in mortality, signifying potential applicability in future pandemic preparedness, especially in resource-constrained settings. %M 39073851 %R 10.2196/47520 %U https://publichealth.jmir.org/2024/1/e47520 %U https://doi.org/10.2196/47520 %U http://www.ncbi.nlm.nih.gov/pubmed/39073851 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56546 %T Preferences for COVID-19 Vaccines: Systematic Literature Review of Discrete Choice Experiments %A Huang,Yiting %A Feng,Shuaixin %A Zhao,Yuyan %A Wang,Haode %A Jiang,Hongbo %+ Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Department of Epidemiology and Biostatistics, School of Public Health Guangdong Pharmaceutical University, No. 283 Jianghai Road, Haizhu District, Guangzhou, 510310, China, 86 0 203 405 5355, hongbojiang3@163.com %K systematic review %K discrete choice experiment %K preference %K COVID-19 %K vaccine %D 2024 %7 29.7.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Vaccination can be viewed as comprising the most important defensive barriers to protect susceptible groups from infection. However, vaccine hesitancy for COVID-19 is widespread worldwide. Objective: We aimed to systematically review studies eliciting the COVID-19 vaccine preference using discrete choice experiments. Methods: A literature search was conducted in PubMed, Embase, Web of Science, Scopus, and CINAHL Plus platforms in April 2023. Search terms included discrete choice experiments, COVID-19, and vaccines and related synonyms. Descriptive statistics were used to summarize the study characteristics. Subgroup analyses were performed by factors such as high-income countries and low- and middle-income countries and study period (before, during, and after the pandemic wave). Quality appraisal was performed using the 5-item Purpose, Respondents, Explanation, Findings, and Significance checklist. Results: The search yield a total of 623 records, and 47 studies with 53 data points were finally included. Attributes were grouped into 4 categories: outcome, process, cost, and others. The vaccine effectiveness (21/53, 40%) and safety (7/53, 13%) were the most frequently reported and important attributes. Subgroup analyses showed that vaccine effectiveness was the most important attribute, although the preference varied by subgroups. Compared to high-income countries (3/29, 10%), a higher proportion of low- and middle-income countries (4/24, 17%) prioritized safety. As the pandemic progressed, the duration of protection (2/24, 8%) during the pandemic wave and COVID-19 mortality risk (5/25, 20%) after the pandemic wave emerged as 2 of the most important attributes. Conclusions: Our review revealed the critical role of vaccine effectiveness and safety in COVID-19 vaccine preference. However, it should be noticed that preference heterogeneity was observed across subpopulations and may change over time. Trial Registration: PROSPERO CRD42023422720; https://tinyurl.com/2etf7ny7 %M 39073875 %R 10.2196/56546 %U https://publichealth.jmir.org/2024/1/e56546 %U https://doi.org/10.2196/56546 %U http://www.ncbi.nlm.nih.gov/pubmed/39073875 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e55422 %T Analyzing Google COVID-19 Vaccine Intent Search Trends and Vaccine Readiness in the United States: Panel Data Study %A Moffett,Kenneth W %A Marshall,Michael C %A Kim,Jae-Eun C %A Dahlen,Heather %A Denison,Benjamin %A Kranzler,Elissa C %A Meaney,Morgan %A Hoffman,Blake %A Pavisic,Ivica %A Hoffman,Leah %+ Fors Marsh, 4250 Fairfax Drive, Ste 520, Arlington, VA, 22203, United States, 1 571 858 3800, kmoffett@forsmarsh.com %K information-seeking behavior %K COVID-19 %K internet use %K vaccination %K vaccine hesitancy %D 2024 %7 29.7.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Factors such as anxiety, worry, and perceptions of insufficient knowledge about a topic motivate individuals to seek web-based health information to guide their health-related decision-making. These factors converged during the COVID-19 pandemic and were linked to COVID-19 vaccination decision-making. While research shows that web-based search relevant to COVID-19 was associated with subsequent vaccine uptake, less is known about COVID-19 vaccine intent search (which assesses vaccine availability, accessibility, and eligibility) as a signal of vaccine readiness. Objective: To increase knowledge about vaccine intent search as a signal of vaccine readiness, we investigated the relationship between COVID-19 vaccine readiness and COVID-19 vaccine intent relative search volume on Google. Methods: We compiled panel data from several data sources in all US counties between January 2021 and April 2023, a time during which those with primary COVID-19 vaccinations increased from <57,000 to >230 million adults. We estimated a random effects generalized least squares regression model with time-fixed effects to assess the relationship between county-level COVID-19 vaccine readiness and COVID-19 vaccine intent relative search volume. We controlled for health care capacity, per capita COVID-19 cases and vaccination doses administered, and sociodemographic indicators. Results: The county-level proportions of unvaccinated adults who reported that they would wait and see before getting a COVID-19 vaccine were positively associated with COVID-19 vaccine intent relative search volume (β=9.123; Z=3.59; P<.001). The county-level proportions of vaccine-enthusiast adults, adults who indicated they were either already vaccinated with a primary COVID-19 vaccine series or planned to complete the vaccine series soon, were negatively associated with COVID-19 vaccine intent relative search volume (β=–10.232; Z=–7.94; P<.001). However, vaccine intent search was higher in counties with high proportions of people who decided to wait and see and lower in counties with high proportions of vaccine enthusiasts. Conclusions: During this period of steep increase in COVID-19 vaccination, web-based search may have signaled differences in county-level COVID-19 vaccine readiness. More vaccine intent searches occurred in high wait-and-see counties, whereas fewer vaccine intent searches occurred in high vaccine-enthusiast counties. Considering previous research that identified a relationship between vaccine intent search and subsequent vaccine uptake, these findings suggest that vaccine intent search aligned with people’s transition from the wait-and-see stage to the vaccine-enthusiast stage. The findings also suggest that web-based search trends may signal localized changes in information seeking and decision-making antecedent to vaccine uptake. Changes in web-based search trends illuminate opportunities for governments and other organizations to strategically allocate resources to increase vaccine uptake. Resource use is part of the larger public policy decisions that influence vaccine uptake, such as efforts to educate the public during evolving public health crises, including future pandemics. %M 39073868 %R 10.2196/55422 %U https://ojphi.jmir.org/2024/1/e55422 %U https://doi.org/10.2196/55422 %U http://www.ncbi.nlm.nih.gov/pubmed/39073868 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49648 %T Kawasaki Disease and Respiratory Viruses: Ecological Spatiotemporal Analysis %A Sawires,Rana %A Clothier,Hazel J %A Burgner,David %A Fahey,Michael Collingwood %A Buttery,Jim %K Kawasaki disease %K pediatric %K infection %K RSV %K human metapneumovirus %K respiratory virus %K virology %K community %K viral infection %K respiratory disease %K respiratory diseases %K children %K epidemiology %K respiratory syncytial virus %D 2024 %7 25.7.2024 %9 %J JMIR Public Health Surveill %G English %X 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. %R 10.2196/49648 %U https://publichealth.jmir.org/2024/1/e49648 %U https://doi.org/10.2196/49648 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e59446 %T The Hand, Foot, and Mouth Disease Sentinel Surveillance System in South Korea: Retrospective Evaluation Study %A Kim,Bryan Inho %A Achangwa,Chiara %A Cho,Seonghui %A Ahn,Jisoo %A Won,Jisu %A Do,Hyunkyung %A Lee,Dayeong %A Yoon,Bohye %A Kim,Joohee %A Ryu,Sukhyun %K hand-foot-mouth disease %K surveillance %K evaluation %K sentinel %K sensitivity %K surveillance system %K effective %K South Korea %K COVID-19 %K public health system %K policy maker %K timeliness %K stability %K completeness %K representativeness %K hand, foot, and mouth disease %D 2024 %7 23.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: South Korea has implemented a hand, foot, and mouth disease (HFMD) surveillance system since 2009 to monitor incidence trends and identify disease burden. This nationwide surveillance involves a network of approximately 100 pediatric clinics that report all probable and confirmed HFMD cases. Following the COVID-19 pandemic, infectious disease surveillance systems must be evaluated to ensure the effective use of limited public health resources. Objective: This study aimed to evaluate the HFMD sentinel surveillance system in South Korea from 2017 to 2022, focusing on the transition period after the COVID-19 pandemic. Methods: We retrospectively reviewed the HFMD sentinel surveillance system from the Korea Disease Control and Prevention Agency using systematic guidelines for public health surveillance system evaluation developed by the US Centers for Disease Control and Prevention. We assessed the system’s overall performance in 5 main factors: timeliness, stability, completeness, sensitivity, and representativeness (ie, the age and geographic distribution of sentinels). We rated these factors as weak, moderate, or good. Results: Our study showed that the completeness, sensitivity, and age representativeness of the HFMD surveillance performance were temporarily reduced to moderate levels from 2020 to 2021 and recovered in 2022, while the timeliness and geographic representativeness were maintained at a good level throughout the study period. The stability of the surveillance was moderate from 2017 to 2021 and weak in 2022. Conclusions: This is the first study to evaluate the HFMD surveillance system after the acute phase of the COVID-19 pandemic. We identified a temporarily reduced level of performance (ie, completeness, sensitivity, and age-specific representativeness) during the acute phase of the pandemic and good performance in 2022. Surveillance system evaluation and maintenance during public health emergencies will provide robust and reliable data to support public health policy development. Regular staff training programs and reducing staff turnover will improve HFMD surveillance system stability. %R 10.2196/59446 %U https://publichealth.jmir.org/2024/1/e59446 %U https://doi.org/10.2196/59446 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54281 %T Pooled Cohort Profile: ReCoDID Consortium’s Harmonized Acute Febrile Illness Arbovirus Meta-Cohort %A Gómez,Gustavo %A Hufstedler,Heather %A Montenegro Morales,Carlos %A Roell,Yannik %A Lozano-Parra,Anyela %A Tami,Adriana %A Magalhaes,Tereza %A Marques,Ernesto T A %A Balmaseda,Angel %A Calvet,Guilherme %A Harris,Eva %A Brasil,Patricia %A Herrera,Victor %A Villar,Luis %A Maxwell,Lauren %A Jaenisch,Thomas %A , %+ Heidelberg Institute of Global Health, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 06221 56 0, heather.hufstedler@uni-heidelberg.de %K infectious disease %K harmonized meta-cohort %K IPD-MA %K arbovirus %K dengue %K zika %K chikungunya %K surveillance %K public health %K open access data %K FAIR principles %K febrile illness %K clinical-epidemiological data %K cross-disease interaction %K epidemiology %K consortium %K innovation %K statistical tool %K Latin America %K Maelstrom's %K methodology %K CDISC %K immunological interaction %K flavivirus %K infection %K arboviral disease %D 2024 %7 23.7.2024 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Infectious disease (ID) cohorts are key to advancing public health surveillance, public policies, and pandemic responses. Unfortunately, ID cohorts often lack funding to store and share clinical-epidemiological (CE) data and high-dimensional laboratory (HDL) data long term, which is evident when the link between these data elements is not kept up to date. This becomes particularly apparent when smaller cohorts fail to successfully address the initial scientific objectives due to limited case numbers, which also limits the potential to pool these studies to monitor long-term cross-disease interactions within and across populations. CE data from 9 arbovirus (arthropod-borne viruses) cohorts in Latin America were retrospectively harmonized using the Maelstrom Research methodology and standardized to Clinical Data Interchange Standards Consortium (CDISC). We created a harmonized and standardized meta-cohort that contains CE and HDL data from 9 arbovirus studies from Latin America. To facilitate advancements in cross-population inference and reuse of cohort data, the Reconciliation of Cohort Data for Infectious Diseases (ReCoDID) Consortium harmonized and standardized CE and HDL from 9 arbovirus cohorts into 1 meta-cohort. Interested parties will be able to access data dictionaries that include information on variables across the data sets via Bio Studies. After consultation with each cohort, linked harmonized and curated human cohort data (CE and HDL) will be made accessible through the European Genome-phenome Archive platform to data users after their requests are evaluated by the ReCoDID Data Access Committee. This meta-cohort can facilitate various joint research projects (eg, on immunological interactions between sequential flavivirus infections and for the evaluation of potential biomarkers for severe arboviral disease). %M 39042429 %R 10.2196/54281 %U https://publichealth.jmir.org/2024/1/e54281 %U https://doi.org/10.2196/54281 %U http://www.ncbi.nlm.nih.gov/pubmed/39042429 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50595 %T Quantifying Disparities in COVID-19 Vaccination Rates by Rural and Urban Areas: Cross-Sectional Observational Study %A Dong,Wenyong %A Miao,Yudong %A Shen,Zhanlei %A Zhang,Wanliang %A Bai,Junwen %A Zhu,Dongfang %A Ren,Ruizhe %A Zhang,Jingbao %A Wu,Jian %A Tarimo,Clifford Silver %A Ojangba,Theodora %A Li,Yi %+ Department of Health Management, College of Public Health, Zhengzhou University, No. 100 Science Avenue, High-Tech Industrial Development Zone, Zhengzhou City, Henan Province, Zhengzhou, 450001, China, 86 13298157145, ly07263026@163.com %K COVID-19 vaccination %K urban and rural %K the fourth COVID-19 (second booster) vaccine %K disparities %K China %K COVID-19 %D 2024 %7 19.7.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 39028548 %R 10.2196/50595 %U https://publichealth.jmir.org/2024/1/e50595 %U https://doi.org/10.2196/50595 %U http://www.ncbi.nlm.nih.gov/pubmed/39028548 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e52762 %T Factors Associated With Surveillance Testing in Individuals With COVID-19 Symptoms During the Last Leg of the Pandemic: Multivariable Regression Analysis %A Dotson,Timothy %A Price,Brad %A Witrick,Brian %A Davis,Sherri %A Kemper,Emily %A Whanger,Stacey %A Hodder,Sally %A Hendricks,Brian %K COVID-19 %K testing %K symptomatic %K RADx %K rural %K health disparities %K regression analysis %K surveillance %K SARS-CoV-2 %K United States %K asymptomatic %K survey %K demographic %K clinical %K behavioral %K logistic regression %K bivariate map %K child %K children %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K public health %K machine learning %K mHealth %K mobile health %K digital health %K cross-sectional study %K physical health %K mental health %K Rapid Acceleration of Diagnostics %D 2024 %7 18.7.2024 %9 %J JMIR Public Health Surveill %G English %X Background: Rural underserved areas facing health disparities have unequal access to health resources. By the third and fourth waves of SARS-CoV-2 infections in the United States, COVID-19 testing had reduced, with more reliance on home testing, and those seeking testing were mostly symptomatic. Objective: This study identifies factors associated with COVID-19 testing among individuals who were symptomatic versus asymptomatic seen at a Rapid Acceleration of Diagnostics for Underserved Populations phase 2 (RADx-UP2) testing site in West Virginia. Methods: Demographic, clinical, and behavioral factors were collected via survey from tested individuals. Logistic regression was used to identify factors associated with the presence of individuals who were symptomatic seen at testing sites. Global tests for spatial autocorrelation were conducted to examine clustering in the proportion of symptomatic to total individuals tested by zip code. Bivariate maps were created to display geographic distributions between higher proportions of tested individuals who were symptomatic and social determinants of health. Results: Among predictors, the presence of a physical (adjusted odds ratio [aOR] 1.85, 95% CI 1.3-2.65) or mental (aOR 1.53, 95% CI 0.96-2.48) comorbid condition, challenges related to a place to stay/live (aOR 307.13, 95% CI 1.46-10,6372), no community socioeconomic distress (aOR 0.99, 95% CI 0.98-1.00), no challenges in getting needed medicine (aOR 0.01, 95% CI 0.00-0.82) or transportation (aOR 0.23, 95% CI 0.05-0.64), an interaction between community socioeconomic distress and not getting needed medicine (aOR 1.06, 95% CI 1.00-1.13), and having no community socioeconomic distress while not facing challenges related to a place to stay/live (aOR 0.93, 95% CI 0.87-0.99) were statistically associated with an individual being symptomatic at the first test visit. Conclusions: This study addresses critical limitations to the current COVID-19 testing literature, which almost exclusively uses population-level disease screening data to inform public health responses. %R 10.2196/52762 %U https://publichealth.jmir.org/2024/1/e52762 %U https://doi.org/10.2196/52762 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50678 %T Estimating the Global and Regional Burden of Streptococcus pneumoniae Meningitis in Children: Protocol for a Systematic Review and Meta-Analysis %A Park,Jay J %A Tiefenbach,Jakov %A Anwar,Mohammed Ma'arij %A Narayanan,Sandhya %A Ope,Beatrice %A Bin Han,Selene Seo %A Ale,Boni Maxime %A Adeloye,Davies %A Rudan,Igor %+ Department of Bioengineering, Imperial College London, Royal School of Mines, South Kensington Campus, London, SW7 2AZ, United Kingdom, 44 7727006197, maarij.anwar22@imperial.ac.uk %K Streptococcus pneumoniae %K meningitis %K streptococcal meningitis %K pneumococcal meningits %K global burden %K pediatric meningitis %K infectious disease %K pneumonia %K sepsis %K infection %K infection prevention and control %K IPC %K child health %K global health %K systematic review %K pneumococcal %D 2024 %7 16.7.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Streptococcus pneumoniae (Spn) has been a leading cause of bacterial meningitis in children. The most recent estimation of the global burden of Spn meningitis indicates a positive trajectory in eliminating Spn through the implementation of pneumococcal conjugate vaccines. However, continuous monitoring and assessment of the disease burden are necessary due to the evidence of serotype replacement, antibiotic resistance, and the impact of the recent COVID-19 pandemic. Objective: The aim of this systematic review is to provide an updated and focused assessment of the global and regional burden of Spn meningitis in children, which can guide policies and strategies to reduce the disease burden. Methods: Population-based studies published from January 1, 2000, to January 1, 2022, were preliminarily searched from the electronic databases PubMed, Embase, Global Health (CABI), and CINAHL Plus without any language restrictions. Studies were included if they reported the incidence, prevalence, mortality, or case-fatality ratio (CFR) for Spn meningitis in children aged 0-4 years; meningitis was confirmed by cerebrospinal fluid culture; the study period was a minimum of 1 year; the number of reported cases was at least 10; and the study had no methodological ambiguities. The article screening process follows the PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses) guidelines. Characteristics including study period, setting, World Health Organization region, income level, vaccination information, and participant data (age, number of cases, deaths, sequelae, and risk factors) will be extracted from the included studies. Search results will be updated and incorporated into our review prior to finalizing the extraction of data. Generalized linear mixed models meta-analysis will be performed to estimate the pooled incidence and CFR. We will further assess the risk of bias and heterogeneity, and will perform subgroup and sensitivity analyses to provide a meaningful interpretation of the current burden and literature for pneumococcal meningitis. Results: Our preliminary search in December 2021 yielded 9295 articles. Out of 275 studies that were assessed with our eligibility criteria, 117 articles were included. Data extraction and analysis are expected to be complete by January 2025. We plan to publish the results from the full study, including an updated search in 2024, by March 2025. Conclusions: Given that the major burden of Spn meningitis affects children under the age of 5 years, this systematic review will provide a thorough understanding of the global burden of Spn meningitis in this vulnerable population over a span of 2 decades. Insights into incidence trends, geospatial distribution, risk factors, and sequelae will be valuable for stakeholders, policy makers, and the academic community. This information will aid in the ongoing monitoring of the disease and in enhancing targeted vaccine programs to further mitigate the impact of the disease on children worldwide. Trial Registration: PROSPERO CRD42021293110; https://tinyurl.com/kc3j5k4m International Registered Report Identifier (IRRID): DERR1-10.2196/50678 %M 39012685 %R 10.2196/50678 %U https://www.researchprotocols.org/2024/1/e50678 %U https://doi.org/10.2196/50678 %U http://www.ncbi.nlm.nih.gov/pubmed/39012685 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51007 %T Adverse Events of COVID-19 Vaccines in the United States: Temporal and Spatial Analysis %A Li,Yiming %A Li,Jianfu %A Dang,Yifang %A Chen,Yong %A Tao,Cui %+ Department of Artificial Intelligence and Informatics, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, United States, 1 904 953 0255, Tao.Cui@mayo.edu %K COVID-19 %K vaccine %K COVID-19 vaccine %K adverse drug event %K ADE %K Vaccine Adverse Event Reporting System %K VAERS %K adverse event following immunization %K AEFI %D 2024 %7 15.7.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic, caused by SARS-CoV-2, has had a profound impact worldwide, leading to widespread morbidity and mortality. Vaccination against COVID-19 is a critical tool in controlling the spread of the virus and reducing the severity of the disease. However, the rapid development and deployment of COVID-19 vaccines have raised concerns about potential adverse events following immunization (AEFIs). Understanding the temporal and spatial patterns of these AEFIs is crucial for an effective public health response and vaccine safety monitoring. Objective: This study aimed to analyze the temporal and spatial characteristics of AEFIs associated with COVID-19 vaccines in the United States reported to the Vaccine Adverse Event Reporting System (VAERS), thereby providing insights into the patterns and distributions of the AEFIs, the safety profile of COVID-19 vaccines, and potential risk factors associated with the AEFIs. Methods: We conducted a retrospective analysis of administration data from the Centers for Disease Control and Prevention (n=663,822,575) and reports from the surveillance system VAERS (n=900,522) between 2020 and 2022. To gain a broader understanding of postvaccination AEFIs reported, we categorized them into system organ classes (SOCs) according to the Medical Dictionary for Regulatory Activities. Additionally, we performed temporal analysis to examine the trends of AEFIs in all VAERS reports, those related to Pfizer-BioNTech and Moderna, and the top 10 AEFI trends in serious reports. We also compared the similarity of symptoms across various regions within the United States. Results: Our findings revealed that the most frequently reported symptoms following COVID-19 vaccination were headache (n=141,186, 15.68%), pyrexia (n=122,120, 13.56%), and fatigue (n=121,910, 13.54%). The most common symptom combination was chills and pyrexia (n=56,954, 6.32%). Initially, general disorders and administration site conditions (SOC 22) were the most prevalent class reported. Moderna exhibited a higher reporting rate of AEFIs compared to Pfizer-BioNTech. Over time, we observed a decreasing reporting rate of AEFIs associated with COVID-19 vaccines. In addition, the overall rates of AEFIs between the Pfizer-BioNTech and Moderna vaccines were comparable. In terms of spatial analysis, the middle and north regions of the United States displayed a higher reporting rate of AEFIs associated with COVID-19 vaccines, while the southeast and south-central regions showed notable similarity in symptoms reported. Conclusions: This study provides valuable insights into the temporal and spatial patterns of AEFIs associated with COVID-19 vaccines in the United States. The findings underscore the critical need for increasing vaccination coverage, as well as ongoing surveillance and monitoring of AEFIs. Implementing targeted monitoring programs can facilitate the effective and efficient management of AEFIs, enhancing public confidence in future COVID-19 vaccine campaigns. %M 39008362 %R 10.2196/51007 %U https://publichealth.jmir.org/2024/1/e51007 %U https://doi.org/10.2196/51007 %U http://www.ncbi.nlm.nih.gov/pubmed/39008362 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e49812 %T Predicting Efficacies of Fractional Doses of Vaccines by Using Neutralizing Antibody Levels: Systematic Review and Meta-Analysis %A Du,Zhanwei %A Liu,Caifen %A Bai,Yuan %A Wang,Lin %A Lim,Wey Wen %A Lau,Eric H Y %A Cowling,Benjamin J %K COVID-19 %K SARS-CoV-2 %K dose fractionation %K neutralizing antibody level %K vaccination %K review %K vaccine %D 2024 %7 12.7.2024 %9 %J JMIR Public Health Surveill %G English %X 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. %R 10.2196/49812 %U https://publichealth.jmir.org/2024/1/e49812 %U https://doi.org/10.2196/49812 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e41749 %T Census-Dependent Mortality of Ventilated Patients With COVID-19 in Israel: Noninterventional Observational Cohort Study %A Mendlovic,Joseph %A Mimouni,Francis B %+ Shaare Zedek Medical Center, Affiliated with the Hadassah-Hebrew University School of Medicine, PO Box 12000, Shmuel (Hans) Beyth St 12, Jerusalem, 91120, Israel, 972 6777111 ext 1, sefimen@gmail.com %K COVID-19 %K mortality %K ventilation %K intensive care %K pandemic %K contagious %K disease %K mortality %K database %K data %K patient %K mortality %K medical %K resources %K validation %K public policy %K policy %K pandemic %K health policy %K global health policy %D 2024 %7 9.7.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The COVID-19 pandemic led to several surges in the mass hospitalization rate. Extreme increases in hospital admissions without adequate medical resources may increase mortality. No study has addressed the impact of daily census of ventilated patients on mortality in the context of the pandemic in a nationwide setting. Objective: This study aimed to determine whether daily census of ventilated patients affected COVID-19 mortality rates nationwide in Israel. Methods: We conducted a cohort study using nationwide, public-domain, population-based COVID-19 data of hospitalized patients from an Israeli database from March 11, 2020, until February 11, 2021. We included all COVID-19 hospital admissions, classified as mild to severe per the Centers for Diseases Control and Prevention classification irrespective of whether they were mechanically ventilated. Outcome measures were daily death rates and death rates expressed as a percentage of ventilated patients. Results: During the study period (338 days from March 11, 2020, to February 11, 2021), 715,743 patients contracted and were clinically confirmed as having COVID-19. Among them, 5577 (0.78%) patients died. In total, 3398 patients were ventilated because of severe COVID-19. Daily mortality correlated with daily census of ventilated patients (R2=0.828, P<.001). The daily percent mortality of ventilated patients also correlated with the daily census of ventilated patients (R2=0.365, P<.001)—backward multiple regression analysis demonstrated that this positive correlation was still highly significant even when correcting for the average age or gender of ventilated patients (R2=0.4328, P<.001) or for the surge in their number. Overall, 40% of the variation in mortality was explained by variations in the daily census of ventilated patients. ANOVA revealed that at less than 50 ventilated patients per day, the daily mortality of ventilated patients was slightly above 5%, and it nearly doubled (10%) with 50-149 patients; moreover, in all categories of ≥200 patients ventilated per day, it more than tripled at ≥15% (P<.001). Conclusions: Daily mortality rates per ventilated patient increased with an increase in the number of ventilated patients, suggesting the saturation of medical resources. Policy makers should be aware that expanding medical services without adequate resources may increase mortality. Governments should perform similar analyses to provide indicators of system saturation, although further validation of these results might be needed to use this indicator to drive public policy. %M 38981116 %R 10.2196/41749 %U https://www.i-jmr.org/2024/1/e41749 %U https://doi.org/10.2196/41749 %U http://www.ncbi.nlm.nih.gov/pubmed/38981116 %0 Journal Article %@ 2563-6316 %I JMIRx Med %V 5 %N %P e54611 %T Human Brucellosis in Iraq: Spatiotemporal Data Analysis From 2007-2018 %A Mustafa,Ali Hazim %A Khaleel,Hanan Abdulghafoor %A Lami,Faris %K human brucellosis %K livestock %K clustering %K spatial %K temporal %K Iraq %D 2024 %7 3.7.2024 %9 %J JMIRx Med %G English %X Background: Brucellosis is both endemic and enzootic in Iraq, resulting in long-term morbidity for humans as well as economic loss. No previous study of the spatial and temporal patterns of brucellosis in Iraq was done to identify potential clustering of cases. Objective: This study aims to detect the spatial and temporal distribution of human brucellosis in Iraq and identify any changes that occurred from 2007 to 2018. Methods: A descriptive, cross-sectional study was conducted using secondary data from the Surveillance Section at the Communicable Diseases Control Center, Public Health Directorate, Ministry of Health in Iraq. The trends of cases by sex and age group from 2007 to 2018 were displayed. The seasonal distribution of the cases from 2007 to 2012 was graphed. We calculated the incidence of human brucellosis per district per year and used local Getis-Ord Gi* statistics to detect the spatial distribution of the data. The data were analyzed using Microsoft Excel and GeoDa software. Results: A total of 51,508 human brucellosis cases were reported during the 12-year study period, with some missing data for age groups. Human brucellosis persisted annually in Iraq across the study period with no specific temporal clustering of cases. In contrast, spatial clustering was predominant in northern Iraq. Conclusions: There were significant differences in the geographic distribution of brucellosis. The number of cases is the highest in the north and northeast regions of the country, which has borders with nearby countries. In addition, people in these areas depend more on locally made dairy products, which can be inadequately pasteurized. Despite the lack of significant temporal clustering of cases, the highest number of cases were reported during summer and spring. Considering these patterns when allocating resources to combat this disease, determining public health priorities, and planning prevention and control strategies is important. %R 10.2196/54611 %U https://xmed.jmir.org/2024/1/e54611 %U https://doi.org/10.2196/54611 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52992 %T Impact Analysis of COVID-19 Pandemic on Hospital Reviews on Dianping Website in Shanghai, China: Empirical Study %A Huo,Weixue %A He,Mengwei %A Zeng,Zhaoxiang %A Bao,Xianhao %A Lu,Ye %A Tian,Wen %A Feng,Jiaxuan %A Feng,Rui %+ Department of Vascular Surgery, Shanghai General Hospital, Shanghai Jiaotong University, 650 New Song Jiang Road, Songjiang District, Shanghai, 201600, China, 86 19174227674, rui.feng@shgh.cn %K patient satisfaction %K physician-patient relationship %K ChatGPT %K patient concern %K COVID-19 %D 2024 %7 2.7.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In the era of the internet, individuals have increasingly accustomed themselves to gathering necessary information and expressing their opinions on public web-based platforms. The health care sector is no exception, as these comments, to a certain extent, influence people’s health care decisions. During the onset of the COVID-19 pandemic, how the medical experience of Chinese patients and their evaluations of hospitals have changed remains to be studied. Therefore, we plan to collect patient medical visit data from the internet to reflect the current status of medical relationships under specific circumstances. Objective: This study aims to explore the differences in patient comments across various stages (during, before, and after) of the COVID-19 pandemic, as well as among different types of hospitals (children’s hospitals, maternity hospitals, and tumor hospitals). Additionally, by leveraging ChatGPT (OpenAI), the study categorizes the elements of negative hospital evaluations. An analysis is conducted on the acquired data, and potential solutions that could improve patient satisfaction are proposed. This study is intended to assist hospital managers in providing a better experience for patients who are seeking care amid an emergent public health crisis. Methods: Selecting the top 50 comprehensive hospitals nationwide and the top specialized hospitals (children’s hospitals, tumor hospitals, and maternity hospitals), we collected patient reviews from these hospitals on the Dianping website. Using ChatGPT, we classified the content of negative reviews. Additionally, we conducted statistical analysis using SPSS (IBM Corp) to examine the scoring and composition of negative evaluations. Results: A total of 30,317 pieces of effective comment information were collected from January 1, 2018, to August 15, 2023, including 7696 pieces of negative comment information. Manual inspection results indicated that ChatGPT had an accuracy rate of 92.05%. The F1-score was 0.914. The analysis of this data revealed a significant correlation between the comments and ratings received by hospitals during the pandemic. Overall, there was a significant increase in average comment scores during the outbreak (P<.001). Furthermore, there were notable differences in the composition of negative comments among different types of hospitals (P<.001). Children’s hospitals received sensitive feedback regarding waiting times and treatment effectiveness, while patients at maternity hospitals showed a greater concern for the attitude of health care providers. Patients at tumor hospitals expressed a desire for timely examinations and treatments, especially during the pandemic period. Conclusions: The COVID-19 pandemic had some association with patient comment scores. There were variations in the scores and content of comments among different types of specialized hospitals. Using ChatGPT to analyze patient comment content represents an innovative approach for statistically assessing factors contributing to patient dissatisfaction. The findings of this study could provide valuable insights for hospital administrators to foster more harmonious physician-patient relationships and enhance hospital performance during public health emergencies. %M 38954461 %R 10.2196/52992 %U https://www.jmir.org/2024/1/e52992 %U https://doi.org/10.2196/52992 %U http://www.ncbi.nlm.nih.gov/pubmed/38954461 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 7 %N %P e51743 %T Chest X-Ray–Based Telemedicine Platform for Pediatric Tuberculosis Diagnosis in Low-Resource Settings: Development and Validation Study %A Gómez-Valverde,Juan J %A Sánchez-Jacob,Ramón %A Ribó,José Luis %A Schaaf,H Simon %A García Delgado,Lara %A Hernanz-Lobo,Alicia %A Capellán-Martín,Daniel %A Lancharro,Ángel %A Augusto,Orvalho %A García-Basteiro,Alberto L %A Santiago-García,Begoña %A López-Varela,Elisa %A Ledesma-Carbayo,María J %+ Biomedical Image Technologies, ETSI Telecomunicación, Universidad Politécnica de Madrid, Avenida Complutense 30, Madrid, 28040, Spain, 34 910672210, juanjo.gomez@upm.es %K telemedicine %K telehealth %K pediatric tuberculosis %K tuberculosis %K screening %K chest radiograph %K usability %K low-resource settings %D 2024 %7 1.7.2024 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Tuberculosis (TB) remains a major cause of morbidity and death worldwide, with a significant impact on children, especially those under the age of 5 years. The complex diagnosis of pediatric TB, compounded by limited access to more accurate diagnostic tests, underscores the need for improved tools to enhance diagnosis and care in resource-limited settings. Objective: This study aims to present a telemedicine web platform, BITScreen PTB (Biomedical Image Technologies Screen for Pediatric Tuberculosis), aimed at improving the evaluation of pulmonary TB in children based on digital chest x-ray (CXR) imaging and clinical information in resource-limited settings. Methods: The platform was evaluated by 3 independent expert readers through a retrospective assessment of a data set with 218 imaging examinations of children under 3 years of age, selected from a previous study performed in Mozambique. The key aspects assessed were the usability through a standardized questionnaire, the time needed to complete the assessment through the platform, the performance of the readers to identify TB cases based on the CXR, the association between the TB features identified in the CXRs and the initial diagnostic classification, and the interreader agreement of the global assessment and the radiological findings. Results: The platform’s usability and user satisfaction were evaluated using a questionnaire, which received an average rating of 4.4 (SD 0.59) out of 5. The average examination completion time ranged from 35 to 110 seconds. In addition, the study on CXR showed low sensitivity (16.3%-28.2%) but high specificity (91.1%-98.2%) in the assessment of the consensus case definition of pediatric TB using the platform. The CXR finding having a stronger association with the initial diagnostic classification was air space opacification (χ21>20.38, P<.001). The study found varying levels of interreader agreement, with moderate/substantial agreement for air space opacification (κ=0.54-0.67) and pleural effusion (κ=0.43-0.72). Conclusions: Our findings support the promising role of telemedicine platforms such as BITScreen PTB in enhancing pediatric TB diagnosis access, particularly in resource-limited settings. Additionally, these platforms could facilitate the multireader and systematic assessment of CXR in pediatric TB clinical studies. %M 38949860 %R 10.2196/51743 %U https://pediatrics.jmir.org/2024/1/e51743 %U https://doi.org/10.2196/51743 %U http://www.ncbi.nlm.nih.gov/pubmed/38949860 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e55013 %T Nonrepresentativeness of Human Mobility Data and its Impact on Modeling Dynamics of the COVID-19 Pandemic: Systematic Evaluation %A Liu,Chuchu %A Holme,Petter %A Lehmann,Sune %A Yang,Wenchuan %A Lu,Xin %+ College of Systems Engineering, National University of Defense Technology, No 137 Yanwachi Street, Changsha, 410073, China, 86 18627561577, xin.lu.lab@outlook.com %K human mobility %K data representativeness %K population composition %K COVID-19 %K epidemiological modeling %D 2024 %7 28.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, a range of novel smartphone-derived data streams about human mobility have become available on a near–real-time basis. These data have been used, for example, to perform traffic forecasting and epidemic modeling. During the COVID-19 pandemic in particular, human travel behavior has been considered a key component of epidemiological modeling to provide more reliable estimates about the volumes of the pandemic’s importation and transmission routes, or to identify hot spots. However, nearly universally in the literature, the representativeness of these data, how they relate to the underlying real-world human mobility, has been overlooked. This disconnect between data and reality is especially relevant in the case of socially disadvantaged minorities. Objective: The objective of this study is to illustrate the nonrepresentativeness of data on human mobility and the impact of this nonrepresentativeness on modeling dynamics of the epidemic. This study systematically evaluates how real-world travel flows differ from census-based estimations, especially in the case of socially disadvantaged minorities, such as older adults and women, and further measures biases introduced by this difference in epidemiological studies. Methods: To understand the demographic composition of population movements, a nationwide mobility data set from 318 million mobile phone users in China from January 1 to February 29, 2020, was curated. Specifically, we quantified the disparity in the population composition between actual migrations and resident composition according to census data, and shows how this nonrepresentativeness impacts epidemiological modeling by constructing an age-structured SEIR (Susceptible-Exposed-Infected- Recovered) model of COVID-19 transmission. Results: We found a significant difference in the demographic composition between those who travel and the overall population. In the population flows, 59% (n=20,067,526) of travelers are young and 36% (n=12,210,565) of them are middle-aged (P<.001), which is completely different from the overall adult population composition of China (where 36% of individuals are young and 40% of them are middle-aged). This difference would introduce a striking bias in epidemiological studies: the estimation of maximum daily infections differs nearly 3 times, and the peak time has a large gap of 46 days. Conclusions: The difference between actual migrations and resident composition strongly impacts outcomes of epidemiological forecasts, which typically assume that flows represent underlying demographics. Our findings imply that it is necessary to measure and quantify the inherent biases related to nonrepresentativeness for accurate epidemiological surveillance and forecasting. %M 38941609 %R 10.2196/55013 %U https://formative.jmir.org/2024/1/e55013 %U https://doi.org/10.2196/55013 %U http://www.ncbi.nlm.nih.gov/pubmed/38941609 %0 Journal Article %@ 2369-2960 %I %V 10 %N %P e54551 %T Syndromic Surveillance Tracks COVID-19 Cases in University and County Settings: Retrospective Observational Study %A Wass,Lily Minh %A O'Keeffe Hoare,Derek %A Smits,Georgia Elena %A Osman,Marwan %A Zhang,Ning %A Klepack,William %A Parrilla,Lara %A Busche,Jefferson M %A Clarkberg,Marin E %A Basu,Sumanta %A Cazer,Casey L %K COVID-19 %K epidemiology %K epidemiological %K SARS-CoV-2 %K syndromic surveillance %K surveillance system %K syndromic %K surveillance %K coronavirus %K pandemic %K epidemic %K respiratory %K infectious %K predict %K predictive %K prediction %K predictions %D 2024 %7 27.6.2024 %9 %J JMIR Public Health Surveill %G English %X 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. %R 10.2196/54551 %U https://publichealth.jmir.org/2024/1/e54551 %U https://doi.org/10.2196/54551 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 10 %N %P e51072 %T Applying the Unified Theory of Acceptance and Use of Technology to Identify Factors Associated With Intention to Use Teledelivered Supportive Care Among Recently Diagnosed Breast Cancer Survivors During COVID-19 in Hong Kong: Cross-Sectional Survey %A Yeung,Nelson C Y %A Lau,Stephanie T Y %A Mak,Winnie W S %A Cheng,Cecilia %A Chan,Emily Y Y %A Siu,Judy Y M %A Cheung,Polly S Y %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, Postgraduate Education Centre, Prince of Wales Hospital, Hong Kong, China (Hong Kong), 852 22528740, nelsonyeung@cuhk.edu.hk %K telehealth %K tele-delivered supportive cancer care %K breast cancer %K COVID-19 %K technology acceptance %K UTAUT %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Cancer %G English %X Background: Many supportive cancer care (SCC) services were teledelivered during COVID-19, but what facilitates patients’ intentions to use teledelivered SCC is unknown. Objective: The study aimed to use the unified theory of acceptance and use of technology to investigate the factors associated with the intentions of breast cancer survivors (BCS) in Hong Kong to use various types of teledelivered SCC (including psychosocial care, medical consultation, complementary care, peer support groups). Favorable telehealth-related perceptions (higher performance expectancy, lower effort expectancy, more facilitating conditions, positive social influences), less technological anxiety, and greater fear of COVID-19 were hypothesized to be associated with higher intentions to use teledelivered SCC. Moreover, the associations between telehealth-related perceptions and intentions to use teledelivered SCC were hypothesized to be moderated by education level, such that associations between telehealth-related perceptions and intentions to use teledelivered SCC would be stronger among those with a higher education level. Methods: A sample of 209 (209/287, 72.8% completion rate) women diagnosed with breast cancer since the start of the COVID-19 outbreak in Hong Kong (ie, January 2020) were recruited from the Hong Kong Breast Cancer Registry to complete a cross-sectional survey between June 2022 and December 2022. Participants’ intentions to use various types of teledelivered SCC (dependent variables), telehealth-related perceptions (independent variables), and sociodemographic variables (eg, education, as a moderator variable) were measured using self-reported, validated measures. Results: Hierarchical regression analysis results showed that greater confidence using telehealth, performance expectancy (believing telehealth helps with daily tasks), social influence (important others encouraging telehealth use), and facilitating conditions (having resources for telehealth use) were associated with higher intentions to use teledelivered SCC (range: β=0.16, P=.03 to β=0.34, P<.001). Moreover, 2-way interactions emerged between education level and 2 of the telehealth perception variables. Education level moderated the associations between (1) performance expectancy and intention to use teledelivered complementary care (β=0.34, P=.04) and (2) facilitating conditions and intention to use teledelivered peer support groups (β=0.36, P=.03). The positive associations between those telehealth perceptions and intentions were only significant among those with a higher education level. Conclusions: The findings of this study implied that enhancing BCS’ skills at using telehealth, BCS’ and their important others’ perceived benefits of telehealth, and providing assistance for telehealth use could increase BCS’ intentions to use teledelivered SCC. For intentions to use specific types of SCC, addressing relevant factors (performance expectancy, facilitating conditions) might be particularly beneficial for those with a higher education level. %M 38935942 %R 10.2196/51072 %U https://cancer.jmir.org/2024/1/e51072 %U https://doi.org/10.2196/51072 %U http://www.ncbi.nlm.nih.gov/pubmed/38935942 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e45840 %T Pandemic Fatigue and Preferences for COVID-19 Public Health and Social Measures in China: Nationwide Discrete Choice Experiment %A Yang,Meng %A He,Zonglin %A Zhang,Yin %A Liu,Taoran %A Ming,Wai-kit %+ Department of Infectious Diseases and Public Health, City University of Hong Kong, Room 1A-503, 5/F, Block 1, To Yuen Building, 31 To Yuen Street, Hong Kong, China (Hong Kong), 852 34426956, wkming2@cityu.edu.hk %K pandemic fatigue %K preference %K public health and social measures %K discrete choice experiment %K COVID-19 %D 2024 %7 27.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Information on the public’s preferences for current public health and social measures (PHSMs) and people’s mental health under PHSMs is insufficient. Objective: This study aimed to quantify the public’s preferences for varied PHSMs and measure the level of pandemic fatigue in the COVID-19 normalization stage in China. Methods: A nationwide cross-sectional study with a discrete choice experiment and psychometric scales was conducted to assess public preferences for and attitudes toward PHSMs, using the quota sampling method. The COVID-19 Pandemic Fatigue Scale (CPFS) was used to screen fatigue levels among respondents. The multinomial logit model, latent class model, and Mann-Whitney test were used for statistical analysis. We also conducted subgroup analysis based on sex, age, monthly income, mental health status, and pandemic fatigue status. Results: A total of 689 respondents across China completed the survey. The discrete choice experiment revealed that respondents attached the greatest importance to the risk of COVID-19 infection within 3 months (45.53%), followed by loss of income within 3 months (30.69%). Vulnerable populations (low-income populations and elderly people) were more sensitive to the risk of infection, while younger respondents were more sensitive to income loss and preferred nonsuspension of social places and transportation. Migrants and those with pandemic fatigue had less acceptance of the mandatory booster vaccination and suspension of transportation. Additionally, a higher pandemic fatigue level was observed in female respondents, younger respondents, migrants, and relatively lower-income respondents (CPFS correlation with age: r=–0.274, P<.001; correlation with monthly income: r=–0.25, P<.001). Mandatory booster COVID-19 vaccination was also not preferred by respondents with a higher level of pandemic fatigue, while universal COVID-19 booster vaccination was preferred by respondents with a lower level of pandemic fatigue. Conclusions: Pandemic fatigue is widely prevalent in respondents across China, and respondents desired the resumption of normal social life while being confronted with the fear of COVID-19 infection in the normalization stage of COVID-19 in China. During future pandemics, the mental burden and adherence of residents should be considered for the proper implementation of PHSMs. %M 38935420 %R 10.2196/45840 %U https://publichealth.jmir.org/2024/1/e45840 %U https://doi.org/10.2196/45840 %U http://www.ncbi.nlm.nih.gov/pubmed/38935420 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e58040 %T Experiences of Governments and Public Health Agencies Regarding Crisis Communication During the COVID-19 Pandemic in the Digital Age: Protocol for a Systematic Review of Qualitative Studies %A Okuhara,Tsuyoshi %A Terada,Marina %A Okada,Hiroko %A Kiuchi,Takahiro %+ Department of Health Communication, School of Public Health, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-8654, Japan, 81 03 5800 8781, okuhara-ctr@umin.ac.jp %K COVID-19 %K health communication %K infodemic %K misinformation %K social media %K SARS-CoV-2 %K coronavirus %K pandemic %K infectious %K digital age %K systematic review %K internet %K public health %K government %K governments %K crisis communication %K qualitative %K methodology %K disinformation %K eHealth %K digital health %K medical informatics %D 2024 %7 27.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Governments and public health agencies worldwide experienced difficulties with social media–mediated infodemics on the internet during the COVID-19 pandemic. Existing public health crisis communication strategies need to be updated. However, crisis communication experiences of governments and public health agencies worldwide during the COVID-19 pandemic have not been systematically compiled, necessitating updated crisis communication strategies. Objective: This systematic review aims to collect and organize the crisis communication experiences of senders (ie, governments and public health agencies) during the COVID-19 pandemic. Our focus is on exploring the difficulties that governments and public health agencies experienced, best practices in crisis communication by governments and public health agencies during the COVID-19 pandemic in times of infodemic, and challenges that should be overcome in future public health crises. Methods: We plan to begin the literature search on May 1, 2024. We will search PubMed, MEDLINE, CINAHL, PsycINFO, PsycARTICLES, Communication Abstracts, and Web of Science. We will filter our database searches to search from the year 2020 and beyond. We will use a combination of keywords by referring to the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, and Research type) tool to search the abstracts in databases. We intend to include qualitative studies on crisis communication by governments and public health agencies (eg, officials, staff, health professionals, and researchers) to the public. Quantitative data–based studies will be excluded. Only papers written in English will be included. Data on study characteristics, study aim, participant characteristics, methodology, theoretical framework, object of crisis communication, and key results will be extracted. The methodological quality of eligible studies will be assessed using the Joanna Briggs Institute critical appraisal checklist for qualitative research. A total of 2 independent reviewers will share responsibility for screening publications, data extraction, and quality assessment. Disagreement will be resolved through discussion, and the third reviewer will be consulted, if necessary. The findings will be summarized in a table and a conceptual diagram and synthesized in a descriptive and narrative review. Results: The results will be systematically integrated and presented in a way that corresponds to our research objectives and interests. We expect the results of this review to be submitted for publication by the end of 2024. Conclusions: To our knowledge, this will be the first systematic review of the experiences of governments and public health agencies regarding their crisis communication to the public during the COVID-19 pandemic. This review will contribute to the future improvement of the guidelines for crisis communication by governments and public health agencies to the public. Trial Registration: PROSPERO CRD42024528975; https://tinyurl.com/4fjmd8te International Registered Report Identifier (IRRID): PRR1-10.2196/58040 %M 38935414 %R 10.2196/58040 %U https://www.researchprotocols.org/2024/1/e58040 %U https://doi.org/10.2196/58040 %U http://www.ncbi.nlm.nih.gov/pubmed/38935414 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46137 %T Drug-Resistant Tuberculosis Case-Finding Strategies: Scoping Review %A van Wyk,Susanna S %A Nliwasa,Marriott %A Lu,Fang-Wen %A Lan,Chih-Chan %A Seddon,James A %A Hoddinott,Graeme %A Viljoen,Lario %A Günther,Gunar %A Ruswa,Nunurai %A Shah,N Sarita %A Claassens,Mareli %+ Department of Human, Biological & Translational Medical Science, School of Medicine, University of Namibia, Bach Street, Windhoek, 10005, Namibia, 264 612063111, mcla@sun.ac.za %K tuberculosis %K drug-resistant tuberculosis %K drug-resistant tuberculosis case finding %K drug-resistant tuberculosis case detection %K drug-resistant tuberculosis screening %K drug-resistant tuberculosis contact investigation %K scoping review %K TB symptom %K anti-tuberculosis drug %K strategies %K multidrug-resistant %K systematic review %K drug resistant %K drug resistance %K medication %K tuberculosis %K diagnosis %K screening %D 2024 %7 26.6.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Finding individuals with drug-resistant tuberculosis (DR-TB) is important to control the pandemic and improve patient clinical outcomes. To our knowledge, systematic reviews assessing the effectiveness, cost-effectiveness, acceptability, and feasibility of different DR-TB case-finding strategies to inform research, policy, and practice, have not been conducted and the scope of primary research is unknown. Objective: We therefore assessed the available literature on DR-TB case-finding strategies. Methods: We looked at systematic reviews, trials, qualitative studies, diagnostic test accuracy studies, and other primary research that sought to improve DR-TB case detection specifically. We excluded studies that included patients seeking care for tuberculosis (TB) symptoms, patients already diagnosed with TB, or were laboratory-based. We searched the academic databases of MEDLINE, Embase, The Cochrane Library, Africa-Wide Information, CINAHL (Cumulated Index to Nursing and Allied Health Literature), Epistemonikos, and PROSPERO (The International Prospective Register of Systematic Reviews) using no language or date restrictions. We screened titles, abstracts, and full-text articles in duplicate. Data extraction and analyses were carried out in Excel (Microsoft Corp). Results: We screened 3646 titles and abstracts and 236 full-text articles. We identified 6 systematic reviews and 61 primary studies. Five reviews described the yield of contact investigation and focused on household contacts, airline contacts, comparison between drug-susceptible tuberculosis and DR-TB contacts, and concordance of DR-TB profiles between index cases and contacts. One review compared universal versus selective drug resistance testing. Primary studies described (1) 34 contact investigations, (2) 17 outbreak investigations, (3) 3 airline contact investigations, (4) 5 epidemiological analyses, (5) 1 public-private partnership program, and (6) an e-registry program. Primary studies were all descriptive and included cross-sectional and retrospective reviews of program data. No trials were identified. Data extraction from contact investigations was difficult due to incomplete reporting of relevant information. Conclusions: Existing descriptive reviews can be updated, but there is a dearth of knowledge on the effectiveness, cost-effectiveness, acceptability, and feasibility of DR-TB case-finding strategies to inform policy and practice. There is also a need for standardization of terminology, design, and reporting of DR-TB case-finding studies. %M 38924777 %R 10.2196/46137 %U https://publichealth.jmir.org/2024/1/e46137 %U https://doi.org/10.2196/46137 %U http://www.ncbi.nlm.nih.gov/pubmed/38924777 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51993 %T Effectiveness, Safety, and Acceptability of Primaquine Mass Drug Administration in Low-Endemicity Areas in Southern Thailand: Proof-of-Concept Study %A Kaewkungwal,Jaranit %A Roobsoong,Wanlapa %A Lawpoolsri,Saranath %A Nguitragool,Wang %A Thammapalo,Suwich %A Prikchoo,Pathomporn %A Khamsiriwatchara,Amnat %A Pawarana,Rungrawee %A Jarujareet,Pawinee %A Parker,Daniel M %A Sripoorote,Piyarat %A Kengganpanich,Mondha %A Ngamjarus,Chetta %A Sattabongkot,Jetsumon %A Cui,Liwang %+ Department of Tropical Hygiene, Mahidol University, Rajavithi Road, Bangkok, 10400, Thailand, 66 0871001951, jaranitk@biophics.org %K mass drug administration %K cluster-crossover randomized controlled trial %K community-based trial %K participatory epidemiology %K Plasmodium vivax %K primaquine %D 2024 %7 26.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: A challenge in achieving the malaria-elimination target in the Greater Mekong Subregion, including Thailand, is the predominance of Plasmodium vivax malaria, which has shown extreme resilience to control measures. Objective: This proof-of-concept study aimed to provide evidence for implementing primaquine mass drug administration (pMDA) as a strategy for P. vivax elimination in low-endemicity settings. Methods: The study employed a mixed-methods trial to thoroughly evaluate the effectiveness, safety, acceptability, and community engagement of pMDA. The quantitative part was designed as a 2-period cluster-crossover randomized controlled trial. The intervention was pMDA augmented to the national prevention and control standards with directly observed treatment (DOT) by village health volunteers. The qualitative part employed in-depth interviews and brainstorming discussions. The study involved 7 clusters in 2 districts of 2 southern provinces in Thailand with persistently low P. vivax transmission. In the quantitative part, 5 cross-sectional blood surveys were conducted in both the pMDA and control groups before and 3 months after pMDA. The effectiveness of pMDA was determined by comparing the proportions of P. vivax infections per 1000 population between the 2 groups, with a multilevel zero-inflated negative binomial model adjusted for cluster and time as covariates and the interaction. The safety data comprised adverse events after drug administration. Thematic content analysis was used to assess the acceptability and engagement of stakeholders. Results: In the pre-pMDA period, the proportions of P. vivax infections in the pMDA (n=1536) and control (n=1577) groups were 13.0 (95% CI 8.2-20.4) and 12.0 (95% CI 7.5-19.1), respectively. At month 3 post-pMDA, these proportions in the pMDA (n=1430) and control (n=1420) groups were 8.4 (95% CI 4.6-15.1) and 5.6 (95% CI 2.6-11.5), respectively. No statistically significant differences were found between the groups. The number of malaria cases reduced in all clusters in both groups, and thus, the impact of pMDA was inconclusive. There were no major safety concerns. Acceptance among the study participants and public health care providers at local and national levels was high, and they believed that pMDA had boosted awareness in the community. Conclusions: pMDA was associated with high adherence, safety, and tolerability, but it may not significantly impact P. vivax transmission. As this was a proof-of-concept study, we decided not to scale up the intervention with larger clusters and samples. An alternative approach involving a targeted primaquine treatment strategy with primaquine and DOT is currently being implemented. We experienced success regarding effective health care workforces at point-of-care centers, effective collaborations in the community, and commitment from authorities at local and national levels. Our efforts boosted the acceptability of the malaria-elimination initiative. Community engagement is recommended to achieve elimination targets. Trial Registration: Thai Clinical Trials Registry TCTR20190806004; https://www.thaiclinicaltrials.org/show/TCTR20190806004 %M 38922648 %R 10.2196/51993 %U https://publichealth.jmir.org/2024/1/e51993 %U https://doi.org/10.2196/51993 %U http://www.ncbi.nlm.nih.gov/pubmed/38922648 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e51662 %T Acceptability of a Digital Adherence Tool Among Patients With Tuberculosis and Tuberculosis Care Providers in Kilimanjaro Region, Tanzania: Mixed Methods Study %A Mtenga,Alan Elias %A Maro,Rehema Anenmose %A Dillip,Angel %A Msoka,Perry %A Emmanuel,Naomi %A Ngowi,Kennedy %A Sumari-de Boer,Marion %+ mHealth Department, Kilimanjaro Clinical Research Institute, KCMC/Kitandu, Longuo st, 2236, Moshi, Moshi, 25116, United Republic of Tanzania, 255 763285424, a.mtenga@kcri.ac.tz %K acceptability %K digital adherence tool %K medication reminder monitors %K patients with tuberculosis %K TB %K adherence %K TB care provider %D 2024 %7 26.6.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: The World Health Organization has recommended digital adherence tools (DATs) as a promising intervention to improve antituberculosis drug adherence. However, the acceptability of DATs in resource-limited settings is not adequately studied. Objective: We investigated the acceptability of a DAT among patients with tuberculosis (TB) and TB care providers in Kilimanjaro, Tanzania. Methods: We conducted a convergent parallel mixed methods study among patients with TB and TB care providers participating in our 2-arm cluster randomized trial (REMIND-TB). The trial aimed to investigate whether the evriMED pillbox with reminder cues and adherence feedback effectively improves adherence to anti-TB treatment among patients with TB in Kilimanjaro, Tanzania. We conducted exit and in-depth interviews among patients as well as in-depth interviews among TB care providers in the intervention arm. We conducted a descriptive analysis of the quantitative data from exit interviews. Translated transcripts and memos were organized using NVivo software. We employed inductive and deductive thematic framework analysis, guided by Sekhon’s theoretical framework of acceptability. Results: Out of the 245 patients who completed treatment, 100 (40.8%) were interviewed during exit interviews, and 18 patients and 15 TB care providers were interviewed in-depth. Our findings showed that the DAT was highly accepted: 83% (83/100) expressed satisfaction, 98% (98/100) reported positive experiences with DAT use, 78% (78/100) understood how the intervention works, and 92% (92/100) successfully used the pillbox. Good perceived effectiveness was reported by 84% (84/100) of the participants who noticed improved adherence, and many preferred continuing receiving reminders through SMS text messages, indicating high levels of self-efficacy. Ethical concerns were minimal, as 85 (85%) participants did not worry about remote monitoring. However, some participants felt burdened using DATs; 9 (9%) faced difficulties keeping the device at home, 12 (12%) were not pleased with receiving daily reminder SMS text messages, and 30 (30%) reported challenges related to mobile network connectivity issues. TB care providers accepted the intervention due to its perceived impact on treatment outcomes and behavior change in adherence counseling, and they demonstrated high level of intervention coherence. Conclusions: DATs are highly acceptable in Tanzania. However, some barriers such as TB-related stigma and mobile network connectivity issues may limit acceptance. International Registered Report Identifier (IRRID): RR2-10.1186/s13063-019-3483-4 %M 38922643 %R 10.2196/51662 %U https://ojphi.jmir.org/2024/1/e51662 %U https://doi.org/10.2196/51662 %U http://www.ncbi.nlm.nih.gov/pubmed/38922643 %0 Journal Article %@ 2371-4379 %I JMIR Publications %V 9 %N %P e55201 %T Inequalities in the Ability for People With Type 2 Diabetes and Prediabetes to Adapt to the Reduction in In-Person Health Support and Increased Use of Digital Support During the COVID-19 Pandemic and Beyond: Qualitative Study %A Turnbull,Sophie %A Cabral,Christie %+ Bristol Medical School, Population Health Sciences, University of Bristol, 5 Tyndall Avenue Bristol, Bristol, BS8 1UD, United Kingdom, 44 117 455 8613, sophie.turnbull@bristol.ac.uk %K diabetes %K diabetic %K DM %K diabetes mellitus %K type 2 diabetes %K type 1 diabetes %K prediabetes %K prediabetic %K COVID-19 pandemic %K COVID-19 %K SARS-CoV-2 %K coronavirus %K severe acute respiratory syndrome %K coronavirus infections %K novel coronavirus %K motivation %K health inequalities %K self-care %K mHealth %K mobile health %K app %K apps %K application %K applications %K digital health %K digital intervention %K digital interventions %K telemedicine %K telehealth %K virtual care %K virtual health %K virtual medicine %K remote consultation %K telephone consultation %K video consultation %K remote consultations %K telephone consultations %K video consultations %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Diabetes %G English %X Background: The COVID-19 pandemic created unprecedented challenges for people with type 2 diabetes (T2D) and prediabetes to access in-person health care support. Primary care teams accelerated plans to implement digital health technologies (DHTs), such as remote consultations and digital self-management. There is limited evidence about whether there were inequalities in how people with T2D and prediabetes adjusted to these changes. Objective: This study aimed to explore how people with T2D and prediabetes adapted to the reduction in in-person health support and the increased provision of support through DHTs during the COVID-19 pandemic and beyond. Methods: A purposive sample of people with T2D and prediabetes was recruited by text message from primary care practices that served low-income areas. Semistructured interviews were conducted by phone or video call, and data were analyzed thematically using a hybrid inductive and deductive approach. Results: A diverse sample of 30 participants was interviewed. There was a feeling that primary care had become harder to access. Participants responded to the challenge of accessing support by rationing or delaying seeking support or by proactively requesting appointments. Barriers to accessing health care support were associated with issues with using the total triage system, a passive interaction style with health care services, or being diagnosed with prediabetes at the beginning of the pandemic. Some participants were able to adapt to the increased delivery of support through DHTs. Others had lower capacity to use DHTs, which was caused by lower digital skills, fewer financial resources, and a lack of support to use the tools. Conclusions: Inequalities in motivation, opportunity, and capacity to engage in health services and DHTs lead to unequal possibilities for people with T2D and prediabetes to self-care and receive care during the COVID-19 pandemic. These issues can be addressed by proactive arrangement of regular checkups by primary care services and improving capacity for people with lower digital skills to engage with DHTs. %M 38917452 %R 10.2196/55201 %U https://diabetes.jmir.org/2024/1/e55201 %U https://doi.org/10.2196/55201 %U http://www.ncbi.nlm.nih.gov/pubmed/38917452 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e53940 %T Effects of User Experience in Automated Information Processing on Perceived Usefulness of Digital Contact-Tracing Apps: Cross-Sectional Survey Study %A Schrills,Tim %A Kojan,Lilian %A Gruner,Marthe %A Calero Valdez,André %A Franke,Thomas %+ Institute for Multimedia and Interactive Systems, Universität zu Lübeck, Ratzeburger Allee 160, Lübeck, 23560, Germany, 49 451 3101 ext 5135, Tim.schrills@uni-luebeck.de %K COVID-19 %K contact tracing %K user experience %K trust %K health information processing %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: In pandemic situations, digital contact tracing (DCT) can be an effective way to assess one’s risk of infection and inform others in case of infection. DCT apps can support the information gathering and analysis processes of users aiming to trace contacts. However, users’ use intention and use of DCT information may depend on the perceived benefits of contact tracing. While existing research has examined acceptance in DCT, automation-related user experience factors have been overlooked. Objective: We pursued three goals: (1) to analyze how automation-related user experience (ie, perceived trustworthiness, traceability, and usefulness) relates to user behavior toward a DCT app, (2) to contextualize these effects with health behavior factors (ie, threat appraisal and moral obligation), and (3) to collect qualitative data on user demands for improved DCT communication. Methods: Survey data were collected from 317 users of a nationwide-distributed DCT app during the COVID-19 pandemic after it had been in app stores for >1 year using a web-based convenience sample. We assessed automation-related user experience. In addition, we assessed threat appraisal and moral obligation regarding DCT use to estimate a partial least squares structural equation model predicting use intention. To provide practical steps to improve the user experience, we surveyed users’ needs for improved communication of information via the app and analyzed their responses using thematic analysis. Results: Data validity and perceived usefulness showed a significant correlation of r=0.38 (P<.001), goal congruity and perceived usefulness correlated at r=0.47 (P<.001), and result diagnosticity and perceived usefulness had a strong correlation of r=0.56 (P<.001). In addition, a correlation of r=0.35 (P<.001) was observed between Subjective Information Processing Awareness and perceived usefulness, suggesting that automation-related changes might influence the perceived utility of DCT. Finally, a moderate positive correlation of r=0.47 (P<.001) was found between perceived usefulness and use intention, highlighting the connection between user experience variables and use intention. Partial least squares structural equation modeling explained 55.6% of the variance in use intention, with the strongest direct predictor being perceived trustworthiness (β=.54; P<.001) followed by moral obligation (β=.22; P<.001). Based on the qualitative data, users mainly demanded more detailed information about contacts (eg, place and time of contact). They also wanted to share information (eg, whether they wore a mask) to improve the accuracy and diagnosticity of risk calculation. Conclusions: The perceived result diagnosticity of DCT apps is crucial for perceived trustworthiness and use intention. By designing for high diagnosticity for the user, DCT apps could improve their support in the action regulation of users, resulting in higher perceived trustworthiness and use in pandemic situations. In general, automation-related user experience has greater importance for use intention than general health behavior or experience. %M 38916941 %R 10.2196/53940 %U https://humanfactors.jmir.org/2024/1/e53940 %U https://doi.org/10.2196/53940 %U http://www.ncbi.nlm.nih.gov/pubmed/38916941 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53807 %T Ischemic Stroke After Bivalent COVID-19 Vaccination: Self-Controlled Case Series Study %A Xu,Stanley %A Sy,Lina S %A Hong,Vennis %A Holmquist,Kimberly J %A Qian,Lei %A Farrington,Paddy %A Bruxvoort,Katia J %A Klein,Nicola P %A Fireman,Bruce %A Han,Bing %A Lewin,Bruno J %+ Department of Research & Evaluation, Southern California Permanente Medical Group, 100 S Los Robles, Pasadena, CA, 91101, United States, 1 6265643958, stan.xu@kp.org %K ischemic stroke %K bivalent COVID-19 vaccine %K influenza vaccine %K self-controlled case series %K coadministration %K ischemic %K stroke %K TIA %K transient ischemic attack %K ischemia %K cardiovascular %K COVID-19 %K SARS-CoV-2 %K vaccine %K vaccines %K vaccination %K association %K correlation %K risk %K risks %K adverse %K side effect %K subgroup analyses %K subgroup analysis %K bivalent %K influenza %K infectious %K respiratory %K incidence %K case series %D 2024 %7 25.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The potential association between bivalent COVID-19 vaccination and ischemic stroke remains uncertain, despite several studies conducted thus far. Objective: This study aimed to evaluate the risk of ischemic stroke following bivalent COVID-19 vaccination during the 2022-2023 season. Methods: A self-controlled case series study was conducted among members aged 12 years and older who experienced ischemic stroke between September 1, 2022, and March 31, 2023, in a large health care system. Ischemic strokes were identified using International Classification of Diseases, Tenth Revision codes in emergency departments and inpatient settings. Exposures were Pfizer-BioNTech or Moderna bivalent COVID-19 vaccination. Risk intervals were prespecified as 1-21 days and 1-42 days after bivalent vaccination; all non–risk-interval person-time served as the control interval. The incidence of ischemic stroke was compared in the risk interval and control interval using conditional Poisson regression. We conducted overall and subgroup analyses by age, history of SARS-CoV-2 infection, and coadministration of influenza vaccine. When an elevated risk was detected, we performed a chart review of ischemic strokes and analyzed the risk of chart-confirmed ischemic stroke. Results: With 4933 ischemic stroke events, we found no increased risk within the 21-day risk interval for the 2 vaccines and by subgroups. However, risk of ischemic stroke was elevated within the 42-day risk interval among individuals aged younger than 65 years with coadministration of Pfizer-BioNTech bivalent and influenza vaccines on the same day; the relative incidence (RI) was 2.13 (95% CI 1.01-4.46). Among those who also had a history of SARS-CoV-2 infection, the RI was 3.94 (95% CI 1.10-14.16). After chart review, the RIs were 2.34 (95% CI 0.97-5.65) and 4.27 (95% CI 0.97-18.85), respectively. Among individuals aged younger than 65 years who received Moderna bivalent vaccine and had a history of SARS-CoV-2 infection, the RI was 2.62 (95% CI 1.13-6.03) before chart review and 2.24 (95% CI 0.78-6.47) after chart review. Stratified analyses by sex did not show a significantly increased risk of ischemic stroke after bivalent vaccination. Conclusions: While the point estimate for the risk of chart-confirmed ischemic stroke was elevated in a risk interval of 1-42 days among individuals younger than 65 years with coadministration of Pfizer-BioNTech bivalent and influenza vaccines on the same day and among individuals younger than 65 years who received Moderna bivalent vaccine and had a history of SARS-CoV-2 infection, the risk was not statistically significant. The potential association between bivalent vaccination and ischemic stroke in the 1-42–day analysis warrants further investigation among individuals younger than 65 years with influenza vaccine coadministration and prior SARS-CoV-2 infection. Furthermore, the findings on ischemic stroke risk after bivalent COVID-19 vaccination underscore the need to evaluate monovalent COVID-19 vaccine safety during the 2023-2024 season. %M 38916940 %R 10.2196/53807 %U https://publichealth.jmir.org/2024/1/e53807 %U https://doi.org/10.2196/53807 %U http://www.ncbi.nlm.nih.gov/pubmed/38916940 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52402 %T The Incidence and Outcomes of Out-of-Hospital Cardiac Arrest During the COVID-19 Pandemic in South Korea: Multicenter Registry Study %A Lee,Heekyung %A Oh,Jaehoon %A Choi,Hyuk Joong %A Shin,Hyungoo %A Cho,Yongil %A Lee,Juncheol %+ Department of Emergency Medicine, Hanyang University College of Medicine, 222 Wangsimni-ro, Seongdong-gu, Seoul, 04763, Republic of Korea, 82 2 2290 9829, ojjai@hanyang.ac.kr %K heart arrest %K cardiopulmonary resuscitation %K SARS-CoV-2 %K mortality %K outpatient %K cardiac arrest %K multicenter registry study %K out-of-hospital cardiac arrest %K heart attack %K observational study %K adult %K older adults %K analysis %K pandemic %K prepandemic %K endemic %K defibrillator %K COVID-19 %D 2024 %7 24.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has profoundly affected out-of-hospital cardiac arrest (OHCA) and disrupted the chain of survival. Even after the end of the pandemic, the risk of new variants and surges persists. Analyzing the characteristics of OHCA during the pandemic is important to prepare for the next pandemic and to avoid repeated negative outcomes. However, previous studies have yielded somewhat varied results, depending on the health care system or the specific characteristics of social structures. Objective: We aimed to investigate and compare the incidence, outcomes, and characteristics of OHCA during the prepandemic and pandemic periods using data from a nationwide multicenter OHCA registry. Methods: We conducted a multicenter, retrospective, observational study using data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry. This study included adult patients with OHCA in South Korea across 3 distinct 1-year periods: the prepandemic period (from January to December 2019), early phase pandemic period (from July 2020 to June 2021), and late phase pandemic period (from July 2021 to June 2022). We extracted and contrasted the characteristics of patients with OHCA, prehospital time factors, and outcomes for the patients across these 3 periods. The primary outcomes were survival to hospital admission and survival to hospital discharge. The secondary outcome was good neurological outcome. Results: From the 3 designated periods, a total of 9031 adult patients with OHCA were eligible for analysis (prepandemic: n=2728; early pandemic: n=2954; and late pandemic: n=3349). Witnessed arrest (P<.001) and arrest at home or residence (P=.001) were significantly more frequent during the pandemic period than during the prepandemic period, and automated external defibrillator use by bystanders was lower in the early phase of the pandemic than during other periods. As the pandemic advanced, the rates of the first monitored shockable rhythm (P=.10) and prehospital endotracheal intubation (P<.001) decreased significantly. Time from cardiac arrest cognition to emergency department arrival increased sequentially (prepandemic: 33 min; early pandemic: 35 min; and late pandemic: 36 min; P<.001). Both survival and neurological outcomes worsened as the pandemic progressed, with survival to discharge showing the largest statistical difference (prepandemic: 385/2728, 14.1%; early pandemic: 355/2954, 12%; and late pandemic: 392/3349, 11.7%; P=.01). Additionally, none of the outcomes differed significantly between the early and late phase pandemic periods (all P>.05). Conclusions: During the pandemic, especially amid community COVID-19 surges, the incidence of OHCA increased while survival rates and good neurological outcome at discharge decreased. Prehospital OHCA factors, which are directly related to OHCA prognosis, were adversely affected by the pandemic. Ongoing discussions are needed to maintain the chain of survival in the event of a new pandemic. Trial Registration: ClinicalTrials.gov NCT03222999; https://classic.clinicaltrials.gov/ct2/show/NCT03222999 %M 38913998 %R 10.2196/52402 %U https://publichealth.jmir.org/2024/1/e52402 %U https://doi.org/10.2196/52402 %U http://www.ncbi.nlm.nih.gov/pubmed/38913998 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53551 %T Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Europe: Longitudinal Trend Analysis %A Lundberg,Alexander L %A Wu,Scott A %A Soetikno,Alan G %A Hawkins,Claudia %A Murphy,Robert L %A Havey,Robert J %A Ozer,Egon A %A Moss,Charles B %A Welch,Sarah B %A Mason,Maryann %A Liu,Yingxuan %A Post,Lori A %+ Buehler Center for Health Policy and Economics, Robert J. Havey, MD Institute for Global Health, Northwestern University, 420 E. Superior, Chicago, IL, 60611, United States, 1 3125031706, lori.post@northwestern.edu %K Europe %K COVID-19 %K history of the pandemic %K method of the moments %K Arellano-Bond estimators %K Albania %K Andorra %K Austria %K Belarus %K Belgium %K Bosnia and Herzegovina %K Bulgaria %K Croatia %K the Czech Republic %K Denmark %K Estonia %K Finland %K France %K Germany %K Greece %K Greenland %K Hungary %K Iceland %K Ireland %K the Isle of Man %K Italy %K Latvia %K Liechtenstein %K Lithuania %K Luxembourg %K Moldova %K Monaco %K Montenegro %K the Netherlands %K Norway %K Poland %K Portugal %K Romania %K San Marino %K Serbia %K Slovakia %K Slovenia %K Spain %K Sweden %K Switzerland %K Ukraine %K the United Kingdom %K the Vatican City %D 2024 %7 21.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In this study, we built upon our initial research published in 2020 by incorporating an additional 2 years of data for Europe. We assessed whether COVID-19 had shifted from the pandemic to endemic phase in the region when the World Health Organization (WHO) declared the end of the public health emergency of international concern on May 5, 2023. Objective: We first aimed to measure whether there was an expansion or contraction in the pandemic in Europe at the time of the WHO declaration. Second, we used dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history. Third, we provided the historical context for the course of the pandemic in Europe in terms of policy and disease burden at the country and region levels. Methods: In addition to the updates of traditional surveillance data and dynamic panel estimates from the original study, this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-tailed t test for whether regional weekly speed was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the sample period. Results: Speed for the region had remained below the outbreak threshold for 4 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. While the 1-day and 7-day persistence coefficients remained statistically significant, the coefficients were moderate in magnitude (0.404 and 0.547, respectively; P<.001 for both). The shift parameters for the 2 weeks around the WHO declaration were small and insignificant, suggesting little change in the clustering effect of cases on future cases at the time. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of speed equal to 10 became insignificant for the first time in April 2023. Conclusions: While COVID-19 continues to circulate in Europe, the rate of transmission remained below the threshold of an outbreak for 4 months ahead of the WHO declaration. The region had previously been in a nearly continuous state of outbreak. The more recent trend suggested that COVID-19 was endemic in the region and no longer reached the threshold of the pandemic definition. However, several countries remained in a state of outbreak, and the conclusion that COVID-19 was no longer a pandemic in Europe at the time is unclear. %M 38568186 %R 10.2196/53551 %U https://publichealth.jmir.org/2024/1/e53551 %U https://doi.org/10.2196/53551 %U http://www.ncbi.nlm.nih.gov/pubmed/38568186 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e48549 %T Testing a Biobehavioral Model of Chronic Stress and Weight Gain in Young Children (Family Stress Study): Protocol and Baseline Demographics for a Prospective Observational Study %A Pare,Shannon M %A Gunn,Elizabeth %A Morrison,Katherine M %A Miller,Alison L %A Duncan,Alison M %A Buchholz,Andrea C %A Ma,David W L %A Tremblay,Paul F %A Vallis,Lori Ann %A Mercer,Nicola J %A Haines,Jess %+ Department of Family Relations and Applied Nutrition, University of Guelph, 50 Stone Road East, Guelph, ON, N1G 2W1, Canada, 1 5198244120 ext 58820, spare@uoguelph.ca %K stress %K child, preschool %K adiposity %K household chaos %K cortisol %K COVID-19 %K behavioral mechanisms %K caregiver-child relationship quality %D 2024 %7 20.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic stress is an important risk factor in the development of obesity. While research suggests chronic stress is linked to excess weight gain in children, the biological or behavioral mechanisms are poorly understood. Objective: The objectives of the Family Stress Study are to examine behavioral and biological pathways through which chronic stress exposure (including stress from COVID-19) may be associated with adiposity in young children, and to determine if factors such as child sex, caregiver-child relationship quality, caregiver education, and caregiver self-regulation moderate the association between chronic stress and child adiposity. Methods: The Family Stress Study is a prospective cohort study of families recruited from 2 Canadian sites: the University of Guelph in Guelph, Ontario, and McMaster University in Hamilton, Ontario. Participants will be observed for 2 years and were eligible to participate if they had at least one child (aged 2-6 years) and no plans to move from the area within the next 3 years. Study questionnaires and measures were completed remotely at baseline and will be assessed using the same methods at 1- and 2-year follow-ups. At each time point, caregivers measure and report their child’s height, weight, and waist circumference, collect a hair sample for cortisol analysis, and fit their child with an activity monitor to assess the child’s physical activity and sleep. Caregivers also complete a web-based health and behaviors survey with questions about family demographics, family stress, their own weight-related behaviors, and their child’s mental health, as well as a 1-day dietary assessment for their child. Results: Enrollment for this study was completed in December 2021. The final second-year follow-up was completed in April 2024. This study’s sample includes 359 families (359 children, 359 female caregivers, and 179 male caregivers). The children’s mean (SD) age is 3.9 years (1.2 years) and 51% (n=182) are female. Approximately 74% (n=263) of children and 80% (n=431) of caregivers identify as White. Approximately 34% (n=184) of caregivers have a college diploma or less and nearly 93% (n=499) are married or cohabiting with a partner. Nearly half (n=172, 47%) of the families have an annual household income ≥CAD $100,000 (an average exchange rate of 1 CAD=0.737626 USD applies). Data cleaning and analysis are ongoing as of manuscript publication. Conclusions: Despite public health restrictions from COVID-19, the Family Stress Study was successful in recruiting and using remote data collection to successfully engage families in this study. The results from this study will help identify the direction and relative contributions of the biological and behavioral pathways linking chronic stress and adiposity. These findings will aid in the development of effective interventions designed to modify these pathways and reduce obesity risk in children. Trial Registration: ClinicalTrials.gov NCT05534711; https://clinicaltrials.gov/study/NCT05534711 International Registered Report Identifier (IRRID): DERR1-10.2196/48549 %M 38900565 %R 10.2196/48549 %U https://www.researchprotocols.org/2024/1/e48549 %U https://doi.org/10.2196/48549 %U http://www.ncbi.nlm.nih.gov/pubmed/38900565 %0 Journal Article %@ 2369-3762 %I %V 10 %N %P e51915 %T Health Care Workers’ Motivations for Enrolling in Massive Open Online Courses During a Public Health Emergency: Descriptive Analysis %A Jones,Jennifer %A Johnston,Jamie Sewan %A Ndiaye,Ngouille Yabsa %A Tokar,Anna %A Singla,Saumya %A Skinner,Nadine Ann %A Strehlow,Matthew %A Utunen,Heini %K massive open online course %K MOOC %K online learning %K online courses %K online course %K health care education %K medical education %K education %K training %K professional development %K continuing education %K COVID-19 training %K infectious disease outbreak response %K emergency %K public health %K crisis %K crises %K outbreak %K pandemic %K COVID-19 %K SARS-CoV-2 %K coronavirus %K humanitarian emergency response %K health care workers %K nurse %K nurses %K practitioner %K practitioners %K clinician %K clinicians %K health care worker %K medic %K low-income %K lower-middle income %K LIC %K LMIC %K developing country %K developing countries %K developing nation %K developing nations %K case study %K survey %K surveys %K descriptive analysis %K descriptive analyses %K motivation %K motivations %K lower-middle–income country %K low-income country %D 2024 %7 19.6.2024 %9 %J JMIR Med Educ %G English %X Background: Massive open online courses (MOOCs) are increasingly used to educate health care workers during public health emergencies. In early 2020, the World Health Organization (WHO) developed a series of MOOCs for COVID-19, introducing the disease and strategies to control its outbreak, with 6 courses specifically targeting health care workers as learners. In 2020, Stanford University also launched a MOOC designed to deliver accurate and timely education on COVID-19, equipping health care workers across the globe to provide health care safely and effectively to patients with the novel infectious disease. Although the use of MOOCs for just-in-time training has expanded during the pandemic, evidence is limited regarding the factors motivating health care workers to enroll in and complete courses, particularly in low-income countries (LICs) and lower-middle–income countries (LMICs). Objective: This study seeks to gain insights on the characteristics and motivations of learners turning to MOOCs for just-in-time training, to provide evidence that can better inform MOOC design to meet the needs of health care workers. We examine data from learners in 1 Stanford University and 6 WHO COVID-19 courses to identify (1) the characteristics of health care workers completing the courses and (2) the factors motivating them to enroll. Methods: We analyze (1) course registration data of the 49,098 health care workers who completed the 7 focal courses and (2) survey responses from 6272 course completers. The survey asked respondents to rank their motivations for enrollment and share feedback about their learning experience. We use descriptive statistics to compare responses by health care profession and by World Bank country income classification. Results: Health care workers completed the focal courses from all regions of the world, with nearly one-third (14,159/49,098, 28.84%) practicing in LICs and LMICs. Survey data revealed a diverse range of professional roles among the learners, including physicians (2171/6272, 34.61%); nurses (1599/6272, 25.49%); and other health care professionals such as allied health professionals, community health workers, paramedics, and pharmacists (2502/6272, 39.89%). Across all health care professions, the primary motivation to enroll was for personal learning to improve clinical practice. Continuing education credit was also an important motivator, particularly for nonphysicians and learners in LICs and LMICs. Course cost (3423/6272, 54.58%) and certification (4238/6272, 67.57%) were also important to a majority of learners. Conclusions: Our results demonstrate that a diverse range of health care professionals accessed MOOCs for just-in-time training during a public health emergency. Although all health care workers were motivated to improve their clinical practice, different factors were influential across professions and locations. These factors should be considered in MOOC design to meet the needs of health care workers, particularly those in lower-resource settings where alternative avenues for training may be limited. %R 10.2196/51915 %U https://mededu.jmir.org/2024/1/e51915 %U https://doi.org/10.2196/51915 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57807 %T Spatiotemporal Epidemiological Trends of Mpox in Mainland China: Spatiotemporal Ecological Comparison Study %A Ma,Shuli %A Ge,Jie %A Qin,Lei %A Chen,Xiaoting %A Du,Linlin %A Qi,Yanbo %A Bai,Li %A Han,Yunfeng %A Xie,Zhiping %A Chen,Jiaxin %A Jia,Yuehui %+ School of Public Health, Qiqihar Medical University, 333 Bukui Street, Jianhua District, Qiqihar, 161000, China, 86 0452 2663409, superyuehui@163.com %K mpox %K spatiotemporal analysis %K emergencies %K prevention and control %K public health %D 2024 %7 19.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The World Health Organization declared mpox an international public health emergency. Since January 1, 2022, China has been ranked among the top 10 countries most affected by the mpox outbreak globally. However, there is a lack of spatial epidemiological studies on mpox, which are crucial for accurately mapping the spatial distribution and clustering of the disease. Objective: This study aims to provide geographically accurate visual evidence to determine priority areas for mpox prevention and control. Methods: Locally confirmed mpox cases were collected between June and November 2023 from 31 provinces of mainland China excluding Taiwan, Macao, and Hong Kong. Spatiotemporal epidemiological analyses, including spatial autocorrelation and regression analyses, were conducted to identify the spatiotemporal characteristics and clustering patterns of mpox attack rate and its spatial relationship with sociodemographic and socioeconomic factors. Results: From June to November 2023, a total of 1610 locally confirmed mpox cases were reported in 30 provinces in mainland China, resulting in an attack rate of 11.40 per 10 million people. Global spatial autocorrelation analysis showed that in July (Moran I=0.0938; P=.08), August (Moran I=0.1276; P=.08), and September (Moran I=0.0934; P=.07), the attack rates of mpox exhibited a clustered pattern and positive spatial autocorrelation. The Getis-Ord Gi* statistics identified hot spots of mpox attack rates in Beijing, Tianjin, Shanghai, Jiangsu, and Hainan. Beijing and Tianjin were consistent hot spots from June to October. No cold spots with low mpox attack rates were detected by the Getis-Ord Gi* statistics. Local Moran I statistics identified a high-high (HH) clustering of mpox attack rates in Guangdong, Beijing, and Tianjin. Guangdong province consistently exhibited HH clustering from June to November, while Beijing and Tianjin were identified as HH clusters from July to September. Low-low clusters were mainly located in Inner Mongolia, Xinjiang, Xizang, Qinghai, and Gansu. Ordinary least squares regression models showed that the cumulative mpox attack rates were significantly and positively associated with the proportion of the urban population (t0.05/2,1=2.4041 P=.02), per capita gross domestic product (t0.05/2,1=2.6955; P=.01), per capita disposable income (t0.05/2,1=2.8303; P=.008), per capita consumption expenditure (PCCE; t0.05/2,1=2.7452; P=.01), and PCCE for health care (t0.05/2,1=2.5924; P=.01). The geographically weighted regression models indicated a positive association and spatial heterogeneity between cumulative mpox attack rates and the proportion of the urban population, per capita gross domestic product, per capita disposable income, and PCCE, with high R2 values in north and northeast China. Conclusions: Hot spots and HH clustering of mpox attack rates identified by local spatial autocorrelation analysis should be considered key areas for precision prevention and control of mpox. Specifically, Guangdong, Beijing, and Tianjin provinces should be prioritized for mpox prevention and control. These findings provide geographically precise and visualized evidence to assist in identifying key areas for targeted prevention and control. %M 38896444 %R 10.2196/57807 %U https://publichealth.jmir.org/2024/1/e57807 %U https://doi.org/10.2196/57807 %U http://www.ncbi.nlm.nih.gov/pubmed/38896444 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51498 %T Population Behavior Changes Underlying Phasic Shifts of SARS-CoV-2 Exposure Settings Across 3 Omicron Epidemic Waves in Hong Kong: Prospective Cohort Study %A Chan,Chin Pok %A Lee,Shui Shan %A Kwan,Tsz Ho %A Wong,Samuel Yeung Shan %A Yeoh,Eng-Kiong %A Wong,Ngai Sze %+ JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Rm 204, School of Public Health Building, Prince of Wales Hospital, New Territories, Hong Kong, China, 86 22528862, candy_wong@cuhk.edu.hk %K exposure risk %K contact setting %K social distancing %K epidemic control %K participatory surveillance %K SARS-CoV-2 %K COVID-19 %D 2024 %7 19.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Exposure risk was shown to have affected individual susceptibility and the epidemic spread of COVID-19. The dynamics of risk by and across exposure settings alongside the variations following the implementation of social distancing interventions are understudied. Objective: This study aims to examine the population’s trajectory of exposure risk in different settings and its association with SARS-CoV-2 infection across 3 consecutive Omicron epidemic waves in Hong Kong. Methods: From March to June 2022, invitation letters were posted to 41,132 randomly selected residential addresses for the recruitment of households into a prospective population cohort. Through web-based monthly surveys coupled with email reminders, a representative from each enrolled household self-reported incidents of SARS-CoV-2 infections, COVID-19 vaccination uptake, their activity pattern in the workplace, and daily and social settings in the preceding month. As a proxy of their exposure risk, the reported activity trend in each setting was differentiated into trajectories based on latent class growth analyses. The associations of different trajectories of SARS-CoV-2 infection overall and by Omicron wave (wave 1: February-April; wave 2: May-September; wave 3: October-December) in 2022 were evaluated by using Cox proportional hazards models and Kaplan-Meier analysis. Results: In total, 33,501 monthly responses in the observation period of February-December 2022 were collected from 5321 individuals, with 41.7% (2221/5321) being male and a median age of 46 (IQR 34-57) years. Against an expanding COVID-19 vaccination coverage from 81.9% to 95.9% for 2 doses and 20% to 77.7% for 3 doses, the cumulative incidence of SARS-CoV-2 infection escalated from <0.2% to 25.3%, 32.4%, and 43.8% by the end of waves 1, 2, and 3, respectively. Throughout February-December 2022, 52.2% (647/1240) of participants had worked regularly on-site, 28.7% (356/1240) worked remotely, and 19.1% (237/1240) showed an assorted pattern. For daily and social settings, 4 and 5 trajectories were identified, respectively, with 11.5% (142/1240) and 14.6% (181/1240) of the participants gauged to have a high exposure risk. Compared to remote working, working regularly on-site (adjusted hazard ratio [aHR] 1.47, 95% CI 1.19-1.80) and living in a larger household (aHR 1.12, 95% CI 1.06-1.18) were associated with a higher risk of SARS-CoV-2 infection in wave 1. Those from the highest daily exposure risk trajectory (aHR 1.46, 95% CI 1.07-2.00) and the second highest social exposure risk trajectory (aHR 1.52, 95% CI 1.18-1.97) were also at an increased risk of infection in waves 2 and 3, respectively, relative to the lowest risk trajectory. Conclusions: In an infection-naive population, SARS-CoV-2 transmission was predominantly initiated at the workplace, accelerated in the household, and perpetuated in the daily and social environments, as stringent restrictions were scaled down. These patterns highlight the phasic shift of exposure settings, which is important for informing the effective calibration of targeted social distancing measures as an alternative to lockdown. %M 38896447 %R 10.2196/51498 %U https://publichealth.jmir.org/2024/1/e51498 %U https://doi.org/10.2196/51498 %U http://www.ncbi.nlm.nih.gov/pubmed/38896447 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e42050 %T Malaria Vector Bionomics: Countrywide Surveillance Study on Implications for Malaria Elimination in India %A Rahi,Manju %A Mishra,AK %A Chand,Gyan %A Baharia,RK %A Hazara,RK %A Singh,SP %A Khan,Siraj %A Sreehari,U %A Kamaraju,Divya %A Kumar,Gaurav %A Gupta,Sanjeev Kumar %A Sharma,Amit %A Raghavendra,K %A Gunasekaran,K %A Singh,Om P %A Subbarao,Sarala K %+ Indian Council of Medical Research, V. Ramalingaswami Bhawan, PO Box Number 4911, Ansari Nagar, Delhi, 110029, India, 91 9999002837, drmanjurahi@gmail.com %K malaria %K bionomics %K sibling species %K insecticide resistance %K elimination %K India %D 2024 %7 17.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The biological characteristics of mosquito vectors vary, impacting their response to control measures. Thus, having up-to-date information on vector bionomics is essential to maintain the effectiveness of existing control strategies and tools, particularly as India aims for malaria elimination by 2030. Objective: This study aims to assess the proportions of vector species resting indoors and outdoors, determine their preference for host biting/feeding, identify transmission sites, and evaluate the susceptibility of vectors to insecticides used in public health programs. Methods: Mosquito collections were conducted in 13 districts across 8 Indian states from 2017 to 2020 using various methods to estimate their densities. Following morphological identification in the field, sibling species of Anopheles mosquitoes were identified molecularly using polymerase chain reaction (PCR)–specific alleles. Plasmodium falciparum and Plasmodium vivax infections in the vectors were detected using enzyme-linked immunosorbent assay (ELISA) and PCR assays. In addition, we assessed the insecticide susceptibility status of primary malaria vectors following the World Health Organization (WHO) protocol. Results: Anopheles culicifacies, a primary malaria vector, was collected (with a man-hour density ranging from 3.1 to 15.9) from all states of India except those in the northeastern region. Anopheles fluviatilis, another primary vector, was collected from the states of Madhya Pradesh, Maharashtra, Karnataka, and Odisha. In Haryana and Karnataka, An. culicifacies sibling species A predominated, whereas species C and E were predominant in Madhya Pradesh and Maharashtra. An. culicifacies displayed mainly endophilic behavior across all states, except in Madhya Pradesh, where the proportion of semigravid and gravid mosquitoes was nearly half of that of unfed mosquitoes. The human blood index of An. culicifacies ranged from 0.001 to 0.220 across all study sites. The sporozoite rate of An. culicifacies ranged from 0.06 to 4.24, except in Madhya Pradesh, where none of the vector mosquitoes were found to be infected with the Plasmodium parasite. In the study area, An. culicifacies exhibited resistance to DDT (dichlorodiphenyltrichloroethane; with <39% mortality). Moreover, it showed resistance to malathion (with mortality rates ranging from 49% to 78%) in all districts except Angul in Odisha and Palwal in Haryana. In addition, resistance to deltamethrin was observed in districts of Maharashtra, Gujarat, Haryana, and Karnataka. Conclusions: Our study offers vital insights into the prevalence, resting behavior, and sibling species composition of malaria vectors in India. It is evident from our findings that resistance development in An. culicifacies, the primary vector, to synthetic pyrethroids is on the rise in the country. Furthermore, the results of our study suggest a potential change in the resting behavior of An. culicifacies in Madhya Pradesh, although further studies are required to confirm this shift definitively. These findings are essential for the development of effective vector control strategies in India, aligning with the goal of malaria elimination by 2030. %M 38885497 %R 10.2196/42050 %U https://publichealth.jmir.org/2024/1/e42050 %U https://doi.org/10.2196/42050 %U http://www.ncbi.nlm.nih.gov/pubmed/38885497 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56064 %T A Prediction Model for Identifying Seasonal Influenza Vaccination Uptake Among Children in Wuxi, China: Prospective Observational Study %A Wang,Qiang %A Yang,Liuqing %A Xiu,Shixin %A Shen,Yuan %A Jin,Hui %A Lin,Leesa %+ Department of Infectious Disease Epidemiology, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 617 632 6142, Leesa.Lin@lshtm.ac.uk %K influenza %K vaccination %K children %K prediction model %K China %K vaccine %K behaviors %K health care professional %K intervention %K sociodemographics %K vaccine hesitancy %K clinic %K Bayesian network %K logistic regression %K accuracy %K Cohen κ %K prediction %K public health %K immunization %K digital age %D 2024 %7 17.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Predicting vaccination behaviors accurately could provide insights for health care professionals to develop targeted interventions. Objective: The aim of this study was to develop predictive models for influenza vaccination behavior among children in China. Methods: We obtained data from a prospective observational study in Wuxi, eastern China. The predicted outcome was individual-level vaccine uptake and covariates included sociodemographics of the child and parent, parental vaccine hesitancy, perceptions of convenience to the clinic, satisfaction with clinic services, and willingness to vaccinate. Bayesian networks, logistic regression, least absolute shrinkage and selection operator (LASSO) regression, support vector machine (SVM), naive Bayes (NB), random forest (RF), and decision tree classifiers were used to construct prediction models. Various performance metrics, including area under the receiver operating characteristic curve (AUC), were used to evaluate the predictive performance of the different models. Receiver operating characteristic curves and calibration plots were used to assess model performance. Results: A total of 2383 participants were included in the study; 83.2% of these children (n=1982) were <5 years old and 6.6% (n=158) had previously received an influenza vaccine. More than half (1356/2383, 56.9%) the parents indicated a willingness to vaccinate their child against influenza. Among the 2383 children, 26.3% (n=627) received influenza vaccination during the 2020-2021 season. Within the training set, the RF model showed the best performance across all metrics. In the validation set, the logistic regression model and NB model had the highest AUC values; the SVM model had the highest precision; the NB model had the highest recall; and the logistic regression model had the highest accuracy, F1 score, and Cohen κ value. The LASSO and logistic regression models were well-calibrated. Conclusions: The developed prediction model can be used to quantify the uptake of seasonal influenza vaccination for children in China. The stepwise logistic regression model may be better suited for prediction purposes. %M 38885032 %R 10.2196/56064 %U https://publichealth.jmir.org/2024/1/e56064 %U https://doi.org/10.2196/56064 %U http://www.ncbi.nlm.nih.gov/pubmed/38885032 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51292 %T How College Students Used Information From Institutions of Higher Education in the United States During COVID-19: Web-Based Cross-Sectional Survey Study %A Peprah,Emmanuel %A Amesimeku,Etornam %A Angulo,Brian %A Chhetri,Himani %A Fordjuoh,Judy %A Ruan,Christina %A Wang,Cong %A Patena,John %A Vieira,Dorice %A Ryan,Nessa %A Iloegbu,Chukwuemeka %A Gyamfi,Joyce %A Odumegwu,Jonathan %+ Implementing Evidence-Based Interventions Through Engagement (ISEE) Lab, Department of Global and Environmental Health, New York University School of Global Public Health, 708 Broadway, New York, NY, 10012, United States, 1 212 992 6095, ep91@nyu.edu %K COVID-19 %K pandemic %K public health %K preventative %K prevention %K social distancing %K masks %K personal protective equipment %K cross-sectional %K surveys %K higher learning %K higher education %K university students %K information source %K web-based information %K health information %K dissemination %K awareness %K information spread %K young adults %K social media %K university %K postsecondary %K students %K young adult %K college %K concern %K worry %K anxiety %K perceptions %D 2024 %7 17.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The start of the COVID-19 pandemic resulted in the implementation of nonpharmaceutical interventions by US institutions of higher education at an unprecedented level. During the backdrop of an emerging pandemic, younger adults (eg, college students) had an overall lower risk for severe outcomes for SARS-CoV-2, making this population a potential source of transmission for age groups with high susceptibility and negative health outcomes. We examine how college students’ level of concern for COVID-19 was influenced by different sources of information, their living status, income level, and other demographic identifiers and its association with prevention behavior change. Objective: We sought to examine the level of concern, defined as the extent to which the participant would take corrective action to mitigate contracting or spreading the virus (to family or friends) by using personal protective equipment such as a face mask, practicing social distancing, and following other public health recommendations, among college students during the COVID-19 pandemic. Methods: A cross-sectional, web-based survey was conducted in 2021 among 185 college students aged 18-41 years, with most living in New York City and the United States (n=134, 72.4%). Out of 185 college students, 94 provided their zip codes, with 51 of those college students indicating they lived in New York City areas. The participants completed the survey via a QR code. Study participants who did not complete the full survey or were not college students in any US college or university were excluded. Analyses were conducted using R (version 4.2.2; R Foundation for Statistical Computing). Results: Of 185 respondents participated in the study, 25 (13.5.%) used emails from their schools, 51 (27.6%) used mainstream media, and 109 (58.9%) used social media and other sources to obtain information about COVID-19. Of the 109 participants who learned about the pandemic from social media, 91 (83.5%) were concerned; however, only 63% (32/51) and 60% (15/25) of the participants who sourced information from mainstream media and their schools’ email, respectively, were concerned. Further, the participants who received information from social media and other sources were about 3 times more likely to be concerned about COVID-19 than participants who received information from the university via email (P=.036; OR=3.07, 95% CI: 1.06-8.83).. Conclusions: College students who received information from social media and other sources were more likely to be concerned about COVID-19 than students who received information from their school via emails. %M 38885019 %R 10.2196/51292 %U https://formative.jmir.org/2024/1/e51292 %U https://doi.org/10.2196/51292 %U http://www.ncbi.nlm.nih.gov/pubmed/38885019 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e57209 %T Pulmonary Tuberculosis Notification Rate Within Shenzhen, China, 2010-2019: Spatial-Temporal Analysis %A Lai,Peixuan %A Cai,Weicong %A Qu,Lin %A Hong,Chuangyue %A Lin,Kaihao %A Tan,Weiguo %A Zhao,Zhiguang %+ Shenzhen Center for Chronic Disease Control, No. 2021 Buxin Road, Shenzhen, 518020, China, 86 0755 2561 8781, 1498384005@qq.com %K tuberculosis %K spatial analysis %K spatial-temporal cluster %K Shenzhen %K China %D 2024 %7 14.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Pulmonary tuberculosis (PTB) is a chronic communicable disease of major public health and social concern. Although spatial-temporal analysis has been widely used to describe distribution characteristics and transmission patterns, few studies have revealed the changes in the small-scale clustering of PTB at the street level. Objective: The aim of this study was to analyze the temporal and spatial distribution characteristics and clusters of PTB at the street level in the Shenzhen municipality of China to provide a reference for PTB prevention and control. Methods: Data of reported PTB cases in Shenzhen from January 2010 to December 2019 were extracted from the China Information System for Disease Control and Prevention to describe the epidemiological characteristics. Time-series, spatial-autocorrelation, and spatial-temporal scanning analyses were performed to identify the spatial and temporal patterns and high-risk areas at the street level. Results: A total of 58,122 PTB cases from 2010 to 2019 were notified in Shenzhen. The annual notification rate of PTB decreased significantly from 64.97 per 100,000 population in 2010 to 43.43 per 100,000 population in 2019. PTB cases exhibited seasonal variations with peaks in late spring and summer each year. The PTB notification rate was nonrandomly distributed and spatially clustered with a Moran I value of 0.134 (P=.02). One most-likely cluster and 10 secondary clusters were detected, and the most-likely clustering area was centered at Nanshan Street of Nanshan District covering 6 streets, with the clustering time spanning from January 2010 to November 2012. Conclusions: This study identified seasonal patterns and spatial-temporal clusters of PTB cases at the street level in the Shenzhen municipality of China. Resources should be prioritized to the identified high-risk areas for PTB prevention and control. %M 38875687 %R 10.2196/57209 %U https://publichealth.jmir.org/2024/1/e57209 %U https://doi.org/10.2196/57209 %U http://www.ncbi.nlm.nih.gov/pubmed/38875687 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53574 %T Understanding COVID-19 Impacts on the Health Workforce: AI-Assisted Open-Source Media Content Analysis %A Pienkowska,Anita %A Ravaut,Mathieu %A Mammadova,Maleyka %A Ang,Chin-Siang %A Wang,Hanyu %A Ong,Qi Chwen %A Bojic,Iva %A Qin,Vicky Mengqi %A Sumsuzzman,Dewan Md %A Ajuebor,Onyema %A Boniol,Mathieu %A Bustamante,Juana Paola %A Campbell,James %A Cometto,Giorgio %A Fitzpatrick,Siobhan %A Kane,Catherine %A Joty,Shafiq %A Car,Josip %+ Lee Kong Chian School of Medicine, Nanyang Technological University, 11 Mandalay Rd, Clinical Sciences Building, Singapore, 308232, Singapore, 65 6513 8572, iva.bojic@ntu.edu.sg %K World Health Organization %K WHO %K public surveillance %K natural language processing %K NLP %K artificial intelligence %K AI %K COVID-19 %K SARS-COV-2 %K COVID-19 pandemic %K human-generated analysis %K decision-making %K strategic policy %K health workforce %K news article %K media content analysis %K news coverage %K health care worker %K mental health %K death risk %K intervention %K efficiency %K public health %K surveillance %K innovation %K innovative method %D 2024 %7 13.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: To investigate the impacts of the COVID-19 pandemic on the health workforce, we aimed to develop a framework that synergizes natural language processing (NLP) techniques and human-generated analysis to reduce, organize, classify, and analyze a vast volume of publicly available news articles to complement scientific literature and support strategic policy dialogue, advocacy, and decision-making. Objective: This study aimed to explore the possibility of systematically scanning intelligence from media that are usually not captured or best gathered through structured academic channels and inform on the impacts of the COVID-19 pandemic on the health workforce, contributing factors to the pervasiveness of the impacts, and policy responses, as depicted in publicly available news articles. Our focus was to investigate the impacts of the COVID-19 pandemic and, concurrently, assess the feasibility of gathering health workforce insights from open sources rapidly. Methods: We conducted an NLP-assisted media content analysis of open-source news coverage on the COVID-19 pandemic published between January 2020 and June 2022. A data set of 3,299,158 English news articles on the COVID-19 pandemic was extracted from the World Health Organization Epidemic Intelligence through Open Sources (EIOS) system. The data preparation phase included developing rules-based classification, fine-tuning an NLP summarization model, and further data processing. Following relevancy evaluation, a deductive-inductive approach was used for the analysis of the summarizations. This included data extraction, inductive coding, and theme grouping. Results: After processing and classifying the initial data set comprising 3,299,158 news articles and reports, a data set of 5131 articles with 3,007,693 words was devised. The NLP summarization model allowed for a reduction in the length of each article resulting in 496,209 words that facilitated agile analysis performed by humans. Media content analysis yielded results in 3 sections: areas of COVID-19 impacts and their pervasiveness, contributing factors to COVID-19–related impacts, and responses to the impacts. The results suggest that insufficient remuneration and compensation packages have been key disruptors for the health workforce during the COVID-19 pandemic, leading to industrial actions and mental health burdens. Shortages of personal protective equipment and occupational risks have increased infection and death risks, particularly at the pandemic’s onset. Workload and staff shortages became a growing disruption as the pandemic progressed. Conclusions: This study demonstrates the capacity of artificial intelligence–assisted media content analysis applied to open-source news articles and reports concerning the health workforce. Adequate remuneration packages and personal protective equipment supplies should be prioritized as preventive measures to reduce the initial impact of future pandemics on the health workforce. Interventions aimed at lessening the emotional toll and workload need to be formulated as a part of reactive measures, enhancing the efficiency and maintainability of health delivery during a pandemic. %M 38869940 %R 10.2196/53574 %U https://formative.jmir.org/2024/1/e53574 %U https://doi.org/10.2196/53574 %U http://www.ncbi.nlm.nih.gov/pubmed/38869940 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53049 %T Care Integration for Hepatitis C Virus Treatment Through Facilitated Telemedicine Within Opioid Treatment Programs: Qualitative Study %A Dickerson,Suzanne S %A George,Saliyah J %A Ventuneac,Ana %A Dharia,Arpan %A Talal,Andrew H %+ Division of Gastroenterology, Hepatology and Nutrition, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, UB-CTRC, Suite 6090, 875 Ellicot Street, Buffalo, NY, 14203, United States, 1 716 829 5354, ahtalal@buffalo.edu %K hepatitis C virus %K integrated treatment %K facilitated telemedicine %K substance users %K people with opioid use disorder %K opioid %K opioids %K telemedicine %K telehealth %K eHealth %K e-health %K ICT %K substance use %K substance abuse %K HCV %K hepatitis %K liver %K interview %K interviews %K qualitative %K hermeneutic %K phenomenological %K implementation %K integration %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K addict %K addiction %K addictions %K addicts %K hepatic %D 2024 %7 12.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine has the potential to remove geographic and temporal obstacles to health care access. Whether and how telemedicine can increase health care access for underserved populations remains an open question. To address this issue, we integrated facilitated telemedicine encounters for the management of hepatitis C virus (HCV), a highly prevalent condition among people with opioid use disorder (OUD), into opioid treatment programs (OTPs). In New York State, OTPs are methadone-dispensing centers that provide patient-centered, evidence-based treatment for OUD. We investigated the integration and impact of facilitated telemedicine into OTP workflows in these settings. Objective: This study aims to understand OTP staff experiences with integrating facilitated telemedicine for HCV treatment into OTPs, including best practices and lessons learned. Methods: We conducted semistructured interviews with 45 OTP staff members (13 clinical, 12 administrative, 6 physicians, and 14 support staff members) at least one year after the implementation of facilitated telemedicine for HCV management. We used hermeneutic phenomenological analysis to understand OTP staff experiences. Results: We identified 4 overarching themes illustrating the successful integration of facilitated telemedicine for HCV care into OTPs. First, integration requires an understanding of the challenges, goals, and values of the OTP. As OTP staff learned about new, highly effective HCV therapies, they valued an HCV cure as a “win” for their patients and were excited about the potential to eliminate a highly prevalent infectious disease. Second, the integration of facilitated telemedicine into OTPs fosters social support and reinforces relationships between patients and OTP staff. OTP staff appreciated the ability to have “eyes on” patients during telemedicine encounters to assess body language, a necessary component of OUD management. Third, participants described high levels of interprofessional collaboration as a care team that included the blurring of lines between disciplines working toward a common goal of improving patient care. Study case managers were integrated into OTP workflows and established communication channels to improve patient outcomes. Fourth, administrators endorsed the sustained and future expansion of facilitated telemedicine to address comorbidities. Conclusions: OTP staff were highly enthusiastic about facilitated telemedicine for an underserved population. They described high levels of collaboration and integration comparable to relevant integrative frameworks. When situated within OTPs, facilitated telemedicine is a high-value application of telemedicine that provides support for underserved populations necessary for high-quality health care. These experiences support sustaining and scaling facilitated telemedicine in comparable settings and evaluating its ability to address other comorbidities. Trial Registration: ClinicalTrials.gov NCT02933970; https://clinicaltrials.gov/study/NCT02933970 %M 38865703 %R 10.2196/53049 %U https://www.jmir.org/2024/1/e53049 %U https://doi.org/10.2196/53049 %U http://www.ncbi.nlm.nih.gov/pubmed/38865703 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53219 %T Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in the Middle East and North Africa: Longitudinal Trend Analysis %A Soetikno,Alan G %A Lundberg,Alexander L %A Ozer,Egon A %A Wu,Scott A %A Welch,Sarah B %A Mason,Maryann %A Liu,Yingxuan %A Havey,Robert J %A Murphy,Robert L %A Hawkins,Claudia %A Moss,Charles B %A Post,Lori Ann %+ Buehler Center for Health Policy and Economics, Robert J. Havey, MD Institute for Global Health, Northwestern University, 420 E. Superior, Chicago, IL, 60611, United States, 1 3125031706, lori.post@northwestern.edu %K SARS-CoV-2 %K COVID-19 %K Middle East %K North Africa %K Bahrain %K Iran %K Iraq %K Israel %K Jordan %K Kuwait %K Lebanon %K Oman %K Qatar %K Saudi Arabia %K Syria %K the United Arab Emirates %K Yemen %K Algeria %K Djibouti %K Egypt %K Libya %K Morocco %K Tunisia %K pandemic history %K COVID-19 transmission %K speed %K acceleration %K deceleration %K jerk %K dynamic panel %K generalized method of moments %K Arellano-Bond %K 7-day lag %D 2024 %7 12.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: This study updates the COVID-19 pandemic surveillance in the Middle East and North Africa (MENA) we first conducted in 2020 with 2 additional years of data for the region. Objective: The objective of this study is to determine whether the MENA region meets the criteria for moving from a pandemic to endemic. In doing so, this study considers pandemic trends, dynamic and genomic surveillance methods, and region-specific historical context for the pandemic. These considerations continue through the World Health Organization (WHO) declaration of the end of the public health emergency for the COVID-19 pandemic on May 5, 2023. Methods: In addition to updates to traditional surveillance data and dynamic panel estimates from the original study by Post et al, this study used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern. We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Finally, we conducted a 1-sided t test to determine whether regional weekly speed of COVID-19 spread was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data from September 4, 2020, to May 12, 2023. Results: The speed of COVID-19 spread for the region had remained below the outbreak threshold for 7 continuous months by the time of the WHO declaration. Acceleration and jerk were also low and stable. Although the 1- and 7-day persistence coefficients remained statistically significant and positive, the weekly shift parameters suggested the coefficients had most recently turned negative, meaning the clustering effect of new COVID-19 cases became even smaller in the 2 weeks around the WHO declaration. From December 2021 onward, Omicron was the predominant variant of concern in sequenced viral samples. The rolling t test of the speed of spread equal to 10 became entirely insignificant from October 2022 onward. Conclusions: The COVID-19 pandemic had far-reaching effects on MENA, impacting health care systems, economies, and social well-being. Although COVID-19 continues to circulate in the MENA region, the rate of transmission remained well below the threshold of an outbreak for over 1 year ahead of the WHO declaration. COVID-19 is endemic in the region and no longer reaches the threshold of the pandemic definition. Both standard and enhanced surveillance metrics confirm that the pandemic had transitioned to endemic by the time of the WHO declaration. %M 38568184 %R 10.2196/53219 %U https://publichealth.jmir.org/2024/1/e53219 %U https://doi.org/10.2196/53219 %U http://www.ncbi.nlm.nih.gov/pubmed/38568184 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e47446 %T 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 %A Hartvigsen,Benedikte %A Jakobsen,Kathrine Kronberg %A Benfield,Thomas %A Gredal,Niels Tobias %A Ersbøll,Annette Kjær %A Grønlund,Mathias Waldemar %A Bundgaard,Henning %A Andersen,Mikkel Porsborg %A Steenhard,Nina %A von Buchwald,Christian %A Todsen,Tobias %+ Department of Otorhinolaryngology, Head and Neck Surgery and Audiology, Rigshospitalet, Copenhagen University Hospital, Inge Lehmanns vej 8, Copenhagen, , Denmark, 45 35456033, benedikte.hartvigsen@regionh.dk %K SARS-CoV-2 %K COVID-19 %K pandemic %K oropharyngeal sampling %K diagnostic accuracy %K PCR %K polymerase chain reaction %K PCR analysis %K swab %K diagnostic %K oropharyngeal %K virology %K testing %K detection %K molecular biology %K microbiology %K laboratory %K palatine tonsil %K COVID-19 detection %K COVID-19 testing %K tonsil %K swabs %K oropharyngeal swabs %K oropharyngeal swab %K nasal swab %K nasal swabs %K molecular detection %K tool %K diagnostic technique %K diagnostic procedure %K clinical laboratory techniques %D 2024 %7 12.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 38865190 %R 10.2196/47446 %U https://www.researchprotocols.org/2024/1/e47446 %U https://doi.org/10.2196/47446 %U http://www.ncbi.nlm.nih.gov/pubmed/38865190 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50653 %T Prospective Spatiotemporal Cluster Detection Using SaTScan: Tutorial for Designing and Fine-Tuning a System to Detect Reportable Communicable Disease Outbreaks %A Levin-Rector,Alison %A Kulldorff,Martin %A Peterson,Eric R %A Hostovich,Scott %A Greene,Sharon K %+ Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, 42-09 28th St, Long Island City, NY, 11101, United States, 1 347 396 2600, alevinrector@health.nyc.gov %K communicable diseases %K disease outbreaks %K disease surveillance %K epidemiology %K infectious disease %K outbreak detection %K public health practice %K SaTScan %K spatiotemporal %K urban health %D 2024 %7 11.6.2024 %9 Tutorial %J JMIR Public Health Surveill %G English %X Staff at public health departments have few training materials to learn how to design and fine-tune systems to quickly detect acute, localized, community-acquired outbreaks of infectious diseases. Since 2014, the Bureau of Communicable Disease at the New York City Department of Health and Mental Hygiene has analyzed reportable communicable diseases daily using SaTScan. SaTScan is a free software that analyzes data using scan statistics, which can detect increasing disease activity without a priori specification of temporal period, geographic location, or size. The Bureau of Communicable Disease’s systems have quickly detected outbreaks of salmonellosis, legionellosis, shigellosis, and COVID-19. This tutorial details system design considerations, including geographic and temporal data aggregation, study period length, inclusion criteria, whether to account for population size, network location file setup to account for natural boundaries, probability model (eg, space-time permutation), day-of-week effects, minimum and maximum spatial and temporal cluster sizes, secondary cluster reporting criteria, signaling criteria, and distinguishing new clusters versus ongoing clusters with additional events. We illustrate how to support health equity by minimizing analytic exclusions of patients with reportable diseases (eg, persons experiencing homelessness who are unsheltered) and accounting for purely spatial patterns, such as adjusting nonparametrically for areas with lower access to care and testing for reportable diseases. We describe how to fine-tune the system when the detected clusters are too large to be of interest or when signals of clusters are delayed, missed, too numerous, or false. We demonstrate low-code techniques for automating analyses and interpreting results through built-in features on the user interface (eg, patient line lists, temporal graphs, and dynamic maps), which became newly available with the July 2022 release of SaTScan version 10.1. This tutorial is the first comprehensive resource for health department staff to design and maintain a reportable communicable disease outbreak detection system using SaTScan to catalyze field investigations as well as develop intuition for interpreting results and fine-tuning the system. While our practical experience is limited to monitoring certain reportable diseases in a dense, urban area, we believe that most recommendations are generalizable to other jurisdictions in the United States and internationally. Additional analytic technical support for detecting outbreaks would benefit state, tribal, local, and territorial public health departments and the populations they serve. %M 38861711 %R 10.2196/50653 %U https://publichealth.jmir.org/2024/1/e50653 %U https://doi.org/10.2196/50653 %U http://www.ncbi.nlm.nih.gov/pubmed/38861711 %0 Journal Article %@ 2563-6316 %I %V 5 %N %P e43341 %T Health Care System Overstretch and In-Hospital Mortality of Intubated Patients With COVID-19 in Greece From September 2020 to April 2022: Updated Retrospective Cohort Study %A Lytras,Theodore %K COVID-19 %K pandemic %K health care disparities %K intensive care unit %K right to health %K quality of care %K intubation %K mortality %K health disparity %K health inequality %K surveillance data %K inpatient %K mortality %K COVID-19 patient %K hospitalization %K ICU %K disparity %K inequality %K surveillance %K health care system %K Greece %K region %K Delta %K Omicron %K vaccination %K vaccine %K public health %K patient load %K deterioration %K time %D 2024 %7 10.6.2024 %9 %J JMIRx Med %G English %X Background: Our previous analysis showed how in-hospital mortality of intubated patients with COVID-19 in Greece is adversely affected by patient load and regional disparities. Objective: We aimed to update this analysis to include the large Delta and Omicron waves that affected Greece during 2021-2022, while also considering the effect of vaccination on in-hospital mortality. Methods: Anonymized surveillance data were analyzed from all patients with COVID-19 in Greece intubated between September 1, 2020, and April 4, 2022, and followed up until May 17, 2022. Time-split Poisson regression was used to estimate the hazard of dying as a function of fixed and time-varying covariates: the daily total count of intubated patients with COVID-19 in Greece, age, sex, COVID-19 vaccination status, region of the hospital (Attica, Thessaloniki, or rest of Greece), being in an intensive care unit, and an indicator for the period from September 1, 2021. Results: A total of 14,011 intubated patients with COVID-19 were analyzed, of whom 10,466 (74.7%) died. Mortality was significantly higher with a load of 400-499 intubated patients, with an adjusted hazard ratio (HR) of 1.22 (95% CI 1.09-1.38), rising progressively up to 1.48 (95% CI 1.31-1.69) for a load of ≥800 patients. Hospitalization away from the Attica region was also independently associated with increased mortality (Thessaloniki: HR 1.22, 95% CI 1.13-1.32; rest of Greece: HR 1.64, 95% CI 1.54-1.75), as was hospitalization after September 1, 2021 (HR 1.21, 95% CI 1.09-1.36). COVID-19 vaccination did not affect the mortality of these already severely ill patients, the majority of whom (11,944/14,011, 85.2%) were unvaccinated. Conclusions: Our results confirm that in-hospital mortality of severely ill patients with COVID-19 is adversely affected by high patient load and regional disparities, and point to a further significant deterioration after September 1, 2021, especially away from Attica and Thessaloniki. This highlights the need for urgent strengthening of health care services in Greece, ensuring equitable and high-quality care for all. %R 10.2196/43341 %U https://xmed.jmir.org/2024/1/e43341 %U https://doi.org/10.2196/43341 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50049 %T Creation of Standardized Common Data Elements for Diagnostic Tests in Infectious Disease Studies: Semantic and Syntactic Mapping %A Stellmach,Caroline %A Hopff,Sina Marie %A Jaenisch,Thomas %A Nunes de Miranda,Susana Marina %A Rinaldi,Eugenia %A , %+ Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Anna-Louisa-Karsch-Str 2, Berlin, 10178, Germany, 49 15752614677, caroline.stellmach@charite.de %K core data element %K CDE %K case report form %K CRF %K interoperability %K semantic standards %K infectious disease %K diagnostic test %K covid19 %K COVID-19 %K mpox %K ZIKV %K patient data %K data model %K syntactic interoperability %K clinical data %K FHIR %K SNOMED CT %K LOINC %K virus infection %K common element %D 2024 %7 10.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: It is necessary to harmonize and standardize data variables used in case report forms (CRFs) of clinical studies to facilitate the merging and sharing of the collected patient data across several clinical studies. This is particularly true for clinical studies that focus on infectious diseases. Public health may be highly dependent on the findings of such studies. Hence, there is an elevated urgency to generate meaningful, reliable insights, ideally based on a high sample number and quality data. The implementation of core data elements and the incorporation of interoperability standards can facilitate the creation of harmonized clinical data sets. Objective: This study’s objective was to compare, harmonize, and standardize variables focused on diagnostic tests used as part of CRFs in 6 international clinical studies of infectious diseases in order to, ultimately, then make available the panstudy common data elements (CDEs) for ongoing and future studies to foster interoperability and comparability of collected data across trials. Methods: We reviewed and compared the metadata that comprised the CRFs used for data collection in and across all 6 infectious disease studies under consideration in order to identify CDEs. We examined the availability of international semantic standard codes within the Systemized Nomenclature of Medicine - Clinical Terms, the National Cancer Institute Thesaurus, and the Logical Observation Identifiers Names and Codes system for the unambiguous representation of diagnostic testing information that makes up the CDEs. We then proposed 2 data models that incorporate semantic and syntactic standards for the identified CDEs. Results: Of 216 variables that were considered in the scope of the analysis, we identified 11 CDEs to describe diagnostic tests (in particular, serology and sequencing) for infectious diseases: viral lineage/clade; test date, type, performer, and manufacturer; target gene; quantitative and qualitative results; and specimen identifier, type, and collection date. Conclusions: The identification of CDEs for infectious diseases is the first step in facilitating the exchange and possible merging of a subset of data across clinical studies (and with that, large research projects) for possible shared analysis to increase the power of findings. The path to harmonization and standardization of clinical study data in the interest of interoperability can be paved in 2 ways. First, a map to standard terminologies ensures that each data element’s (variable’s) definition is unambiguous and that it has a single, unique interpretation across studies. Second, the exchange of these data is assisted by “wrapping” them in a standard exchange format, such as Fast Health care Interoperability Resources or the Clinical Data Interchange Standards Consortium’s Clinical Data Acquisition Standards Harmonization Model. %M 38857066 %R 10.2196/50049 %U https://www.jmir.org/2024/1/e50049 %U https://doi.org/10.2196/50049 %U http://www.ncbi.nlm.nih.gov/pubmed/38857066 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48464 %T Effect of a Structured Multilevel Telehealth Service on Hospital Admissions and Mortality During COVID-19 in a Resource-Limited Region in Brazil: Retrospective Cohort Study %A Oliveira,Clara Rodrigues Alves %A Pires,Magda Carvalho %A Meira,Karina Cardoso %A de Jesus,Jordana Cristina %A Borges,Isabela Nascimento %A Paixão,Maria Cristina %A Mendes,Mayara Santos %A Ribeiro,Leonardo Bonisson %A Marcolino,Milena Soriano %A Alkmim,Maria Beatriz Moreira %A Ribeiro,Antonio Luiz Pinho %+ Department of Internal Medicine, Medical School, Universidade Federal de Minas Gerais, 110 Avenida Professor Alfredo Balena, Room 107, Ala Sul Santa Efigênia, Belo Horizonte, 30130-100, Brazil, 55 3134099669, claralves@gmail.com %K COVID-19 %K telehealth %K health care %K clinical outcomes %K hospital admission %K mortality %K adoption %K effectiveness %K digital health tool %K flu %K teleconsultation %K digital health %K digital literacy %K telemonitoring %D 2024 %7 10.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic represented a great stimulus for the adoption of telehealth and many initiatives in this field have emerged worldwide. However, despite this massive growth, data addressing the effectiveness of telehealth with respect to clinical outcomes remain scarce.  Objective: The aim of this study was to evaluate the impact of the adoption of a structured multilevel telehealth service on hospital admissions during the acute illness course and the mortality of adult patients with flu syndrome in the context of the COVID-19 pandemic. Methods: A retrospective cohort study was performed in two Brazilian cities where a public COVID-19 telehealth service (TeleCOVID-MG) was deployed. TeleCOVID-MG was a structured multilevel telehealth service, including (1) first response and risk stratification through a chatbot software or phone call center, (2) teleconsultations with nurses and medical doctors, and (3) a telemonitoring system. For this analysis, we included data of adult patients registered in the Flu Syndrome notification databases who were diagnosed with flu syndrome between June 1, 2020, and May 31, 2021. The exposed group comprised patients with flu syndrome who used TeleCOVID-MG at least once during the illness course and the control group comprised patients who did not use this telehealth service during the respiratory illness course. Sociodemographic characteristics, comorbidities, and clinical outcomes data were extracted from the Brazilian official databases for flu syndrome, Severe Acute Respiratory Syndrome (due to any respiratory virus), and mortality. Models for the clinical outcomes were estimated by logistic regression. Results: The final study population comprised 82,182 adult patients with a valid registry in the Flu Syndrome notification system. When compared to patients who did not use the service (n=67,689, 82.4%), patients supported by TeleCOVID-MG (n=14,493, 17.6%) had a lower chance of hospitalization during the acute respiratory illness course, even after adjusting for sociodemographic characteristics and underlying medical conditions (odds ratio [OR] 0.82, 95% CI 0.71-0.94; P=.005). No difference in mortality was observed between groups (OR 0.99, 95% CI 0.86-1.12; P=.83). Conclusions: A telehealth service applied on a large scale in a limited-resource region to tackle COVID-19 was related to reduced hospitalizations without increasing the mortality rate. Quality health care using inexpensive and readily available telehealth and digital health tools may be delivered in areas with limited resources and should be considered as a potential and valuable health care strategy. The success of a telehealth initiative relies on a partnership between the involved stakeholders to define the roles and responsibilities; set an alignment between the different modalities and levels of health care; and address the usual drawbacks related to the implementation process, such as infrastructure and accessibility issues. %M 38857068 %R 10.2196/48464 %U https://www.jmir.org/2024/1/e48464 %U https://doi.org/10.2196/48464 %U http://www.ncbi.nlm.nih.gov/pubmed/38857068 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48043 %T A Metric of Societal Burden Based on Virus Succession to Determine Economic Losses and Health Benefits of China’s Lockdown Policies: Model Development and Validation %A Chen,Wenxiu %A Zhang,Bin %A Wang,Chen %A An,Wei %A Guruge,Shashika Kumudumali %A Chui,Ho-kwong %A Yang,Min %+ National Engineering Reaserch Center of Industrial Wastewater Detoxification and Resource Recovery, Research Center for Eco-Environmental Sciences, Chinese Academy of Sciences, 18 Shuangqing Road, Beijing, 100085, China, 86 18001155476, anwei@rcees.ac.cn %K SARS-CoV-2 %K lockdown %K virus succession %K benefit %K loss %K fatality rate %K pandemic %K blanket lockdown %K partial lockdown %D 2024 %7 7.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic had a profound impact on the global health system and economic structure. Although the implementation of lockdown measures achieved notable success in curbing the spread of the pandemic, it concurrently incurred substantial socioeconomic costs. Objective: The objective of this study was to delineate an equilibrium between the economic losses and health benefits of lockdown measures, with the aim of identifying the optimal boundary conditions for implementing these measures at various pandemic phases. Methods: This study used a model to estimate the half-lives of the observed case fatality rates of different strains. It was based on global infection and death data collected by the World Health Organization and strain sequence time series data provided by Nextstrain. The connection between the health benefits and economic losses brought by lockdown measures was established through the calculation of disability-adjusted life years. Taking China’s city lockdowns as an example, this study determined the cost-benefit boundary of various lockdown measures during the evolution of COVID-19. Results: The study reveals a direct proportionality between economic losses due to lockdowns and the observed case fatality rates of virus strains, a relationship that holds true irrespective of population size or per capita economic output. As SARS-CoV-2 strains evolve and population immunity shifts, there has been a notable decrease in the observed case fatality rate over time, exhibiting a half-life of roughly 8 months. This decline in fatality rates may offset the health benefits of maintaining unchanged lockdown measures, given that the resultant economic losses might exceed the health benefits. Conclusions: The initial enforcement of lockdown in Wuhan led to significant health benefits. However, with the decline in the observed case fatality rate of the virus strains, the economic losses increasingly outweighed the health benefits. Consequently, it is essential to consistently refine and enhance lockdown strategies in accordance with the evolving fatality and infection rates of different virus strains, thereby optimizing outcomes in anticipation of future pandemics. %M 38848555 %R 10.2196/48043 %U https://publichealth.jmir.org/2024/1/e48043 %U https://doi.org/10.2196/48043 %U http://www.ncbi.nlm.nih.gov/pubmed/38848555 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e48076 %T Association Between Discrimination and Depressive Symptoms Among Hispanic or Latino Adults During the COVID-19 Pandemic: Cross-Sectional Study %A Ormiston,Cameron K %A Villalobos,Kevin %A Montiel Ishino,Francisco Alejandro %A Williams,Faustine %+ National Institute on Minority Health and Health Disparities, National Institutes of Health, 11545 Rockville Pike, Rockville, MD, 20852, United States, 1 301 827 2727, cameron.ormiston@icahn.mssm.edu %K depressive symptoms %K everyday discrimination %K COVID-19 pandemic %K Hispanic and Latino %K immigrant health %D 2024 %7 6.6.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Discrimination and xenophobia toward Hispanic and Latino communities increased during the COVID-19 pandemic, likely inflicting significant harm on the mental health of Hispanic and Latino individuals. Pandemic-related financial and social instability has disproportionately affected Hispanic and Latino communities, potentially compounding existing disparities and worsening mental health. Objective: This study aims to examine the association between discrimination and depressive symptoms during the COVID-19 pandemic among a national sample of Hispanic and Latino adults. Methods: Data from a 116-item web-based nationally distributed survey from May 2021 to January 2022 were analyzed. The sample (N=1181) was restricted to Hispanic or Latino (Mexican or Mexican American, Puerto Rican; Cuban or Cuban American, Central or South American, and Dominican or another Hispanic or Latino ethnicity) adults. Depression symptoms were assessed using the 2-item Patient Health Questionnaire. Discrimination was assessed using the 5-item Everyday Discrimination Scale. A multinomial logistic regression with a block entry model was used to assess the relationship between discrimination and the likelihood of depressive symptoms, as well as examine how controls and covariates affected the relationship of interest. Results: Mexican or Mexican American adults comprised the largest proportion of the sample (533/1181, 45.13%), followed by Central or South American (204/1181, 17.3%), Puerto Rican (189/1181, 16%), Dominican or another Hispanic or Latino ethnicity (172/1181, 14.6%), and Cuban or Cuban American (83/1181, 7.03%). Approximately 31.26% (367/1181) of the sample had depressive symptoms. Regarding discrimination, 54.56% (634/1181) reported experiencing some form of discrimination. Compared with those who did not experience discrimination, those who experienced discrimination had almost 230% higher odds of depressive symptoms (adjusted odds ratio [AOR] 3.31, 95% CI 2.42-4.54). Also, we observed that sociodemographic factors such as age and gender were significant. Compared with participants aged 56 years and older, participants aged 18-35 years and those aged 36-55 years had increased odds of having depressive symptoms (AOR 3.83, 95% CI 2.13-6.90 and AOR 3.10, 95% CI 1.74-5.51, respectively). Women had higher odds of having depressive symptoms (AOR 1.67, 95% CI 1.23-2.30) than men. Respondents with an annual income of less than US $25,000 (AOR 2.14, 95% CI 1.34-3.41) and US $25,000 to less than US $35,000 (AOR 1.89, 95% CI 1.17-3.06) had higher odds of depressive symptoms than those with an annual income of US $50,000 to less than US $75,000. Conclusions: Our findings provide significant importance especially when considering the compounding, numerous socioeconomic challenges stemming from the pandemic that disproportionately impact the Hispanic and Latino communities. These challenges include rising xenophobia and tensions against immigrants, inadequate access to mental health resources for Hispanic and Latino individuals, and existing hesitations toward seeking mental health services among this population. Ultimately, these findings can serve as a foundation for promoting health equity. %M 38843512 %R 10.2196/48076 %U https://formative.jmir.org/2024/1/e48076 %U https://doi.org/10.2196/48076 %U http://www.ncbi.nlm.nih.gov/pubmed/38843512 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48491 %T News Coverage of the COVID-19 Pandemic on Social Media and the Public’s Negative Emotions: Computational Study %A Wang,Hanjing %A Li,Yupeng %A Ning,Xuan %+ Department of Interactive Media, Hong Kong Baptist University, Kowloon Tong, Kowloon, Hong Kong, 000000, China (Hong Kong), 852 3411 8263, ivanypli@gmail.com %K web news coverage %K emotions %K social media %K Facebook %K COVID-19 %D 2024 %7 6.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media has become an increasingly popular and critical tool for users to digest diverse information and express their perceptions and attitudes. While most studies endeavor to delineate the emotional responses of social media users, there is limited research exploring the factors associated with the emergence of emotions, particularly negative ones, during news consumption. Objective: We aim to first depict the web coverage by news organizations on social media and then explore the crucial elements of news coverage that trigger the public’s negative emotions. Our findings can act as a reference for responsible parties and news organizations in times of crisis. Methods: We collected 23,705 Facebook posts with 1,019,317 comments from the public pages of representative news organizations in Hong Kong. We used text mining techniques, such as topic models and Bidirectional Encoder Representations from Transformers, to analyze news components and public reactions. Beyond descriptive analysis, we used regression models to shed light on how news coverage on social media is associated with the public’s negative emotional responses. Results: Our results suggest that occurrences of issues regarding pandemic situations, antipandemic measures, and supportive actions are likely to reduce the public’s negative emotions, while comments on the posts mentioning the central government and the Government of Hong Kong reveal more negativeness. Negative and neutral media tones can alleviate the rage and interact with the subjects and issues in the news to affect users’ negative emotions. Post length is found to have a curvilinear relationship with users’ negative emotions. Conclusions: This study sheds light on the impacts of various components of news coverage (issues, subjects, media tone, and length) on social media on the public’s negative emotions (anger, fear, and sadness). Our comprehensive analysis provides a reference framework for efficient crisis communication for similar pandemics at present or in the future. This research, although first extending the analysis between the components of news coverage and negative user emotions to the scenario of social media, echoes previous studies drawn from traditional media and its derivatives, such as web newspapers. Although the era of COVID-19 pandemic gradually brings down the curtain, the commonality of this research and previous studies also contributes to establishing a clearer territory in the field of health crises. %M 38843521 %R 10.2196/48491 %U https://www.jmir.org/2024/1/e48491 %U https://doi.org/10.2196/48491 %U http://www.ncbi.nlm.nih.gov/pubmed/38843521 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e56271 %T Defining and Risk-Stratifying Immunosuppression (the DESTINIES Study): Protocol for an Electronic Delphi Study %A Leston,Meredith %A Ordóñez-Mena,José %A Joy,Mark %A de Lusignan,Simon %A Hobbs,Richard %A McInnes,Iain %A Lee,Lennard %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 7896980320, meredith.leston@phc.ox.ac.uk %K immunosuppressed %K immunocompromised %K COVID %K vaccines %K COVID-19 %K surveillance %K phenotype %K adult %K immunosuppression %K clinical risk %K disease surveillance %K clinical consensus %K eDelphi %K immunosuppressed patient %K immunosuppressed patients %K study design %K Delphi %K methods %K methodology %K statistic %K statistics %K statistical %K consensus %K immune %K immunity %K immunology %K immunological %D 2024 %7 6.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, there are marked inconsistencies in how immunosuppression is characterized and subdivided into clinical risk groups. This is detrimental to the precision and comparability of disease surveillance efforts—which has negative implications for the care of those who are immunosuppressed and their health outcomes. This was particularly apparent during the COVID-19 pandemic; despite collective motivation to protect these patients, conflicting clinical definitions created international rifts in how those who were immunosuppressed were monitored and managed during this period. We propose that international clinical consensus be built around the conditions that lead to immunosuppression and their gradations of severity concerning COVID-19. Such information can then be formalized into a digital phenotype to enhance disease surveillance and provide much-needed intelligence on risk-prioritizing these patients. Objective: We aim to demonstrate how electronic Delphi objectives, methodology, and statistical approaches will help address this lack of consensus internationally and deliver a COVID-19 risk-stratified phenotype for “adult immunosuppression.” Methods: Leveraging existing evidence for heterogeneous COVID-19 outcomes in adults who are immunosuppressed, this work will recruit over 50 world-leading clinical, research, or policy experts in the area of immunology or clinical risk prioritization. After 2 rounds of clinical consensus building and 1 round of concluding debate, these panelists will confirm the medical conditions that should be classed as immunosuppressed and their differential vulnerability to COVID-19. Consensus statements on the time and dose dependencies of these risks will also be presented. This work will be conducted iteratively, with opportunities for panelists to ask clarifying questions between rounds and provide ongoing feedback to improve questionnaire items. Statistical analysis will focus on levels of agreement between responses. Results: This protocol outlines a robust method for improving consensus on the definition and meaningful subdivision of adult immunosuppression concerning COVID-19. Panelist recruitment took place between April and May of 2024; the target set for over 50 panelists was achieved. The study launched at the end of May and data collection is projected to end in July 2024. Conclusions: This protocol, if fully implemented, will deliver a universally acceptable, clinically relevant, and electronic health record–compatible phenotype for adult immunosuppression. As well as having immediate value for COVID-19 resource prioritization, this exercise and its output hold prospective value for clinical decision-making across all diseases that disproportionately affect those who are immunosuppressed. International Registered Report Identifier (IRRID): PRR1-10.2196/56271 %M 38842925 %R 10.2196/56271 %U https://www.researchprotocols.org/2024/1/e56271 %U https://doi.org/10.2196/56271 %U http://www.ncbi.nlm.nih.gov/pubmed/38842925 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 7 %N %P e55471 %T Long-Term Adoption of Televisits in Nursing Homes During the COVID-19 Crisis and Following Up Into the Postpandemic Setting: Mixed Methods Study %A Martin,Tobias %A Veldeman,Sarah %A Großmann,Heidrun %A Fuchs-Frohnhofen,Paul %A Czaplik,Michael %A Follmann,Andreas %+ Department of Anesthesiology, Faculty of Medicine, RWTH Aachen University, Pauwelsstraße 30, Aachen, 52074, Germany, 49 241 80 83137, tmartin@ukaachen.de %K telemedicine %K televisits %K telehealth %K eHealth %K electronic health %K older adult care %K nursing homes %K change management %K implementation science %K technology transfer %K innovation transfer %K long-term adoption %K COVID-19 crisis %K postpandemic %K coronavirus %K digitalization %D 2024 %7 6.6.2024 %9 Original Paper %J JMIR Aging %G English %X Background: There is growing evidence that telemedicine can improve the access to and quality of health care for nursing home residents. However, it is still unclear how to best manage and guide the implementation process to ensure long-term adoption, especially in the context of a decline in telemedicine use after the COVID-19 crisis. Objective: This study aims to identify and address major challenges for the implementation of televisits among residents in a nursing home, their caring nurses, and their treating general practitioners (GPs). It also evaluated the impact of televisits on the nurses’ workload and their nursing practice. Methods: A telemedical system with integrated medical devices was introduced in 2 nursing homes and their cooperating GP offices in rural Germany. The implementation process was closely monitored from the initial decision to introduce telemedicine in November 2019 to its long-term routine use until March 2023. Regular evaluation was based on a mixed methods approach combining rigorous qualitative approaches with quantitative measurements. Results: In the first phase during the COVID-19 pandemic, both nursing homes achieved short-term adoption. In the postpandemic phase, an action-oriented approach made it possible to identify barriers and take control actions for long-term adoption. The implementation of asynchronous visits, strong leadership, and sustained training of the nurses were critical elements in achieving long-term implementation in 1 nursing home. The implementation led to enhanced clinical skills, higher professional recognition, and less psychological distress among the nursing staff. Televisits resulted in a modest increase in time demands for the nursing staff compared to organizing in-person home visits with the GPs. Conclusions: Focusing on health care workflow and change management aspects depending on the individual setting is of utmost importance to achieve successful long-term implementation of telemedicine. %M 38842915 %R 10.2196/55471 %U https://aging.jmir.org/2024/1/e55471 %U https://doi.org/10.2196/55471 %U http://www.ncbi.nlm.nih.gov/pubmed/38842915 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52221 %T Epidemic Characteristics and Meteorological Risk Factors of Hemorrhagic Fever With Renal Syndrome in 151 Cities in China From 2015 to 2021: Retrospective Analysis %A Luo,Yizhe %A Zhang,Longyao %A Xu,Yameng %A Kuai,Qiyuan %A Li,Wenhao %A Wu,Yifan %A Liu,Licheng %A Ren,Jiarong %A Zhang,Lingling %A Shi,Qiufang %A Liu,Xiaobo %A Tan,Weilong %+ Department of Epidemiology, School of Public Health, Nanjing Medical University, Meiyuan Xincun Street, Nanjing, 210002, China, 86 17384408593, njcdc@163.com %K China %K hemorrhagic fever with renal syndrome %K HFRS %K climate change %K meteorological factors %K distributed lag nonlinear model %D 2024 %7 5.6.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Hemorrhagic fever with renal syndrome (HFRS) continues to pose a significant public health threat to the population in China. Previous epidemiological evidence indicates that HFRS is climate sensitive and influenced by meteorological factors. However, past studies either focused on too-narrow geographical regions or investigated time periods that were too early. There is an urgent need for a comprehensive analysis to interpret the epidemiological patterns of meteorological factors affecting the incidence of HFRS across diverse climate zones. Objective: In this study, we aimed to describe the overall epidemic characteristics of HFRS and explore the linkage between monthly HFRS cases and meteorological factors at different climate levels in China. Methods: The reported HFRS cases and meteorological data were collected from 151 cities in China during the period from 2015 to 2021. We conducted a 3-stage analysis, adopting a distributed lag nonlinear model and a generalized additive model to estimate the interactions and marginal effects of meteorological factors on HFRS. Results: This study included a total of 63,180 cases of HFRS; the epidemic trends showed seasonal fluctuations, with patterns varying across different climate zones. Temperature had the greatest impact on the incidence of HFRS, with the maximum hysteresis effects being at 1 month (–19 ºC; relative risk [RR] 1.64, 95% CI 1.24-2.15) in the midtemperate zone, 0 months (28 ºC; RR 3.15, 95% CI 2.13-4.65) in the warm-temperate zone, and 0 months (4 ºC; RR 1.72, 95% CI 1.31-2.25) in the subtropical zone. Interactions were discovered between the average temperature, relative humidity, and precipitation in different temperature zones. Moreover, the influence of precipitation and relative humidity on the incidence of HFRS had different characteristics under different temperature layers. The hysteresis effect of meteorological factors did not end after an epidemic season, but gradually weakened in the following 1 or 2 seasons. Conclusions: Weather variability, especially low temperature, plays an important role in epidemics of HFRS in China. A long hysteresis effect indicates the necessity of continuous intervention following an HFRS epidemic. This finding can help public health departments guide the prevention and control of HFRS and develop strategies to cope with the impacts of climate change in specific regions. %M 38837197 %R 10.2196/52221 %U https://publichealth.jmir.org/2024/1/e52221 %U https://doi.org/10.2196/52221 %U http://www.ncbi.nlm.nih.gov/pubmed/38837197 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47070 %T COVID-19 Vaccine Effectiveness and Digital Pandemic Surveillance in Germany (eCOV Study): Web Application–Based Prospective Observational Cohort Study %A Lang,Anna-Lena %A Hohmuth,Nils %A Višković,Vukašin %A Konigorski,Stefan %A Scholz,Stefan %A Balzer,Felix %A Remschmidt,Cornelius %A Leistner,Rasmus %+ d4l Data4Life gGmbH, c/o Digital Health Cluster (DHC) im Hasso-Plattner-Institut, Rudolf-Breitscheid-Straße 187, Potsdam, 14482, Germany, 49 015756025551, annalena.lang.26@gmail.com %K COVID-19 %K SARS-CoV-2 %K COVID-19 vaccines %K BNT162b2 %K vaccine effectiveness %K participatory disease surveillance %K web application %K digital public health %K vaccination %K Germany %K effectiveness %K data collection %K disease surveillance %K tool %D 2024 %7 4.6.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic posed significant challenges to global health systems. Efficient public health responses required a rapid and secure collection of health data to improve the understanding of SARS-CoV-2 and examine the vaccine effectiveness (VE) and drug safety of the novel COVID-19 vaccines. Objective: This study (COVID-19 study on vaccinated and unvaccinated subjects over 16 years; eCOV study) aims to (1) evaluate the real-world effectiveness of COVID-19 vaccines through a digital participatory surveillance tool and (2) assess the potential of self-reported data for monitoring key parameters of the COVID-19 pandemic in Germany. Methods: Using a digital study web application, we collected self-reported data between May 1, 2021, and August 1, 2022, to assess VE, test positivity rates, COVID-19 incidence rates, and adverse events after COVID-19 vaccination. Our primary outcome measure was the VE of SARS-CoV-2 vaccines against laboratory-confirmed SARS-CoV-2 infection. The secondary outcome measures included VE against hospitalization and across different SARS-CoV-2 variants, adverse events after vaccination, and symptoms during infection. Logistic regression models adjusted for confounders were used to estimate VE 4 to 48 weeks after the primary vaccination series and after third-dose vaccination. Unvaccinated participants were compared with age- and gender-matched participants who had received 2 doses of BNT162b2 (Pfizer-BioNTech) and those who had received 3 doses of BNT162b2 and were not infected before the last vaccination. To assess the potential of self-reported digital data, the data were compared with official data from public health authorities. Results: We enrolled 10,077 participants (aged ≥16 y) who contributed 44,786 tests and 5530 symptoms. In this young, primarily female, and digital-literate cohort, VE against infections of any severity waned from 91.2% (95% CI 70.4%-97.4%) at week 4 to 37.2% (95% CI 23.5%-48.5%) at week 48 after the second dose of BNT162b2. A third dose of BNT162b2 increased VE to 67.6% (95% CI 50.3%-78.8%) after 4 weeks. The low number of reported hospitalizations limited our ability to calculate VE against hospitalization. Adverse events after vaccination were consistent with previously published research. Seven-day incidences and test positivity rates reflected the course of the pandemic in Germany when compared with official numbers from the national infectious disease surveillance system. Conclusions: Our data indicate that COVID-19 vaccinations are safe and effective, and third-dose vaccinations partially restore protection against SARS-CoV-2 infection. The study showcased the successful use of a digital study web application for COVID-19 surveillance and continuous monitoring of VE in Germany, highlighting its potential to accelerate public health decision-making. Addressing biases in digital data collection is vital to ensure the accuracy and reliability of digital solutions as public health tools. %M 38833299 %R 10.2196/47070 %U https://www.jmir.org/2024/1/e47070 %U https://doi.org/10.2196/47070 %U http://www.ncbi.nlm.nih.gov/pubmed/38833299 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e49562 %T Identifying X (Formerly Twitter) Posts Relevant to Dementia and COVID-19: Machine Learning Approach %A Azizi,Mehrnoosh %A Jamali,Ali Akbar %A Spiteri,Raymond J %+ Department of Computer Science, University of Saskatchewan, S425 Thorvaldson Building, 110 Science Place, Saskatoon, SK, S7N5C9, Canada, 1 306 966 2909, spiteri@cs.usask.ca %K machine learning %K dementia %K Alzheimer disease %K COVID-19 %K X (Twitter) %K natural language processing %D 2024 %7 4.6.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 38833288 %R 10.2196/49562 %U https://formative.jmir.org/2024/1/e49562 %U https://doi.org/10.2196/49562 %U http://www.ncbi.nlm.nih.gov/pubmed/38833288 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54853 %T Incidence, Risk, and Clinical Course of New-Onset Diabetes in Long COVID: Protocol for a Systematic Review and Meta-Analysis of Cohort Studies %A Talanki,Ananya Sri %A Bajaj,Neha %A Trehan,Twinkle %A Thirunavukkarasu,Sathish %+ Department of Family and Preventive Medicine, Emory University School of Medicine, 1518 Clifton Rd NE, Atlanta, GA, 30322, United States, 1 4703578308, sathish.thirunavukkarasu@emory.edu %K COVID-19 %K SARS-CoV-2 %K type 1 diabetes %K type 2 diabetes %K new-onset diabetes %K long COVID %K incidence %K cohort studies %K postacute sequela %K systematic review %K meta-analysis %D 2024 %7 4.6.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19, an infectious disease pandemic, affected millions of people globally, resulting in high morbidity and mortality. Causing further concern, significant proportions of COVID-19 survivors endure the lingering health effects of SARS-CoV-2, the pathogen that causes COVID-19. One of the diseases manifesting as a postacute sequela of COVID-19 (also known as “long COVID”) is new-onset diabetes. Objective: The aim of this study is to examine the incidence of new-onset diabetes in patients with long COVID and assess the excess risk compared with individuals who tested negative for COVID-19. The study also aims to estimate the population-attributable fraction for COVID-19 as a risk factor for new-onset diabetes in long COVID and investigate the clinical course of new-onset diabetes cases. Methods: This is a protocol for a systematic review and meta-analysis. PubMed, MEDLINE, Embase, Scopus, and Web of Science databases will be systematically searched to identify articles published between December 2019 and July 2024. A comprehensive search strategy for each database will be developed using a combination of Medical Subject Headings terms, subject headings, and text words to identify eligible studies. Cohort studies and randomized controlled trials (only control arms) involving patients with COVID-19 of any age, with follow-up data on new-onset diabetes in long COVID, will be considered for inclusion. Controls will comprise individuals who tested negative for COVID-19, with or without other respiratory tract infections. Three independent reviewers (AST, NB, and TT) will perform article selection, data extraction, and quality assessment of the studies. A fourth reviewer (ST) will review the identified studies for final inclusion in the analysis. The random-effects DerSimonian-Laird models will be used to estimate the pooled incidence proportion (%), incidence rate of diabetes (per 1000 person-years), and risk ratio (with 95% CIs) for diabetes incidence. Results: A total of 1972 articles were identified through the initial search conducted in August 2023. After excluding duplicates, conducting title and abstract screening, and completing full-text reviews, 41 articles were found to be eligible for inclusion. The search will be updated in July 2024. Currently, data extraction is underway, and the meta-analysis is expected to be completed in August 2024. Publication of the study findings is anticipated by the end of 2024. Conclusions: The study findings should provide valuable insights to inform both clinical practice and public health policies regarding the effective management of new-onset diabetes in patients with long COVID. International Registered Report Identifier (IRRID): DERR1-10.2196/54853 %M 38833277 %R 10.2196/54853 %U https://www.researchprotocols.org/2024/1/e54853 %U https://doi.org/10.2196/54853 %U http://www.ncbi.nlm.nih.gov/pubmed/38833277 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52655 %T Searching COVID-19 Clinical Research Using Graph Queries: Algorithm Development and Validation %A Invernici,Francesco %A Bernasconi,Anna %A Ceri,Stefano %+ Department of Electronics, Information, and Bioengineering, Politecnico di Milano, Via Ponzio 34/5, Milan, 20133, Italy, 39 23993494, anna.bernasconi@polimi.it %K big data corpus %K clinical research %K co-occurrence network %K COVID-19 Open Research Dataset %K CORD-19 %K graph search %K Named Entity Recognition %K Neo4j %K text mining %D 2024 %7 30.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the beginning of the COVID-19 pandemic, >1 million studies have been collected within the COVID-19 Open Research Dataset, a corpus of manuscripts created to accelerate research against the disease. Their related abstracts hold a wealth of information that remains largely unexplored and difficult to search due to its unstructured nature. Keyword-based search is the standard approach, which allows users to retrieve the documents of a corpus that contain (all or some of) the words in a target list. This type of search, however, does not provide visual support to the task and is not suited to expressing complex queries or compensating for missing specifications. Objective: This study aims to consider small graphs of concepts and exploit them for expressing graph searches over existing COVID-19–related literature, leveraging the increasing use of graphs to represent and query scientific knowledge and providing a user-friendly search and exploration experience. Methods: We considered the COVID-19 Open Research Dataset corpus and summarized its content by annotating the publications’ abstracts using terms selected from the Unified Medical Language System and the Ontology of Coronavirus Infectious Disease. Then, we built a co-occurrence network that includes all relevant concepts mentioned in the corpus, establishing connections when their mutual information is relevant. A sophisticated graph query engine was built to allow the identification of the best matches of graph queries on the network. It also supports partial matches and suggests potential query completions using shortest paths. Results: We built a large co-occurrence network, consisting of 128,249 entities and 47,198,965 relationships; the GRAPH-SEARCH interface allows users to explore the network by formulating or adapting graph queries; it produces a bibliography of publications, which are globally ranked; and each publication is further associated with the specific parts of the query that it explains, thereby allowing the user to understand each aspect of the matching. Conclusions: Our approach supports the process of query formulation and evidence search upon a large text corpus; it can be reapplied to any scientific domain where documents corpora and curated ontologies are made available. %M 38814687 %R 10.2196/52655 %U https://www.jmir.org/2024/1/e52655 %U https://doi.org/10.2196/52655 %U http://www.ncbi.nlm.nih.gov/pubmed/38814687 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e44827 %T An Accessible Web-Based Survey to Monitor the Mental Health of People With Mild Intellectual Disability or Low Literacy Skills During the COVID-19 Pandemic: Comparative Data Analysis %A Koks-Leensen,Monique CJ %A Menko,Anouk %A Raaijmakers,Fieke %A Fransen-Kuppens,Gerdine AJ %A Bevelander,Kirsten E %+ Department of Primary and Community Care, Radboud university medical center, Geert Grooteplein 21, Nijmegen, 6525 EZ, Netherlands, 31 243618181, monique.koks-leensen@radboudumc.nl %K monitoring %K mental health %K intellectual disabilities %K low literacy %K COVID-19 %K web-based survey %D 2024 %7 30.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic and related control measures affected the mental health of all populations. Particular subgroups are underrepresented in mainstream surveys because they are hard to reach, and study measurements are not adapted to their skills. These subgroups include people with lower cognitive and literacy skills, such as people with mild intellectual disability (MID), who were considered vulnerable during the COVID-19 pandemic given their low socioeconomic status, small social networks, increased risks of health problems, and difficulties understanding health-related information. Objective: This study examines the impact of the COVID-19 pandemic on mental health among people with MID or low literacy skills compared with those predominantly represented in national surveys. Methods: A repeated cross-sectional study of people with MID or low literacy skills and a general population sample was conducted in the Netherlands. An easy-read web-based survey was co-designed with, and tested among, people with MID or low literacy skills and conducted in 3 rounds within 1 year of the COVID-19 pandemic (T1: November to December 2020, T2: March to April 2021, and T3: September to October 2021). The survey contained questions about demographics and 6 aspects of mental health: feeling happy, feeling energized, feeling stressed, worry, feeling lonely, and sleeping problems. Results: Our adapted survey and recruitment procedure enabled 1059 persons with MID or low literacy skills to participate (T1: n=412, 38.9%; T2: n=351, 33.1%; and T3: n=296, 28%). They were significantly younger, had a lower level of education, and more often than not were born outside the Netherlands compared to the general population sample (P<.001). Approximately half of them (604/1059, 57.03%) received professional care. They displayed poorer mental health scores than the general population sample. The percentages of people with MID or low literacy skills who reported more negative feelings in T1 ranged from 20.6% (85/412) reporting feeling lonely often or almost always to 57.8% (238/412) reporting feeling happy almost never or sometimes. The general population sample’s percentages were 5.4% (160/2930) and 32.2% (941/2918), respectively. Although scores improved over time in both populations, the disproportional effects remained. Conclusions: General COVID-19–related restrictions for the entire Dutch population affected people with MID or low literacy skills more negatively than the general population. Our study underscores the relevance of including these subpopulations in public health research because they are often overlooked in regular health data. An accessible web-based survey particularly targeted at this population enabled us to do so, and we reached a group of respondents significantly different from regular survey participants. This survey’s results provided insights into the health of people with MID or low literacy skills and gained knowledge to be used by care organizations and policy makers to reduce health disparities during a pandemic and in general. %M 38607229 %R 10.2196/44827 %U https://publichealth.jmir.org/2024/1/e44827 %U https://doi.org/10.2196/44827 %U http://www.ncbi.nlm.nih.gov/pubmed/38607229 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53056 %T Health Care Professionals’ Experiences With Using Information and Communication Technologies in Patient Care During the COVID-19 Pandemic: Qualitative Study %A Cermak,Carly A %A Read,Heather %A Jeffs,Lianne %+ Science of Care Institute, Sinai Health, 1 Bridgepoint Drive, Toronto, ON, M4M 2B5, Canada, 1 4165864800, carly.cermak@mail.utoronto.ca %K COVID-19 %K information and communication technology %K health care provider experiences %K web-based care %K interview %D 2024 %7 28.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic acted as a catalyst for the use of information and communication technology (ICT) in inpatient and outpatient health care settings. Digital tools were used to connect patients, families, and providers amid visitor restrictions, while web-based platforms were used to continue care amid COVID-19 lockdowns. What we have yet to learn is the experiences of health care providers (HCPs) regarding the use of ICT that supported changes to clinical care during the COVID-19 pandemic. Objective: The aim of this paper was to describe the experiences of HCPs in using ICT to support clinical care changes during the COVID-19 pandemic. This paper is reporting on a subset of a larger body of data that examined changes to models of care during the pandemic. Methods: This study used a qualitative, descriptive study design. In total, 30 HCPs were recruited from 3 hospitals in Canada. One-on-one semistructured interviews were conducted between December 2022 and June 2023. Qualitative data were analyzed using an inductive thematic approach to identify themes across participants. Results: A total of 30 interviews with HCPs revealed 3 themes related to their experiences using ICT to support changes to clinical care during the COVID-19 pandemic. These included the use of ICT (1) to support in-person communication with patients, (2) to facilitate connection between provider to patient and patient to family, and (3) to provide continuity of care. Conclusions: HCP narratives revealed the benefits of digital tools to support in-person communication between patient and provider, the need for thoughtful consideration for the use of ICT at end-of-life care, and the decision-making that is needed when choosing service delivery modality (eg, web based or in person). Moving forward, organizations are encouraged to provide education and training on how to support patient-provider communication, find ways to meet patient and family wishes at end-of-life care, and continue to give autonomy to HCPs in their clinical decision-making regarding service delivery modality. %M 38805250 %R 10.2196/53056 %U https://formative.jmir.org/2024/1/e53056 %U https://doi.org/10.2196/53056 %U http://www.ncbi.nlm.nih.gov/pubmed/38805250 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51191 %T Modeling the Regional Distribution of International Travelers in Spain to Estimate Imported Cases of Dengue and Malaria: Statistical Inference and Validation Study %A García-García,David %A Fernández-Martínez,Beatriz %A Bartumeus,Frederic %A Gómez-Barroso,Diana %+ Department of Communicable Diseases, National Centre of Epidemiology, Instituto de Salud Carlos III, Monforte de Lemos 5, Madrid, 28029, Spain, 34 91 822 26 46, dawex14@gmail.com %K epidemiology %K imported infections %K modeling %K surveillance system %K vector-borne diseases %D 2024 %7 27.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Understanding the patterns of disease importation through international travel is paramount for effective public health interventions and global disease surveillance. While global airline network data have been used to assist in outbreak prevention and effective preparedness, accurately estimating how these imported cases disseminate locally in receiving countries remains a challenge. Objective: This study aimed to describe and understand the regional distribution of imported cases of dengue and malaria upon arrival in Spain via air travel. Methods: We have proposed a method to describe the regional distribution of imported cases of dengue and malaria based on the computation of the “travelers’ index” from readily available socioeconomic data. We combined indicators representing the main drivers for international travel, including tourism, economy, and visits to friends and relatives, to measure the relative appeal of each region in the importing country for travelers. We validated the resulting estimates by comparing them with the reported cases of malaria and dengue in Spain from 2015 to 2019. We also assessed which motivation provided more accurate estimates for imported cases of both diseases. Results: The estimates provided by the best fitted model showed high correlation with notified cases of malaria (0.94) and dengue (0.87), with economic motivation being the most relevant for imported cases of malaria and visits to friends and relatives being the most relevant for imported cases of dengue. Conclusions: Factual descriptions of the local movement of international travelers may substantially enhance the design of cost-effective prevention policies and control strategies, and essentially contribute to decision-support systems. Our approach contributes in this direction by providing a reliable estimate of the number of imported cases of nonendemic diseases, which could be generalized to other applications. Realistic risk assessments will be obtained by combining this regional predictor with the observed local distribution of vectors. %M 38801767 %R 10.2196/51191 %U https://publichealth.jmir.org/2024/1/e51191 %U https://doi.org/10.2196/51191 %U http://www.ncbi.nlm.nih.gov/pubmed/38801767 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e56218 %T Lessons Learned From a Sequential Mixed-Mode Survey Design to Recruit and Collect Data From Case-Control Study Participants: Formative Evaluation %A Tran,Amanda D %A White,Alice E %A Torok,Michelle R %A Jervis,Rachel H %A Albanese,Bernadette A %A Scallan Walter,Elaine J %+ Department of Epidemiology, Colorado School of Public Health, University of Colorado, 13001 East 17th Place, 3rd Floor, Mail Stop B119, Aurora, CO, 80045, United States, 1 303 724 5162, elaine.scallanwalter@cuanschutz.edu %K case-control studies %K mixed-mode design %K epidemiologic study methods %K web-based survey %K telephone interview %K public health %K outbreak preparedness %K COVID-19 %K survey %K recruitment %K epidemiology %K methods %D 2024 %7 27.5.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Sequential mixed-mode surveys using both web-based surveys and telephone interviews are increasingly being used in observational studies and have been shown to have many benefits; however, the application of this survey design has not been evaluated in the context of epidemiological case-control studies. Objective: In this paper, we discuss the challenges, benefits, and limitations of using a sequential mixed-mode survey design for a case-control study assessing risk factors during the COVID-19 pandemic. Methods: Colorado adults testing positive for SARS-CoV-2 were randomly selected and matched to those with a negative SARS-CoV-2 test result from March to April 2021. Participants were first contacted by SMS text message to complete a self-administered web-based survey asking about community exposures and behaviors. Those who did not respond were contacted for a telephone interview. We evaluated the representativeness of survey participants to sample populations and compared sociodemographic characteristics, participant responses, and time and resource requirements by survey mode using descriptive statistics and logistic regression models. Results: Of enrolled case and control participants, most were interviewed by telephone (308/537, 57.4% and 342/648, 52.8%, respectively), with overall enrollment more than doubling after interviewers called nonresponders. Participants identifying as female or White non-Hispanic, residing in urban areas, and not working outside the home were more likely to complete the web-based survey. Telephone participants were more likely than web-based participants to be aged 18-39 years or 60 years and older and reside in areas with lower levels of education, more linguistic isolation, lower income, and more people of color. While there were statistically significant sociodemographic differences noted between web-based and telephone case and control participants and their respective sample pools, participants were more similar to sample pools when web-based and telephone responses were combined. Web-based participants were less likely to report close contact with an individual with COVID-19 (odds ratio [OR] 0.70, 95% CI 0.53-0.94) but more likely to report community exposures, including visiting a grocery store or retail shop (OR 1.55, 95% CI 1.13-2.12), restaurant or cafe or coffee shop (OR 1.52, 95% CI 1.20-1.92), attending a gathering (OR 1.69, 95% CI 1.34-2.15), or sport or sporting event (OR 1.05, 95% CI 1.05-1.88). The web-based survey required an average of 0.03 (SD 0) person-hours per enrolled participant and US $920 in resources, whereas the telephone interview required an average of 5.11 person-hours per enrolled participant and US $70,000 in interviewer wages. Conclusions: While we still encountered control recruitment challenges noted in other observational studies, the sequential mixed-mode design was an efficient method for recruiting a more representative group of participants for a case-control study with limited impact on data quality and should be considered during public health emergencies when timely and accurate exposure information is needed to inform control measures. %M 38801768 %R 10.2196/56218 %U https://formative.jmir.org/2024/1/e56218 %U https://doi.org/10.2196/56218 %U http://www.ncbi.nlm.nih.gov/pubmed/38801768 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47154 %T Short- and Long-Term Predicted and Witnessed Consequences of Digital Surveillance During the COVID-19 Pandemic: Scoping Review %A Comer,Leigha %A Donelle,Lorie %A Hiebert,Bradley %A Smith,Maxwell J %A Kothari,Anita %A Stranges,Saverio %A Gilliland,Jason %A Long,Jed %A Burkell,Jacquelyn %A Shelley,Jacob J %A Hall,Jodi %A Shelley,James %A Cooke,Tommy %A Ngole Dione,Marionette %A Facca,Danica %+ School of Nursing, University of South Carolina, 1601 Greene Street, Room 617, Columbia, SC, 29208-4001, United States, 1 803 777 6528, LDONELLE@mailbox.sc.edu %K digital surveillance %K COVID-19 %K public health %K scoping review %K pandemic %K digital technologies %D 2024 %7 24.5.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has prompted the deployment of digital technologies for public health surveillance globally. The rapid development and use of these technologies have curtailed opportunities to fully consider their potential impacts (eg, for human rights, civil liberties, privacy, and marginalization of vulnerable groups). Objective: We conducted a scoping review of peer-reviewed and gray literature to identify the types and applications of digital technologies used for surveillance during the COVID-19 pandemic and the predicted and witnessed consequences of digital surveillance. Methods: Our methodology was informed by the 5-stage methodological framework to guide scoping reviews: identifying the research question; identifying relevant studies; study selection; charting the data; and collating, summarizing, and reporting the findings. We conducted a search of peer-reviewed and gray literature published between December 1, 2019, and December 31, 2020. We focused on the first year of the pandemic to provide a snapshot of the questions, concerns, findings, and discussions emerging from peer-reviewed and gray literature during this pivotal first year of the pandemic. Our review followed the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) reporting guidelines. Results: We reviewed a total of 147 peer-reviewed and 79 gray literature publications. Based on our analysis of these publications, we identified a total of 90 countries and regions where digital technologies were used for public health surveillance during the COVID-19 pandemic. Some of the most frequently used technologies included mobile phone apps, location-tracking technologies, drones, temperature-scanning technologies, and wearable devices. We also found that the literature raised concerns regarding the implications of digital surveillance in relation to data security and privacy, function creep and mission creep, private sector involvement in surveillance, human rights, civil liberties, and impacts on marginalized groups. Finally, we identified recommendations for ethical digital technology design and use, including proportionality, transparency, purpose limitation, protecting privacy and security, and accountability. Conclusions: A wide range of digital technologies was used worldwide to support public health surveillance during the COVID-19 pandemic. The findings of our analysis highlight the importance of considering short- and long-term consequences of digital surveillance not only during the COVID-19 pandemic but also for future public health crises. These findings also demonstrate the ways in which digital surveillance has rendered visible the shifting and blurred boundaries between public health surveillance and other forms of surveillance, particularly given the ubiquitous nature of digital surveillance. International Registered Report Identifier (IRRID): RR2-https://doi.org/10.1136/bmjopen-2021-053962 %M 38788212 %R 10.2196/47154 %U https://publichealth.jmir.org/2024/1/e47154 %U https://doi.org/10.2196/47154 %U http://www.ncbi.nlm.nih.gov/pubmed/38788212 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e39297 %T A Profile of Influenza Vaccine Coverage for 2019-2020: Database Study of the English Primary Care Sentinel Cohort %A Hoang,Uy %A Delanerolle,Gayathri %A Fan,Xuejuan %A Aspden,Carole %A Byford,Rachel %A Ashraf,Mansoor %A Haag,Mendel %A Elson,William %A Leston,Meredith %A Anand,Sneha %A Ferreira,Filipa %A Joy,Mark %A Hobbs,Richard %A de Lusignan,Simon %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, 7 Walton Well Road, Oxford, OX2 6ED, United Kingdom, 44 01865 289 344, simon.delusignan@phc.ox.ac.uk %K medical records systems %K computerize %K influenza %K influenza vaccines %K sentinel surveillance %K vocabulary controlled %K general practitioners %K general practice %K primary health care %K vaccine %K public health %K surveillance %K uptake %D 2024 %7 24.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 38787605 %R 10.2196/39297 %U https://publichealth.jmir.org/2024/1/e39297 %U https://doi.org/10.2196/39297 %U http://www.ncbi.nlm.nih.gov/pubmed/38787605 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e56054 %T Out-of-Hospital Cardiac Arrest Before and During the COVID-19 Pandemic in Hong Kong: Registry-Based Study From 2017 to 2023 %A Xu,Richard Huan %A Sun,Ruiqi %A Fu,Siu-Ngor %+ Department of Rehabilitation Sciences, Faculty of Health and Social Sciences, Hong Kong Polytechnic University, Hung Hom, Kowloon, China (Hong Kong), 852 27664199, richard.xu@polyu.edu.hk %K out-of-hospital cardiac arrest %K OHCA %K COVID-19 %K pandemic %K survival %K Chinese %K Asian %D 2024 %7 21.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has exerted a significant toll on individual health and the efficacy of health care systems. However, the influence of COVID-19 on the frequency and outcomes of out-of-hospital cardiac arrest (OHCA) within the Chinese population, both before and throughout the entire pandemic period, remains to be clarified. Objective: This study aimed to fill the gaps by investigating the prevalence and outcomes of OHCA in Hong Kong (HK) both before and during the whole pandemic period. Methods: This is a retrospective regional registry study. The researchers matched OHCA data with COVID-19–confirmed case records between December 2017 and May 2023. The data included information on response times, location of OHCA, witness presence, initial rhythm, bystander cardiopulmonary resuscitation (CPR), use of public-access defibrillation, resuscitation in the accident and emergency department, and survival to admission. Descriptive analyses were conducted, and statistical tests such as analysis of variance and χ2 were used to examine differences between variables. The incidence of OHCA and survival rates were calculated, and logistic regression analysis was performed to assess associations. The prevalence of OHCA and COVID-19 during the peak of the pandemic was also described. Results: A total of 43,882 cases of OHCA were reported in HK and included in our analysis. Around 13,946 cases were recorded during the prepandemic period (2017-2019), and the remaining 29,936 cases were reported during the pandemic period (2020-2023). During the pandemic period, the proportion of female patients increased to 44.1% (13,215/29,936), and the average age increased slightly to 76.5 (SD 18.5) years. The majority of OHCAs (n=18,143, 61.1% cases) occurred at home. A witness was present in 45.9% (n=10,723) of the cases, and bystander CPR was initiated in 44.6% (n=13,318) of the cases. There was a significant increase in OHCA incidence, with a corresponding decrease in survival rates compared to the prepandemic period. The location of OHCA shifted, with a decrease in incidents in public places and a potential increase in incidents at home. We found that CPR (odds ratio 1.48, 95% CI 1.17-1.86) and public-access defibrillation (odds ratio 1.16, 95% CI 1.05-1.28) were significantly associated with a high survival to admission rate during the pandemic period. There was a correlation between the development of OHCA and the prevalence of COVID-19 in HK. Conclusions: The COVID-19 pandemic has had a significant impact on OHCA in HK, resulting in increased incidence and decreased survival rates. The findings highlight the importance of addressing the indirect effects of the pandemic, such as increased stress levels and strain on health care systems, on OHCA outcomes. Strategies should be developed to improve OHCA prevention, emergency response systems, and health care services during public health emergencies to mitigate the impact on population health. %M 38771620 %R 10.2196/56054 %U https://publichealth.jmir.org/2024/1/e56054 %U https://doi.org/10.2196/56054 %U http://www.ncbi.nlm.nih.gov/pubmed/38771620 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53968 %T User Dynamics and Thematic Exploration in r/Depression During the COVID-19 Pandemic: Insights From Overlapping r/SuicideWatch Users %A Zhu,Jianfeng %A Jin,Ruoming %A Kenne,Deric R %A Phan,NhatHai %A Ku,Wei-Shinn %+ Department of Computer Science, Kent State University, 800 E. Summit St., Kent, OH, 44242, United States, 1 3306729980, jzhu10@kent.edu %K reddit %K natural language processing %K NLP %K suicidal ideation %K SI %K online communities %K depression symptoms %K COVID-19 pandemic %K bidirectional encoder representations from transformers %K BERT %K r/SuicideWatch %K r/Depression %D 2024 %7 20.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: In 2023, the United States experienced its highest- recorded number of suicides, exceeding 50,000 deaths. In the realm of psychiatric disorders, major depressive disorder stands out as the most common issue, affecting 15% to 17% of the population and carrying a notable suicide risk of approximately 15%. However, not everyone with depression has suicidal thoughts. While “suicidal depression” is not a clinical diagnosis, it may be observed in daily life, emphasizing the need for awareness. Objective: This study aims to examine the dynamics, emotional tones, and topics discussed in posts within the r/Depression subreddit, with a specific focus on users who had also engaged in the r/SuicideWatch community. The objective was to use natural language processing techniques and models to better understand the complexities of depression among users with potential suicide ideation, with the goal of improving intervention and prevention strategies for suicide. Methods: Archived posts were extracted from the r/Depression and r/SuicideWatch Reddit communities in English spanning from 2019 to 2022, resulting in a final data set of over 150,000 posts contributed by approximately 25,000 unique overlapping users. A broad and comprehensive mix of methods was conducted on these posts, including trend and survival analysis, to explore the dynamic of users in the 2 subreddits. The BERT family of models extracted features from data for sentiment and thematic analysis. Results: On August 16, 2020, the post count in r/SuicideWatch surpassed that of r/Depression. The transition from r/Depression to r/SuicideWatch in 2020 was the shortest, lasting only 26 days. Sadness emerged as the most prevalent emotion among overlapping users in the r/Depression community. In addition, physical activity changes, negative self-view, and suicidal thoughts were identified as the most common depression symptoms, all showing strong positive correlations with the emotion tone of disappointment. Furthermore, the topic “struggles with depression and motivation in school and work” (12%) emerged as the most discussed topic aside from suicidal thoughts, categorizing users based on their inclination toward suicide ideation. Conclusions: Our study underscores the effectiveness of using natural language processing techniques to explore language markers and patterns associated with mental health challenges in online communities like r/Depression and r/SuicideWatch. These insights offer novel perspectives distinct from previous research. In the future, there will be potential for further refinement and optimization of machine classifications using these techniques, which could lead to more effective intervention and prevention strategies. %M 38767953 %R 10.2196/53968 %U https://www.jmir.org/2024/1/e53968 %U https://doi.org/10.2196/53968 %U http://www.ncbi.nlm.nih.gov/pubmed/38767953 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e44398 %T Updated Surveillance Metrics and History of the COVID-19 Pandemic (2020-2023) in Latin America and the Caribbean: Longitudinal Trend Analysis %A Post,Lori Ann %A Wu,Scott A %A Soetikno,Alan G %A Ozer,Egon A %A Liu,Yingxuan %A Welch,Sarah B %A Hawkins,Claudia %A Moss,Charles B %A Murphy,Robert L %A Mason,Maryann %A Havey,Robert J %A Lundberg,Alexander L %+ Buehler Center for Health Policy and Economics, Robert J Havey, MD Institute for Global Health, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States, 1 312 503 1706, lori.post@northwestern.edu %K SARS-CoV-2 %K COVID-19 %K Latin America %K Caribbean %K pandemic %K surveillance %K COVID-19 transmission %K speed %K acceleration %K deceleration %K jerk %K dynamic panel %K generalized method of moments %K GMM %K Arellano-Bond %K 7-day lag %K epidemiological %K pandemic %K genomic %K transmission %D 2024 %7 17.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In May 2020, the World Health Organization (WHO) declared Latin America and the Caribbean (LAC) the epicenter of the COVID-19 pandemic, with over 40% of worldwide COVID-19–related deaths at the time. This high disease burden was a result of the unique circumstances in LAC. Objective: This study aimed to (1) measure whether the pandemic was expanding or contracting in LAC when the WHO declared the end of COVID-19 as a public health emergency of international concern on May 5, 2023; (2) use dynamic and genomic surveillance methods to describe the history of the pandemic in the region and situate the window of the WHO declaration within the broader history; and (3) provide, with a focus on prevention policies, a historical context for the course of the pandemic in the region. Methods: In addition to updates of traditional surveillance data and dynamic panel estimates from the original study, we used data on sequenced SARS-CoV-2 variants from the Global Initiative on Sharing All Influenza Data (GISAID) to identify the appearance and duration of variants of concern (VOCs). We used Nextclade nomenclature to collect clade designations from sequences and Pangolin nomenclature for lineage designations of SARS-CoV-2. Additionally, we conducted a 1-sided t test for whether the regional weekly speed (rate of novel COVID-19 transmission) was greater than an outbreak threshold of 10. We ran the test iteratively with 6 months of data across the period from August 2020 to May 2023. Results: The speed of pandemic spread for the region had remained below the outbreak threshold for 6 months by the time of the WHO declaration. Acceleration and jerk were also low and stable. Although the 1- and 7-day persistence coefficients remained statistically significant for the 120-day period ending on the week of May 5, 2023, the coefficients were relatively modest in magnitude (0.457 and 0.491, respectively). Furthermore, the shift parameters for either of the 2 most recent weeks around May 5, 2023, did not indicate any change in this clustering effect of cases on future cases. From December 2021 onward, Omicron was the predominant VOC in sequenced viral samples. The rolling t test of speed=10 became entirely insignificant from January 2023 onward. Conclusions: Although COVID-19 continues to circulate in LAC, surveillance data suggest COVID-19 is endemic in the region and no longer reaches the threshold of the pandemic definition. However, the region experienced a high COVID-19 burden in the early stages of the pandemic, and prevention policies should be an immediate focus in future pandemics. Ahead of vaccination development, these policies can include widespread testing of individuals and an epidemiological task force with a contact-tracing system. %M 38568194 %R 10.2196/44398 %U https://publichealth.jmir.org/2024/1/e44398 %U https://doi.org/10.2196/44398 %U http://www.ncbi.nlm.nih.gov/pubmed/38568194 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e55623 %T Implementation of Inpatient Electronic Consultations During the COVID-19 Crisis and Its Sustainability Beyond the Pandemic: Quality Improvement Study %A Aledia,Anna S %A Dangodara,Amish A %A Amin,Aanya A %A Amin,Alpesh N %+ Department of Medicine & Hospital Medicine, University of California, Irvine, 333 City Boulevard West, Suite 500, Orange, CA, 92868, United States, 1 714 456 3785, anamin@uci.edu %K COVID-19 %K electronic consultation %K eConsult %K e-consult %K inpatient %K consultations %K pandemic %K infectious %K novel coronavirus %K coronavirus %K patients %K patient %K staff %K health care %K health care providers %K tool %K tools %K effectiveness %D 2024 %7 16.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Limiting in-person contact was a key strategy for controlling the spread of the highly infectious novel coronavirus (COVID-19). To protect patients and staff from the risk of infection while providing continued access to necessary health care services, we implemented a new electronic consultation (e-consult) service that allowed referring providers to receive subspecialty consultations for patients who are hospitalized and do not require in-person evaluation by the specialist. Objective: We aimed to assess the impact of implementing e-consults in the inpatient setting to reduce avoidable face-to-face referrals during the COVID-19 pandemic. Methods: This quality improvement study evaluated all inpatient e-consults ordered from July 2020 to December 2022 at the University of California Irvine Medical Center. The impact of e-consults was assessed by evaluating use (eg, number of e-consults ordered), e-consult response times, and outcome of the e-consult requests (eg, resolved electronically or converted to the in-person evaluation of patient). Results: There were 1543 inpatient e-consults ordered across 11 participating specialties. A total of 53.5% (n=826) of requests were addressed electronically, without the need for a formal in-person evaluation of the patient. The median time between ordering an e-consult and a specialist documenting recommendations in an e-consult note was 3.7 (IQR 1.3-8.2) hours across all specialties, contrasted with 7.3 (IQR 3.6-22.0) hours when converted to an in-person consult (P<.001). The monthly volume of e-consult requests increased, coinciding with surges of COVID-19 cases in California. After the peaks of the COVID-19 crisis subsided, the use of inpatient e-consults persisted at a rate well above the precrisis levels. Conclusions: An inpatient e-consult service was successfully implemented, resulting in fewer unnecessary face-to-face consultations and significant reductions in the response times for consults requested on patients who are hospitalized and do not require an in-person evaluation. Thus, e-consults provided timely, efficient delivery of inpatient consultation services for appropriate problems while minimizing the risk of direct transmission of the COVID-19 virus between health care providers and patients. The service also demonstrated its value as a tool for effective inpatient care coordination beyond the peaks of the pandemic leading to the sustainability of service and value. %M 38754103 %R 10.2196/55623 %U https://www.jmir.org/2024/1/e55623 %U https://doi.org/10.2196/55623 %U http://www.ncbi.nlm.nih.gov/pubmed/38754103 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50088 %T Public and Research Interest in Telemedicine From 2017 to 2022: Infodemiology Study of Google Trends Data and Bibliometric Analysis of Scientific Literature %A Maugeri,Andrea %A Barchitta,Martina %A Basile,Guido %A Agodi,Antonella %+ Department of Medical and Surgical Sciences and Advanced Technologies “GF Ingrassia”, University of Catania, Via Santa Sofia 87, Catania, 95123, Italy, 39 0953792183, agodia@unict.it %K telemedicine %K eHealth %K digital medicine %K COVID-19 %K Google Trends %K bibliometric %K Google %K data spanning %K COVID-19 %K accessibility %K cost reduction %K cost %K noncommunicable disease %K eHealth %K mobile health %K awareness %K policy decision %D 2024 %7 16.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine offers a multitude of potential advantages, such as enhanced health care accessibility, cost reduction, and improved patient outcomes. The significance of telemedicine has been underscored by the COVID-19 pandemic, as it plays a crucial role in maintaining uninterrupted care while minimizing the risk of viral exposure. However, the adoption and implementation of telemedicine have been relatively sluggish in certain areas. Assessing the level of interest in telemedicine can provide valuable insights into areas that require enhancement. Objective: The aim of this study is to provide a comprehensive analysis of the level of public and research interest in telemedicine from 2017 to 2022 and also consider any potential impact of the COVID-19 pandemic. Methods: Google Trends data were retrieved using the search topics “telemedicine” or “e-health” to assess public interest, geographic distribution, and trends through a joinpoint regression analysis. Bibliographic data from Scopus were used to chart publications referencing the terms “telemedicine” or “eHealth” (in the title, abstract, and keywords) in terms of scientific production, key countries, and prominent keywords, as well as collaboration and co-occurrence networks. Results: Worldwide, telemedicine generated higher mean public interest (relative search volume=26.3%) compared to eHealth (relative search volume=17.6%). Interest in telemedicine remained stable until January 2020, experienced a sudden surge (monthly percent change=95.7%) peaking in April 2020, followed by a decline (monthly percent change=–22.7%) until August 2020, and then returned to stability. A similar trend was noted in the public interest regarding eHealth. Chile, Australia, Canada, and the United States had the greatest public interest in telemedicine. In these countries, moderate to strong correlations were evident between Google Trends and COVID-19 data (ie, new cases, new deaths, and hospitalized patients). Examining 19,539 original medical articles in the Scopus database unveiled a substantial rise in telemedicine-related publications, showing a total increase of 201.5% from 2017 to 2022 and an average annual growth rate of 24.7%. The most significant surge occurred between 2019 and 2020. Notably, the majority of the publications originated from a single country, with 20.8% involving international coauthorships. As the most productive country, the United States led a cluster that included Canada and Australia as well. European, Asian, and Latin American countries made up the remaining 3 clusters. The co-occurrence network categorized prevalent keywords into 2 clusters, the first cluster primarily focused on applying eHealth, mobile health (mHealth), or digital health to noncommunicable or chronic diseases; the second cluster was centered around the application of telemedicine and telehealth within the context of the COVID-19 pandemic. Conclusions: Our analysis of search and bibliographic data over time and across regions allows us to gauge the interest in this topic, offer evidence regarding potential applications, and pinpoint areas for additional research and awareness-raising initiatives. %M 38753427 %R 10.2196/50088 %U https://www.jmir.org/2024/1/e50088 %U https://doi.org/10.2196/50088 %U http://www.ncbi.nlm.nih.gov/pubmed/38753427 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47626 %T 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 %A Chen,Li %A Wang,Liping %A Xing,Yi %A Xie,Junqing %A Su,Binbin %A Geng,Mengjie %A Ren,Xiang %A Zhang,Yi %A Liu,Jieyu %A Ma,Tao %A Chen,Manman %A Miller,Jessica E %A Dong,Yanhui %A Song,Yi %A Ma,Jun %A Sawyer,Susan %+ Institute of Child and Adolescent Health, School of Public Health, National Health Commission Key Laboratory of Reproductive Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100083, China, 86 15123132408, dongyanhui@bjmu.edu.cn %K children and adolescents %K COVID-19 %K notifiable infectious diseases %D 2024 %7 15.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 38748469 %R 10.2196/47626 %U https://publichealth.jmir.org/2024/1/e47626 %U https://doi.org/10.2196/47626 %U http://www.ncbi.nlm.nih.gov/pubmed/38748469 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48564 %T Difference in Rumor Dissemination and Debunking Before and After the Relaxation of COVID-19 Prevention and Control Measures in China: Infodemiology Study %A Liu,Xiaoqi %A Hu,Qingyuan %A Wang,Jie %A Wu,Xusheng %A Hu,Dehua %+ Department of Biomedical Informatics, School of Life Sciences, Central South University, 172 Tongzipo Road, Changsha, Hunan, 410013, China, 86 13975869106, hudehua@csu.edu.cn %K new stage %K public health emergency %K information epidemic %K propagation characteristic %K debunking mechanism %K China %D 2024 %7 15.5.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The information epidemic emerged along with the COVID-19 pandemic. While controlling the spread of COVID-19, the secondary harm of epidemic rumors to social order cannot be ignored. Objective: The objective of this paper was to understand the characteristics of rumor dissemination before and after the pandemic and the corresponding rumor management and debunking mechanisms. This study aimed to provide a theoretical basis and effective methods for relevant departments to establish a sound mechanism for managing network rumors related to public health emergencies such as COVID-19. Methods: This study collected data sets of epidemic rumors before and after the relaxation of the epidemic prevention and control measures, focusing on large-scale network rumors. Starting from 3 dimensions of rumor content construction, rumor propagation, and rumor-refuting response, the epidemic rumors were subdivided into 7 categories, namely, involved subjects, communication content, emotional expression, communication channels, communication forms, rumor-refuting subjects, and verification sources. Based on this framework, content coding and statistical analysis of epidemic rumors were carried out. Results: The study found that the rumor information was primarily directed at a clear target audience. The main themes of rumor dissemination were related to the public’s immediate interests in the COVID-19 field, with significant differences in emotional expression and mostly negative emotions. Rumors mostly spread through social media interactions, community dissemination, and circle dissemination, with text content as the main form, but they lack factual evidence. The preferences of debunking subjects showed differences, and the frequent occurrence of rumors reflected the unsmooth channels of debunking. The χ2 test of data before and after the pandemic showed that the P value was less than .05, indicating that the difference in rumor content before and after the pandemic had statistical significance. Conclusions: This study’s results showed that the themes of rumors during the pandemic are closely related to the immediate interests of the public, and the emotions of the public accelerate the spread of these rumors, which are mostly disseminated through social networks. Therefore, to more effectively prevent and control the spread of rumors during the pandemic and to enhance the capability to respond to public health crises, relevant authorities should strengthen communication with the public, conduct emotional risk assessments, and establish a joint mechanism for debunking rumors. %M 38748460 %R 10.2196/48564 %U https://www.jmir.org/2024/1/e48564 %U https://doi.org/10.2196/48564 %U http://www.ncbi.nlm.nih.gov/pubmed/38748460 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46029 %T Ambulance Services Attendance for Mental Health and Overdose Before and During COVID-19 in Canada and the United Kingdom: Interrupted Time Series Study %A Law,Graham %A Cooper,Rhiannon %A Pirrie,Melissa %A Ferron,Richard %A McLeod,Brent %A Spaight,Robert %A Siriwardena,A Niroshan %A Agarwal,Gina %A , %+ Department of Family Medicine, McMaster University, 100 Main Street West, Hamilton, ON, , Canada, 1 905 525 9140, gina.agarwal@gmail.com %K COVID-19 %K mental health %K overdose %K emergency medical services %K administrative data %K Canada %K the United Kingdom %K ambulance %K sex %K age %K lockdown %K pandemic planning %K emergency service %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic impacted mental health and health care systems worldwide. Objective: This study examined the COVID-19 pandemic’s impact on ambulance attendances for mental health and overdose, comparing similar regions in the United Kingdom and Canada that implemented different public health measures. Methods: An interrupted time series study of ambulance attendances was conducted for mental health and overdose in the United Kingdom (East Midlands region) and Canada (Hamilton and Niagara regions). Data were obtained from 182,497 ambulance attendance records for the study period of December 29, 2019, to August 1, 2020. Negative binomial regressions modeled the count of attendances per week per 100,000 population in the weeks leading up to the lockdown, the week the lockdown was initiated, and the weeks following the lockdown. Stratified analyses were conducted by sex and age. Results: Ambulance attendances for mental health and overdose had very small week-over-week increases prior to lockdown (United Kingdom: incidence rate ratio [IRR] 1.002, 95% CI 1.002-1.003 for mental health). However, substantial changes were observed at the time of lockdown; while there was a statistically significant drop in the rate of overdose attendances in the study regions of both countries (United Kingdom: IRR 0.573, 95% CI 0.518-0.635 and Canada: IRR 0.743, 95% CI 0.602-0.917), the rate of mental health attendances increased in the UK region only (United Kingdom: IRR 1.125, 95% CI 1.031-1.227 and Canada: IRR 0.922, 95% CI 0.794-1.071). Different trends were observed based on sex and age categories within and between study regions. Conclusions: The observed changes in ambulance attendances for mental health and overdose at the time of lockdown differed between the UK and Canada study regions. These results may inform future pandemic planning and further research on the public health measures that may explain observed regional differences. %M 38728683 %R 10.2196/46029 %U https://publichealth.jmir.org/2024/1/e46029 %U https://doi.org/10.2196/46029 %U http://www.ncbi.nlm.nih.gov/pubmed/38728683 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47064 %T Giving a Voice to Patients With Smell Disorders Associated With COVID-19: Cross-Sectional Longitudinal Analysis Using Natural Language Processing of Self-Reports %A Menger,Nick S %A Tognetti,Arnaud %A Farruggia,Michael C %A Mucignat,Carla %A Bhutani,Surabhi %A Cooper,Keiland W %A Rohlfs Domínguez,Paloma %A Heinbockel,Thomas %A Shields,Vonnie D C %A D'Errico,Anna %A Pereda-Loth,Veronica %A Pierron,Denis %A Koyama,Sachiko %A Croijmans,Ilja %+ Department of Molecular Medicine, University of Padova, Via Francesco Marzolo, Padua, 35131, Italy, 39 0498275304, carla.mucignat@unipd.it %K parosmia %K anosmia %K phantosmia %K hyposmia %K hyperosmia %K long-hauler %K sentiment classification %K web-based study %K COVID-19 %K smell disorders %D 2024 %7 10.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Smell disorders are commonly reported with COVID-19 infection. The smell-related issues associated with COVID-19 may be prolonged, even after the respiratory symptoms are resolved. These smell dysfunctions can range from anosmia (complete loss of smell) or hyposmia (reduced sense of smell) to parosmia (smells perceived differently) or phantosmia (smells perceived without an odor source being present). Similar to the difficulty that people experience when talking about their smell experiences, patients find it difficult to express or label the symptoms they experience, thereby complicating diagnosis. The complexity of these symptoms can be an additional burden for patients and health care providers and thus needs further investigation. Objective: This study aims to explore the smell disorder concerns of patients and to provide an overview for each specific smell disorder by using the longitudinal survey conducted in 2020 by the Global Consortium for Chemosensory Research, an international research group that has been created ad hoc for studying chemosensory dysfunctions. We aimed to extend the existing knowledge on smell disorders related to COVID-19 by analyzing a large data set of self-reported descriptive comments by using methods from natural language processing. Methods: We included self-reported data on the description of changes in smell provided by 1560 participants at 2 timepoints (second survey completed between 23 and 291 days). Text data from participants who still had smell disorders at the second timepoint (long-haulers) were compared with the text data of those who did not (non–long-haulers). Specifically, 3 aims were pursued in this study. The first aim was to classify smell disorders based on the participants’ self-reports. The second aim was to classify the sentiment of each self-report by using a machine learning approach, and the third aim was to find particular food and nonfood keywords that were more salient among long-haulers than those among non–long-haulers. Results: We found that parosmia (odds ratio [OR] 1.78, 95% CI 1.35-2.37; P<.001) as well as hyposmia (OR 1.74, 95% CI 1.34-2.26; P<.001) were more frequently reported in long-haulers than in non–long-haulers. Furthermore, a significant relationship was found between long-hauler status and sentiment of self-report (P<.001). Finally, we found specific keywords that were more typical for long-haulers than those for non–long-haulers, for example, fire, gas, wine, and vinegar. Conclusions: Our work shows consistent findings with those of previous studies, which indicate that self-reports, which can easily be extracted online, may offer valuable information to health care and understanding of smell disorders. At the same time, our study on self-reports provides new insights for future studies investigating smell disorders. %M 38728069 %R 10.2196/47064 %U https://publichealth.jmir.org/2024/1/e47064 %U https://doi.org/10.2196/47064 %U http://www.ncbi.nlm.nih.gov/pubmed/38728069 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e40792 %T The Changing Landscape of Respiratory Viruses Contributing to Hospitalizations in Quebec, Canada: Results From an Active Hospital-Based Surveillance Study %A Gilca,Rodica %A Amini,Rachid %A Carazo,Sara %A Doggui,Radhouene %A Frenette,Charles %A Boivin,Guy %A Charest,Hugues %A Dumaresq,Jeannot %+ Direction des risques biologiques, Institut national de santé publique du Québec, 945 Av. Wolfe, Québec, QC, G1V5B3, Canada, 1 4186505115 ext 6278, rodica.gilca@inspq.qc.ca %K respiratory viruses %K SARS-CoV-2 %K COVID-19 %K hospitalizations %K acute respiratory infections %K children %K adults %K coinfections %K prepandemic %K pandemic %D 2024 %7 6.5.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: A comprehensive description of the combined effect of SARS-CoV-2 and respiratory viruses other than SARS-CoV-2 (ORVs) on acute respiratory infection (ARI) hospitalizations is lacking. Objective: This study aimed to compare the viral etiology of ARI hospitalizations before the pandemic (8 prepandemic influenza seasons, 2012-13 to 2019-20) and during 3 pandemic years (periods of increased SARS-CoV-2 and ORV circulation in 2020-21, 2021-22, and 2022-23) from an active hospital-based surveillance network in Quebec, Canada. Methods: We compared the detection of ORVs and SARS-CoV-2 during 3 pandemic years to that in 8 prepandemic influenza seasons among patients hospitalized with ARI who were tested systematically by the same multiplex polymerase chain reaction (PCR) assay during periods of intense respiratory virus (RV) circulation. The proportions of infections between prepandemic and pandemic years were compared by using appropriate statistical tests. Results: During prepandemic influenza seasons, overall RV detection was 92.7% (1384/1493) (respiratory syncytial virus [RSV]: 721/1493, 48.3%; coinfections: 456/1493, 30.5%) in children (<18 years) and 62.8% (2723/4339) (influenza: 1742/4339, 40.1%; coinfections: 264/4339, 6.1%) in adults. Overall RV detection in children was lower during pandemic years but increased from 58.6% (17/29) in 2020-21 (all ORVs; coinfections: 7/29, 24.1%) to 90.3% (308/341) in 2021-22 (ORVs: 278/341, 82%; SARS-CoV-2: 30/341, 8.8%; coinfections: 110/341, 32.3%) and 88.9% (361/406) in 2022-23 (ORVs: 339/406, 84%; SARS-CoV-2: 22/406, 5.4%; coinfections: 128/406, 31.5%). In adults, overall RV detection was also lower during pandemic years but increased from 43.7% (333/762) in 2020-21 (ORVs: 26/762, 3.4%; SARS-CoV-2: 307/762, 40.3%; coinfections: 7/762, 0.9%) to 57.8% (731/1265) in 2021-22 (ORVs: 179/1265, 14.2%; SARS-CoV-2: 552/1265, 43.6%; coinfections: 42/1265, 3.3%) and 50.1% (746/1488) in 2022-23 (ORVs: 409/1488, 27.5%; SARS-CoV-2: 337/1488, 22.6%; coinfections: 36/1488, 2.4%). No influenza or RSV was detected in 2020-21; however, their detection increased in the 2 subsequent years but did not reach prepandemic levels. Compared to the prepandemic period, the peaks of RSV hospitalization shifted in 2021-22 (16 weeks earlier) and 2022-23 (15 weeks earlier). Moreover, the peaks of influenza hospitalization shifted in 2021-22 (17 weeks later) and 2022-23 (4 weeks earlier). Age distribution was different compared to the prepandemic period, especially during the first pandemic year. Conclusions: Significant shifts in viral etiology, seasonality, and age distribution of ARI hospitalizations occurred during the 3 pandemic years. Changes in age distribution observed in our study may reflect modifications in the landscape of circulating RVs and their contribution to ARI hospitalizations. During the pandemic period, SARS-CoV-2 had a low contribution to pediatric ARI hospitalizations, while it was the main contributor to adult ARI hospitalizations during the first 2 seasons and dropped below ORVs during the third pandemic season. Evolving RVs epidemiology underscores the need for increased scrutiny of ARI hospitalization etiology to inform tailored public health recommendations. %M 38709551 %R 10.2196/40792 %U https://publichealth.jmir.org/2024/1/e40792 %U https://doi.org/10.2196/40792 %U http://www.ncbi.nlm.nih.gov/pubmed/38709551 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49841 %T Defining the Subtypes of Long COVID and Risk Factors for Prolonged Disease: Population-Based Case-Crossover Study %A Resendez,Skyler %A Brown,Steven H %A Ruiz Ayala,Hugo Sebastian %A Rangan,Prahalad %A Nebeker,Jonathan %A Montella,Diane %A Elkin,Peter L %+ Department of Biomedical Informatics, University at Buffalo, State University of New York, 77 Goodell Street, Suite 540, Buffalo, NY, 14203, United States, 1 5073581341, elkinp@buffalo.edu %K long COVID %K PASC %K postacute sequelae of COVID-19 %K public health %K policy initiatives %K pandemic %K diagnosis %K COVID-19 treatment %K long COVID cause %K health care support %K public safety %K COVID-19 %K Veterans Affairs %K United States %K COVID-19 testing %K clinician %K mobile phone %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There have been over 772 million confirmed cases of COVID-19 worldwide. A significant portion of these infections will lead to long COVID (post–COVID-19 condition) and its attendant morbidities and costs. Numerous life-altering complications have already been associated with the development of long COVID, including chronic fatigue, brain fog, and dangerous heart rhythms. Objective: We aim to derive an actionable long COVID case definition consisting of significantly increased signs, symptoms, and diagnoses to support pandemic-related clinical, public health, research, and policy initiatives. Methods: This research employs a case-crossover population-based study using International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) data generated at Veterans Affairs medical centers nationwide between January 1, 2020, and August 18, 2022. In total, 367,148 individuals with ICD-10-CM data both before and after a positive COVID-19 test were selected for analysis. We compared ICD-10-CM codes assigned 1 to 7 months following each patient’s positive test with those assigned up to 6 months prior. Further, 350,315 patients had novel codes assigned during this window of time. We defined signs, symptoms, and diagnoses as being associated with long COVID if they had a novel case frequency of ≥1:1000, and they significantly increased in our entire cohort after a positive test. We present odds ratios with CIs for long COVID signs, symptoms, and diagnoses, organized by ICD-10-CM functional groups and medical specialty. We used our definition to assess long COVID risk based on a patient’s demographics, Elixhauser score, vaccination status, and COVID-19 disease severity. Results: We developed a long COVID definition consisting of 323 ICD-10-CM diagnosis codes grouped into 143 ICD-10-CM functional groups that were significantly increased in our 367,148 patient post–COVID-19 population. We defined 17 medical-specialty long COVID subtypes such as cardiology long COVID. Patients who were COVID-19–positive developed signs, symptoms, or diagnoses included in our long COVID definition at a proportion of at least 59.7% (268,320/449,450, based on a denominator of all patients who were COVID-19–positive). The long COVID cohort was 8 years older with more comorbidities (2-year Elixhauser score 7.97 in the patients with long COVID vs 4.21 in the patients with non–long COVID). Patients who had a more severe bout of COVID-19, as judged by their minimum oxygen saturation level, were also more likely to develop long COVID. Conclusions: An actionable, data-driven definition of long COVID can help clinicians screen for and diagnose long COVID, allowing identified patients to be admitted into appropriate monitoring and treatment programs. This long COVID definition can also support public health, research, and policy initiatives. Patients with COVID-19 who are older or have low oxygen saturation levels during their bout of COVID-19, or those who have multiple comorbidities should be preferentially watched for the development of long COVID. %M 38687984 %R 10.2196/49841 %U https://publichealth.jmir.org/2024/1/e49841 %U https://doi.org/10.2196/49841 %U http://www.ncbi.nlm.nih.gov/pubmed/38687984 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54769 %T COVID-19 Vaccine Hesitancy: Umbrella Review of Systematic Reviews and Meta-Analysis %A Rahbeni,Tahani Al %A Satapathy,Prakasini %A Itumalla,Ramaiah %A Marzo,Roy Rillera %A Mugheed,Khalid A L %A Khatib,Mahalaqua Nazli %A Gaidhane,Shilpa %A Zahiruddin,Quazi Syed %A Rabaan,Ali A %A Alrasheed,Hayam A %A Al-Subaie,Maha F %A Al Kaabil,Nawal A %A Alissa,Mohammed %A Ibrahim,Amani Ahmed A L %A Alsaif,Hussain Abdulkhaliq %A Naser,Israa Habeeb %A Rustagi,Sarvesh %A Kukreti,Neelima %A Dziedzic,Arkadiusz %+ Center for Global Health Research, Saveetha Medical College and Hospital, Saveetha Institute of Medical and Technical Sciences, Saveetha University, 162, Poonamallee High Road, Poonamallee, Chennai, 600077, India, 91 8763766300, prakasini.satapathy@gmail.com %K COVID-19 %K vaccine acceptance %K vaccine hesitancy %K umbrella review %K systematic review %K meta-analysis %K vaccine %K hesitancy %K global perceptions %K perception %K random effect model %K synthesis %K healthcare workers %K patients %K patient %K chronic disease %K pregnant women %K parents %K child %K children %D 2024 %7 30.4.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: The unprecedented emergence of the COVID-19 pandemic necessitated the development and global distribution of vaccines, making the understanding of global vaccine acceptance and hesitancy crucial to overcoming barriers to vaccination and achieving widespread immunization. Objective: This umbrella review synthesizes findings from systematic reviews and meta-analyses to provide insights into global perceptions on COVID-19 vaccine acceptance and hesitancy across diverse populations and regions. Methods: We conducted a literature search across major databases to identify systematic reviews and meta-analysis that reported COVID-19 vaccine acceptance and hesitancy. The AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews) criteria were used to assess the methodological quality of included systematic reviews. Meta-analysis was performed using STATA 17 with a random effect model. The data synthesis is presented in a table format and via a narrative. Results: Our inclusion criteria were met by 78 meta-analyses published between 2021 and 2023. Our analysis revealed a moderate vaccine acceptance rate of 63% (95% CI 0.60%-0.67%) in the general population, with significant heterogeneity (I2 = 97.59%). Higher acceptance rates were observed among health care workers and individuals with chronic diseases, at 64% (95% CI 0.57%-0.71%) and 69% (95% CI 0.61%-0.76%), respectively. However, lower acceptance was noted among pregnant women, at 48% (95% CI 0.42%-0.53%), and parents consenting for their children, at 61.29% (95% CI 0.56%-0.67%). The pooled vaccine hesitancy rate was 32% (95% CI 0.25%-0.39%) in the general population. The quality assessment revealed 19 high-quality, 38 moderate-quality, 15 low-quality, and 6 critically low-quality meta-analyses. Conclusions: This review revealed the presence of vaccine hesitancy globally, emphasizing the necessity for population-specific, culturally sensitive interventions and clear, credible information dissemination to foster vaccine acceptance. The observed disparities accentuate the need for continuous research to understand evolving vaccine perceptions and to address the unique concerns and needs of diverse populations, thereby aiding in the formulation of effective and inclusive vaccination strategies. Trial Registration: PROSPERO CRD42023468363; https://tinyurl.com/2p9kv9cr %M 38687992 %R 10.2196/54769 %U https://publichealth.jmir.org/2024/1/e54769 %U https://doi.org/10.2196/54769 %U http://www.ncbi.nlm.nih.gov/pubmed/38687992 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e46945 %T Expanding Youth-Friendly HIV Self-Testing Services During the COVID-19 Pandemic: Qualitative Analysis of a Crowdsourcing Open Call in Nigeria %A Anikamadu,Onyekachukwu %A Ezechi,Oliver %A Engelhart,Alexis %A Nwaozuru,Ucheoma %A Obiezu-Umeh,Chisom %A Ogunjemite,Ponmile %A Bale,Babatunde Ismail %A Nwachukwu,Daniel %A Gbaja-biamila,Titilola %A Oladele,David %A Musa,Adesola Z %A Mason,Stacey %A Ojo,Temitope %A Tucker,Joseph %A Iwelunmor,Juliet %+ Brown School of Social Work, Washington University in St Louis, 1 Brookings Drive, St Louis, MO, 63130, United States, 1 314 935 6600, a.onyekachukwu@wustl.edu %K crowdsourcing %K World AIDS Day %K HIV %K self-testing %K young people %K COVID-19 pandemic restrictions %K Nigeria %K HIV self-testing %K health promotion %K crowdsourcing open call %K young adult %D 2024 %7 30.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: HIV self-testing (HIVST) among young people is an effective approach to enhance the uptake of HIV testing recommended by the World Health Organization. However, the COVID-19 pandemic disrupted conventional facility-based HIV testing services, necessitating the exploration of innovative strategies for the effective delivery of HIVST. Objective: This study analyzed the outcomes of a digital World AIDS Day crowdsourcing open call, designed to elicit youth responses on innovative approaches to promote HIVST among young people (14-24 years) in Nigeria during COVID-19 restrictions. Methods: From November 2 to 22, 2020, a World AIDS Day 2020 crowdsourcing open call was held digitally due to COVID-19 restrictions. The crowdsourcing open call followed World Health Organization standardized steps, providing a structured framework for participant engagement. Young people in Nigeria, aged 10-24 years, participated by submitting ideas digitally through Google Forms or email in response to this crowdsourcing open call prompt: “How will you promote HIV self-testing among young people during COVID-19 pandemic?” Data and responses from each submission were analyzed, and proposed ideas were closely examined to identify common themes. Four independent reviewers (AE, SM, AZM, and TG) judged each submission based on the desirability, feasibility, and impact on a 9-point scale (3-9, with 3 being the lowest and 9 being the highest). Results: The crowdsourcing open call received 125 eligible entries, 44 from women and 65 from men. The median age of participants was 20 (IQR 24-20) years, with the majority having completed their highest level of education at the senior secondary school level. The majority of participants lived in the South-West region (n=61) and Lagos state (n=36). Of the 125 eligible entries, the top 20 submissions received an average total score of 7.5 (SD 2.73) or above. The panel of judges ultimately selected 3 finalists to receive a monetary award. Three prominent themes were identified from the 125 crowdsourcing open call submissions as specific ways that HIVST can adapt during the COVID-19 pandemic: (1) digital approaches (such as gamification, photoverification system, and digital media) to generate demand for HIVST and avoid risks associated with attending clinics, (2) awareness and sensitization through existing infrastructures (such as churches, schools, and health facilities), and (3) partnerships with influencers, role models, and leaders (such as religious and youth leaders and social influencers in businesses, churches, organizations, and schools) to build trust in HIVST services. Conclusions: The crowdsourcing open call effectively engaged a diverse number of young people who proposed a variety of ways to improve the uptake of HIVST during the COVID-19 pandemic. Findings contribute to the need for innovative HIVST strategies that close critical knowledge and practice gaps on ways to reach young people with HIVST during and beyond the pandemic. Trial Registration: ClinicalTrials.gov NCT04710784; https://clinicaltrials.gov/study/NCT04710784 %M 38687582 %R 10.2196/46945 %U https://formative.jmir.org/2024/1/e46945 %U https://doi.org/10.2196/46945 %U http://www.ncbi.nlm.nih.gov/pubmed/38687582 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53154 %T Acceptance, Satisfaction, and Preference With Telemedicine During the COVID-19 Pandemic in 2021-2022: Survey Among Patients With Chronic Pain %A Harnik,Michael Alexander %A Scheidegger,Alina %A Blättler,Larissa %A Nemecek,Zdenek %A Sauter,Thomas C %A Limacher,Andreas %A Reisig,Florian %A grosse Holtforth,Martin %A Streitberger,Konrad %+ Department of Anaesthesiology and Pain Medicine, Inselspital, Bern University Hospital, University of Bern, Freiburgstrasse 18, Bern, 3010, Switzerland, 41 31 632 39 65, michael.harnik@insel.ch %K acceptance %K satisfaction %K patient preferences %K COVID-19 pandemic %K health care providers %K phone consultations %K pain therapy %K eHealth services %K patient care %K health care delivery %K telemedicine %K chronic pain %K preference %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has forced many health care providers to make changes in their treatment, with telemedicine being expanded on a large scale. An earlier study investigated the acceptance of telephone calls but did not record satisfaction with treatment or patients’ preferences. This warranted a follow-up study to investigate acceptance, satisfaction, and preferences regarding telemedicine, comprising of phone consultations, among health care recipients. Objective: The primary aim was to assess the acceptance and satisfaction of telemedicine during the subsequent months of 2021-2022, after the initial wave of the COVID-19 pandemic in Switzerland. Furthermore, we aimed to assess patients’ preferences and whether these differed in patients who had already experienced telemedicine in the past, as well as correlations between acceptance and satisfaction, pain intensity, general condition, perception of telemedicine, and catastrophizing. Finally, we aimed to investigate whether more governmental restrictions were correlated with higher acceptance. Methods: An anonymous cross-sectional web-based survey was conducted between January 27, 2021, and February 4, 2022, enrolling patients undergoing outpatient pain therapy in a tertiary university clinic. We conducted a descriptive analysis of acceptance and satisfaction with telemedicine and investigated patients’ preferences. Further, we conducted a descriptive and correlational analysis of the COVID-19 stringency index. Spearman correlation analysis and a chi-square test for categorical data were used with Cramer V statistic to assess effect sizes. Results: Our survey was completed by 60 patients. Telemedicine acceptance and satisfaction were high, with an average score of 7.6 (SD 3.3; on an 11-point Numeric Rating Scale from 0=not at all to 10=completely), and 8.8 (SD 1.8), respectively. Respondents generally preferred on-site consultations to telemedicine (n=35, 58% vs n=24, 40%). A subgroup analysis revealed that respondents who already had received phone consultation, showed a higher preference for telemedicine (n/N=21/42, 50% vs n/N=3/18, 17%; χ22 [N=60]=7.5, P=.02, Cramer V=0.354), as well as those who had been treated for more than 3 months (n/N=17/31, 55% vs n/N=7/29, 24%; χ22 [N=60]=6.5, P=.04, Cramer V=0.329). Acceptance of telemedicine showed a moderate positive correlation with satisfaction (rs{58}=0.41, P<.05), but there were no correlations between the COVID-19 stringency index and the other variables. Conclusions: Despite high acceptance of and satisfaction with telemedicine, patients preferred on-site consultations. Preference for telemedicine was markedly higher in patients who had already received phone consultations or had been treated for longer than 3 months. This highlights the need to convey knowledge of eHealth services to patients and the value of building meaningful relationships with patients at the beginning of treatment. During the COVID-19 pandemic, the modality of patient care should be discussed individually. %M 38684086 %R 10.2196/53154 %U https://formative.jmir.org/2024/1/e53154 %U https://doi.org/10.2196/53154 %U http://www.ncbi.nlm.nih.gov/pubmed/38684086 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e38761 %T 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 %A Chadwick,Verity L %A Saich,Freya %A Freeman,Joseph %A Martiniuk,Alexandra %+ Faculty of Medicine and Health, University of Sydney, Edward Ford Building, A27 Fisher Road, Camperdown, 2006, Australia, 61 (02) 9351 2222, alexandra.martiniuk@sydney.edu.au %K COVID-19 %K SARS-CoV-2 %K vaccine %K mRNA %K Pfizer-BioNTech %K pediatric %K children %K media %K news %K web-based %K infodemic %K disinformation %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 36383344 %R 10.2196/38761 %U https://formative.jmir.org/2024/1/e38761 %U https://doi.org/10.2196/38761 %U http://www.ncbi.nlm.nih.gov/pubmed/36383344 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50303 %T Changes in the Clinical Practice of Mental Health Service Providers Throughout the COVID-19 Pandemic: Longitudinal Questionnaire Study %A Gotra,Milena %A Lindberg,Katharine %A Jasinski,Nicholas %A Scarisbrick,David %A Reilly,Shannon %A Perle,Jonathan %A Miller,Liv %A Mahoney III,James %+ Department of Behavioral Medicine and Psychiatry, Rockefeller Neuroscience Institute, West Virginia University School of Medicine, 64 Medical Center Dr, Morgantown, WV, 26506, United States, 1 304 598 4740, nicholas.jasinski1@hsc.wvu.edu %K COVID-19 pandemic %K mental health %K social worker %K psychologist %K neuropsychologist %K academic medical center %K community mental health %K private practice %K Veteran’s Affairs hospital %K longitudinal questionnaire study %K COVID-19 %K implementation %K telemental health %K hybrid model %K availability %D 2024 %7 29.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic impacted the practices of most mental health providers and resulted in a rapid transition to providing telemental health services, changes that were likely related to stay-at-home policies as well as increased need for services. Objective: The aim of this study was to examine whether these changes to practice have been sustained over time throughout the course of the COVID-19 pandemic and whether there are differences among mental health provider type and setting. We hypothesized that there would be an increase in the number of patients seen in person after the initial surge of the pandemic in spring 2020 and subsequent discontinuation of stay-at-home policies, though with continued implementation of telemental health services across settings. Methods: This study surveyed 235 of the 903 mental health providers who responded to a survey in spring 2020 (Time point 1) and at a 1-year follow-up in spring 2021 (Time point 2). Differences in practice adjustments, factors related to telemental health, and number of patients seen were examined across provider type (social worker, psychologist, neuropsychologist) and setting (academic medical center [AMC], community mental health, private practice, and Veterans Affairs hospital). Results: From Time point 1 to Time point 2, there was a small but significant increase in the overall number of providers who were implementing telehealth (191/235, 81% to 204/235, 87%, P=.01) and there was a significant decline in canceled or rescheduled appointments (25%-50% in 2020 to 3%-7% in 2021, P<.001). Psychologists and providers working at AMCs reported decreased difficulty with telehealth implementation (P<.001), and providers working at AMCs and in private practice settings indicated they were more likely to continue telehealth services beyond spring 2021 (P<.001). The percent of time working remotely decreased overall (78% to 59%, P<.001), which was most notable among neuropsychologists and providers working at an AMC. There was an overall increase in the average number of patients seen in person per week compared with earlier in the pandemic (mean 4.3 to 8.7, P<.001), with no change in the number of patients seen via telehealth (mean 9.7 to 9.9, P=.66). Conclusions: These results show that the rapid transition to telemental health at the onset of the COVID-19 pandemic in spring 2020 was sustained over the next year, despite an overall increase in the number of patients seen in person. Although more providers reported returning to working on-site, over 50% of providers continued to use a hybrid model, and many providers reported they would be more likely to continue telemental health beyond spring 2021. This suggests the continued importance and reliance on telemental health services beyond the acute pandemic phase and has implications for future policies regulating the availability of telemental health services to patients. %M 38683653 %R 10.2196/50303 %U https://formative.jmir.org/2024/1/e50303 %U https://doi.org/10.2196/50303 %U http://www.ncbi.nlm.nih.gov/pubmed/38683653 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51279 %T Telehealth Utilization and Associations in the United States During the Third Year of the COVID-19 Pandemic: Population-Based Survey Study in 2022 %A Kim,Jiyeong %A Cai,Zhuo Ran %A Chen,Michael L %A Onyeka,Sonia %A Ko,Justin M %A Linos,Eleni %+ Stanford Center for Digital Health, School of Medicine, Stanford University, 3180 Porter Dr, Stanford, CA, 94305, United States, 1 6507245017, jykim3@stanford.edu %K telehealth %K telemedicine %K digital health %K e-health %K e-medicine %K utilization %K population-based study %K clinical practice %K healthcare delivery %K sociodemographic factor %K COVID-19 %K pandemic %D 2024 %7 26.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic rapidly changed the landscape of clinical practice in the United States; telehealth became an essential mode of health care delivery, yet many components of telehealth use remain unknown years after the disease’s emergence. Objective: We aim to comprehensively assess telehealth use and its associated factors in the United States. Methods: This cross-sectional study used a nationally representative survey (Health Information National Trends Survey) administered to US adults (≥18 years) from March 2022 through November 2022. To assess telehealth adoption, perceptions of telehealth, satisfaction with telehealth, and the telehealth care purpose, we conducted weighted descriptive analyses. To identify the subpopulations with low adoption of telehealth, we developed a weighted multivariable logistic regression model. Results: Among a total of 6252 survey participants, 39.3% (2517/6252) reported telehealth use in the past 12 months (video: 1110/6252, 17.8%; audio: 876/6252, 11.6%). The most prominent reason for not using telehealth was due to telehealth providers failing to offer this option (2200/3529, 63%). The most common reason for respondents not using offered telehealth services was a preference for in-person care (527/578, 84.4%). Primary motivations to use telehealth were providers’ recommendations (1716/2517, 72.7%) and convenience (1516/2517, 65.6%), mainly for acute minor illness (600/2397, 29.7%) and chronic condition management (583/2397, 21.4%), yet care purposes differed by age, race/ethnicity, and income. The satisfaction rate was predominately high, with no technical problems (1829/2517, 80.5%), comparable care quality to that of in-person care (1779/2517, 75%), and no privacy concerns (1958/2517, 83.7%). Younger individuals (odd ratios [ORs] 1.48-2.23; 18-64 years vs ≥75 years), women (OR 1.33, 95% CI 1.09-1.61), Hispanic individuals (OR 1.37, 95% CI 1.05-1.80; vs non-Hispanic White), those with more education (OR 1.72, 95% CI 1.03-2.87; at least a college graduate vs less than high school), unemployed individuals (OR 1.25, 95% CI 1.02-1.54), insured individuals (OR 1.83, 95% CI 1.25-2.69), or those with poor general health status (OR 1.66, 95% CI 1.30-2.13) had higher odds of using telehealth. Conclusions: To our best knowledge, this is among the first studies to examine patient factors around telehealth use, including motivations to use, perceptions of, satisfaction with, and care purpose of telehealth, as well as sociodemographic factors associated with telehealth adoption using a nationally representative survey. The wide array of descriptive findings and identified associations will help providers and health systems understand the factors that drive patients toward or away from telehealth visits as the technology becomes more routinely available across the United States, providing future directions for telehealth use and telehealth research. %M 38669075 %R 10.2196/51279 %U https://publichealth.jmir.org/2024/1/e51279 %U https://doi.org/10.2196/51279 %U http://www.ncbi.nlm.nih.gov/pubmed/38669075 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52191 %T The Role of Trust as a Driver of Private-Provider Participation in Disease Surveillance: Cross-Sectional Survey From Nigeria %A Mitchell,Ellen MH %A Adejumo,Olusola Adedeji %A Abdur-Razzaq,Hussein %A Ogbudebe,Chidubem %A Gidado,Mustapha %+ Mycobacterial Diseases and Neglected Tropical Diseases Unit, Department of Public Health, Institute for Tropical Medicine, 155 Nationaalestraat, Roche, Antwerp, 2000, Belgium, 31 634790509, emitchell@itg.be %K surveillance %K trust %K Integrated Disease Surveillance and Response %K IDSR %K tuberculosis %K notification %K public-private mix %K infectious disease %K disease surveillance %K surveillance behavior %K health care worker %K health professional %K public health %K Nigeria %K survey %K behavior %K self-reported %D 2024 %7 25.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Recognition of the importance of valid, real-time knowledge of infectious disease risk has renewed scrutiny into private providers’ intentions, motives, and obstacles to comply with an Integrated Disease Surveillance Response (IDSR) framework. Appreciation of how private providers’ attitudes shape their tuberculosis (TB) notification behaviors can yield lessons for the surveillance of emerging pathogens, antibiotic stewardship, and other crucial public health functions. Reciprocal trust among actors and institutions is an understudied part of the “software” of surveillance. Objective: We aimed to assess the self-reported knowledge, motivation, barriers, and TB case notification behavior of private health care providers to public health authorities in Lagos, Nigeria. We measured the concordance between self-reported notification, TB cases found in facility records, and actual notifications received. Methods: A representative, stratified sample of 278 private health care workers was surveyed on TB notification attitudes, behavior, and perceptions of public health authorities using validated scales. Record reviews were conducted to identify the TB treatment provided and facility case counts were abstracted from the records. Self-reports were triangulated against actual notification behavior for 2016. The complex health system framework was used to identify potential predictors of notification behavior. Results: Noncompliance with the legal obligations to notify infectious diseases was not attributable to a lack of knowledge. Private providers who were uncomfortable notifying TB cases via the IDSR system scored lower on the perceived benevolence subscale of trust. Health care workers who affirmed “always” notifying via IDSR monthly reported higher median trust in the state’s public disease control capacity. Although self-reported notification behavior was predicted by age, gender, and positive interaction with public health bodies, the self-report numbers did not tally with actual TB notifications. Conclusions: Providers perceived both risks and benefits to recording and reporting TB cases. To improve private providers’ public health behaviors, policy makers need to transcend instrumental and transactional approaches to surveillance to include building trust in public health, simplifying the task, and enhancing the link to improved health. Renewed attention to the “software” of health systems (eg, norms, values, and relationships) is vital to address pandemic threats. Surveys with private providers may overestimate their actual participation in public health surveillance. %M 38506095 %R 10.2196/52191 %U https://publichealth.jmir.org/2024/1/e52191 %U https://doi.org/10.2196/52191 %U http://www.ncbi.nlm.nih.gov/pubmed/38506095 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e54326 %T Exploring the Prevalence of Tinnitus and Ear-Related Symptoms in China After the COVID-19 Pandemic: Online Cross-Sectional Survey %A Wang,Di %A Li,Peifan %A Huang,Xiaoling %A Liu,Yixuan %A Mao,Shihang %A Yin,Haoning %A Wang,Na %A Luo,Yan %A Sun,Shan %+ Research Service Office, Eye & ENT Hospital, Fudan University, 83 Fenyang Road, Shanghai, 200031, China, 86 18917786102, shansun@fudan.edu.cn %K COVID-19 pandemic %K tinnitus %K ear-related symptoms %K online survey %K prevalence %K ear-related %K China %K cross-sectional %K complex %K heterogeneous %K symptom %K symptoms %K Chinese %K population %K investigate %K health care %K exploratory %K teen %K teens %K teenager %K teenagers %K older adult %K older adults %K elder %K elderly %K older person %K older people %K COVID-19 %K regression analysis %D 2024 %7 24.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Tinnitus is a complex and heterogeneous disease that has been identified as a common manifestation of COVID-19. To gain a comprehensive understanding of tinnitus symptoms in individuals following COVID-19 infection, we conducted an online survey called the China Ear Nose and Throat Symptom Survey in the COVID-19 Pandemic (CENTSS) among the Chinese population. Objective: Our objective was to investigate tinnitus and ear-related symptoms after COVID-19 infection in the Chinese population, with the aim of providing a solid empirical foundation for improved health care. The findings from CENTSS can contribute to the development of enhanced management strategies for tinnitus in the context of long COVID. By gaining a better understanding of the factors contributing to tinnitus in individuals with COVID-19, health care providers can tailor interventions to address the specific needs of affected patients. Furthermore, this study serves as a basis for research on the long-term consequences of COVID-19 infection and its associated tinnitus symptoms. Methods: A quantitative, online, cross-sectional survey study design was used to explore the impact of the COVID-19 pandemic on experiences with tinnitus in China. Data were collected through an online questionnaire designed to identify the presence of tinnitus and its impacts. Descriptive statistics were used to analyze individuals' demographic characteristics, COVID-19 infection–related ear symptoms, and the cognitive and emotional implications of tinnitus. Univariable and multivariable logistic regression analyses were used to model the cross-sectional baseline associations between demographic characteristics, noise exposure, educational level, health and lifestyle factors, and the occurrence of tinnitus. Results: Between December 19, 2022, and February 1, 2023, we obtained responses from 1262 Chinese participants representing 24 regions, with an average age of 37 years. Among them, 540 patients (42.8%) reported experiencing ear-related symptoms after COVID-19 infection. Only 114 (9%) of these patients sought medical attention specifically for their ear symptoms, while 426 (33.8%) did not seek hospital care. Tinnitus emerged as the most prevalent and impactful symptom among all ear-related symptoms experienced after COVID-19 infection. Of the respondents, female participants (688/888, 77.78%), younger individuals (<30 years), individuals with lower education levels, participants residing in western China, and those with a history of otolaryngology diseases were more likely to develop tinnitus following COVID-19 infection. Conclusions: In summary, tinnitus was identified as the most common ear-related symptom during COVID-19 infection. Individuals experiencing tinnitus after COVID-19 infection were found to have poorer cognitive and emotional well-being. Different ear-related symptoms in patients post–COVID-19 infection may suggest viral invasion of various parts of the ear. It is therefore crucial to monitor and manage hearing-related changes resulting from COVID-19 as clinical services resume. %R 10.2196/54326 %U https://formative.jmir.org/2024/1/e54326 %U https://doi.org/10.2196/54326 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e51880 %T Now Is the Time to Strengthen Government-Academic Data Infrastructures to Jump-Start Future Public Health Crisis Response %A Lee,Jian-Sin %A Tyler,Allison R B %A Veinot,Tiffany Christine %A Yakel,Elizabeth %+ School of Information, University of Michigan, 105 S State St, Ann Arbor, MI, 48109-1285, United States, 1 734 389 9552, jianslee@umich.edu %K COVID-19 %K crisis response %K cross-sector collaboration %K data infrastructures %K data science %K data sharing %K pandemic %K public health %D 2024 %7 24.4.2024 %9 Viewpoint %J JMIR Public Health Surveill %G English %X During public health crises, the significance of rapid data sharing cannot be overstated. In attempts to accelerate COVID-19 pandemic responses, discussions within society and scholarly research have focused on data sharing among health care providers, across government departments at different levels, and on an international scale. A lesser-addressed yet equally important approach to sharing data during the COVID-19 pandemic and other crises involves cross-sector collaboration between government entities and academic researchers. Specifically, this refers to dedicated projects in which a government entity shares public health data with an academic research team for data analysis to receive data insights to inform policy. In this viewpoint, we identify and outline documented data sharing challenges in the context of COVID-19 and other public health crises, as well as broader crisis scenarios encompassing natural disasters and humanitarian emergencies. We then argue that government-academic data collaborations have the potential to alleviate these challenges, which should place them at the forefront of future research attention. In particular, for researchers, data collaborations with government entities should be considered part of the social infrastructure that bolsters their research efforts toward public health crisis response. Looking ahead, we propose a shift from ad hoc, intermittent collaborations to cultivating robust and enduring partnerships. Thus, we need to move beyond viewing government-academic data interactions as 1-time sharing events. Additionally, given the scarcity of scholarly exploration in this domain, we advocate for further investigation into the real-world practices and experiences related to sharing data from government sources with researchers during public health crises. %M 38656780 %R 10.2196/51880 %U https://publichealth.jmir.org/2024/1/e51880 %U https://doi.org/10.2196/51880 %U http://www.ncbi.nlm.nih.gov/pubmed/38656780 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e50443 %T The Role of Social Media in the Experiences of COVID-19 Among Long-Hauler Women: Qualitative Study %A Garrett,Camryn %A Aghaei,Atefeh %A Aggarwal,Abhishek %A Qiao,Shan %+ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States, 1 803 777 6844, camrynmg@email.sc.edu %K COVID-19 %K long COVID %K long-haulers %K women %K gender %K social media %K digital media %K qualitative study %D 2024 %7 23.4.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The extant literature suggests that women are more vulnerable to COVID-19 infection and at higher risk for developing long COVID. Due to pandemic mitigation recommendations, social media was relied upon for various aspects of daily life, likely with differences of usage between genders. Objective: This study aimed to explore the role and functions of social media in the lives of long-hauler women. Methods: Participants were purposively snowball-sampled from an online health promotion intervention for long-hauler women with COVID-19 from March to June 2021. During this time, one-on-one, semistructured interviews were conducted online until data saturation was agreed to have been achieved (ie, 15 interviews). Interview transcripts and field notes were analyzed using an emergent, inductive approach. Results: In total, 15 women were enrolled. The main roles of social media included facilitating support group participation, experience sharing, interpersonal connections, and media consumption. Emergent themes demonstrated that participants rely on social media to fulfill needs of emotional support, social engagement, spirituality, health planning, information gathering, professional support, and recreationally for relaxation. As long-hauler women turn to social media to discuss symptom and health management as well as the intention to vaccinate, this study demonstrates both the associated benefits (ie, decreased isolation) and challenges (ie, misinformation, rumination, resentment, jealousy). Conclusions: The public health implications of these findings support the development of gender-tailored health promotion interventions that leverage the benefits of social media, while mitigating the negative impacts, for women with long COVID. %M 38652515 %R 10.2196/50443 %U https://humanfactors.jmir.org/2024/1/e50443 %U https://doi.org/10.2196/50443 %U http://www.ncbi.nlm.nih.gov/pubmed/38652515 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e45700 %T Effect of the COVID-19 Pandemic on Gambling Behavior in Mainland Chinese Gamblers in Macau: Cross-Sectional Survey Study %A Zhou,Jinquan %A Ho,Hong-Wai %A Chan,ChiBiu %+ Macao Polytechnic University, R de Luís Gonzaga Gomes, Macao, China, 853 88593326, jqzhou@mpu.edu.mo %K Chinese gamblers %K gambling behavior %K online gambling %K COVID-19 %K Macau %D 2024 %7 22.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: This study examined the effects of the COVID-19 pandemic on the gambling behavior of individuals who were already actively engaged in such pursuits. We aimed to uncover the intricate consequences of the pandemic on this specific demographic, emphasizing the importance of understanding the complex connection between public health concerns such as the COVID-19 pandemic and gambling behavior from a public health perspective. In addition to identifying immediate impacts, this study holds significance in assessing potential long-term public health implications for the broader gambling industry. Objective: This study investigated how the COVID-19 pandemic has affected the gambling behavior of Mainland Chinese tourists in Macau from a public health perspective. We aimed to understand the changing patterns of gambling habits within this specific demographic by comparing their behavior before and during the pandemic, with a particular emphasis on the evolving dynamics of gambling and their public health consequences. This study provides a detailed exploration of the impact and implications of global health emergencies on this particular demographic’s gambling behaviors and preferences. Methods: This study used a robust cross-sectional analysis involving a sample of 334 Mainland Chinese gamblers with prior experiences in casinos in Macau. The sample deliberately encompassed individuals involved in gambling before and during the COVID-19 pandemic. Data were collected through carefully designed questionnaires to gather information on gambling habits, preferences, and observed behavioral changes in the sample. Results: This study unveiled a notable shift in Mainland Chinese gamblers’ behavior during the COVID-19 pandemic. A considerable number of participants opted for web-based platforms over traditional land-based casinos, resulting in reduced budgets, less time spent on gambling, and decreased participation in social gambling. Remarkably, there was a notable surge in online gambling, indicating a noteworthy adaptability of gamblers to changing circumstances. These findings emphasize the dynamic nature of gambling habits during global public health emergencies, revealing the resilient and evolving preferences of Mainland Chinese gamblers in response to the challenges posed by the pandemic. Conclusions: This study highlights the negative impact of the COVID-19 pandemic on casino gambling, notably evident in a significant decline in Mainland Chinese tourists visiting Macau for gambling. There is a noticeable shift from traditional gambling to web-based alternatives, with individuals seeking options within the pandemic constraints. Furthermore, the findings point out an increase in gambling among the younger generation and behavioral changes in individuals with mood disorders. The findings of this study emphasize the critical need for proactive measures to address evolving gambling preferences and associated risks during public health crises; furthermore, these findings underscore the importance of adaptive strategies within the gambling industry, as well as the necessity for effective public health interventions and regulatory frameworks to respond to unprecedented challenges with efficacy and precision. %M 38648630 %R 10.2196/45700 %U https://formative.jmir.org/2024/1/e45700 %U https://doi.org/10.2196/45700 %U http://www.ncbi.nlm.nih.gov/pubmed/38648630 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e44931 %T 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 %A Kurita,Junko %A Iwasaki,Yoshitaro %+ Department of Nursing, Faculty of Sports & Health Science, Daitobunka University, 560 Iwadono, Higashimatsuyama-shi, 3558501, Japan, 81 0493 31 1503, kuritaj@ic.daito.ac.jp %K airport users %K COVID-19 %K effective reproduction number %K Go To Travel campaign %K hotel visitors %K mobility %K long-distance travel %K infection control %K lockdown %K travelling %K travel %K pandemic %D 2024 %7 22.4.2024 %9 Original Paper %J Online J Public Health Inform %G English %X 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. %M 38648635 %R 10.2196/44931 %U https://ojphi.jmir.org/2024/1/e44931 %U https://doi.org/10.2196/44931 %U http://www.ncbi.nlm.nih.gov/pubmed/38648635 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50958 %T 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 %A Liao,Qiuyan %A Yuan,Jiehu %A Wong,Irene Oi Ling %A Ni,Michael Yuxuan %A Cowling,Benjamin John %A Lam,Wendy Wing Tak %+ School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 2/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39179289, qyliao11@hku.hk %K COVID-19 %K vaccination acceptance %K vaccine hesitancy %K motivators %K co-occurrence network analysis %D 2024 %7 22.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 38648099 %R 10.2196/50958 %U https://publichealth.jmir.org/2024/1/e50958 %U https://doi.org/10.2196/50958 %U http://www.ncbi.nlm.nih.gov/pubmed/38648099 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e53837 %T Investigating SARS-CoV-2 Incidence and Morbidity in Ponce, Puerto Rico: Protocol and Baseline Results From a Community Cohort Study %A Major,Chelsea G %A Rodríguez,Dania M %A Sánchez-González,Liliana %A Rodríguez-Estrada,Vanessa %A Morales-Ortíz,Tatiana %A Torres,Carolina %A Pérez-Rodríguez,Nicole M %A Medina-Lópes,Nicole A %A Alexander,Neal %A Mabey,David %A Ryff,Kyle %A Tosado-Acevedo,Rafael %A Muñoz-Jordán,Jorge %A Adams,Laura E %A Rivera-Amill,Vanessa %A Rolfes,Melissa %A Paz-Bailey,Gabriela %+ Division of Vector Borne Diseases, Centers for Disease Control and Prevention, 1324 Calle Cañada, San Juan, 00920, Puerto Rico, 1 787 706 2254, lhi5@cdc.gov %K cohort studies %K COVID-19 %K epidemiologic studies %K Hispanic or Latino %K incidence %K prospective studies %K research methodology %K SARS-CoV-2 %K seroprevalence %D 2024 %7 19.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: A better understanding of SARS-CoV-2 infection risk among Hispanic and Latino populations and in low-resource settings in the United States is needed to inform control efforts and strategies to improve health equity. Puerto Rico has a high poverty rate and other population characteristics associated with increased vulnerability to COVID-19, and there are limited data to date to determine community incidence. Objective: This study describes the protocol and baseline seroprevalence of SARS-CoV-2 in a prospective community-based cohort study (COPA COVID-19 [COCOVID] study) to investigate SARS-CoV-2 infection incidence and morbidity in Ponce, Puerto Rico. Methods: In June 2020, we implemented the COCOVID study within the Communities Organized to Prevent Arboviruses project platform among residents of 15 communities in Ponce, Puerto Rico, aged 1 year or older. Weekly, participants answered questionnaires on acute symptoms and preventive behaviors and provided anterior nasal swab samples for SARS-CoV-2 polymerase chain reaction testing; additional anterior nasal swabs were collected for expedited polymerase chain reaction testing from participants that reported 1 or more COVID-19–like symptoms. At enrollment and every 6 months during follow-up, participants answered more comprehensive questionnaires and provided venous blood samples for multiantigen SARS-CoV-2 immunoglobulin G antibody testing (an indicator of seroprevalence). Weekly follow-up activities concluded in April 2022 and 6-month follow-up visits concluded in August 2022. Primary study outcome measures include SARS-CoV-2 infection incidence and seroprevalence, relative risk of SARS-CoV-2 infection by participant characteristics, SARS-CoV-2 household attack rate, and COVID-19 illness characteristics and outcomes. In this study, we describe the characteristics of COCOVID participants overall and by SARS-CoV-2 seroprevalence status at baseline. Results: We enrolled a total of 1030 participants from 388 households. Relative to the general populations of Ponce and Puerto Rico, our cohort overrepresented middle-income households, employed and middle-aged adults, and older children (P<.001). Almost all participants (1021/1025, 99.61%) identified as Latino/a, 17.07% (175/1025) had annual household incomes less than US $10,000, and 45.66% (463/1014) reported 1 or more chronic medical conditions. Baseline SARS-CoV-2 seroprevalence was low (16/1030, 1.55%) overall and increased significantly with later study enrollment time (P=.003). Conclusions: The COCOVID study will provide a valuable opportunity to better estimate the burden of SARS-CoV-2 and associated risk factors in a primarily Hispanic or Latino population, assess the limitations of surveillance, and inform mitigation measures in Puerto Rico and other similar populations. International Registered Report Identifier (IRRID): RR1-10.2196/53837 %M 38640475 %R 10.2196/53837 %U https://www.researchprotocols.org/2024/1/e53837 %U https://doi.org/10.2196/53837 %U http://www.ncbi.nlm.nih.gov/pubmed/38640475 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51858 %T AI-Led Mental Health Support (Wysa) for Health Care Workers During COVID-19: Service Evaluation %A Chang,Christel Lynne %A Sinha,Chaitali %A Roy,Madhavi %A Wong,John Chee Meng %+ Department of Psychological Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Level 9, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore, 65 6772 3481, pcmwcmj@nus.edu.sg %K AI %K app %K application %K artificial intelligence %K COVID-19 %K digital %K health care workers %K mental health %K pandemic %K Wysa %D 2024 %7 19.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: The impact that the COVID-19 pandemic has had on health care workers’ mental health, in particular, cannot be ignored. Not only did the pandemic exacerbate mental health challenges through elevated stress, anxiety, risk of infection, and social isolation, but regulations to minimize infection additionally hindered the conduct of traditional in-person mental health care. Objective: This study explores the feasibility of using Wysa, an artificial intelligence–led mental health app, among health care workers. Methods: A national tertiary health care cluster in Singapore piloted the use of Wysa among its own health care workers to support the management of their mental well-being during the pandemic (July 2020-June 2022). The adoption of this digital mental health intervention circumvented the limitations of in-person contact and enabled large-scale access to evidence-based care. Rates and patterns of user engagement were evaluated. Results: Overall, the opportunity to use Wysa was well-received. Out of the 527 staff who were onboarded in the app, 80.1% (422/527) completed a minimum of 2 sessions. On average, users completed 10.9 sessions over 3.80 weeks. The interventions most used were for sleep and anxiety, with a strong repeat-use rate. In this sample, 46.2% (73/158) of health care workers reported symptoms of anxiety (Generalized Anxiety Disorder Assessment-7 [GAD-7]), and 15.2% (24/158) were likely to have symptoms of depression (Patient Health Questionnaire-2 [PHQ-2]). Conclusions: Based on the present findings, Wysa appears to strongly engage those with none to moderate symptoms of anxiety. This evaluation demonstrates the viability of implementing Wysa as a standard practice among this sample of health care workers, which may support the use of similar digital interventions across other communities. %M 38640476 %R 10.2196/51858 %U https://formative.jmir.org/2024/1/e51858 %U https://doi.org/10.2196/51858 %U http://www.ncbi.nlm.nih.gov/pubmed/38640476 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48784 %T Assessing SARS-CoV-2 Testing Adherence in a University Town: Recurrent Event Modeling Analysis %A García,Yury E %A Schmidt,Alec J %A Solis,Leslie %A Daza-Torres,María L %A Montesinos-López,J Cricelio %A Pollock,Brad H %A Nuño,Miriam %+ Department of Public Health Sciences, University of California, 1 Shields Avenue, Davis, CA, 95616, United States, 1 5056999560, mnuno@ucdavis.edu %K Healthy Davis Together %K COVID-19 %K COVID-19 surveillance program %K community surveillance %K HDT: HYT %K Healthy Yolo Together %K SARS-CoV-2 %K severe acute respiratory syndrome coronavirus 2 %K coronavirus %K demographic %K demographics %K testing %K adherence %K compliance %K USA %K United States %K response program %K response programs %K engagement %K participation %K infectious %K trend %K trends %K community based %K surveillance %K public health %K infection control %K PCR %K polymerase chain reaction %K RT-qPCR %K reverse transcription quantitative polymerase chain reaction %K viral %K virus %K viruses %D 2024 %7 17.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 38631033 %R 10.2196/48784 %U https://publichealth.jmir.org/2024/1/e48784 %U https://doi.org/10.2196/48784 %U http://www.ncbi.nlm.nih.gov/pubmed/38631033 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e38170 %T Comparing Contact Tracing Through Bluetooth and GPS Surveillance Data: Simulation-Driven Approach %A Qian,Weicheng %A Cooke,Aranock %A Stanley,Kevin Gordon %A Osgood,Nathaniel David %+ Department of Computer Science, University of Saskatchewan, 110 Science Place, Saskatoon, SK, S7N 5C9, Canada, 1 3069661947, weicheng.qian@usask.ca %K smartphone-based sensing %K proximity contact data %K transmission models %K agent-based simulation %K health informatics %K mobile phone %D 2024 %7 17.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Accurate and responsive epidemiological simulations of epidemic outbreaks inform decision-making to mitigate the impact of pandemics. These simulations must be grounded in quantities derived from measurements, among which the parameters associated with contacts between individuals are notoriously difficult to estimate. Digital contact tracing data, such as those provided by Bluetooth beaconing or GPS colocating, can provide more precise measures of contact than traditional methods based on direct observation or self-reporting. Both measurement modalities have shortcomings and are prone to false positives or negatives, as unmeasured environmental influences bias the data. Objective: We aim to compare GPS colocated versus Bluetooth beacon–derived proximity contact data for their impacts on transmission models’ results under community and types of diseases. Methods: We examined the contact patterns derived from 3 data sets collected in 2016, with participants comprising students and staff from the University of Saskatchewan in Canada. Each of these 3 data sets used both Bluetooth beaconing and GPS localization on smartphones running the Ethica Data (Avicenna Research) app to collect sensor data about every 5 minutes over a month. We compared the structure of contact networks inferred from proximity contact data collected with the modalities of GPS colocating and Bluetooth beaconing. We assessed the impact of sensing modalities on the simulation results of transmission models informed by proximate contacts derived from sensing data. Specifically, we compared the incidence number, attack rate, and individual infection risks across simulation results of agent-based susceptible-exposed-infectious-removed transmission models of 4 different contagious diseases. We have demonstrated their differences with violin plots, 2-tailed t tests, and Kullback-Leibler divergence. Results: Both network structure analyses show visually salient differences in proximity contact data collected between GPS colocating and Bluetooth beaconing, regardless of the underlying population. Significant differences were found for the estimated attack rate based on distance threshold, measurement modality, and simulated disease. This finding demonstrates that the sensor modality used to trace contact can have a significant impact on the expected propagation of a disease through a population. The violin plots of attack rate and Kullback-Leibler divergence of individual infection risks demonstrated discernible differences for different sensing modalities, regardless of the underlying population and diseases. The results of the t tests on attack rate between different sensing modalities were mostly significant (P<.001). Conclusions: We show that the contact networks generated from these 2 measurement modalities are different and generate significantly different attack rates across multiple data sets and pathogens. While both modalities offer higher-resolution portraits of contact behavior than is possible with most traditional contact measures, the differential impact of measurement modality on the simulation outcome cannot be ignored and must be addressed in studies only using a single measure of contact in the future. %M 38422493 %R 10.2196/38170 %U https://www.jmir.org/2024/1/e38170 %U https://doi.org/10.2196/38170 %U http://www.ncbi.nlm.nih.gov/pubmed/38422493 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e50139 %T Twitter Analysis of Health Care Workers’ Sentiment and Discourse Regarding Post–COVID-19 Condition in Children and Young People: Mixed Methods Study %A Chepo,Macarena %A Martin,Sam %A Déom,Noémie %A Khalid,Ahmad Firas %A Vindrola-Padros,Cecilia %+ Department of Targeted Intervention, University College London, Charles Bell House 43-45, Foley Street, London, W1W 7TY, United Kingdom, 44 (0)20 3108 3232, sam.martin@ucl.ac.uk %K COVID-19 %K postacute sequelae of SARS-CoV-2 %K PASC %K post–COVID-19 condition %K children %K vaccines %K social media %K social network analysis %K Twitter %D 2024 %7 17.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had a significant global impact, with millions of cases and deaths. Research highlights the persistence of symptoms over time (post–COVID-19 condition), a situation of particular concern in children and young people with symptoms. Social media such as Twitter (subsequently rebranded as X) could provide valuable information on the impact of the post–COVID-19 condition on this demographic. Objective: With a social media analysis of the discourse surrounding the prevalence of post–COVID-19 condition in children and young people, we aimed to explore the perceptions of health care workers (HCWs) concerning post–COVID-19 condition in children and young people in the United Kingdom between January 2021 and January 2022. This will allow us to contribute to the emerging knowledge on post–COVID-19 condition and identify critical areas and future directions for researchers and policy makers. Methods: From a pragmatic paradigm, we used a mixed methods approach. Through discourse, keyword, sentiment, and image analyses, using Pulsar and InfraNodus, we analyzed the discourse about the experience of post–COVID-19 condition in children and young people in the United Kingdom shared on Twitter between January 1, 2021, and January 31, 2022, from a sample of HCWs with Twitter accounts whose biography identifies them as HCWs. Results: We obtained 300,000 tweets, out of which (after filtering for relevant tweets) we performed an in-depth qualitative sample analysis of 2588 tweets. The HCWs were responsive to announcements issued by the authorities regarding the management of the COVID-19 pandemic in the United Kingdom. The most frequent sentiment expressed was negative. The main themes were uncertainty about the future, policies and regulations, managing and addressing the COVID-19 pandemic and post–COVID-19 condition in children and young people, vaccination, using Twitter to share scientific literature and management strategies, and clinical and personal experiences. Conclusions: The perceptions described on Twitter by HCWs concerning the presence of the post–COVID-19 condition in children and young people appear to be a relevant and timely issue and responsive to the declarations and guidelines issued by health authorities over time. We recommend further support and training strategies for health workers and school staff regarding the manifestations and treatment of children and young people with post–COVID-19 condition. %M 38630514 %R 10.2196/50139 %U https://www.jmir.org/2024/1/e50139 %U https://doi.org/10.2196/50139 %U http://www.ncbi.nlm.nih.gov/pubmed/38630514 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e53608 %T Factors Impacting Chinese Older Adults’ Intention to Prevent COVID-19 in the Post–COVID-19 Pandemic Era: Survey Study %A Guan,Huixin %A Wang,Wei %+ USC-SJTU Institute of Cultural and Creative Industry, Shanghai Jiao Tong University, No155. Tanjiatang Road, Shanghai, 200241, China, 86 13840128403, guan_hx@sjtu.edu.cn %K COVID-19 %K SARS-CoV-2 %K health protection %K social capital %K media exposure %K negative emotions %K structural influence model of communication %K SIM %K protect %K protection %K protective %K intent %K intention %K prevention %K preventative %K restriction %K restrictions %K public health measures %K safety %K news %K newspaper %K media %K radio %K health communication %K influence %K influencing %K infectious %K infection control %K pandemic %K gerontology %K geriatric %K geriatrics %K older adult %K older adults %K older person %K older people %K aging %D 2024 %7 17.4.2024 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 38630517 %R 10.2196/53608 %U https://formative.jmir.org/2024/1/e53608 %U https://doi.org/10.2196/53608 %U http://www.ncbi.nlm.nih.gov/pubmed/38630517 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54838 %T Global Trends of Medical Misadventures Using International Classification of Diseases, Tenth Revision Cluster Y62-Y69 Comparing Pre–, Intra–, and Post–COVID-19 Pandemic Phases: Protocol for a Retrospective Analysis Using the TriNetX Platform %A Caruso,Rosario %A Di Muzio,Marco %A Di Simone,Emanuele %A Dionisi,Sara %A Magon,Arianna %A Conte,Gianluca %A Stievano,Alessandro %A Girani,Emanuele %A Boveri,Sara %A Menicanti,Lorenzo %A Dolansky,Mary A %+ Health Professions Research and Development Unit, IRCCS Policlinico San Donato, via morandi 30, San Donato Milanese, 20097, Italy, 39 025277 ext 4940, rosario.caruso@grupposandonato.it %K COVID-19 %K curve-fitting analyses %K health care quality %K health care safety %K International Classification of Diseases, Tenth Revision %K ICD-10 %K incidence rates %K safety %K TriNetX %D 2024 %7 17.4.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has sharpened the focus on health care safety and quality, underscoring the importance of using standardized metrics such as the International Classification of Diseases, Tenth Revision (ICD-10). In this regard, the ICD-10 cluster Y62-Y69 serves as a proxy assessment of safety and quality in health care systems, allowing researchers to evaluate medical misadventures. Thus far, extensive research and reports support the need for more attention to safety and quality in health care. The study aims to leverage the pandemic’s unique challenges to explore health care safety and quality trends during prepandemic, intrapandemic, and postpandemic phases, using the ICD-10 cluster Y62-Y69 as a key tool for their evaluation. Objective: This research aims to perform a comprehensive retrospective analysis of incidence rates associated with ICD-10 cluster Y62-Y69, capturing both linear and nonlinear trends across prepandemic, intrapandemic, and postpandemic phases over an 8-year span. Therefore, it seeks to understand how these trends inform health care safety and quality improvements, policy, and future research. Methods: This study uses the extensive data available through the TriNetX platform, using an observational, retrospective design and applying curve-fitting analyses and quadratic models to comprehend the relationships between incidence rates over an 8-year span (from 2015 to 2023). These techniques will enable the identification of nuanced trends in the data, facilitating a deeper understanding of the impacts of the COVID-19 pandemic on medical misadventures. The anticipated results aim to outline complex patterns in health care safety and quality during the COVID-19 pandemic, using global real-world data for robust and generalizable conclusions. This study will explore significant shifts in health care practices and outcomes, with a special focus on geographical variations and key clinical conditions in cardiovascular and oncological care, ensuring a comprehensive analysis of the pandemic’s impact across different regions and medical fields. Results: This study is currently in the data collection phase, with funding secured in November 2023 through the Ricerca Corrente scheme of the Italian Ministry of Health. Data collection via the TriNetX platform is anticipated to be completed in May 2024, covering an 8-year period from January 2015 to December 2023. This dataset spans pre-pandemic, intra-pandemic, and early post-pandemic phases, enabling a comprehensive analysis of trends in medical misadventures using the ICD-10 cluster Y62-Y69. The final analytics are anticipated to be completed by June 2024. The study's findings aim to provide actionable insights for enhancing healthcare safety and quality, reflecting on the pandemic's transformative impact on global healthcare systems. Conclusions: This study is anticipated to contribute significantly to health care safety and quality literature. It will provide actionable insights for health care professionals, policy makers, and researchers. It will highlight critical areas for intervention and funding to enhance health care safety and quality globally by examining the incidence rates of medical misadventures before, during, and after the pandemic. In addition, the use of global real-world data enhances the study’s strength by providing a practical view of health care safety and quality, paving the way for initiatives that are informed by data and tailored to specific contexts worldwide. This approach ensures the findings are applicable and actionable across different health care settings, contributing significantly to the global understanding and improvement of health care safety and quality. International Registered Report Identifier (IRRID): PRR1-10.2196/54838 %M 38630516 %R 10.2196/54838 %U https://www.researchprotocols.org/2024/1/e54838 %U https://doi.org/10.2196/54838 %U http://www.ncbi.nlm.nih.gov/pubmed/38630516 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 16 %N %P e50771 %T Machine Learning for Prediction of Tuberculosis Detection: Case Study of Trained African Giant Pouched Rats %A Jonathan,Joan %A Barakabitze,Alcardo Alex %A Fast,Cynthia D %A Cox,Christophe %+ Department of Informatics and Information Technology, Sokoine University of Agriculture, PO Box 3038, Morogoro, United Republic of Tanzania, 255 763 630 054, joanjonathan@sua.ac.tz %K machine learning %K African giant pouched rat %K diagnosis %K tuberculosis %K health care %D 2024 %7 16.4.2024 %9 Original Paper %J Online J Public Health Inform %G English %X Background: Technological advancement has led to the growth and rapid increase of tuberculosis (TB) medical data generated from different health care areas, including diagnosis. Prioritizing better adoption and acceptance of innovative diagnostic technology to reduce the spread of TB significantly benefits developing countries. Trained TB-detection rats are used in Tanzania and Ethiopia for operational research to complement other TB diagnostic tools. This technology has increased new TB case detection owing to its speed, cost-effectiveness, and sensitivity. Objective: During the TB detection process, rats produce vast amounts of data, providing an opportunity to identify interesting patterns that influence TB detection performance. This study aimed to develop models that predict if the rat will hit (indicate the presence of TB within) the sample or not using machine learning (ML) techniques. The goal was to improve the diagnostic accuracy and performance of TB detection involving rats. Methods: APOPO (Anti-Persoonsmijnen Ontmijnende Product Ontwikkeling) Center in Morogoro provided data for this study from 2012 to 2019, and 366,441 observations were used to build predictive models using ML techniques, including decision tree, random forest, naïve Bayes, support vector machine, and k-nearest neighbor, by incorporating a variety of variables, such as the diagnostic results from partner health clinics using methods endorsed by the World Health Organization (WHO). Results: The support vector machine technique yielded the highest accuracy of 83.39% for prediction compared to other ML techniques used. Furthermore, this study found that the inclusion of variables related to whether the sample contained TB or not increased the performance accuracy of the predictive model. Conclusions: The inclusion of variables related to the diagnostic results of TB samples may improve the detection performance of the trained rats. The study results may be of importance to TB-detection rat trainers and TB decision-makers as the results may prompt them to take action to maintain the usefulness of the technology and increase the TB detection performance of trained rats. %M 38625737 %R 10.2196/50771 %U https://ojphi.jmir.org/2024/1/e50771 %U https://doi.org/10.2196/50771 %U http://www.ncbi.nlm.nih.gov/pubmed/38625737 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e56415 %T Global Rate of Willingness to Volunteer Among Medical and Health Students During Pandemic: Systemic Review and Meta-Analysis %A Mahsusi,Mahsusi %A Hudaa,Syihaabul %A Nuryani,Nuryani %A Fahmi,Mustofa %A Tsurayya,Ghina %A Iqhrammullah,Muhammad %+ Department of Islamic Education Management, Faculty of Tarbiyah and Teacher Training, Universitas Islam Negeri Syarif Hidayatullah Jakarta, Jl Ir H Djuanda No 95, Tangerang Selatan, 15412, Indonesia, 62 83806254803, mahsusi@uinjkt.ac.id %K COVID-19 %K education %K health crisis %K human resource management %K volunteer %D 2024 %7 15.4.2024 %9 Review %J JMIR Med Educ %G English %X Background: During health crises such as the COVID-19 pandemic, shortages of health care workers often occur. Recruiting students as volunteers could be an option, but it is uncertain whether the idea is well-accepted. Objective: This study aims to estimate the global rate of willingness to volunteer among medical and health students in response to the COVID-19 pandemic. Methods: A systematic search was conducted on PubMed, Embase, Scopus, and Google Scholar for studies reporting the number of health students willing to volunteer during COVID-19 from 2019 to November 17, 2023. The meta-analysis was performed using a restricted maximum-likelihood model with logit transformation. Results: A total of 21 studies involving 26,056 health students were included in the meta-analysis. The pooled estimate of the willingness-to-volunteer rate among health students across multiple countries was 66.13%, with an I2 of 98.99% and P value of heterogeneity (P-Het)<.001. Removing a study with the highest influence led to the rate being 64.34%. Our stratified analyses indicated that those with older age, being first-year students, and being female were more willing to volunteer (P<.001). From highest to lowest, the rates were 77.38%, 77.03%, 65.48%, 64.11%, 62.71%, and 55.23% in Africa, Western Europe, East and Southeast Asia, Middle East, and Eastern Europe, respectively. Because of the high heterogeneity, the evidence from this study has moderate strength. Conclusions: The majority of students are willing to volunteer during COVID-19, suggesting that volunteer recruitment is well-accepted. %M 38621233 %R 10.2196/56415 %U https://mededu.jmir.org/2024/1/e56415 %U https://doi.org/10.2196/56415 %U http://www.ncbi.nlm.nih.gov/pubmed/38621233 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e52412 %T Novel Approach for Detecting Respiratory Syncytial Virus in Pediatric Patients Using Machine Learning Models Based on Patient-Reported Symptoms: Model Development and Validation Study %A Kawamoto,Shota %A Morikawa,Yoshihiko %A Yahagi,Naohisa %+ Graduate School of Media and Governance, Keio University, 5322 Endo, Fujisawa, 252-0882, Japan, 81 466 49 3404, yahagin@sfc.keio.ac.jp %K respiratory syncytial virus %K machine learning %K self-reported information %K clinical decision support system %K decision support %K decision-making %K artificial intelligence %K model development %K evaluation study %K detection %K respiratory %K respiratory virus %K virus %K machine learning model %K pediatric %K Japan %K detection model %D 2024 %7 12.4.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Respiratory syncytial virus (RSV) affects children, causing serious infections, particularly in high-risk groups. Given the seasonality of RSV and the importance of rapid isolation of infected individuals, there is an urgent need for more efficient diagnostic methods to expedite this process. Objective: This study aimed to investigate the performance of a machine learning model that leverages the temporal diversity of symptom onset for detecting RSV infections and elucidate its discriminatory ability. Methods: The study was conducted in pediatric and emergency outpatient settings in Japan. We developed a detection model that remotely confirms RSV infection based on patient-reported symptom information obtained using a structured electronic template incorporating the differential points of skilled pediatricians. An extreme gradient boosting–based machine learning model was developed using the data of 4174 patients aged ≤24 months who underwent RSV rapid antigen testing. These patients visited either the pediatric or emergency department of Yokohama City Municipal Hospital between January 1, 2009, and December 31, 2015. The primary outcome was the diagnostic accuracy of the machine learning model for RSV infection, as determined by rapid antigen testing, measured using the area under the receiver operating characteristic curve. The clinical efficacy was evaluated by calculating the discriminative performance based on the number of days elapsed since the onset of the first symptom and exclusion rates based on thresholds of reasonable sensitivity and specificity. Results: Our model demonstrated an area under the receiver operating characteristic curve of 0.811 (95% CI 0.784-0.833) with good calibration and 0.746 (95% CI 0.694-0.794) for patients within 3 days of onset. It accurately captured the temporal evolution of symptoms; based on adjusted thresholds equivalent to those of a rapid antigen test, our model predicted that 6.9% (95% CI 5.4%-8.5%) of patients in the entire cohort would be positive and 68.7% (95% CI 65.4%-71.9%) would be negative. Our model could eliminate the need for additional testing in approximately three-quarters of all patients. Conclusions: Our model may facilitate the immediate detection of RSV infection in outpatient settings and, potentially, in home environments. This approach could streamline the diagnostic process, reduce discomfort caused by invasive tests in children, and allow rapid implementation of appropriate treatments and isolation at home. The findings underscore the potential of machine learning in augmenting clinical decision-making in the early detection of RSV infection. %M 38608268 %R 10.2196/52412 %U https://formative.jmir.org/2024/1/e52412 %U https://doi.org/10.2196/52412 %U http://www.ncbi.nlm.nih.gov/pubmed/38608268 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47170 %T Evaluating the Knowledge of and Behavior Toward COVID-19 and the Possibility of Isolating at a City Level: Survey Study %A Verot,Elise %A Chaux,Robin %A Gagnaire,Julie %A Bonjean,Paul %A Gagneux-Brunon,Amandine %A Berthelot,Philippe %A Pelissier,Carole %A Boulamail,Billal %A Chauvin,Franck %A Pozzetto,Bruno %A Botelho-Nevers,Elisabeth %+ CIC EC 1408 INSERM Saint-Etienne, CHU de Saint-Etienne, Bâtiment le Canopée- 2ème étage, Saint-Etienne cedex 2, 42055, France, 33 04 77 12 77 88, elise.verot@univ-st-etienne.fr %K SARS-CoV-2 %K COVID-19 %K health literacy %K knowledge, attitude, and perception/practices (KAP) %K public health %K population %K mass testing %K screening %K pandemic %K sociological trends %K COVID-19 screening %D 2024 %7 11.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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-Étienne (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 β coefficient=0.14, 95% CI 0.04-0.23; corrected P=.02). Older ages of 50-59 years (adjusted β coefficient=0.25, 95% CI 0.19-0.31; corrected P<.001) and ≥60 years (adjusted β 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 β 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 β coefficient=0.03, 95% CI 0.001-0.004; corrected P=.001). Older ages of 50-59 years (adjusted β coefficient=0.21, 95% CI 0.13-0.29; corrected P<.001) and ≥60 years (adjusted β 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. %M 38602767 %R 10.2196/47170 %U https://publichealth.jmir.org/2024/1/e47170 %U https://doi.org/10.2196/47170 %U http://www.ncbi.nlm.nih.gov/pubmed/38602767 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54008 %T Longitudinal Monitoring of Clinician-Patient Video Visits During the Peak of the COVID-19 Pandemic: Adoption and Sustained Challenges in an Integrated Health Care Delivery System %A Palakshappa,Jessica A %A Hale,Erica R %A Brown,Joshua D %A Kittel,Carol A %A Dressler,Emily %A Rosenthal,Gary E %A Cutrona,Sarah L %A Foley,Kristie L %A Haines,Emily R %A Houston II,Thomas K %+ Wake Forest University School of Medicine, 1 Medical Center Blvd, Winston Salem, NC, 27157, United States, 1 336 716 8465, jpalaksh@wakehealth.edu %K telehealth %K telemedicine %K e-health %K eHealth %K video visits %K video %K ICT %K information and communication technology %K survey %K surveys %K adoption %K usability %K experience %K experiences %K attitude %K attitudes %K opinion %K perception %K perceptions %K perspective %K perspectives %K COVID-19 %D 2024 %7 8.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Numerous prior opinion papers, administrative electronic health record data studies, and cross-sectional surveys of telehealth during the pandemic have been published, but none have combined assessments of video visit success monitoring with longitudinal assessments of perceived challenges to the rapid adoption of video visits during the pandemic. Objective: This study aims to quantify (1) the use of video visits (compared with in-person and telephone visits) over time during the pandemic, (2) video visit successful connection rates, and (3) changes in perceived video visit challenges. Methods: A web-based survey was developed for the dual purpose of monitoring and improving video visit implementation in our health care system during the COVID-19 pandemic. The survey included questions regarding rates of in-person, telephone, and video visits for clinician-patient encounters; the rate of successful connection for video visits; and perceived challenges to video visits (eg, software, hardware, bandwidth, and technology literacy). The survey was distributed via email to physicians, advanced practice professionals, and clinicians in May 2020. The survey was repeated in March 2021. Differences between the 2020 and 2021 responses were adjusted for within-respondent correlation across surveys and tested using generalized estimating equations. Results: A total of 1126 surveys were completed (511 surveys in 2020 and 615 surveys in 2021). In 2020, only 21.7% (73/336) of clinicians reported no difficulty connecting with patients during video visits and 28.6% (93/325) of clinicians reported no difficulty in 2021. The distribution of the percentage of successfully connected video visits (“Over the past two weeks of scheduled visits, what percentage did you successfully connect with patients by video?”) was not significantly different between 2020 and 2021 (P=.74). Challenges in conducting video visits persisted over time. Poor connectivity was the most common challenge reported by clinicians. This response increased over time, with 30.5% (156/511) selecting it as a challenge in 2020 and 37.1% (228/615) in 2021 (P=.01). Patients not having access to their electronic health record portals was also a commonly reported challenge (109/511, 21.3% in 2020 and 137/615, 22.3% in 2021, P=.73). Conclusions: During the pandemic, our health care delivery system rapidly adopted synchronous patient-clinician communication using video visits. As experience with video visits increased, the reported failure rate did not significantly decline, and clinicians continued to report challenges related to general network connectivity and patient access to technology. %M 38587889 %R 10.2196/54008 %U https://www.jmir.org/2024/1/e54008 %U https://doi.org/10.2196/54008 %U http://www.ncbi.nlm.nih.gov/pubmed/38587889 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e54340 %T Responding to the Return of Influenza in the United States by Applying Centers for Disease Control and Prevention Surveillance, Analysis, and Modeling to Inform Understanding of Seasonal Influenza %A Borchering,Rebecca K %A Biggerstaff,Matthew %A Brammer,Lynnette %A Budd,Alicia %A Garg,Shikha %A Fry,Alicia M %A Iuliano,A Danielle %A Reed,Carrie %+ National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Rd, NE MS H24-7, Atlanta, GA, 30329, United States, 1 4046395214, xhq2@cdc.gov %K disease burden %K modeling %K seasonal influenza %K surveillance %D 2024 %7 8.4.2024 %9 Viewpoint %J JMIR Public Health Surveill %G English %X We reviewed the tools that have been developed to characterize and communicate seasonal influenza activity in the United States. Here we focus on systematic surveillance and applied analytics, including seasonal burden and disease severity estimation, short-term forecasting, and longer-term modeling efforts. For each set of activities, we describe the challenges and opportunities that have arisen because of the COVID-19 pandemic. In conclusion, we highlight how collaboration and communication have been and will continue to be key components of reliable and actionable influenza monitoring, forecasting, and modeling activities. %M 38587882 %R 10.2196/54340 %U https://publichealth.jmir.org/2024/1/e54340 %U https://doi.org/10.2196/54340 %U http://www.ncbi.nlm.nih.gov/pubmed/38587882 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50673 %T Epidemiological Characteristics of Varicella in Anhui Province, China, 2012-2021: Surveillance Study %A Xuan,Kun %A Zhang,Ning %A Li,Tao %A Pang,Xingya %A Li,Qingru %A Zhao,Tianming %A Wang,Binbing %A Zha,Zhenqiu %A Tang,Jihai %+ Anhui Provincial Center for Disease Control and Prevention, No. 12560 Fanhua Road, Economic and Technological Development Zone, Hefei, Anhui Province, 230601, China, 86 055163674908, phgis@qq.com %K varicella %K incidence %K epidemiology %K spatial autocorrelation %K contagious disease %K chicken pox %K varicella zoster virus %K China %D 2024 %7 5.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Varicella is a mild, self-limited disease caused by varicella-zoster virus (VZV) infection. Recently, the disease burden of varicella has been gradually increasing in China; however, the epidemiological characteristics of varicella have not been reported for Anhui Province. Objective: The aim of this study was to analyze the epidemiology of varicella in Anhui from 2012 to 2021, which can provide a basis for the future study and formulation of varicella prevention and control policies in the province. Methods: Surveillance data were used to characterize the epidemiology of varicella in Anhui from 2012 to 2021 in terms of population, time, and space. Spatial autocorrelation of varicella was explored using the Moran index (Moran I). The Kulldorff space-time scan statistic was used to analyze the spatiotemporal aggregation of varicella. Results: A total of 276,115 cases of varicella were reported from 2012 to 2021 in Anhui, with an average annual incidence of 44.8 per 100,000, and the highest incidence was 81.2 per 100,000 in 2019. The male-to-female ratio of cases was approximately 1.26, which has been gradually decreasing in recent years. The population aged 5-14 years comprised the high-incidence group, although the incidence in the population 30 years and older has gradually increased. Students accounted for the majority of cases, and the proportion of cases in both home-reared children (aged 0-7 years who are not sent to nurseries, daycare centers, or school) and kindergarten children (aged 3-6 years) has changed slightly in recent years. There were two peaks of varicella incidence annually, except for 2020, and the incidence was typically higher in the winter peak than in summer. The incidence of varicella in southern Anhui was higher than that in northern Anhui. The average annual incidence at the county level ranged from 6.61 to 152.14 per 100,000, and the varicella epidemics in 2018-2021 were relatively severe. The spatial and temporal distribution of varicella in Anhui was not random, with a positive spatial autocorrelation found at the county level (Moran I=0.412). There were 11 districts or counties with high-high clusters, mainly distributed in the south of Anhui, and 3 districts or counties with high-low or low-high clusters. Space-time scan analysis identified five possible clusters of areas, and the most likely cluster was distributed in the southeastern region of Anhui. Conclusions: This study comprehensively describes the epidemiology and changing trend of varicella in Anhui from 2012 to 2021. In the future, preventive and control measures should be strengthened for the key populations and regions of varicella. %M 38579276 %R 10.2196/50673 %U https://publichealth.jmir.org/2024/1/e50673 %U https://doi.org/10.2196/50673 %U http://www.ncbi.nlm.nih.gov/pubmed/38579276 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47241 %T Perspectives of European Patient Advocacy Groups on Volunteer Registries and Vaccine Trials: VACCELERATE Survey Study %A Themistocleous,Sophia %A Argyropoulos,Christos D %A Vogazianos,Paris %A Shiamakkides,George %A Noula,Evgenia %A Nearchou,Andria %A Yiallouris,Andreas %A Filippou,Charalampos %A Stewart,Fiona A %A Koniordou,Markela %A Kopsidas,Ioannis %A Askling,Helena H %A Vene,Sirkka %A Gagneux-Brunon,Amandine %A Prellezo,Jana Baranda %A Álvarez-Barco,Elena %A Salmanton-García,Jon %A Leckler,Janina %A Macken,Alan J %A Davis,Ruth Joanna %A Azzini,Anna Maria %A Armeftis,Charis %A Hellemans,Margot %A Di Marzo,Romina %A Luis,Catarina %A Olesen,Ole F %A Valdenmaiier,Olena %A Jakobsen,Stine Finne %A Nauclér,Pontus %A Launay,Odile %A Mallon,Patrick %A Ochando,Jordi %A van Damme,Pierre %A Tacconelli,Evelina %A Zaoutis,Theoklis %A Cornely,Oliver A %A Pana,Zoi Dorothea %+ School of Medicine, European University Cyprus, 6 Diogenis Str., Engomi, Nicosia, 2404, Cyprus, 357 94049474, z.pana@euc.ac.cy %K patient advocacy groups %K clinical trials %K volunteer registry %K vaccines %K public health %K healthcare %K COVID-19 %K vaccine trial %K VACCELERATE %K health promotion %K health advocate %K clinical trial %D 2024 %7 4.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The VACCELERATE Pan-European Scientific network aims to strengthen the foundation of vaccine trial research across Europe by following the principles of equity, inclusion, and diversity. The VACCELERATE Volunteer Registry network provides access to vaccine trial sites across the European region and supports a sustainable volunteer platform for identifying potential participants for forthcoming vaccine clinical research. Objective: The aim of this study was to approach members of patient advocacy groups (PAGs) across Europe to assess their willingness to register for the VACCELERATE Volunteer Registry and their perspectives related to participating in vaccine trials. Methods: In an effort to understand how to increase recruitment for the VACCELERATE Volunteer Registry, a standardized survey was developed in English and translated into 8 different languages (Dutch, English, French, German, Greek, Italian, Spanish, and Swedish) by the respective National Coordinator team. The online, anonymous survey was circulated, from March 2022 to May 2022, to PAGs across 10 European countries (Belgium, Cyprus, Denmark, France, Germany, Greece, Ireland, Italy, Spain, and Sweden) to share with their members. The questionnaire constituted of multiple choice and open-ended questions evaluating information regarding participants’ perceptions on participating in vaccine trials and their willingness to become involved in the VACCELERATE Volunteer Registry. Results: In total, 520 responses were collected and analyzed. The PAG members reported that the principal criteria influencing their decision to participate in clinical trials overall are (1) the risks involved, (2) the benefits that will be gained from their potential participation, and (3) the quality and quantity of information provided regarding the trial. The survey revealed that, out of the 520 respondents, 133 individuals across all age groups were “positive” toward registering in the VACCELERATE Volunteer Registry, with an additional 47 individuals reporting being “very positive.” Respondents from Northern European countries were 1.725 (95% CI 1.206-2.468) times more likely to be willing to participate in the VACCELERATE Volunteer Registry than respondents from Southern European countries. Conclusions: Factors discouraging participants from joining vaccine trial registries or clinical trials primarily include concerns of the safety of novel vaccines and a lack of trust in those involved in vaccine development. These outcomes aid in identifying issues and setbacks in present registries, providing the VACCELERATE network with feedback on how to potentially increase participation and enrollment in trials across Europe. Development of European health communication strategies among diverse public communities, especially via PAGs, is the key for increasing patients’ willingness to participate in clinical studies. %M 38573762 %R 10.2196/47241 %U https://publichealth.jmir.org/2024/1/e47241 %U https://doi.org/10.2196/47241 %U http://www.ncbi.nlm.nih.gov/pubmed/38573762 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53367 %T Moving Biosurveillance Beyond Coded Data Using AI for Symptom Detection From Physician Notes: Retrospective Cohort Study %A McMurry,Andrew J %A Zipursky,Amy R %A Geva,Alon %A Olson,Karen L %A Jones,James R %A Ignatov,Vladimir %A Miller,Timothy A %A Mandl,Kenneth D %+ Computational Health Informatics Program, Boston Children's Hospital, Landmark 5506 Mail Stop BCH3187, 401 Park Drive, Boston, MA, 02215, United States, 1 6173554145, kenneth_mandl@harvard.edu %K natural language processing %K COVID-19 %K artificial intelligence %K AI %K public health, biosurveillance %K surveillance %K respiratory %K infectious %K pulmonary %K SARS-CoV-2 %K symptom %K symptoms %K detect %K detection %K pipeline %K pipelines %K clinical note %K clinical notes %K documentation %K emergency %K urgent %K pediatric %K pediatrics %K paediatric %K paediatrics %K child %K children %K youth %K adolescent %K adolescents %K teen %K teens %K teenager %K teenagers %K diagnose %K diagnosis %K diagnostic %K diagnostics %D 2024 %7 4.4.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Real-time surveillance of emerging infectious diseases necessitates a dynamically evolving, computable case definition, which frequently incorporates symptom-related criteria. For symptom detection, both population health monitoring platforms and research initiatives primarily depend on structured data extracted from electronic health records. Objective: This study sought to validate and test an artificial intelligence (AI)–based natural language processing (NLP) pipeline for detecting COVID-19 symptoms from physician notes in pediatric patients. We specifically study patients presenting to the emergency department (ED) who can be sentinel cases in an outbreak. Methods: Subjects in this retrospective cohort study are patients who are 21 years of age and younger, who presented to a pediatric ED at a large academic children’s hospital between March 1, 2020, and May 31, 2022. The ED notes for all patients were processed with an NLP pipeline tuned to detect the mention of 11 COVID-19 symptoms based on Centers for Disease Control and Prevention (CDC) criteria. For a gold standard, 3 subject matter experts labeled 226 ED notes and had strong agreement (F1-score=0.986; positive predictive value [PPV]=0.972; and sensitivity=1.0). F1-score, PPV, and sensitivity were used to compare the performance of both NLP and the International Classification of Diseases, 10th Revision (ICD-10) coding to the gold standard chart review. As a formative use case, variations in symptom patterns were measured across SARS-CoV-2 variant eras. Results: There were 85,678 ED encounters during the study period, including 4% (n=3420) with patients with COVID-19. NLP was more accurate at identifying encounters with patients that had any of the COVID-19 symptoms (F1-score=0.796) than ICD-10 codes (F1-score =0.451). NLP accuracy was higher for positive symptoms (sensitivity=0.930) than ICD-10 (sensitivity=0.300). However, ICD-10 accuracy was higher for negative symptoms (specificity=0.994) than NLP (specificity=0.917). Congestion or runny nose showed the highest accuracy difference (NLP: F1-score=0.828 and ICD-10: F1-score=0.042). For encounters with patients with COVID-19, prevalence estimates of each NLP symptom differed across variant eras. Patients with COVID-19 were more likely to have each NLP symptom detected than patients without this disease. Effect sizes (odds ratios) varied across pandemic eras. Conclusions: This study establishes the value of AI-based NLP as a highly effective tool for real-time COVID-19 symptom detection in pediatric patients, outperforming traditional ICD-10 methods. It also reveals the evolving nature of symptom prevalence across different virus variants, underscoring the need for dynamic, technology-driven approaches in infectious disease surveillance. %M 38573752 %R 10.2196/53367 %U https://www.jmir.org/2024/1/e53367 %U https://doi.org/10.2196/53367 %U http://www.ncbi.nlm.nih.gov/pubmed/38573752 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52047 %T Postpandemic Sentinel Surveillance of Respiratory Diseases in the Context of the World Health Organization Mosaic Framework: Protocol for a Development and Evaluation Study Involving the English Primary Care Network 2023-2024 %A Gu,Xinchun %A Watson,Conall %A Agrawal,Utkarsh %A Whitaker,Heather %A Elson,William H. %A Anand,Sneha %A Borrow,Ray %A Buckingham,Anna %A Button,Elizabeth %A Curtis,Lottie %A Dunn,Dominic %A Elliot,Alex J. %A Ferreira,Filipa %A Goudie,Rosalind %A Hoang,Uy %A Hoschler,Katja %A Jamie,Gavin %A Kar,Debasish %A Kele,Beatrix %A Leston,Meredith %A Linley,Ezra %A Macartney,Jack %A Marsden,Gemma L %A Okusi,Cecilia %A Parvizi,Omid %A Quinot,Catherine %A Sebastianpillai,Praveen %A Sexton,Vanashree %A Smith,Gillian %A Suli,Timea %A Thomas,Nicholas P B %A Thompson,Catherine %A Todkill,Daniel %A Wimalaratna,Rashmi %A Inada-Kim,Matthew %A Andrews,Nick %A Tzortziou-Brown,Victoria %A Byford,Rachel %A Zambon,Maria %A Lopez-Bernal,Jamie %A de Lusignan,Simon %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 01865 617 283 ext 17 283, simon.delusignan@phc.ox.ac.uk %K sentinel surveillance %K pandemic %K COVID-19 %K human influenza %K influenza vaccines %K respiratory tract infections %K vaccination %K World Health Organization %K respiratory syncytial virus %K phenotype %K computerized medical record system %D 2024 %7 3.4.2024 %9 Protocol %J JMIR Public Health Surveill %G English %X Background: Prepandemic sentinel surveillance focused on improved management of winter pressures, with influenza-like illness (ILI) being the key clinical indicator. The World Health Organization (WHO) global standards for influenza surveillance include monitoring acute respiratory infection (ARI) and ILI. The WHO’s mosaic framework recommends that the surveillance strategies of countries include the virological monitoring of respiratory viruses with pandemic potential such as influenza. The Oxford-Royal College of General Practitioner Research and Surveillance Centre (RSC) in collaboration with the UK Health Security Agency (UKHSA) has provided sentinel surveillance since 1967, including virology since 1993. Objective: We aim to describe the RSC’s plans for sentinel surveillance in the 2023-2024 season and evaluate these plans against the WHO mosaic framework. Methods: Our approach, which includes patient and public involvement, contributes to surveillance objectives across all 3 domains of the mosaic framework. We will generate an ARI phenotype to enable reporting of this indicator in addition to ILI. These data will support UKHSA’s sentinel surveillance, including vaccine effectiveness and burden of disease studies. The panel of virology tests analyzed in UKHSA’s reference laboratory will remain unchanged, with additional plans for point-of-care testing, pneumococcus testing, and asymptomatic screening. Our sampling framework for serological surveillance will provide greater representativeness and more samples from younger people. We will create a biomedical resource that enables linkage between clinical data held in the RSC and virology data, including sequencing data, held by the UKHSA. We describe the governance framework for the RSC. Results: We are co-designing our communication about data sharing and sampling, contextualized by the mosaic framework, with national and general practice patient and public involvement groups. We present our ARI digital phenotype and the key data RSC network members are requested to include in computerized medical records. We will share data with the UKHSA to report vaccine effectiveness for COVID-19 and influenza, assess the disease burden of respiratory syncytial virus, and perform syndromic surveillance. Virological surveillance will include COVID-19, influenza, respiratory syncytial virus, and other common respiratory viruses. We plan to pilot point-of-care testing for group A streptococcus, urine tests for pneumococcus, and asymptomatic testing. We will integrate test requests and results with the laboratory-computerized medical record system. A biomedical resource will enable research linking clinical data to virology data. The legal basis for the RSC’s pseudonymized data extract is The Health Service (Control of Patient Information) Regulations 2002, and all nonsurveillance uses require research ethics approval. Conclusions: The RSC extended its surveillance activities to meet more but not all of the mosaic framework’s objectives. We have introduced an ARI indicator. We seek to expand our surveillance scope and could do more around transmissibility and the benefits and risks of nonvaccine therapies. %M 38569175 %R 10.2196/52047 %U https://publichealth.jmir.org/2024/1/e52047 %U https://doi.org/10.2196/52047 %U http://www.ncbi.nlm.nih.gov/pubmed/38569175 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53948 %T The Impact of Optimal Glycemic Control on Tuberculosis Treatment Outcomes in Patients With Diabetes Mellitus: Systematic Review and Meta-Analysis %A Zhao,Li %A Gao,Feng %A Zheng,Chunlan %A Sun,Xuezhi %+ Department of Tuberculosis III, Wuhan Pulmonary Hospital, Hubei Province, Wuhan, 430030, China, 86 15871745280, sxz16032002@163.com %K optical glycemic control %K poor glycemic control %K tuberculosis treatment %K diabetes mellitus %K health management, healthcare %K health care %K glycemic control %K tuberculosis %K TB %K DM %K diabetes %K systematic review %K meta-analysis %K risks %K treatment %K treatment outcome %K mortality %K patients %K burden %K disease burden %D 2024 %7 2.4.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Diabetes mellitus (DM) increases the risk of developing tuberculosis (TB), and optimal glycemic control has been shown to reduce the risk of complications and improve the TB treatment outcomes in patients with DM. Objective: This study aims to investigate the role of glycemic control in improving TB treatment outcomes among patients with DM. Methods: MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials databases were searched for randomized controlled trials (RCTs) assessing the impact of oral glycemic control in patients with TB who have DM. Outcomes of interest were radiological findings, treatment success, sputum positivity, and mortality. Evaluations were reported as risk ratios (RRs) with 95% CIs using weighted random-effects models. Results: The analysis included 6919 patients from 7 observational studies. Our meta-analysis showed significant differences between patients with optimal glycemic control and those with poor glycemic control with regard to improved treatment outcomes (RR 1.13, 95% CI 1.02-1.25; P=.02; I²=65%), reduced sputum positivity (RR 0.23, 95% CI 0.09-0.61; P=.003; I²=66%), and fewer cavitary lesions (RR 0.59, 95% CI 0.51-0.68; P<.001; I²=0%) in radiological findings. There was no significant difference between the 2 groups in terms of mortality (RR 0.57, 95% CI 0.22-1.49; P=.25; I²=0%), multilobar involvement (RR 0.57, 95% CI 0.22-1.49; P=.25; I²=0%) on radiologic examination, and upper lobe (RR 0.94, 95% CI 0.76-1.17; P=.58; I²=0%) and lower lobe (RR 1.05, 95% CI 0.48-2.30; P=.91; I²=75%) involvement on radiologic examination. Conclusions: We concluded that optimal glycemic control is crucial for reducing susceptibility, minimizing complications, and improving treatment outcomes in patients with TB with DM. Emphasizing effective health management and health care strategies are essential in achieving this control. Integrating comprehensive care among patients with TB with DM will enhance patient outcomes and alleviate the burden of disease in this population. Trial Registration: PROSPERO CRD42023427362; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=427362 %M 38564244 %R 10.2196/53948 %U https://publichealth.jmir.org/2024/1/e53948 %U https://doi.org/10.2196/53948 %U http://www.ncbi.nlm.nih.gov/pubmed/38564244 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50189 %T Sex Differences in Clustering Unhealthy Lifestyles Among Survivors of COVID-19: Latent Class Analysis %A Le,Lan T H %A Hoang,Thi Ngoc Anh %A Nguyen,Tan T %A Dao,Tien D %A Do,Binh N %A Pham,Khue M %A Vu,Vinh H %A Pham,Linh V %A Nguyen,Lien T H %A Nguyen,Hoang C %A Tran,Tuan V %A Nguyen,Trung H %A Nguyen,Anh T %A Nguyen,Hoan V %A Nguyen,Phuoc B %A Nguyen,Hoai T T %A Pham,Thu T M %A Le,Thuy T %A Nguyen,Thao T P %A Tran,Cuong Q %A Quach,Ha-Linh %A Nguyen,Kien T %A Duong,Tuyen Van %+ School of Nutrition and Health Sciences, Taipei Medical University, No. 250, Wuxing Street, Taipei, 11031, Taiwan, 886 227361661 ext 6545, tvduong@tmu.edu.tw %K sex difference %K cluster %K lifestyle behavior %K COVID-19 recovery %K latent class analysis %K sex %K unhealthy %K lifestyle %K adult %K long COVID-19 %K infected %K survivor %K public health %K intervention %K promote %K well-being %K COVID-19 %K adults %K mobile phone %D 2024 %7 2.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has underscored the significance of adopting healthy lifestyles to mitigate the risk of severe outcomes and long-term consequences. Objective: This study focuses on assessing the prevalence and clustering of 5 unhealthy lifestyle behaviors among Vietnamese adults after recovering from COVID-19, with a specific emphasis on sex differences. Methods: The cross-sectional data of 5890 survivors of COVID-19 in Vietnam were analyzed from December 2021 to October 2022. To examine the sex differences in 5 unhealthy lifestyle behaviors (smoking, drinking, unhealthy diet, physical inactivity, and sedentary behavior), the percentages were plotted along with their corresponding 95% CI for each behavior. Latent class analysis was used to identify 2 distinct classes of individuals based on the clustering of these behaviors: the “less unhealthy” group and the “more unhealthy” group. We examined the sociodemographic characteristics associated with each identified class and used logistic regression to investigate the factors related to the “more unhealthy” group. Results: The majority of individuals (male participants: 2432/2447, 99.4% and female participants: 3411/3443, 99.1%) exhibited at least 1 unhealthy behavior, with male participants being more susceptible to multiple unhealthy behaviors. The male-to-female ratio for having a single behavior was 1.003, but it escalated to 25 for individuals displaying all 5 behaviors. Male participants demonstrated a higher prevalence of combining alcohol intake with sedentary behavior (949/2447, 38.8%) or an unhealthy diet (861/2447, 35.2%), whereas female participants tended to exhibit physical inactivity combined with sedentary behavior (1305/3443, 37.9%) or an unhealthy diet (1260/3443, 36.6%). Married male participants had increased odds of falling into the “more unhealthy” group compared to their single counterparts (odds ratio [OR] 1.45, 95% CI 1.14-1.85), while female participants exhibited lower odds (OR 0.65, 95% CI 0.51-0.83). Female participants who are underweight showed a higher likelihood of belonging to the “more unhealthy” group (OR 1.11, 95% CI 0.89-1.39), but this was not observed among male participants (OR 0.6, 95% CI 0.41-0.89). In both sexes, older age, dependent employment, high education, and obesity were associated with higher odds of being in the “more unhealthy” group. Conclusions: The study identified notable sex differences in unhealthy lifestyle behaviors among survivors of COVID-19. Male survivors are more likely to engage in unhealthy behaviors compared to female survivors. These findings emphasize the importance of tailored public health interventions targeting sex-specific unhealthy behaviors. Specifically, addressing unhealthy habits is crucial for promoting post–COVID-19 health and well-being. %M 38564248 %R 10.2196/50189 %U https://publichealth.jmir.org/2024/1/e50189 %U https://doi.org/10.2196/50189 %U http://www.ncbi.nlm.nih.gov/pubmed/38564248 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47422 %T Timely Pulmonary Tuberculosis Diagnosis Based on the Epidemiological Disease Spectrum: Population-Based Prospective Cohort Study in the Republic of Korea %A Ko,Yousang %A Park,Jae Seuk %A Min,Jinsoo %A Kim,Hyung Woo %A Koo,Hyeon-Kyoung %A Oh,Jee Youn %A Jeong,Yun-Jeong %A Lee,Eunhye %A Yang,Bumhee %A Kim,Ju Sang %A Lee,Sung-Soon %A Kwon,Yunhyung %A Yang,Jiyeon %A Han,Ji yeon %A Jang,You Jin %A Kim,Jinseob %+ Division of Pulmonary, Allergy and Critical Care Medicine, Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Sung-an ro 150, Kangdonggu, Seoul, 05355/82, Republic of Korea, 82 2224 2561, koyus@naver.com %K pulmonary tuberculosis %K disease spectrum %K timely diagnosis %K patient delay %K health care delay %K risk factor %K epidemiological disease %K tuberculosis %K treatment %K TB %K PTB disease spectrum %K mortality %K early diagnosis %D 2024 %7 1.4.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Timely pulmonary tuberculosis (PTB) diagnosis is a global health priority for interrupting transmission and optimizing treatment outcomes. The traditional dichotomous time-divided approach for addressing time delays in diagnosis has limited clinical application because the time delay significantly varies depending on each community in question. Objective: We aimed to reevaluate the diagnosis time delay based on the PTB disease spectrum using a novel scoring system that was applied at the national level in the Republic of Korea. Methods: The Pulmonary Tuberculosis Spectrum Score (PTBSS) was developed based on previously published proposals related to the disease spectrum, and its validity was assessed by examining both all-cause and PTB-related mortality. In our analysis, we integrated the PTBSS into the Korea Tuberculosis Cohort Registry. We evaluated various time delays, including patient, health care, and overall delays, and their system-associated variables in line with each PTBSS. Furthermore, we reclassified the scores into distinct categories of mild (PTBSS=0-1), moderate (PBTBSS=2-3), and severe (PBTBSS=4-6) using a multivariate regression approach. Results: Among the 14,031 Korean patients with active PTB whose data were analyzed from 2018 to 2020, 37% (n=5191), 38% (n=5328), and 25% (n=3512) were classified as having a mild, moderate, and severe disease status, respectively, according to the PTBSS. This classification can therefore reflect the disease spectrum of PTB by considering the correlation of the score with mortality. The time delay patterns differed according to the PTBSS. In health care delays according to the PTBSS, greater PTB disease progression was associated with a shorter diagnosis period, since the condition is microbiologically easy to diagnose. However, with respect to patient delays, the change in elapsed time showed a U-shaped pattern as PTB progressed. This means that a remarkable patient delay in the real-world setting might occur at both apical ends of the spectrum (ie, in both mild and severe cases of PTB). Independent risk factors for a severe PTB pattern were age (adjusted odds ratio 1.014) and male sex (adjusted odds ratio 1.422), whereas no significant risk factor was found for mild PTB. Conclusions: Timely PTB diagnosis should be accomplished. This can be improved with use of the PTBSS, a simple and intuitive scoring system, which can be more helpful in clinical and public health applications compared to the traditional dichotomous time-only approach. %M 38557939 %R 10.2196/47422 %U https://publichealth.jmir.org/2024/1/e47422 %U https://doi.org/10.2196/47422 %U http://www.ncbi.nlm.nih.gov/pubmed/38557939 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e41559 %T Response of Unvaccinated US Adults to Official Information About the Pause in Use of the Johnson & Johnson–Janssen COVID-19 Vaccine: Cross-Sectional Survey Study %A Mishra,Vishala %A Dexter,Joseph P %+ Data Science Initiative, Harvard University, Science and Engineering Complex 1.312-10, 150 Western Avenue, Allston, MA, 02134, United States, 1 8023381330, jdexter@fas.harvard.edu %K Centers for Disease Control and Prevention %K CDC %K COVID-19 %K health communication %K health information %K health literacy %K public health %K risk perception %K SARS-CoV-2 %K vaccine hesitancy %K web-based surveys %D 2024 %7 1.4.2024 %9 Research Letter %J J Med Internet Res %G English %X Using a rapid response web-based survey, we identified gaps in public understanding of the Centers for Disease Control and Prevention’s messaging about the pause in use of the Johnson & Johnson–Janssen COVID-19 vaccine and estimated changes in vaccine hesitancy using counterfactual questions. %M 38557597 %R 10.2196/41559 %U https://www.jmir.org/2024/1/e41559 %U https://doi.org/10.2196/41559 %U http://www.ncbi.nlm.nih.gov/pubmed/38557597 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e53343 %T Identification of Predictors for Clinical Deterioration in Patients With COVID-19 via Electronic Nursing Records: Retrospective Observational Study %A Sung,Sumi %A Kim,Youlim %A Kim,Su Hwan %A Jung,Hyesil %+ Department of Nursing, College of Medicine, Inha University, 100 Inha-ro, Michuhol-gu, Incheon, 22212, Republic of Korea, 82 32 860 8206, hsjung@inha.ac.kr %K COVID-19 %K infectious %K respiratory %K SARS-CoV-2 %K nursing records %K SNOMED CT %K random forest %K logistic regression %K EHR %K EHRs %K machine learning %K documentation %K deterioration %K health records %K health record %K patient record %K patient records %K nursing %K standardization %K standard %K standards %K standardized %K standardize %K nomenclature %K term %K terms %K terminologies %K terminology %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Few studies have used standardized nursing records with Systematized Nomenclature of Medicine–Clinical Terms (SNOMED CT) to identify predictors of clinical deterioration. Objective: This study aims to standardize the nursing documentation records of patients with COVID-19 using SNOMED CT and identify predictive factors of clinical deterioration in patients with COVID-19 via standardized nursing records. Methods: In this study, 57,558 nursing statements from 226 patients with COVID-19 were analyzed. Among these, 45,852 statements were from 207 patients in the stable (control) group and 11,706 from 19 patients in the exacerbated (case) group who were transferred to the intensive care unit within 7 days. The data were collected between December 2019 and June 2022. These nursing statements were standardized using the SNOMED CT International Edition released on November 30, 2022. The 260 unique nursing statements that accounted for the top 90% of 57,558 statements were selected as the mapping source and mapped into SNOMED CT concepts based on their meaning by 2 experts with more than 5 years of SNOMED CT mapping experience. To identify the main features of nursing statements associated with the exacerbation of patient condition, random forest algorithms were used, and optimal hyperparameters were selected for nursing problems or outcomes and nursing procedure–related statements. Additionally, logistic regression analysis was conducted to identify features that determine clinical deterioration in patients with COVID-19. Results: All nursing statements were semantically mapped to SNOMED CT concepts for “clinical finding,” “situation with explicit context,” and “procedure” hierarchies. The interrater reliability of the mapping results was 87.7%. The most important features calculated by random forest were “oxygen saturation below reference range,” “dyspnea,” “tachypnea,” and “cough” in “clinical finding,” and “oxygen therapy,” “pulse oximetry monitoring,” “temperature taking,” “notification of physician,” and “education about isolation for infection control” in “procedure.” Among these, “dyspnea” and “inadequate food diet” in “clinical finding” increased clinical deterioration risk (dyspnea: odds ratio [OR] 5.99, 95% CI 2.25-20.29; inadequate food diet: OR 10.0, 95% CI 2.71-40.84), and “oxygen therapy” and “notification of physician” in “procedure” also increased the risk of clinical deterioration in patients with COVID-19 (oxygen therapy: OR 1.89, 95% CI 1.25-3.05; notification of physician: OR 1.72, 95% CI 1.02-2.97). Conclusions: The study used SNOMED CT to express and standardize nursing statements. Further, it revealed the importance of standardized nursing records as predictive variables for clinical deterioration in patients. %M 38414056 %R 10.2196/53343 %U https://www.jmir.org/2024/1/e53343 %U https://doi.org/10.2196/53343 %U http://www.ncbi.nlm.nih.gov/pubmed/38414056 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e49921 %T The Influence of Joe Wicks on Physical Activity During the COVID-19 Pandemic: Thematic, Location, and Social Network Analysis of X Data %A Ahmed,Wasim %A Aiyenitaju,Opeoluwa %A Chadwick,Simon %A Hardey,Mariann %A Fenton,Alex %+ Management School, University of Stirling, Airthrey Road, Stirling, FK9 4LA, United Kingdom, 44 1482 346311, w.ahmed@hull.ac.uk %K social media %K social network analysis %K COVID-19 %K influencers %K public health %K social network %K physical activity %K promotion %K fitness %K exercise %K workout %K Twitter %K content creation %K communication %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background:  Social media (SM) was essential in promoting physical activity during the COVID-19 pandemic, especially among people confined to their homes. Joe Wicks, a fitness coach, became particularly popular on SM during this time, posting daily workouts that millions of people worldwide followed. Objective:  This study aims to investigate the influence of Joe Wicks on SM and the impact of his content on physical activity levels among the public. Methods:  We used NodeXL Pro (Social Media Research Foundation) to collect data from X (formerly Twitter) over 54 days (March 23, 2020, to May 15, 2020), corresponding to the strictest lockdowns in the United Kingdom. We collected 290,649 posts, which we analyzed using social network analysis, thematic analysis, time-series analysis, and location analysis. Results:  We found that there was significant engagement with content generated by Wicks, including reposts, likes, and comments. The most common types of posts were those that contained images, videos, and text of young people (school-aged children) undertaking physical activity by watching content created by Joe Wicks and posts from schools encouraging pupils to engage with the content. Other shared posts included those that encouraged others to join the fitness classes run by Wicks and those that contained general commentary. We also found that Wicks’ network of influence was extensive and complex. It contained numerous subcommunities and resembled a broadcast network shape. Other influencers added to engagement with Wicks via their networks. Our results show that influencers can create networks of influence that are exhibited in distinctive ways. Conclusions: Our study found that Joe Wicks was a highly influential figure on SM during the COVID-19 pandemic and that his content positively impacted physical activity levels among the public. Our findings suggest that influencers can play an important role in promoting public health and that government officials should consider working with influencers to communicate health messages and promote healthy behaviors. Our study has broader implications beyond the status of fitness influencers. Recognizing the critical role of individuals such as Joe Wicks in terms of health capital should be a critical area of inquiry for governments, public health authorities, and policy makers and mirrors the growing interest in health capital as part of embodied and digital experiences in everyday life. %M 38551627 %R 10.2196/49921 %U https://www.jmir.org/2024/1/e49921 %U https://doi.org/10.2196/49921 %U http://www.ncbi.nlm.nih.gov/pubmed/38551627 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e45864 %T #ProtectOurElders: Analysis of Tweets About Older Asian Americans and Anti-Asian Sentiments During the COVID-19 Pandemic %A Ng,Reuben %A Indran,Nicole %+ Lee Kuan Yew School of Public Policy, National University of Singapore, 469C Bukit Timah Road, Singapore, 259772, Singapore, 65 66013967, spprng@nus.edu.sg %K AAPI %K anti-Asian hate %K anti-Asian %K Asian Americans and Pacific Islanders %K Asian-American %K content analysis %K coronavirus %K COVID-19 %K discourse %K discriminate %K discrimination %K discriminatory %K Pacific Islander %K racial %K racism %K racist %K SARS-CoV-2 %K social media %K tweet %K Twitter %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: A silver lining to the COVID-19 pandemic is that it cast a spotlight on a long-underserved group. The barrage of attacks against older Asian Americans during the crisis galvanized society into assisting them in various ways. On Twitter, now known as X, support for them coalesced around the hashtag #ProtectOurElders. To date, discourse surrounding older Asian Americans has escaped the attention of gerontologists—a gap we seek to fill. Our study serves as a reflection of the level of support that has been extended to older Asian Americans, even as it provides timely insights that will ultimately advance equity for them. Objective: This study explores the kinds of discourse surrounding older Asian Americans during the COVID-19 crisis, specifically in relation to the surge in anti-Asian sentiments. The following questions guide this study: What types of discourse have emerged in relation to older adults in the Asian American community and the need to support them? How do age and race interact to shape these discourses? What are the implications of these discourses for older Asian Americans? Methods: We retrieved tweets (N=6099) through 2 search queries. For the first query, we collated tweets with the hashtag #ProtectOurElders. For the second query, we collected tweets with an age-based term, for example, “elderly” or “old(er) adults(s)” and either the hashtag #StopAAPIHate or #StopAsianHate. Tweets were posted from January 1, 2020, to August 1, 2023. After applying the exclusion criteria, the final data set contained 994 tweets. Inductive and deductive approaches informed our qualitative content analysis. Results: A total of 4 themes emerged, with 50.1% (498/994) of posts framing older Asian Americans as “vulnerable and in need of protection” (theme 1). Tweets in this theme either singled them out as a group in need of protection because of their vulnerable status or discussed initiatives aimed at safeguarding their well-being. Posts in theme 2 (309/994, 31%) positioned them as “heroic and resilient.” Relevant tweets celebrated older Asian Americans for displaying tremendous strength in the face of attack or described them as individuals not to be trifled with. Tweets in theme 3 (102/994, 10.2%) depicted them as “immigrants who have made selfless contributions and sacrifices.” Posts in this section referenced the immense sacrifices made by older Asian Americans as they migrated to the United States, as well as the systemic barriers they had to overcome. Posts in theme 4 (85/994, 8.5%) venerated older Asian Americans as “worthy of honor.” Conclusions: The COVID-19 crisis had the unintended effect of garnering greater support for older Asian Americans. It is consequential that support be extended to this group not so much by virtue of their perceived vulnerability but more so in view of their boundless contributions and sacrifices. %M 38551624 %R 10.2196/45864 %U https://www.jmir.org/2024/1/e45864 %U https://doi.org/10.2196/45864 %U http://www.ncbi.nlm.nih.gov/pubmed/38551624 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e48130 %T Medical Misinformation in Polish on the World Wide Web During the COVID-19 Pandemic Period: Infodemiology Study %A Chlabicz,Małgorzata %A Nabożny,Aleksandra %A Koszelew,Jolanta %A Łaguna,Wojciech %A Szpakowicz,Anna %A Sowa,Paweł %A Budny,Wojciech %A Guziejko,Katarzyna %A Róg-Makal,Magdalena %A Pancewicz,Sławomir %A Kondrusik,Maciej %A Czupryna,Piotr %A Cudowska,Beata %A Lebensztejn,Dariusz %A Moniuszko-Malinowska,Anna %A Wierzbicki,Adam %A Kamiński,Karol A %+ Department of Software Engineering, Gdańsk University of Technology, ul. Gabriela Narutowicza 11/12, Gdańsk, 80-233, Poland, 48 58 348 67 00, alenaboz@pg.edu.pl %K infodemic %K fake news %K information credibility %K online health information %K evidence based medicine %K EBM %K false %K credibility %K credible %K health information %K online information %K information quality %K infoveillance %K infodemiology %K misinformation %K disinformation %D 2024 %7 29.3.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Although researchers extensively study the rapid generation and spread of misinformation about the novel coronavirus during the pandemic, numerous other health-related topics are contaminating the internet with misinformation that have not received as much attention. Objective: This study aims to gauge the reach of the most popular medical content on the World Wide Web, extending beyond the confines of the pandemic. We conducted evaluations of subject matter and credibility for the years 2021 and 2022, following the principles of evidence-based medicine with assessments performed by experienced clinicians. Methods: We used 274 keywords to conduct web page searches through the BuzzSumo Enterprise Application. These keywords were chosen based on medical topics derived from surveys administered to medical practitioners. The search parameters were confined to 2 distinct date ranges: (1) January 1, 2021, to December 31, 2021; (2) January 1, 2022, to December 31, 2022. Our searches were specifically limited to web pages in the Polish language and filtered by the specified date ranges. The analysis encompassed 161 web pages retrieved in 2021 and 105 retrieved in 2022. Each web page underwent scrutiny by a seasoned doctor to assess its credibility, aligning with evidence-based medicine standards. Furthermore, we gathered data on social media engagements associated with the web pages, considering platforms such as Facebook, Pinterest, Reddit, and Twitter. Results: In 2022, the prevalence of unreliable information related to COVID-19 saw a noteworthy decline compared to 2021. Specifically, the percentage of noncredible web pages discussing COVID-19 and general vaccinations decreased from 57% (43/76) to 24% (6/25) and 42% (10/25) to 30% (3/10), respectively. However, during the same period, there was a considerable uptick in the dissemination of untrustworthy content on social media pertaining to other medical topics. The percentage of noncredible web pages covering cholesterol, statins, and cardiology rose from 11% (3/28) to 26% (9/35) and from 18% (5/28) to 26% (6/23), respectively. Conclusions: Efforts undertaken during the COVID-19 pandemic to curb the dissemination of misinformation seem to have yielded positive results. Nevertheless, our analysis suggests that these interventions need to be consistently implemented across both established and emerging medical subjects. It appears that as interest in the pandemic waned, other topics gained prominence, essentially “filling the vacuum” and necessitating ongoing measures to address misinformation across a broader spectrum of health-related subjects. %M 38551638 %R 10.2196/48130 %U https://www.jmir.org/2024/1/e48130 %U https://doi.org/10.2196/48130 %U http://www.ncbi.nlm.nih.gov/pubmed/38551638 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e52587 %T Data Sharing in a Decentralized Public Health System: Lessons From COVID-19 Syndromic Surveillance %A Rigby,Ryan C %A Ferdinand,Alva O %A Kum,Hye-Chung %A Schmit,Cason %+ Population Informatics Lab, Department of Health Policy and Management, Texas A&M University School of Public Health, 212 Adriance Lab Rd, College Station, TX, 77845, United States, 1 9794360277, schmit@tamu.edu %K syndromic surveillance %K federalism %K COVID-19 %K public health %K SARS-CoV-2 %K COVID-19 pandemic %K United States %K decentralized %K data sharing %K digital health %K ethical guidelines %K risk score %K technology %K innovation %K information system %K collaborative framework %K infodemiology %K digital technology %K health information %K health data %K health policy %K surveillance %D 2024 %7 28.3.2024 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 pandemic revealed that data sharing challenges persist across public health information systems. We examine the specific challenges in sharing syndromic surveillance data between state, local, and federal partners. These challenges are complicated by US federalism, which decentralizes public health response and creates friction between different government units. The current policies restrict federal access to state and local syndromic surveillance data without each jurisdiction’s consent. These policies frustrate legitimate federal governmental interests and are contrary to ethical guidelines for public health data sharing. Nevertheless, state and local public health agencies must continue to play a central role as there are important risks in interpreting syndromic surveillance data without understanding local contexts. Policies establishing a collaborative framework will be needed to support data sharing between federal, state, and local partners. A collaborative framework would be enhanced by a governance group with robust state and local involvement and policy guardrails to ensure the use of data is appropriate. These policy and relational challenges must be addressed to actualize a truly national public health information system. %M 38546731 %R 10.2196/52587 %U https://publichealth.jmir.org/2024/1/e52587 %U https://doi.org/10.2196/52587 %U http://www.ncbi.nlm.nih.gov/pubmed/38546731 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51152 %T A Snapshot of COVID-19 Vaccine Discourse Related to Ethnic Minority Communities in the United Kingdom Between January and April 2022: Mixed Methods Analysis %A Ullah,Nazifa %A Martin,Sam %A Poduval,Shoba %+ Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 (0)20 3549 5969, s.poduval@ucl.ac.uk %K COVID-19 %K ethnic minorities %K vaccine %K hesitancy %K social media %K discourse %K minority groups %D 2024 %7 26.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Existing literature highlights the role of social media as a key source of information for the public during the COVID-19 pandemic and its influence on vaccination attempts. Yet there is little research exploring its role in the public discourse specifically among ethnic minority communities, who have the highest rates of vaccine hesitancy (delay or refusal of vaccination despite availability of services). Objective: This study aims to understand the discourse related to minority communities on social media platforms Twitter and YouTube. Methods: Social media data from the United Kingdom was extracted from Twitter and YouTube using the software Netlytics and YouTube Data Tools to provide a “snapshot” of the discourse between January and April 2022. A mixed method approach was used where qualitative data were contextualized into codes. Network analysis was applied to provide insight into the most frequent and weighted keywords and topics of conversations. Results: A total of 260 tweets and 156 comments from 4 YouTube videos were included in our analysis. Our data suggests that the most popular topics of conversation during the period sampled were related to communication strategies adopted during the booster vaccine rollout. These were noted to be divisive in nature and linked to wider conversations around racism and historical mistrust toward institutions. Conclusions: Our study suggests a shift in narrative from concerns about the COVID-19 vaccine itself, toward the strategies used in vaccination implementation, in particular the targeting of ethnic minority groups through vaccination campaigns. The implications for public health communication during crisis management in a pandemic context include acknowledging wider experiences of discrimination when addressing ethnic minority communities. %M 38530334 %R 10.2196/51152 %U https://formative.jmir.org/2024/1/e51152 %U https://doi.org/10.2196/51152 %U http://www.ncbi.nlm.nih.gov/pubmed/38530334 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e43554 %T The Impact of Wireless Emergency Alerts on a Floating Population in Seoul, South Korea: Panel Data Analysis %A Yoon,Sungwook %A Lim,Hyungsoo %A Park,Sungho %+ Business School, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 2 880 6949, spark104@snu.ac.kr %K COVID-19 %K empirical identification %K floating population %K social distancing %K wireless emergency alert %D 2024 %7 25.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Wireless emergency alerts (WEAs), which deliver disaster information directly to individuals’ mobile phones, have been widely used to provide information related to COVID-19 and to encourage compliance with social distancing guidelines during the COVID-19 pandemic. The floating population refers to the number of people temporarily staying in a specific area, and this demographic data can be a useful indicator to understand the level of social distancing people are complying with during the COVID-19 pandemic. Objective: This study aimed to empirically analyze the impact of WEAs on the floating population where WEAs were transmitted in the early stages of the COVID-19 pandemic. As most WEA messages focus on compliance with the government’s social distancing guidelines, one of the goals of transmitting WEAs during the COVID-19 pandemic is to control the floating population at an appropriate level. Methods: We investigated the empirical impact of WEAs on the floating population across 25 districts in Seoul by estimating a panel regression model at the district-hour level with a series of fixed effects. The main independent variables were the number of instant WEAs, the daily cumulative number of WEAs, the total cumulative number of WEAs, and information extracted from WEAs by natural language processing at the district-hour level. The data set provided a highly informative empirical setting as WEAs were sent by different local governments with various identifiable district-hour–level data. Results: The estimates of the impact of WEAs on the floating population were significantly negative (–0.013, P=.02 to –0.014, P=.01) across all specifications, implying that an additional WEA issuance reduced the floating population by 1.3% (=100(1–e–0.013)) to 1.4% (=100(1–e–0.014)). Although the coefficients of DCN (the daily cumulative number of WEAs) were also negative (–0.0034, P=.34 to –0.0052, P=.15) across all models, they were not significant. The impact of WEAs on the floating population doubled (–0.025, P=.02 to –0.033, P=.005) when the first 82 days of observations were used as subsamples to reduce the possibility of people blocking WEAs. Conclusions: Our results suggest that issuing WEAs and distributing information related to COVID-19 to a specific district was associated with a decrease in the floating population of that district. Furthermore, among the various types of information in the WEAs, location information was the only significant type of information that was related to a decrease in the floating population. This study makes important contributions. First, this study measured the impact of WEAs in a highly informative empirical setting. Second, this study adds to the existing literature on the mechanisms by which WEAs can affect public response. Lastly, this study has important implications for making optimal WEAs and suggests that location information should be included. %M 38526536 %R 10.2196/43554 %U https://publichealth.jmir.org/2024/1/e43554 %U https://doi.org/10.2196/43554 %U http://www.ncbi.nlm.nih.gov/pubmed/38526536 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e50799 %T Use of Sentinel Surveillance Platforms for Monitoring SARS-CoV-2 Activity: Evidence From Analysis of Kenya Influenza Sentinel Surveillance Data %A Owusu,Daniel %A Ndegwa,Linus K %A Ayugi,Jorim %A Kinuthia,Peter %A Kalani,Rosalia %A Okeyo,Mary %A Otieno,Nancy A %A Kikwai,Gilbert %A Juma,Bonventure %A Munyua,Peninah %A Kuria,Francis %A Okunga,Emmanuel %A Moen,Ann C %A Emukule,Gideon O %+ Influenza Division, US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30333, United States, 1 4044014398, pgv7@cdc.gov %K SARS-CoV-2 %K COVID-19 %K influenza %K sentinel surveillance %K Kenya %K epidemic %K local outbreak %K respiratory infection %K surveillance %K cocirculation %K monitoring %K respiratory pathogen %D 2024 %7 25.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Little is known about the cocirculation of influenza and SARS-CoV-2 viruses during the COVID-19 pandemic and the use of respiratory disease sentinel surveillance platforms for monitoring SARS-CoV-2 activity in sub-Saharan Africa. Objective: We aimed to describe influenza and SARS-CoV-2 cocirculation in Kenya and how the SARS-CoV-2 data from influenza sentinel surveillance correlated with that of universal national surveillance. Methods: From April 2020 to March 2022, we enrolled 7349 patients with severe acute respiratory illness or influenza-like illness at 8 sentinel influenza surveillance sites in Kenya and collected demographic, clinical, underlying medical condition, vaccination, and exposure information, as well as respiratory specimens, from them. Respiratory specimens were tested for influenza and SARS-CoV-2 by real-time reverse transcription polymerase chain reaction. The universal national-level SARS-CoV-2 data were also obtained from the Kenya Ministry of Health. The universal national-level SARS-CoV-2 data were collected from all health facilities nationally, border entry points, and contact tracing in Kenya. Epidemic curves and Pearson r were used to describe the correlation between SARS-CoV-2 positivity in data from the 8 influenza sentinel sites in Kenya and that of the universal national SARS-CoV-2 surveillance data. A logistic regression model was used to assess the association between influenza and SARS-CoV-2 coinfection with severe clinical illness. We defined severe clinical illness as any of oxygen saturation <90%, in-hospital death, admission to intensive care unit or high dependence unit, mechanical ventilation, or a report of any danger sign (ie, inability to drink or eat, severe vomiting, grunting, stridor, or unconsciousness in children younger than 5 years) among patients with severe acute respiratory illness. Results: Of the 7349 patients from the influenza sentinel surveillance sites, 76.3% (n=5606) were younger than 5 years. We detected any influenza (A or B) in 8.7% (629/7224), SARS-CoV-2 in 10.7% (768/7199), and coinfection in 0.9% (63/7165) of samples tested. Although the number of samples tested for SARS-CoV-2 from the sentinel surveillance was only 0.2% (60 per week vs 36,000 per week) of the number tested in the universal national surveillance, SARS-CoV-2 positivity in the sentinel surveillance data significantly correlated with that of the universal national surveillance (Pearson r=0.58; P<.001). The adjusted odds ratios (aOR) of clinical severe illness among participants with coinfection were similar to those of patients with influenza only (aOR 0.91, 95% CI 0.47-1.79) and SARS-CoV-2 only (aOR 0.92, 95% CI 0.47-1.82). Conclusions: Influenza substantially cocirculated with SARS-CoV-2 in Kenya. We found a significant correlation of SARS-CoV-2 positivity in the data from 8 influenza sentinel surveillance sites with that of the universal national SARS-CoV-2 surveillance data. Our findings indicate that the influenza sentinel surveillance system can be used as a sustainable platform for monitoring respiratory pathogens of pandemic potential or public health importance. %M 38526537 %R 10.2196/50799 %U https://publichealth.jmir.org/2024/1/e50799 %U https://doi.org/10.2196/50799 %U http://www.ncbi.nlm.nih.gov/pubmed/38526537 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e43585 %T Influence of Environmental Factors and Genome Diversity on Cumulative COVID-19 Cases in the Highland Region of China: Comparative Correlational Study %A Deji,Zhuoga %A Tong,Yuantao %A Huang,Honglian %A Zhang,Zeyu %A Fang,Meng %A Crabbe,M James C %A Zhang,Xiaoyan %A Wang,Ying %+ Department of Clinical Laboratory Medicine Center, Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine, 110 Ganhe Rd, Shanghai, 200437, China, 86 021 65161782, nadger_wang@139.com %K COVID-19 %K environmental factors %K altitude %K population density %K virus mutation %D 2024 %7 25.3.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: The novel coronavirus SARS-CoV-2 caused the global COVID-19 pandemic. Emerging reports support lower mortality and reduced case numbers in highland areas; however, comparative studies on the cumulative impact of environmental factors and viral genetic diversity on COVID-19 infection rates have not been performed to date. Objective: The aims of this study were to determine the difference in COVID-19 infection rates between high and low altitudes, and to explore whether the difference in the pandemic trend in the high-altitude region of China compared to that of the lowlands is influenced by environmental factors, population density, and biological mechanisms. Methods: We examined the correlation between population density and COVID-19 cases through linear regression. A zero-shot model was applied to identify possible factors correlated to COVID-19 infection. We further analyzed the correlation of meteorological and air quality factors with infection cases using the Spearman correlation coefficient. Mixed-effects multiple linear regression was applied to evaluate the associations between selected factors and COVID-19 cases adjusting for covariates. Lastly, the relationship between environmental factors and mutation frequency was evaluated using the same correlation techniques mentioned above. Results: Among the 24,826 confirmed COVID-19 cases reported from 40 cities in China from January 23, 2020, to July 7, 2022, 98.4% (n=24,430) were found in the lowlands. Population density was positively correlated with COVID-19 cases in all regions (ρ=0.641, P=.003). In high-altitude areas, the number of COVID-19 cases was negatively associated with temperature, sunlight hours, and UV index (P=.003, P=.001, and P=.009, respectively) and was positively associated with wind speed (ρ=0.388, P<.001), whereas no correlation was found between meteorological factors and COVID-19 cases in the lowlands. After controlling for covariates, the mixed-effects model also showed positive associations of fine particulate matter (PM2.5) and carbon monoxide (CO) with COVID-19 cases (P=.002 and P<.001, respectively). Sequence variant analysis showed lower genetic diversity among nucleotides for each SARS-CoV-2 genome (P<.001) and three open reading frames (P<.001) in high altitudes compared to 300 sequences analyzed from low altitudes. Moreover, the frequencies of 44 nonsynonymous mutations and 32 synonymous mutations were significantly different between the high- and low-altitude groups (P<.001, mutation frequency>0.1). Key nonsynonymous mutations showed positive correlations with altitude, wind speed, and air pressure and showed negative correlations with temperature, UV index, and sunlight hours. Conclusions: By comparison with the lowlands, the number of confirmed COVID-19 cases was substantially lower in high-altitude regions of China, and the population density, temperature, sunlight hours, UV index, wind speed, PM2.5, and CO influenced the cumulative pandemic trend in the highlands. The identified influence of environmental factors on SARS-CoV-2 sequence variants adds knowledge of the impact of altitude on COVID-19 infection, offering novel suggestions for preventive intervention. %M 38526532 %R 10.2196/43585 %U https://www.i-jmr.org/2024/1/e43585 %U https://doi.org/10.2196/43585 %U http://www.ncbi.nlm.nih.gov/pubmed/38526532 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e54840 %T Chatbots and COVID-19: Taking Stock of the Lessons Learned %A Arnold,Virginia %A Purnat,Tina D %A Marten,Robert %A Pattison,Andrew %A Gouda,Hebe %+ Department of Health Promotion, Division of UHC Healthier Populations, World Health Organization, Avenue Appia 20, Geneva, 1211, Switzerland, 41 793865070, goudah@who.int %K chatbots %K COVID-19 %K health %K public health %K pandemic %K health care %D 2024 %7 21.3.2024 %9 Editorial %J J Med Internet Res %G English %X While digital innovation in health was already rapidly evolving, the COVID-19 pandemic has accelerated the generation of digital technology tools, such as chatbots, to help increase access to crucial health information and services to those who were cut off or had limited contact with health services. This theme issue titled “Chatbots and COVID-19” presents articles from researchers and practitioners across the globe, describing the development, implementation, and evaluation of chatbots designed to address a wide range of health concerns and services. In this editorial, we present some of the key challenges and lessons learned arising from the content of this theme issue. Most notably, we note that a stronger evidence base is needed to ensure that chatbots and other digital tools are developed to best serve the needs of population health. %M 38512309 %R 10.2196/54840 %U https://www.jmir.org/2024/1/e54840 %U https://doi.org/10.2196/54840 %U http://www.ncbi.nlm.nih.gov/pubmed/38512309 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46903 %T Revealing the Mysteries of Population Mobility Amid the COVID-19 Pandemic in Canada: Comparative Analysis With Internet of Things–Based Thermostat Data and Google Mobility Insights %A Sahu,Kirti Sundar %A Dubin,Joel A %A Majowicz,Shannon E %A Liu,Sam %A Morita,Plinio P %+ School of Public Health Sciences, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567 ext 31372, plinio.morita@uwaterloo.ca %K population-level health indicators %K internet of things %K public health surveillance %K mobility %K risk factors %K chronic diseases %K chronic %K risk %K surveillance %K mobility %K movement %K sensor %K population %D 2024 %7 20.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic necessitated public health policies to limit human mobility and curb infection spread. Human mobility, which is often underestimated, plays a pivotal role in health outcomes, impacting both infectious and chronic diseases. Collecting precise mobility data is vital for understanding human behavior and informing public health strategies. Google’s GPS-based location tracking, which is compiled in Google Mobility Reports, became the gold standard for monitoring outdoor mobility during the pandemic. However, indoor mobility remains underexplored. Objective: This study investigates in-home mobility data from ecobee’s smart thermostats in Canada (February 2020 to February 2021) and compares it directly with Google’s residential mobility data. By assessing the suitability of smart thermostat data, we aim to shed light on indoor mobility patterns, contributing valuable insights to public health research and strategies. Methods: Motion sensor data were acquired from the ecobee “Donate Your Data” initiative via Google’s BigQuery cloud platform. Concurrently, residential mobility data were sourced from the Google Mobility Report. This study centered on 4 Canadian provinces—Ontario, Quebec, Alberta, and British Columbia—during the period from February 15, 2020, to February 14, 2021. Data processing, analysis, and visualization were conducted on the Microsoft Azure platform using Python (Python Software Foundation) and R programming languages (R Foundation for Statistical Computing). Our investigation involved assessing changes in mobility relative to the baseline in both data sets, with the strength of this relationship assessed using Pearson and Spearman correlation coefficients. We scrutinized daily, weekly, and monthly variations in mobility patterns across the data sets and performed anomaly detection for further insights. Results: The results revealed noteworthy week-to-week and month-to-month shifts in population mobility within the chosen provinces, aligning with pandemic-driven policy adjustments. Notably, the ecobee data exhibited a robust correlation with Google’s data set. Examination of Google’s daily patterns detected more pronounced mobility fluctuations during weekdays, a trend not mirrored in the ecobee data. Anomaly detection successfully identified substantial mobility deviations coinciding with policy modifications and cultural events. Conclusions: This study’s findings illustrate the substantial influence of the Canadian stay-at-home and work-from-home policies on population mobility. This impact was discernible through both Google’s out-of-house residential mobility data and ecobee’s in-house smart thermostat data. As such, we deduce that smart thermostats represent a valid tool for facilitating intelligent monitoring of population mobility in response to policy-driven shifts. %M 38506901 %R 10.2196/46903 %U https://publichealth.jmir.org/2024/1/e46903 %U https://doi.org/10.2196/46903 %U http://www.ncbi.nlm.nih.gov/pubmed/38506901 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 4 %N %P e51113 %T Government-Nongovernmental Organization (NGO) Collaboration in Macao’s COVID-19 Vaccine Promotion: Social Media Case Study %A Xian,Xuechang %A Neuwirth,Rostam J %A Chang,Angela %+ Department of Communication, University of Macau, Avenida da Universidade, Taipa, Macao SAR, 999078, China, 86 88228991, wychang@um.edu.mo %K COVID-19 %K government %K vaccine %K automated content analysis %K Granger causality test %K network agenda setting %K QAP %K social media %D 2024 %7 19.3.2024 %9 Original Paper %J JMIR Infodemiology %G English %X 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. %M 38502184 %R 10.2196/51113 %U https://infodemiology.jmir.org/2024/1/e51113 %U https://doi.org/10.2196/51113 %U http://www.ncbi.nlm.nih.gov/pubmed/38502184 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53040 %T Investigating Nonspecific Effects of the Live-Attenuated Japanese Encephalitis Vaccine on Lower Respiratory Tract Infections in Children Aged 25-35 Months: Retrospective Cohort Study %A Zhan,Siyi %A Lin,Hongbo %A Yang,Yingying %A Chen,Tao %A Mao,Sheng %A Fu,Chuanxi %+ The Institute of Infectious Disease and Vaccine, School of Public Health, Zhejiang Chinese Medical University, 548 Binwen Road, Binjiang District, Hangzhou, 310053, China, 86 13675863596, fuchuanxi@zcmu.edu.cn %K nonspecific effect of vaccines %K Japanese encephalitis vaccine %K lower respiratory tract infectious diseases %K trained immunity %K Anderson Gill model %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Live attenuated vaccines may be used to prevent nontargeted diseases such as lower respiratory tract infections (LRTIs) due to their nonspecific effects (NSEs). Objective: We aimed to analyze the NSEs of the Japanese encephalitis vaccine on pediatric LRTIs in children aged 25 months to 35 months. Methods: A retrospective cohort study was conducted by using a population-based electronic health record database in Zhejiang, China. Enrolled participants were children born from January 1, 2017, to December 31, 2017, and who were inoculated with the live-attenuated Japanese encephalitis vaccine (JE-L) or inactivated Japanese encephalitis vaccine (JE-I) as the most recent vaccine at 24 months of age. The study was carried out between January 1, 2019, and December 31, 2019. All inpatient and outpatient hospital visits for LRTIs among children aged 25 months to 35 months were recorded. The Andersen-Gill model was used to assess the NSEs of JE-L against LRTIs in children and compared with those of JE-I as the most recent vaccine. Results: A total of 810 children born in 2017 were enrolled, of whom 585 received JE-L (JE-L cohort) and 225 received JE-I (JE-I cohort) as their last vaccine. The JE-L cohort showed a reduced risk of LRTIs (adjusted hazard ratio [aHR] 0.537, 95% CI 0.416-0.693), including pneumonia (aHR 0.501, 95% CI 0.393-0.638) and acute bronchitis (aHR 0.525, 95% CI 0.396-0.698) at 25 months to 35 months of age. The NSEs provided by JE-L were especially pronounced in female children (aHR 0.305, 95% CI 0.198-0.469) and children without chronic diseases (aHR 0.553, 95% CI 0.420-0.729), without siblings (aHR 0.361, 95% CI 0.255-0.511), with more than 30 inpatient and outpatient hospital visits prior to 24 months of age (aHR 0.163, 95% CI 0.091-0.290), or with 5 to 10 inpatient and outpatient hospital visits due to infectious diseases prior to 24 months old (aHR 0.058, 95% CI 0.017-0.202). Conclusions: Compared with JE-I, receiving JE-L as the most recent vaccine was associated with lower risk of inpatient and outpatient hospital visits for LRTIs among children aged 25 months to 35 months. The nature of NSEs induced by JE-L should be considered for policymakers and physicians when recommending JE vaccines to those at high risk of infection from the Japanese encephalitis virus. %M 38498052 %R 10.2196/53040 %U https://publichealth.jmir.org/2024/1/e53040 %U https://doi.org/10.2196/53040 %U http://www.ncbi.nlm.nih.gov/pubmed/38498052 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47979 %T Predicting COVID-19 Vaccination Uptake Using a Small and Interpretable Set of Judgment and Demographic Variables: Cross-Sectional Cognitive Science Study %A Vike,Nicole L %A Bari,Sumra %A Stefanopoulos,Leandros %A Lalvani,Shamal %A Kim,Byoung Woo %A Maglaveras,Nicos %A Block,Martin %A Breiter,Hans C %A Katsaggelos,Aggelos K %+ Department of Computer Science, University of Cincinnati, 2901 Woodside Drive, Cincinnati, OH, 45219, United States, 1 617 413 0953, breitehs@ucmail.uc.edu %K reward %K aversion %K judgment %K relative preference theory %K cognitive science %K behavioral economics %K machine learning %K balanced random forest %K mediation %K moderation %K mobile phone %K smartphone %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite COVID-19 vaccine mandates, many chose to forgo vaccination, raising questions about the psychology underlying how judgment affects these choices. Research shows that reward and aversion judgments are important for vaccination choice; however, no studies have integrated such cognitive science with machine learning to predict COVID-19 vaccine uptake. Objective: This study aims to determine the predictive power of a small but interpretable set of judgment variables using 3 machine learning algorithms to predict COVID-19 vaccine uptake and interpret what profile of judgment variables was important for prediction. Methods: We surveyed 3476 adults across the United States in December 2021. Participants answered demographic, COVID-19 vaccine uptake (ie, whether participants were fully vaccinated), and COVID-19 precaution questions. Participants also completed a picture-rating task using images from the International Affective Picture System. Images were rated on a Likert-type scale to calibrate the degree of liking and disliking. Ratings were computationally modeled using relative preference theory to produce a set of graphs for each participant (minimum R2>0.8). In total, 15 judgment features were extracted from these graphs, 2 being analogous to risk and loss aversion from behavioral economics. These judgment variables, along with demographics, were compared between those who were fully vaccinated and those who were not. In total, 3 machine learning approaches (random forest, balanced random forest [BRF], and logistic regression) were used to test how well judgment, demographic, and COVID-19 precaution variables predicted vaccine uptake. Mediation and moderation were implemented to assess statistical mechanisms underlying successful prediction. Results: Age, income, marital status, employment status, ethnicity, educational level, and sex differed by vaccine uptake (Wilcoxon rank sum and chi-square P<.001). Most judgment variables also differed by vaccine uptake (Wilcoxon rank sum P<.05). A similar area under the receiver operating characteristic curve (AUROC) was achieved by the 3 machine learning frameworks, although random forest and logistic regression produced specificities between 30% and 38% (vs 74.2% for BRF), indicating a lower performance in predicting unvaccinated participants. BRF achieved high precision (87.8%) and AUROC (79%) with moderate to high accuracy (70.8%) and balanced recall (69.6%) and specificity (74.2%). It should be noted that, for BRF, the negative predictive value was <50% despite good specificity. For BRF and random forest, 63% to 75% of the feature importance came from the 15 judgment variables. Furthermore, age, income, and educational level mediated relationships between judgment variables and vaccine uptake. Conclusions: The findings demonstrate the underlying importance of judgment variables for vaccine choice and uptake, suggesting that vaccine education and messaging might target varying judgment profiles to improve uptake. These methods could also be used to aid vaccine rollouts and health care preparedness by providing location-specific details (eg, identifying areas that may experience low vaccination and high hospitalization). %M 38315620 %R 10.2196/47979 %U https://publichealth.jmir.org/2024/1/e47979 %U https://doi.org/10.2196/47979 %U http://www.ncbi.nlm.nih.gov/pubmed/38315620 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e50716 %T Use of Digital COVID-19 Exposure Notifications at a Large Gathering: Survey Analysis of Public Health Conference Attendees %A Drover,Caitlin M %A Elder,Adam S %A Guthrie,Brandon L %A Revere,Debra %A Briggs,Nicole L %A West,Laura M %A Higgins,Amanda %A Lober,William B %A Karras,Bryant T %A Baseman,Janet G %+ Department of Epidemiology, School of Public Health, University of Washington, Hans Rosling Center for Population Health, 3980 15th Avenue NE, Seattle, WA, 98195-1616, United States, 1 5056159180, eldera3@uw.edu %K COVID-19 %K exposure notification %K digital public health tool %K survey analysis %K conference %K online survey %K digital tool %K public health %K contact tracing %D 2024 %7 18.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: WA Notify was Washington State’s smartphone-based COVID-19 digital exposure notification (EN) tool, which was used to help limit the spread of COVID-19 between November 30, 2020, and May 11, 2023. Following the 2022 Washington State Public Health Association Annual Conference, attendees who had WA Notify activated began receiving ENs alerting them to a possible COVID-19 exposure during the conference. A survey was emailed to all conference attendees to measure WA Notify adoption, mechanisms through which attendees received ENs, and self-reported engagement in protective behaviors postexposure. Objective: This study aimed to learn more about the experiences of WA Notify adopters and nonadopters who may have been exposed to COVID-19 at a large group gathering. Methods: A web-based survey administered through REDCap (Research Electronic Data Capture; Vanderbilt University) was sent to all attendees of the Washington State Public Health Association conference. Self-reported demographic information and characteristics of respondents were summarized. Regression models were used to estimate relative risks to compare WA Notify adoption and testing behaviors between groups. Results: Of the 464 total registered attendees who were sent the survey, 205 (44%) responses were received; 201 eligible attendees were included in this analysis. Of those, 149 (74%) respondents reported having WA Notify activated on their phones at the time of the conference. Among respondents with WA Notify activated, 54% (n=77) reported learning of their potential exposure from a WA Notify EN. Respondents who reported that they did not have WA Notify activated and learned of their potential exposure via the event-wide email from conference organizers were 39% less likely to test for COVID-19 compared to respondents with WA Notify activated who learned of their potential exposure from the email (relative risk 0.61, 95% CI 0.40-0.93; P=.02), and this gap was even larger when compared to respondents who learned of their exposure from a WA Notify EN. The most commonly cited reason for not having WA Notify activated was privacy concerns (n=17, 35%), followed by not wanting to receive ENs (n=6, 12%) and being unaware of WA Notify (n=5, 10%). Conclusions: Digital EN systems are an important tool to directly and anonymously notify close contacts of potential exposures and provide guidance on the next steps in a timely manner. Given the privacy concerns, there is still a need for increasing transparency surrounding EN technology to increase uptake by the public if this technology were to be used in the future to slow the spread of communicable diseases. %M 38498047 %R 10.2196/50716 %U https://formative.jmir.org/2024/1/e50716 %U https://doi.org/10.2196/50716 %U http://www.ncbi.nlm.nih.gov/pubmed/38498047 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 8 %N %P e51331 %T Latino Parents’ Reactions to and Engagement With a Facebook Group–Based COVID-19 Vaccine Promotion Intervention: Mixed Methods Pilot Study %A González-Salinas,Anna I %A Andrade,Elizabeth L %A Abroms,Lorien C %A Gómez,Kaitlyn %A Favetto,Carla %A Gómez,Valeria M %A Collins,Karen K %+ George Washington University, 950 New Hampshire Avenue, Washington, DC, 20052, United States, 1 (202) 994 7400, agonzalez985@gwmail.gwu.edu %K COVID-19 %K misinformation %K social media %K Latino parents %K Spanish %K vaccines %K digital intervention %D 2024 %7 14.3.2024 %9 Original Paper %J JMIR Form Res %G English %X Background: Misinformation in Spanish on social media platforms has contributed to COVID-19 vaccine hesitancy among Latino parents. Brigada Digital de Salud was established to disseminate credible, science-based information about COVID-19 in Spanish on social media. Objective: This study aims to assess participants’ reactions to and engagement with Brigada Digital content that sought to increase COVID-19 vaccine uptake among US Latino parents and their children. Methods: We conducted a 5-week intervention in a private, moderator-led Facebook (Meta Platforms, Inc) group with Spanish-speaking Latino parents of children aged ≤18 years (N=55). The intervention participants received 3 to 4 daily Brigada Digital posts and were encouraged to discuss the covered topics through comments and polls. To assess participants’ exposure, reactions, and engagement, we used participants’ responses to a web-based survey administered at 2 time points (baseline and after 5 weeks) and Facebook analytics to calculate the average number of participant views, reactions, and comments. Descriptive statistics were assessed for quantitative survey items, qualitative responses were thematically analyzed, and quotes were selected to illustrate the themes. Results: Overall, 101 posts were published. Most participants reported visiting the group 1 to 3 times (22/55, 40%) or 4 to 6 (18/55, 33%) times per week and viewing 1 to 2 (23/55, 42%) or 3 to 4 (16/55, 29%) posts per day. Facebook analytics validated this exposure, with 36 views per participant on average. The participants reacted positively to the intervention. Most participants found the content informative and trustworthy (49/55, 89%), easy to understand, and presented in an interesting manner. The participants thought that the moderators were well informed (51/55, 93%) and helpful (50/55, 91%) and praised them for being empathic and responsive. The participants viewed the group environment as welcoming and group members as friendly (45/55, 82%) and supportive (19/55, 35%). The 3 most useful topics for participants were the safety and efficacy of adult COVID-19 vaccines (29/55, 53%), understanding child risk levels (29/55, 53%), and the science behind COVID-19 (24/55, 44%). The preferred formats were educational posts that could be read (38/55, 69%) and videos, including expert (28/55, 51%) and instructional (26/55, 47%) interviews. Regarding engagement, most participants self-reported reacting to posts 1 to 2 (16/55, 29%) or 3 to 4 (15/55, 27%) times per week and commenting on posts 1 to 2 (16/55, 29%) or <1 (20/55, 36%) time per week. This engagement level was validated by analytics, with 10.6 reactions and 3 comments per participant, on average, during the 5 weeks. Participants recommended more opportunities for engagement, such as interacting with the moderators in real time. Conclusions: With adequate intervention exposure and engagement and overall positive participant reactions, the findings highlight the promise of this digital approach for COVID-19 vaccine–related health promotion. %M 38483457 %R 10.2196/51331 %U https://formative.jmir.org/2024/1/e51331 %U https://doi.org/10.2196/51331 %U http://www.ncbi.nlm.nih.gov/pubmed/38483457 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49307 %T Effects of Face Mask Mandates on COVID-19 Transmission in 51 Countries: Retrospective Event Study %A Näher,Anatol-Fiete %A Schulte-Althoff,Matthias %A Kopka,Marvin %A Balzer,Felix %A Pozo-Martin,Francisco %+ Digital Global Public Health, Hasso Plattner Institute, University of Potsdam, Rudolf-Breitscheid-Strasse 187, Campus III, Bldg G2, Potsdam, 14482, Germany, 49 331 5509176, anatolfiete.naeher@hpi.de %K nonpharmacological interventions %K face masks %K infectious diseases %K acute respiratory infections %K COVID-19 %K real-world evidence %D 2024 %7 8.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 38457225 %R 10.2196/49307 %U https://publichealth.jmir.org/2024/1/e49307 %U https://doi.org/10.2196/49307 %U http://www.ncbi.nlm.nih.gov/pubmed/38457225 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48255 %T Durability of the Effectiveness of Heterologous COVID-19 Vaccine Regimens in Thailand: Retrospective Cohort Study Using National Registration Data %A Kumwichar,Ponlagrit %A Poonsiri,Chittawan %A Botwright,Siobhan %A Sirichumroonwit,Natchalaikorn %A Loharjun,Bootsakorn %A Thawillarp,Supharerk %A Cheewaruangroj,Nontawit %A Chokchaisiripakdee,Amorn %A Teerawattananon,Yot %A Chongsuvivatwong,Virasakdi %+ Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, 15 Kanchanavanit Road, Hat Yai, Songkhla, 90110, Thailand, 66 74451165, cvirasak@medicine.psu.ac.th %K COVID-19 %K heterologous vaccine %K vaccine %K vaccine effectiveness %K durability %K time %K waning %K real-world %K public health %K vaccination strategy %K health outcome %K vaccines %K vaccination %K unvaccinated %K big data %K registry %K registries %K health outcomes %K effectiveness %K SARS-CoV-2 %K cohort %K database %K databases %K vaccinated %K Cochran-Mantel-Haenszel %K Mantel-Haenszel %K regression %K risk %K risks %K association %K associations %K odds ratio %K odds ratios %D 2024 %7 5.3.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 38441923 %R 10.2196/48255 %U https://publichealth.jmir.org/2024/1/e48255 %U https://doi.org/10.2196/48255 %U http://www.ncbi.nlm.nih.gov/pubmed/38441923 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e53982 %T The Effectiveness of National Expanded Program on Immunization With Hepatitis A Vaccines in the Chinese Mainland: Interrupted Time-Series Analysis %A Ming,Bo-Wen %A Li,Li %A Huang,Hao-Neng %A Ma,Jia-Jun %A Shi,Chen %A Xu,Xiao-Han %A Yang,Zhou %A Ou,Chun-Quan %+ State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, No1023, South Shatai Road, Baiyun District, Guangzhou, 510515, China, 86 020 61649461, ouchunquan@hotmail.com %K hepatitis A %K incidence %K Expanded Program on Immunization %K vaccine %K interrupted time series %K intervention %K China %D 2024 %7 28.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The high prevalence of hepatitis A delivered a blow to public health decades ago. The World Health Organization (WHO) set a goal to eliminate viral hepatitis including hepatitis A by 2030. In 2008, hepatitis A vaccines were integrated into the Expanded Program on Immunization (EPI) in China to alleviate the burden of hepatitis A, although the effectiveness of the EPI has not been well investigated. Objective: We aimed to evaluate the intervention effect at both provincial and national levels on the incidence of hepatitis A in the Chinese mainland from 2005 to 2019. Methods: Based on the monthly reported number of hepatitis A cases from 2005 to 2019 in each provincial-level administrative division, we adopted generalized additive models with an interrupted time-series design to estimate province-specific effects of the EPI on the incidence of hepatitis A among the target population (children aged 2-9 years) from 2005 to 2019. We then pooled province-specific effect estimates using random-effects meta-analyses. We also assessed the effect among the nontarget population and the whole population. Results: A total of 98,275 hepatitis A cases among children aged 2-9 years were reported in the Chinese mainland from 2005 to 2019, with an average annual incidence of 5.33 cases per 100,000 persons. Nationally, the EPI decreased the hepatitis A incidence by 80.77% (excess risk [ER] –80.77%, 95% CI –85.86% to –72.92%) during the study period, guarding an annual average of 28.52 (95% empirical CI [eCI] 27.37-29.00) cases per 100,000 persons among the target children against hepatitis A. Western China saw a more significant effect of the EPI on the decrease in the incidence of hepatitis A among the target children. A greater number of target children were protected from onset in Northwest and Southwest China, with an excess incidence rate of –129.72 (95% eCI –135.67 to –117.86) and –66.61 (95% eCI –67.63 to –64.22) cases per 100,000 persons on average, respectively. Intervention effects among nontarget (ER –32.88%, 95% CI –39.76% to –25.21%) and whole populations (ER –31.97%, 95% CI –39.61% to –23.37%) were relatively small. Conclusions: The EPI has presented a lasting positive effect on the containment of hepatitis A in the target population in China. The EPI’s effect on the target children also provided a degree of indirect protection for unvaccinated individuals. The continuous surveillance of hepatitis A and the maintenance of mass vaccination should shore up the accomplishment in the decline of hepatitis A incidence to ultimately achieve the goal set by the WHO. %M 38416563 %R 10.2196/53982 %U https://publichealth.jmir.org/2024/1/e53982 %U https://doi.org/10.2196/53982 %U http://www.ncbi.nlm.nih.gov/pubmed/38416563 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e44349 %T Optimization of Screening Strategies for COVID-19: Scoping Review %A Liu,Yuanhua %A Yin,Yun %A Ward,Michael P %A Li,Ke %A Chen,Yue %A Duan,Mengwei %A Wong,Paulina P Y %A Hong,Jie %A Huang,Jiaqi %A Shi,Jin %A Zhou,Xuan %A Chen,Xi %A Xu,Jiayao %A Yuan,Rui %A Kong,Lingcai %A Zhang,Zhijie %+ Department of Epidemiology and Health Statistics, School of Public Health, Fudan University, No.130, Dong'An Road, Xuhui District, Shanghai, 200032, China, 86 021 54237410, epistat@gmail.com %K COVID-19 %K screening strategy %K optimization %K polymerase chain reaction test %K antigen test %D 2024 %7 27.2.2024 %9 Review %J JMIR Public Health Surveill %G English %X 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. %M 38412011 %R 10.2196/44349 %U https://publichealth.jmir.org/2024/1/e44349 %U https://doi.org/10.2196/44349 %U http://www.ncbi.nlm.nih.gov/pubmed/38412011 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 12 %N %P e45546 %T A Serious Game (“Fight With Virus”) for Preventing COVID-19 Health Rumors: Development and Experimental Study %A Xiong,Shuo %A Zuo,Long %A Chen,Qiwei %A Zeliang,Zhang %A Nor Akmal Khalid,Mohd %+ Philosophy and Social Sciences Laboratory of Big Data and National Communication Strategy, Huazhong University of Science and Technology, Building 6, No 1037, Luoyu Road, Wuhan, 430074, China, 86 15927188806, xiongshuo@hust.edu.cn %K serious game %K COVID-19 %K health rumor %K game communication %K game TCP model %K Transmission Control Protocol %K gaming %K misinformation %K disinformation %K rumor %K health communication %K false information %K elder %K older adult %D 2024 %7 26.2.2024 %9 Original Paper %J JMIR Serious Games %G English %X Background: Health rumors arbitrarily spread in mainstream social media on the internet. Health rumors emerged in China during the outbreak of COVID-19 in early 2020. Many midelders/elders (age over 40 years) who lived in Wuhan believed these rumors. Objective: This study focused on designing a serious game as an experimental program to prevent and control health rumors. The focus of the study was explicitly on the context of the social networking service for midelders/elders. Methods: This research involved 2 major parts: adopting the Transmission Control Protocol model for games and then, based on the model, designing a game named “Fight With Virus” as an experimental platform and developing a cognitive questionnaire with a 5-point Likert scale. The relevant variables for this experimental study were defined, and 10 hypotheses were proposed and tested with an empirical study. In total, 200 participants were selected for the experiments. By collecting relevant data in the experiments, we conducted statistical observations and comparative analysis to test whether the experimental hypotheses could be proved. Results: We noted that compared to traditional media, serious games are more capable of inspiring interest in research participants toward their understanding of the knowledge and learning of health commonsense. In judging and recognizing the COVID-19 health rumor, the test group that used game education had a stronger ability regarding identification of the rumor and a higher accuracy rate of identification. Results showed that the more educated midelders/elders are, the more effective they are at using serious games. Conclusions: Compared to traditional media, serious games can effectively improve midelders’/elders’ cognitive abilities while they face a health rumor. The gameplay effect is related to the individual’s age and educational background, while income and gender have no impact. %M 38407954 %R 10.2196/45546 %U https://games.jmir.org/2024/1/e45546 %U https://doi.org/10.2196/45546 %U http://www.ncbi.nlm.nih.gov/pubmed/38407954 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e47667 %T Building Pandemic-Resilient Primary Care Systems: Lessons Learned From COVID-19 %A Jeong,Yejin %A Crowell,Trevor %A Devon-Sand,Anna %A Sakata,Theadora %A Sattler,Amelia %A Shah,Shreya %A Tsai,Timothy %A Lin,Steven %+ Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 585 Broadway, Suite 800, Redwood City, CA, 94063, United States, 1 4086889720, timothy.tsai@stanford.edu %K barrier %K COVID-19 %K digital health %K implementation %K internet-based care %K pandemic %K primary care %K resilience %K resilient system %K telehealth %K telemedicine %D 2024 %7 23.2.2024 %9 Viewpoint %J J Med Internet Res %G English %X On January 30, 2023, the Biden Administration announced its intention to end the existing COVID-19 public health emergency declaration. The transition to a “postpandemic” landscape presents a unique opportunity to sustain and strengthen pandemic-era changes in care delivery. With this in mind, we present 3 critical lessons learned from a primary care perspective during the COVID-19 pandemic. First, clinical workflows must support both in-person and internet-based care delivery. Second, the integration of asynchronous care delivery is critical. Third, planning for the future means planning for everyone, including those with potentially limited access to health care due to barriers in technology and communication. While these lessons are neither unique to primary care settings nor all-encompassing, they establish a grounded foundation on which to construct higher-quality, more resilient, and more equitable health systems. %M 38393776 %R 10.2196/47667 %U https://www.jmir.org/2024/1/e47667 %U https://doi.org/10.2196/47667 %U http://www.ncbi.nlm.nih.gov/pubmed/38393776 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e54286 %T Effectiveness of a Nursing Educational Intervention in Adults to Promote Control Behaviors Against Dengue: Protocol for a Randomized Controlled Trial %A Llorente Pérez,Yolima Judith %A Rodríguez-Acelas,Alba Luz %A Mattiello,Rita %A Cañon-Montañez,Wilson %+ Nursing Program, Universidad de Córdoba, Calle 31 b # 3w - 27 Campo alegre, Montería, 230001, Colombia, 57 3116882792, yolima.llorente@udea.edu.co %K dengue %K health education %K health promotion %K nursing care %K prevention & control %D 2024 %7 23.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The increase in dengue cases can be attributed to social, demographic, environmental changes, or community-driven factors. In this regard, different strategies have been established in health education, using educational interventions as necessary tools for the reduction of the disease with the aim of reinforcing and stimulating the prevention and control of dengue. Objective: This study aims to evaluate the effectiveness of a nursing educational intervention for dengue control. Methods: A randomized controlled trial will be conducted with adults living in rural areas and participating in health promotion and disease prevention programs. We will enroll 116 adults. Adults will be randomized 1:1, with 58 adults assigned to the educational intervention group and 58 to the usual care group. Participants will receive 4 sessions over the course of a month, 1 week apart, and will be followed up for 1 month after the end of the educational intervention. Nursing Outcome Classification labels will be used to measure the outcomes: risk control (1902) and participation in health care decisions (1606). Results: The participants in the intervention group are expected to achieve better dengue control behaviors than those in the usual care group. Conclusions: Risk factors are fostered by the community, largely caused by artificial reservoirs or unprotected tanks in homes; also, the lack of information hinders the identification of symptomatology and the poor implementation of effective measures, and the development of standardized educational strategies can contribute to efficient and cost-effective control of the disease. Trial Registration: ClinicalTrials.gov NCT05321264; https://clinicaltrials.gov/study/NCT05321264 International Registered Report Identifier (IRRID): PRR1-10.2196/54286 %M 38393755 %R 10.2196/54286 %U https://www.researchprotocols.org/2024/1/e54286 %U https://doi.org/10.2196/54286 %U http://www.ncbi.nlm.nih.gov/pubmed/38393755 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48134 %T Newspaper Coverage of Hospitals During a Prolonged Health Crisis: Longitudinal Mixed Methods Study %A van de Baan,Frank %A Gifford,Rachel %A Ruwaard,Dirk %A Fleuren,Bram %A Westra,Daan %+ Department of Health Services Research, Faculty of Health, Medicine and Life Sciences, Maastricht University, Duboisdomein 30, Maastricht, 6229GT, Netherlands, 31 043 38 81 553, f.vandebaan@maastrichtuniversity.nl %K health communication %K news coverage %K media %K misinformation %K accuracy %K news %K reporting %K newspaper %K knowledge translation %K COVID-19 %K dissemination %K communication %D 2024 %7 21.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: It is important for health organizations to communicate with the public through newspapers during health crises. Although hospitals were a main source of information for the public during the COVID-19 pandemic, little is known about how this information was presented to the public through (web-based) newspaper articles. Objective: This study aims to examine newspaper reporting on the situation in hospitals during the first year of the COVID-19 pandemic in the Netherlands and to assess the degree to which the reporting in newspapers aligned with what occurred in practice. Methods: We used a mixed methods longitudinal design to compare internal data from all hospitals (n=5) located in one of the most heavily affected regions of the Netherlands with the information reported by a newspaper covering the same region. The internal data comprised 763 pages of crisis meeting documents and 635 minutes of video communications. A total of 14,401 newspaper articles were retrieved from the LexisNexis Academic (RELX Group) database, of which 194 (1.3%) articles were included for data analysis. For qualitative analysis, we used content and thematic analyses. For quantitative analysis, we used chi-square tests. Results: The content of the internal data was categorized into 12 themes: COVID-19 capacity; regular care capacity; regional, national, and international collaboration; human resources; well-being; public support; material resources; innovation; policies and protocols; finance; preparedness; and ethics. Compared with the internal documents, the newspaper articles focused significantly more on the themes COVID-19 capacity (P<.001), regular care capacity (P<.001), and public support (P<.001) during the first year of the pandemic, whereas they focused significantly less on the themes material resources (P=.004) and policies and protocols (P<.001). Differences in attention toward themes were mainly observed between the first and second waves of the pandemic and at the end of the third wave. For some themes, the attention in the newspaper articles preceded the attention given to these themes in the internal documents. Reporting was done through various forms, including diary articles written from the perspective of the hospital staff. No indication of the presence of misinformation was found in the newspaper articles. Conclusions: Throughout the first year of the pandemic, newspaper articles provided coverage on the situation of hospitals and experiences of staff. The focus on themes within newspaper articles compared with internal hospital data differed significantly for 5 (42%) of the 12 identified themes. The discrepancies between newspapers and hospitals in their focus on themes could be attributed to their gatekeeping roles. Both parties should be aware of their gatekeeping role and how this may affect information distribution. During health crises, newspapers can be a credible source of information for the public. The information can also be valuable for hospitals themselves, as it allows them to anticipate internal and external developments. %M 38381496 %R 10.2196/48134 %U https://publichealth.jmir.org/2024/1/e48134 %U https://doi.org/10.2196/48134 %U http://www.ncbi.nlm.nih.gov/pubmed/38381496 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e44258 %T 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 %A Kopilaš,Vanja %A Nasadiuk,Khrystyna %A Martinelli,Lucia %A Lhotska,Lenka %A Todorovic,Zoran %A Vidmar,Matjaz %A Machado,Helena %A Svalastog,Anna Lydia %A Gajović,Srećko %+ BIMIS-Biomedical Research Center Šalata, University of Zagreb School of Medicine, Šalata 4, Zagreb, 10000, Croatia, 385 1 4566 948, srecko.gajovic@hiim.hr %K SARS-CoV-2 virus %K COVID-19 vaccination %K pandemic %K hesitancy %K safety %K vaccination %K COVID-19 %K tool %K implementation %K vaccine hesitancy %K effectiveness %K sociocultural %K communication %K disinformation %D 2024 %7 19.2.2024 %9 Original Paper %J JMIR Hum Factors %G English %X 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 2×2 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. %M 38373020 %R 10.2196/44258 %U https://humanfactors.jmir.org/2024/1/e44258 %U https://doi.org/10.2196/44258 %U http://www.ncbi.nlm.nih.gov/pubmed/38373020 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49285 %T Integrated Network Analysis of Symptom Clusters Across Monkeypox Epidemics From 1970 to 2023: Systematic Review and Meta-Analysis %A Su,Shu %A Jia,Meng %A Yu,Yingni %A Li,Hu %A Yin,Wenwei %A Lu,Yi %A Huang,Rongzhong %A Xiang,Rong %A Huang,Huizhe %A Hu,Peng %+ Key Laboratory of Molecular Biology for Infectious Diseases, Department of Infectious Diseases, The Second Affiliated Hospital of Chongqing Medical University, Tianwen Road 288, Chongqing, 400060, China, 86 13608338064, hupengcq@hospital.cqmu.edu.cn %K monkeypox %K mpox %K symptoms %K prevalence %K meta-analysis %K network analysis %K evolution trends %D 2024 %7 16.2.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: The worldwide spread of monkeypox (mpox) has witnessed a significant increase, particularly in nonendemic countries. Objective: We aimed to investigate the changing clinical symptoms associated with mpox from 1970 to 2023 and explore their interrelations. Methods: In this systematic review and meta-analysis, 3 electronic databases were searched for English peer-reviewed studies conducted from January 1970 to April 2023 that reported any symptoms among confirmed mpox cases. We categorized the mpox epidemics into 3 periods: 1970-2002 (period 1, within the African region), 2003-2021(period 2, epidemics outside Africa), and 2022-2023 (period 3, worldwide outbreak). Following PRISMA guidelines, a meta-analysis was performed to estimate the pooled prevalence for each symptom. The correlation among symptoms was analyzed and visualized using network analysis. Results: The meta-analysis included 61 studies that reported 21 symptoms in 720 patients from period 1, 39 symptoms in 1756 patients from period 2, and 37 symptoms in 12,277 patients from period 3. The most common symptom among patients from all 3 periods was rash (period 1: 92.6%, 95% CI 78.2%-100%; period 2: 100%, 95% CI 99.9%-100%; and period 3: 94.8%, 95% CI 90.9%-98.8%), followed by lymphadenopathy (period 1: 59.8%, 95% CI 50.3%-69.2%; period 2: 74.1%, 95% CI 64.2%-84.1%; and period 3: 61.1%, 95% CI 54.2%-68.1%). Fever (99%, 95% CI 97%-100%), enlarged lymph nodes (80.5%, 95% CI 75.4%-85.0%), and headache (69.1%, 95% CI 4%-100%) were the main symptoms in period 1, with a significant decrease in period 3: 37.9%, 31.2%, and 28.7%, respectively. Chills/rigors (73.3%, 95% CI 60.9%-85.7%), fatigue (68.2%, 95% CI 51.6%-84.8%), and dysphagia/swallowing difficulty (61.2%, 95% CI 10.5%-100%) emerged as primary new symptoms in period 2 and decreased significantly in period 3. Most other symptoms remained unchanged or decreased in period 3 compared to the former 2 periods. Nausea/vomiting had the highest degree of correlation (with 13 symptoms) and was highly positively correlated with lymphadenopathy (r=0.908) and conjunctivitis (r=0.900) in period 2. In contrast, rash and headache were 2 symptoms with the highest degree of correlation (with 21 and 21 symptoms, respectively) in period 3 and were highly positively correlated with fever (r=0.918 and 0.789, respectively). Conclusions: The manifestation of symptoms in patients with mpox has become more diverse, leading to an increase in their correlation. Although the prevalence of rash remains steady, other symptoms have decreased. It is necessary to surveil the evolving nature of mpox and the consequential changes in clinical characteristics. Epidemic countries may shift their focus on the potential association among symptoms and the high synergy risk. Trial Registration: PROSPERO Registration: CRD42023403282; http://tinyurl.com/yruuas5n %M 38363593 %R 10.2196/49285 %U https://publichealth.jmir.org/2024/1/e49285 %U https://doi.org/10.2196/49285 %U http://www.ncbi.nlm.nih.gov/pubmed/38363593 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48466 %T Ethnic Disparities in COVID-19 Vaccine Mistrust and Receipt in British Columbia, Canada: Population Survey %A Mahmood,Bushra %A Adu,Prince %A McKee,Geoffrey %A Bharmal,Aamir %A Wilton,James %A Janjua,Naveed Zafar %+ Division of Endocrinology, University of British Columbia, 2775 Laurel St 4116, Vancouver, BC, V5Z 1M9, Canada, 1 7787073711, bushra.mahmood@bccdc.ca %K COVID-19 %K vaccine hesitancy %K mistrust %K trust %K ethnic minorities %K South Asian %K vaccine %K vaccination %K hesitancy %K ethnic %K ethnicity %K minority %K cultural %K racial %K minorities %K SARS-CoV-2 %K coronavirus %K Asia %K Asian %D 2024 %7 16.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Racialized populations in the United States, Canada, and the United Kingdom have been disproportionately affected by COVID-19. Higher vaccine hesitancy has been reported among racial and ethnic minorities in some of these countries. In the United Kingdom, for example, higher vaccine hesitancy has been observed among the South Asian population and Black compared with the White population, and this has been attributed to lack of trust in government due to historical and ongoing racism and discrimination. Objective: This study aimed to assess vaccine receipt by ethnicity and its relationship with mistrust among ethnic groups in British Columbia (BC), Canada. Methods: We included adults ≥18 years of age who participated in the BC COVID-19 Population Mixing Patterns Survey (BC-Mix) from March 8, 2021, to August 8, 2022. The survey included questions about vaccine receipt and beliefs based on a behavioral framework. Multivariable logistic regression was used to assess the association between mistrust in vaccines and vaccine receipt among ethnic groups. Results: The analysis included 25,640 adults. Overall, 76.7% (22,010/28,696) of respondents reported having received at least 1 dose of COVID-19 vaccines (Chinese=86.1%, South Asian=79.6%, White=75.5%, and other ethnicity=73.2%). Overall, 13.7% (3513/25,640) of respondents reported mistrust of COVID-19 vaccines (Chinese=7.1%, South Asian=8.2%, White=15.4%, and other ethnicity=15.2%). In the multivariable model (adjusting for age, sex, ethnicity, educational attainment, and household size), mistrust was associated with a 93% reduced odds of vaccine receipt (adjusted odds ratio 0.07, 95% CI 0.06-0.08). In the models stratified by ethnicity, mistrust was associated with 81%, 92%, 94%, and 95% reduced odds of vaccine receipt among South Asian, Chinese, White, and other ethnicities, respectively. Indecision, whether to trust the vaccine or not, was significantly associated with a 70% and 78% reduced odds of vaccine receipt among those who identified as White and of other ethnic groups, respectively. Conclusions: Vaccine receipt among those who identified as South Asian and Chinese in BC was higher than that among the White population. Vaccine mistrust was associated with a lower odds of vaccine receipt in all ethnicities, but it had a lower effect on vaccine receipt among the South Asian and Chinese populations. Future research needs to focus on sources of mistrust to better understand its potential influence on vaccine receipt among visible minorities in Canada. %M 38363596 %R 10.2196/48466 %U https://publichealth.jmir.org/2024/1/e48466 %U https://doi.org/10.2196/48466 %U http://www.ncbi.nlm.nih.gov/pubmed/38363596 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e40491 %T Learning From COVID-19: What Would It Take to Be Better Prepared in the Eastern Mediterranean Region? %A Kufoof,Lara %A Hajjeh,Rana %A Al Nsour,Mohannad %A Saad,Randa %A Bélorgeot,Victoria %A Abubakar,Abdinasir %A Khader,Yousef %A Rawaf,Salman %+ Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Alramtha-Amman Street, Irbid, 22110, Jordan, 962 796802040, yskhader@just.edu.jo %K COVID-19 %K integration %K pandemic preparedness %K primary health care %K public health %D 2024 %7 15.2.2024 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 transmission in the Eastern Mediterranean Region (EMR) was influenced by various factors such as conflict, demographics, travel and social restrictions, migrant workers, weak health systems, and mass gatherings. The countries that responded well to COVID-19 had high-level political commitment, multisectoral coordination, and existing infrastructures that could quickly mobilize. However, some EMR countries faced challenges due to political instability and fragile health systems, which hindered their response strategies. The pandemic highlighted the region’s weak health systems and preparedness, fragmented surveillance systems, and lack of trust in information sharing. COVID-19 exposed the disruption of access and delivery of essential health services as a major health system fragility. In 2020, the World Health Organization (WHO) conducted a global pulse survey, which demonstrated that the EMR experienced the highest disruption in health services compared to other WHO regions. However, thanks to prioritization by the WHO and its member states, significant improvement was observed in 2021 during the second round of the WHO’s National Pulse Survey. The pandemic underscored the importance of political leadership, community engagement, and trust and emphasized that investing in health security benefits everyone. Increasing vaccine coverage, building regional capacities, strengthening health systems, and working toward universal health coverage and health security are all priorities in the EMR. Emergency public health plays a key role in preparing for and responding to pandemics and biological threats. Integrating public health into primary care and investing in public health workforce capacity building is essential to reshaping public health and health emergency preparedness. %M 38359418 %R 10.2196/40491 %U https://publichealth.jmir.org/2024/1/e40491 %U https://doi.org/10.2196/40491 %U http://www.ncbi.nlm.nih.gov/pubmed/38359418 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 13 %N %P e50064 %T Factors Associated With Worsened Mental Health of Health Care Workers in Canada During the COVID-19 Pandemic: Cross-Sectional Survey Study %A AbdulHussein,Ali %A Butt,Zahid Ahmad %A Dimitrov,Stanko %A Cozzarin,Brian %+ Department of Management Science, Faculty of Engineering, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada, 1 (519) 888 4567, a9abdulh@uwaterloo.ca %K health care workers %K COVID-19 %K mental health %K demographic factors %K occupational factors %K access to PPE %K pandemic %K health care system %K psychological trauma %K psychological %K trauma %K respirators %K eye protection %K face shields %K support %D 2024 %7 15.2.2024 %9 Original Paper %J Interact J Med Res %G English %X Background: Health care workers (HCWs) in Canada have endured difficult conditions during the COVID-19 pandemic. Many worked long hours while attending to patients in a contagious environment. This introduced an additional burden that may have contributed to worsened mental health conditions. Objective: In this study, we examine the factors associated with worsened mental health conditions of HCWs as compared to before the start of the pandemic. Methods: We use data from a survey of HCWs by Statistics Canada. A regression model is used to estimate the odds ratios (ORs) of worsened mental health after the start of the pandemic. The estimated odds ratio (OR) is associated with different independent variables that include demographics (age, sex, immigration status, and geographic area), occupational factors (work status, occupational group, and exposure category), and different access levels to personal protective equipment (PPE). Results: Of 18,139 eligible participants surveyed, 13,990 (77.1%) provided valid responses. We found that HCWs younger than 35 years old were more likely (OR 1.14, 95% CI 1.03-1.27; P=.01) to exhibit worsened mental health as compared to the reference group (35-44 years old). As for sex, male HCWs were less likely (OR 0.76, 95% CI 0.67-0.86; P<.001) to exhibit worsened mental health as compared to female HCWs. Immigrant HCWs were also less likely (OR 0.57, 95% CI 0.51-0.64; P<.001) to exhibit worsened mental health as compared to nonimmigrant HCWs. Further, HCWs working in Alberta had the highest likelihood of exhibiting worsened mental health as compared to HCWs working elsewhere (Atlantic provinces, Quebec, Manitoba, Saskatchewan, Ontario, British Columbia, and Northern Territories). Frontline workers were more likely (OR 1.26, 95% CI 1.16-1.38; P<.001) to exhibit worsened mental health than nonfrontline HCWs. Part-time HCWs were less likely (OR 0.85, 95% CI 0.76-0.93; P<.001) to exhibit worsened mental health than full-time HCWs. HCWs who reported encountering COVID-19 cases were more likely (OR 1.55, 95% CI 1.41-1.70; P<.001) to exhibit worsened mental health as compared to HCWs who reported no contact with the disease. As for PPE, HCWs who never had access to respirators, eye protection, and face shields are more likely to exhibit worsened mental health by 1.31 (95% CI 1.07-1.62; P<.001), 1.51 (95% CI 1.17-1.96; P<.001), and 1.41 (95% CI 1.05-1.92; P=.02) than those who always had access to the same PPE, respectively. Conclusions: Different HCW groups experienced the pandemic differently based on their demographic and occupational backgrounds as well as access to PPE. Such findings are important to stakeholders involved in the planning of personalized support programs and aid mental health mitigation in future crises. Certain groups require more attention. %M 38358785 %R 10.2196/50064 %U https://www.i-jmr.org/2024/1/e50064 %U https://doi.org/10.2196/50064 %U http://www.ncbi.nlm.nih.gov/pubmed/38358785 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48430 %T Impact of the COVID-19 Pandemic on People Living With Rare Diseases and Their Families: Results of a National Survey %A Macaluso,Maurizio %A Rothenberg,Marc E %A Ferkol,Thomas %A Kuhnell,Pierce %A Kaminski,Henry J %A Kimberlin,David W %A Benatar,Michael %A Chehade,Mirna %A , %+ Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, 3333 Burnet Ave - MLC 5041, Cincinnati, OH, 45229, United States, 1 513 636 2710, maurizio.macaluso@cchmc.org %K rare diseases %K rare %K chronic %K COVID-19 infection %K cross-sectional survey %K access to care %K changes in symptoms and use of medications %K psychological impact on self and family %K access %K accessibility %K cross-sectional %K national %K nationwide %K survey %K surveys %K COVID-19 %K SARS-CoV-2 %K coronavirus %K comorbid %K comorbidity %K vulnerable %D 2024 %7 14.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 38354030 %R 10.2196/48430 %U https://publichealth.jmir.org/2024/1/e48430 %U https://doi.org/10.2196/48430 %U http://www.ncbi.nlm.nih.gov/pubmed/38354030 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e50733 %T Genomic, Proteomic, and Phenotypic Biomarkers of COVID-19 Severity: Protocol for a Retrospective Observational Study %A English,Andrew %A McDaid,Darren %A Lynch,Seodhna M %A McLaughlin,Joseph %A Cooper,Eamonn %A Wingfield,Benjamin %A Kelly,Martin %A Bhavsar,Manav %A McGilligan,Victoria %A Irwin,Rachelle E %A Bucholc,Magda %A Zhang,Shu-Dong %A Shukla,Priyank %A Rai,Taranjit Singh %A Bjourson,Anthony J %A Murray,Elaine %A Gibson,David S %A Walsh,Colum %+ Personalised Medicine Centre, School of Medicine, Ulster University, C-TRIC Building, Altnagelvin Area Hospital, Glenshane Road, Derry/Londonderry, BT47 6SB, United Kingdom, 44 028 7161 1249, d.gibson@ulster.ac.uk %K COVID-19 %K clinical research %K multiomics %K comorbidity %K severity %K electronic health record %D 2024 %7 14.2.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health organizations and countries around the world have found it difficult to control the spread of COVID-19. To minimize the future impact on the UK National Health Service and improve patient care, there is a pressing need to identify individuals who are at a higher risk of being hospitalized because of severe COVID-19. Early targeted work was successful in identifying angiotensin-converting enzyme-2 receptors and type II transmembrane serine protease dependency as drivers of severe infection. Although a targeted approach highlights key pathways, a multiomics approach will provide a clearer and more comprehensive picture of severe COVID-19 etiology and progression. Objective: The COVID-19 Response Study aims to carry out an integrated multiomics analysis to identify biomarkers in blood and saliva that could contribute to host susceptibility to SARS-CoV-2 and the development of severe COVID-19. Methods: The COVID-19 Response Study aims to recruit 1000 people who recovered from SARS-CoV-2 infection in both community and hospital settings on the island of Ireland. This protocol describes the retrospective observational study component carried out in Northern Ireland (NI; Cohort A); the Republic of Ireland cohort will be described separately. For all NI participants (n=519), SARS-CoV-2 infection has been confirmed by reverse transcription-quantitative polymerase chain reaction. A prospective Cohort B of 40 patients is also being followed up at 1, 3, 6, and 12 months postinfection to assess longitudinal symptom frequency and immune response. Data will be sourced from whole blood, saliva samples, and clinical data from the electronic care records, the general health questionnaire, and a 12-item general health questionnaire mental health survey. Saliva and blood samples were processed to extract DNA and RNA before whole-genome sequencing, RNA sequencing, DNA methylation analysis, microbiome analysis, 16S ribosomal RNA gene sequencing, and proteomic analysis were performed on the plasma. Multiomics data will be combined with clinical data to produce sensitive and specific prognostic models for severity risk. Results: An initial demographic and clinical profile of the NI Cohort A has been completed. A total of 249 hospitalized patients and 270 nonhospitalized patients were recruited, of whom 184 (64.3%) were female, and the mean age was 45.4 (SD 13) years. High levels of comorbidity were evident in the hospitalized cohort, with cardiovascular disease and metabolic and respiratory disorders being the most significant (P<.001), grouped according to the International Classification of Diseases 10 codes. Conclusions: This study will provide a comprehensive opportunity to study the mechanisms of COVID-19 severity in recontactable participants. International Registered Report Identifier (IRRID): DERR1-10.2196/50733 %M 38354037 %R 10.2196/50733 %U https://www.researchprotocols.org/2024/1/e50733 %U https://doi.org/10.2196/50733 %U http://www.ncbi.nlm.nih.gov/pubmed/38354037 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e41792 %T The Effect of the COVID-19 Pandemic on Non–COVID-19 Deaths: Population-Wide Retrospective Cohort Study %A Wai,Abraham Ka-chung %A Yip,Tsz Fung %A Wong,Yui Hang %A Chu,Chun Kit %A Lee,Teddy %A Yu,Ken Hung On %A So,Wang Leong %A Wong,Janet Y H %A Wong,Carlos King-ho %A Ho,Joshua W %A Rainer,Timothy %+ School of Biomedical Sciences, The University of Hong Kong, L4-44, Laboratory Block, 21 Sassoon Road, Hong Kong, China (Hong Kong), 852 6518 4979, jwkho@hku.hk %K excess death %K causal inference %K health care avoidance %K emergency department %K COVID-19 %K hospital avoidance behavior %K mortality %K epidemiology %K health care %K hospital care %K death rate %K death %K hospital %K avoidance %K population %K cohort %K death toll %K impact %K excess %K Hong Kong %D 2024 %7 13.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Health care avoidance in the COVID-19 pandemic has been widely reported. Yet few studies have investigated the dynamics of hospital avoidance behavior during pandemic waves and inferred its impact on excess non–COVID-19 deaths. Objective: This study aimed to measure the impact of hospital avoidance on excess non–COVID-19 deaths in public hospitals in Hong Kong. Methods: This was a retrospective cohort study involving 11,966,786 patients examined between January 1, 2016, and December 31, 2021, in Hong Kong. All data were linked to service, treatment, and outcomes. To estimate excess mortality, the 2-stage least squares method was used with daily tallies of emergency department (ED) visits and 28-day mortality. Records for older people were categorized by long-term care (LTC) home status, and comorbidities were used to explain the demographic and clinical attributes of excess 28-day mortality. The primary outcome was actual excess death in 2020 and 2021. The 2-stage least squares method was used to estimate the daily excess 28-day mortality by daily reduced visits. Results: Compared with the prepandemic (2016-2019) average, there was a reduction in total ED visits in 2020 of 25.4% (548,116/2,142,609). During the same period, the 28-day mortality of non–COVID-19 ED deaths increased by 7.82% (2689/34,370) compared with 2016-2019. The actual excess deaths in 2020 and 2021 were 3143 and 4013, respectively. The estimated total excess non–COVID-19 28-day deaths among older people in 2020 to 2021 were 1958 (95% CI 1100-2820; no time lag). Deaths on arrival (DOAs) or deaths before arrival (DBAs) increased by 33.6% (1457/4336) in 2020, while non–DOA/DBAs increased only by a moderate 4.97% (1202/24,204). In both types of deaths, the increases were higher during wave periods than in nonwave periods. Moreover, non-LTC patients saw a greater reduction in ED visits than LTC patients across all waves, by more than 10% (non-LTC: 93,896/363,879, 25.8%; LTC: 7,956/67,090, 11.9%). Most of the comorbidity subsets demonstrated an annualized reduction in visits in 2020. Renal diseases and severe liver diseases saw notable increases in deaths. Conclusions: We demonstrated a statistical method to estimate hospital avoidance behavior during a pandemic and quantified the consequent excess 28-day mortality with a focus on older people, who had high frequencies of ED visits and deaths. This study serves as an informed alert and possible investigational guideline for health care professionals for hospital avoidance behavior and its consequences. %M 38349717 %R 10.2196/41792 %U https://publichealth.jmir.org/2024/1/e41792 %U https://doi.org/10.2196/41792 %U http://www.ncbi.nlm.nih.gov/pubmed/38349717 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e46687 %T Estimating the Epidemic Size of Superspreading Coronavirus Outbreaks in Real Time: Quantitative Study %A Lau,Kitty Y %A Kang,Jian %A Park,Minah %A Leung,Gabriel %A Wu,Joseph T %A Leung,Kathy %+ WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, 1/F North Wing, Patrick Manson Building, 7 Sassoon Road, Pok Fu Lam, The University of Hong Kong, China (Hong Kong), 852 3917 6735, ksmleung@hku.hk %K coronavirus %K superspreading event %K SSE %K epidemic size %K severe acute respiratory syndrome %K SARS %K Middle East respiratory syndrome %K MERS %K coronavirus disease 2019 %K COVID-19 %D 2024 %7 12.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Novel coronaviruses have emerged and caused major epidemics and pandemics in the past 2 decades, including SARS-CoV-1, MERS-CoV, and SARS-CoV-2, which led to the current COVID-19 pandemic. These coronaviruses are marked by their potential to produce disproportionally large transmission clusters from superspreading events (SSEs). As prompt action is crucial to contain and mitigate SSEs, real-time epidemic size estimation could characterize the transmission heterogeneity and inform timely implementation of control measures. Objective: This study aimed to estimate the epidemic size of SSEs to inform effective surveillance and rapid mitigation responses. Methods: We developed a statistical framework based on back-calculation to estimate the epidemic size of ongoing coronavirus SSEs. We first validated the framework in simulated scenarios with the epidemiological characteristics of SARS, MERS, and COVID-19 SSEs. As case studies, we retrospectively applied the framework to the Amoy Gardens SARS outbreak in Hong Kong in 2003, a series of nosocomial MERS outbreaks in South Korea in 2015, and 2 COVID-19 outbreaks originating from restaurants in Hong Kong in 2020. Results: The accuracy and precision of the estimation of epidemic size of SSEs improved with longer observation time; larger SSE size; and more accurate prior information about the epidemiological characteristics, such as the distribution of the incubation period and the distribution of the onset-to-confirmation delay. By retrospectively applying the framework, we found that the 95% credible interval of the estimates contained the true epidemic size after 37% of cases were reported in the Amoy Garden SARS SSE in Hong Kong, 41% to 62% of cases were observed in the 3 nosocomial MERS SSEs in South Korea, and 76% to 86% of cases were confirmed in the 2 COVID-19 SSEs in Hong Kong. Conclusions: Our framework can be readily integrated into coronavirus surveillance systems to enhance situation awareness of ongoing SSEs. %M 38345850 %R 10.2196/46687 %U https://publichealth.jmir.org/2024/1/e46687 %U https://doi.org/10.2196/46687 %U http://www.ncbi.nlm.nih.gov/pubmed/38345850 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e45429 %T Impact of the COVID-19 Pandemic on the Personal Networks and Neurological Outcomes of People With Multiple Sclerosis: Cross-Sectional and Longitudinal Case-Control Study %A Riley,Claire %A Venkatesh,Shruthi %A Dhand,Amar %A Doshi,Nandini %A Kavak,Katelyn %A Levit,Elle %A Perrone,Christopher %A Weinstock-Guttman,Bianca %A Longbrake,Erin %A De Jager,Philip %A Xia,Zongqi %+ University of Pittsburgh, 3501 Fifth Ave, BST3-10.044, Pittsburgh, PA, 15260, United States, 1 412 383 5377, zxia1@post.harvard.edu %K neurology %K neurodegenerative disease %K multiple sclerosis %K personal networks %K COVID-19 %D 2024 %7 6.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease 2019 (COVID-19) pandemic has negatively affected the social fabric. Objective: We evaluated the associations between personal social networks and neurological function in people with multiple sclerosis (pwMS) and controls in the prepandemic and pandemic periods. Methods: During the early pandemic (March-December 2020), 8 cohorts of pwMS and controls completed a questionnaire quantifying the structure and composition of their personal social networks, including the health behaviors of network members. Participants from 3 of the 8 cohorts had additionally completed the questionnaire before the pandemic (2017-2019). We assessed neurological function using 3 interrelated patient-reported outcomes: Patient Determined Disease Steps (PDDS), Multiple Sclerosis Rating Scale-Revised (MSRS-R), and Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function. We identified the network features associated with neurological function using paired 2-tailed t tests and covariate-adjusted regressions. Results: In the cross-sectional analysis of the pandemic data from 1130 pwMS and 1250 controls during the pandemic, having a higher percentage of network members with a perceived negative health influence was associated with worse disability in pwMS (MSRS-R: β=2.181, 95% CI 1.082-3.279; P<.001) and poor physical function in controls (PROMIS Physical Function: β=–5.707, 95% CI –7.405 to –4.010; P<.001). In the longitudinal analysis of 230 pwMS and 136 controls, the networks of all participants contracted, given an increase in constraint (pwMS-prepandemic: mean 52.24, SD 15.81; pwMS-pandemic: mean 56.77, SD 18.91; P=.006. Controls-prepandemic: mean 48.07, SD 13.36; controls-pandemic: mean 53.99, SD 16.31; P=.001) and a decrease in network size (pwMS-prepandemic: mean 8.02, SD 5.70; pwMS-pandemic: mean 6.63, SD 4.16; P=.003. Controls-prepandemic: mean 8.18, SD 4.05; controls-pandemic: mean 6.44, SD 3.92; P<.001), effective size (pwMS-prepandemic: mean 3.30, SD 1.59; pwMS-pandemic: mean 2.90, SD 1.50; P=.007. Controls-prepandemic: mean 3.85, SD 1.56; controls-pandemic: mean 3.40, SD 1.55; P=.01), and maximum degree (pwMS-prepandemic: mean 4.78, SD 1.86; pwMS-pandemic: mean 4.32, SD 1.92; P=.01. Controls-prepandemic: mean 5.38, SD 1.94; controls-pandemic: mean 4.55, SD 2.06; P<.001). These network changes were not associated with worsening function. The percentage of kin in the networks of pwMS increased (mean 46.06%, SD 29.34% to mean 54.36%, SD 30.16%; P=.003) during the pandemic, a change that was not seen in controls. Conclusions: Our findings suggest that high perceived negative health influence in the network was associated with worse function in all participants during the pandemic. The networks of all participants became tighter knit, and the percentage of kin in the networks of pwMS increased during the pandemic. Despite these perturbations in social connections, network changes from the prepandemic to the pandemic period were not associated with worsening function in all participants, suggesting possible resilience. %M 38319703 %R 10.2196/45429 %U https://publichealth.jmir.org/2024/1/e45429 %U https://doi.org/10.2196/45429 %U http://www.ncbi.nlm.nih.gov/pubmed/38319703 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47453 %T Profiles of Cough and Associated Risk Factors in Nonhospitalized Individuals With SARS-CoV-2 Omicron Variant Infection: Cross-Sectional Online Survey in China %A Xu,Tingting %A Chen,Yuehan %A Zhan,Wenzhi %A Chung,Kian Fan %A Qiu,Zhongmin %A Huang,Kewu %A Chen,Ruchong %A Xie,Jiaxing %A Wang,Gang %A Zhang,Min %A Wang,Xuefen %A Yao,Hongmei %A Liao,Xiuqing %A Zhang,Yunhui %A Zhang,Guojun %A Zhang,Wei %A Sun,Dejun %A Zhu,Jia %A Jiang,Shujuan %A Feng,Juntao %A Zhao,Jianping %A Sun,Gengyun %A Huang,Huaqiong %A Zhang,Jianyong %A Wang,Lingwei %A Wu,Feng %A Li,Suyun %A Xu,Pusheng %A Chi,Chunhua %A Chen,Ping %A Jiang,Mei %A He,Wen %A Huang,Lianrong %A Luo,Wei %A Li,Shiyue %A Zhong,Nanshan %A Lai,Kefang %A , %+ State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Rd, Guangzhou, 510000, China, 86 18826437341, klai@163.com %K COVID-19 %K Omicron variant %K nonhospitalized %K cough %D 2024 %7 5.2.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Cough is a common symptom during and after COVID-19 infection; however, few studies have described the cough profiles of COVID-19. Objective: The aim of this study was to investigate the prevalence, severity, and associated risk factors of severe and persistent cough in individuals with COVID-19 during the latest wave of the Omicron variant in China. Methods: In this nationwide cross-sectional study, we collected information of the characteristics of cough from individuals with infection of the SARS-CoV-2 Omicron variant using an online questionnaire sent between December 31, 2022, and January 11, 2023. Results: There were 11,718 (n=7978, 68.1% female) nonhospitalized responders, with a median age of 37 (IQR 30-47) years who responded at a median of 16 (IQR 12-20) days from infection onset to the time of the survey. Cough was the most common symptom, occurring in 91.7% of participants, followed by fever, fatigue, and nasal congestion (68.8%-87.4%). The median cough visual analog scale (VAS) score was 70 (IQR 50-80) mm. Being female (odds ratio [OR] 1.31, 95% CI 1.20-1.43), having a COVID-19 vaccination history (OR 1.71, 95% CI 1.37-2.12), current smoking (OR 0.48, 95% CI 0.41-0.58), chronic cough (OR 2.04, 95% CI 1.69-2.45), coronary heart disease (OR 1.71, 95% CI 1.17-2.52), asthma (OR 1.22, 95% CI 1.02-1.46), and gastroesophageal reflux disease (GERD) (OR 1.21, 95% CI 1.01-1.45) were independent factors for severe cough (VAS>70, 37.4%). Among all respondents, 35.0% indicated having a productive cough, which was associated with risk factors of being female (OR 1.44, 95% CI 1.31-1.57), having asthma (OR 1.84, 95% CI 1.52-2.22), chronic cough (OR 1.44, 95% CI 1.19-1.74), and GERD (OR 1.22, 95% CI 1.01-1.47). Persistent cough (>3 weeks) occurred in 13.0% of individuals, which was associated with the risk factors of having diabetes (OR 2.24, 95% CI 1.30-3.85), asthma (OR 1.70, 95% CI 1.11-2.62), and chronic cough (OR 1.97, 95% CI 1.32-2.94). Conclusions: Cough is the most common symptom in nonhospitalized individuals with Omicron SARS-CoV-2 variant infection. Being female, having asthma, chronic cough, GERD, coronary heart disease, diabetes, and a COVID-19 vaccination history emerged as independent factors associated with severe cough, productive cough, and persistent cough. %M 38315527 %R 10.2196/47453 %U https://publichealth.jmir.org/2024/1/e47453 %U https://doi.org/10.2196/47453 %U http://www.ncbi.nlm.nih.gov/pubmed/38315527 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 11 %N %P e46637 %T Effectiveness of Online and Remote Interventions for Mental Health in Children, Adolescents, and Young Adults After the Onset of the COVID-19 Pandemic: Systematic Review and Meta-Analysis %A Fischer-Grote,Linda %A Fössing,Vera %A Aigner,Martin %A Fehrmann,Elisabeth %A Boeckle,Markus %+ Department of Psychology and Psychodynamics, Karl Landsteiner University of Health Sciences, Dr.-Karl-Dorrek-Straße 30, Krems, 3500, Austria, 43 6503032923, elisabeth.fehrmann@kl.ac.at %K COVID-19 pandemic %K online/digital mental health intervention %K e-mental health %K anxiety %K social functioning %K depression %K well-being %K psychological distress %K eating disorder %K COVID-19 symptoms %D 2024 %7 5.2.2024 %9 Review %J JMIR Ment Health %G English %X Background: The prevalence of mental illness increased in children, adolescents, and young adults during the COVID-19 pandemic, while at the same time, access to treatment facilities has been restricted, resulting in a need for the quick implementation of remote or online interventions. Objective: This study aimed to give an overview of randomized controlled studies examining remote or online interventions for mental health in children, adolescents, and young adults and to explore the overall effectiveness of these interventions regarding different symptoms. Methods: A systematic literature search was conducted according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analysis) guidelines using PubMed, PsycInfo, Psyndex, Embase, and Google Scholar. A meta-analysis was conducted using a random effects model to calculate overall effect sizes for interventions using standardized mean differences (SMDs) for postintervention scores. Results: We identified 17 articles with 8732 participants in the final sample, and 13 were included in the quantitative analysis. The studies examined different digital interventions for several outcomes, showing better outcomes than the control in some studies. Meta-analyses revealed significant medium overall effects for anxiety (SMD=0.44, 95% CI 0.20 to 0.67) and social functioning (SMD=0.42, 95% CI –0.68 to –0.17) and a large significant effect for depression (SMD=1.31, 95% CI 0.34 to 2.95). In contrast, no significant overall treatment effects for well-being, psychological distress, disordered eating, and COVID-19–related symptoms were found. Conclusions: The qualitative and quantitative analyses of the included studies show promising results regarding the effectiveness of online interventions, especially for symptoms of anxiety and depression and for training of social functioning. However, the effectiveness needs to be further investigated for other groups of symptoms in the future. All in all, more research with high-quality studies is required. %M 38315524 %R 10.2196/46637 %U https://mental.jmir.org/2024/1/e46637 %U https://doi.org/10.2196/46637 %U http://www.ncbi.nlm.nih.gov/pubmed/38315524 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47048 %T Depression and Anxiety Symptoms Among Cisgender Gay and Bisexual Men During the Onset of the COVID-19 Pandemic: Time Series Analysis of a US National Cohort Study %A Mirzayi,Chloe %A Westmoreland,Drew %A Stief,Matthew %A Grov,Christian %+ CUNY Graduate School of Public Health and Health Policy, 55 W 125 Street, New York, NY, 10027, United States, 1 6463640254, cgrov@sph.cuny.edu %K COVID-19 pandemic %K lesbian, gay, bisexual, transgender, and queer %K LGBTQ %K mental health %K depression %K anxiety %K time series %K gay and bisexual men %K cisgender gay %K pandemic %K gay %D 2024 %7 26.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The onset of the COVID-19 pandemic in the United States in March 2020 caused a dramatic change in the way many people lived. Few aspects of daily life were left undisrupted by the pandemic’s onset as well as the accompanying policies to control the spread of the disease. Previous research has found that the pandemic may have significantly impacted the mental health of lesbian, gay, bisexual, transgender, and queer (LGBTQ) individuals—potentially more so than other individuals. However, the pandemic did not affect all areas of the United States at the same time, and there may be regional variation in the impact of the onset of the pandemic on depressive symptoms among LGBTQ individuals. Objective: To assess regional variation of the impact of the pandemic, we conducted a time series analysis stratified by US geographic region to examine symptoms of depression and anxiety among a sample of primarily cisgender gay and bisexual men before and after the onset of the COVID-19 pandemic in the United States. Methods: In total, 5007 participants completed assessments as part of the Together 5000 study, an ongoing prospective cohort study. Depressive and anxiety symptoms were measured using the Patient Health Questionnaire-4. Patient Health Questionnaire-4 scores were graphed as a function of days from March 15, 2020. Locally estimated scatterplot smoothing trend lines were applied. A sieve-bootstrap Mann-Kendall test for monotonic trend was conducted to assess the presence and direction of trends in the scatterplots. We then compared the observed trends to those observed for 1 year prior (2018-2019) to the pandemic onset using data collected from the same sample. Results: Significant positive trends were detected for the Northeast (P=.03) and Midwest (P=.01) regions of the United States in the 2020 assessment, indicating that symptoms of anxiety and depression were increasing in the sample in these regions immediately prior to and during the onset of the pandemic. In contrast, these trends were not present in data from the 2018 to 2019 assessment window. Conclusions: Symptoms of anxiety and depression increased among the study population in the Northeast and Midwest during the beginning months of the COVID-19 pandemic, but similar increase was not observed in the South and West regions. These trends were also not found for any region in the 2018 to 2019 assessment window. This may indicate region-specific trends in anxiety and depression, potentially driven by the burden of the pandemic and policies that varied from region to region. Future studies should consider geographic variation in COVID-19 spread and policies as well as explore potential mechanisms by which this could influence the mental health of LGBTQ individuals. %M 38277213 %R 10.2196/47048 %U https://publichealth.jmir.org/2024/1/e47048 %U https://doi.org/10.2196/47048 %U http://www.ncbi.nlm.nih.gov/pubmed/38277213 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e48159 %T Impact of the COVID-19 Pandemic on Health Care Utilization in the Vaccine Safety Datalink: Retrospective Cohort Study %A Qian,Lei %A Sy,Lina S %A Hong,Vennis %A Glenn,Sungching C %A Ryan,Denison S %A Nelson,Jennifer C %A Hambidge,Simon J %A Crane,Bradley %A Zerbo,Ousseny %A DeSilva,Malini B %A Glanz,Jason M %A Donahue,James G %A Liles,Elizabeth %A Duffy,Jonathan %A Xu,Stanley %+ Research and Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, 5th Floor, Pasadena, CA, 91101, United States, 1 626 564 3538, lei.x.qian@kp.org %K COVID-19 pandemic %K health care utilization %K telehealth %K inpatient %K emergency department %K outpatient %K vaccine safety %K electronic health record %K resource allocation %K difference-in-difference %K interrupted time series analysis %D 2024 %7 23.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Understanding the long-term impact of the COVID-19 pandemic on health care utilization is important to health care organizations and policy makers for strategic planning, as well as to researchers when designing studies that use observational electronic health record data during the pandemic period. Objective: This study aimed to evaluate the changes in health care utilization across all care settings among a large, diverse, and insured population in the United States during the COVID-19 pandemic. Methods: We conducted a retrospective cohort study within 8 health care organizations participating in the Vaccine Safety Datalink Project using electronic health record data from members of all ages from January 1, 2017, to December 31, 2021. The visit rates per person-year were calculated monthly during the study period for 4 health care settings combined as well as by inpatient, emergency department (ED), outpatient, and telehealth settings, both among all members and members without COVID-19. Difference-in-difference analysis and interrupted time series analysis were performed to assess the changes in visit rates from the prepandemic period (January 2017 to February 2020) to the early pandemic period (April-December 2020) and the later pandemic period (July-December 2021), respectively. An exploratory analysis was also conducted to assess trends through June 2023 at one of the largest sites, Kaiser Permanente Southern California. Results: The study included more than 11 million members from 2017 to 2021. Compared with the prepandemic period, we found reductions in visit rates during the early pandemic period for all in-person care settings. During the later pandemic period, overall use reached 8.36 visits per person-year, exceeding the prepandemic level of 7.49 visits per person-year in 2019 (adjusted percent change 5.1%, 95% CI 0.6%-9.9%); inpatient and ED visits returned to prepandemic levels among all members, although they remained low at 0.095 and 0.241 visits per person-year, indicating a 7.5% and 8% decrease compared to pre-pandemic levels among members without COVID-19, respectively. Telehealth visits, which were approximately 42% of the volume of outpatient visits during the later pandemic period, were increased by 97.5% (95% CI 86.0%-109.7%) from 0.865 visits per person-year in 2019 to 2.35 visits per person-year in the later pandemic period. The trends in Kaiser Permanente Southern California were similar to those of the entire study population. Visit rates from January 2022 to June 2023 were stable and appeared to be a continuation of the use levels observed at the end of 2021. Conclusions: Telehealth services became a mainstay of the health care system during the late COVID-19 pandemic period. Inpatient and ED visits returned to prepandemic levels, although they remained low among members without evidence of COVID-19. Our findings provide valuable information for strategic resource allocation for postpandemic patient care and for designing observational studies involving the pandemic period. %M 38091476 %R 10.2196/48159 %U https://publichealth.jmir.org/2024/1/e48159 %U https://doi.org/10.2196/48159 %U http://www.ncbi.nlm.nih.gov/pubmed/38091476 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e51596 %T Effects of a Rice-Farming Simulation Video Game on Nature Relatedness, Nutritional Status, and Psychological State in Urban-Dwelling Adults During the COVID-19 Pandemic: Randomized Waitlist Controlled Trial %A Lee,Seulki %A Yuh,Chisung %A Shin,Yu-Bin %A Lee,Heon-Jeong %A Lee,Young-Mee %A Lee,Jungsil %A Cho,Chul-Hyun %+ Department of Psychiatry, Korea University College of Medicine, 73 Goryeodae-ro Seongbuk-gu, Seoul, 02841, Republic of Korea, 82 0221993827, david0203@gmail.com %K video game %K digital intervention %K nature relatedness %K nutritional status %K psychological state %K COVID-19 %K urban-dwelling adults %D 2024 %7 22.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, urban inhabitants faced significant challenges in maintaining connections with nature, adhering to nutritional guidelines, and managing mental well-being. Objective: Recognizing the urgent need for innovative approaches, this study was designed to explore the potential benefits of a specific digital intervention, the rice-farming simulation game Sakuna: Of Rice and Ruin, for nature relatedness, nutritional behaviors, and psychological well-being. Methods: A total of 66 adults without any prior major psychiatric disorders residing in an urban area were recruited for the study. They were randomly assigned to 2 groups through block randomization: the immediate intervention group (IIG; 34/66, 52%) and the waitlist group (32/66, 48%). Participants in the IIG were instructed to play the game for at least 4 days per week for 3 weeks, with each session lasting from 30 minutes to 3 hours. Assessments were performed at baseline, week 1, and week 3. The Nature Relatedness Scale (NR) and Nutrition Quotient Scale were used to evaluate nature relatedness and nutritional state, respectively. Furthermore, psychological state was assessed using the World Health Organization Quality of Life–Brief Version (WHOQOL-BREF), Brief Fear of Negative Evaluation Scale, Social Avoidance and Distress Scale, Toronto Alexithymia Scale, State-Trait Anxiety Inventory, Center for Epidemiologic Studies Depression Scale Revised, and Korean Resilience Quotient. Results: This study’s results revealed significant time interactions between the IIG and waitlist group for both the total NR score (P=.001) and the score of the self subdomain of NR (P<.001), indicating an impact of the game on nature relatedness. No group×time interactions were found for the total Nutrition Quotient Scale and subdomain scores, although both groups showed increases from baseline. For psychological state, a significant group×time interaction was observed in the total WHOQOL-BREF score (P=.049), suggesting an impact of the game on quality of life. The psychological (P=.01), social (P=.003), and environmental (P=.04) subdomains of the WHOQOL-BREF showed only a significant time effect. Other psychological scales did not display any significant changes (all P>.05). Conclusions: Our findings suggest that the rice-farming game intervention might have positive effects on nature relatedness, nature-friendly dietary behaviors, quality of life, anxiety, depression, interpersonal relationships, and resilience among urban adults during the COVID-19 pandemic. The impact of pronature games in confined urban environments provides valuable evidence of how digital technologies can be used to enhance urban residents’ affinity for nature and psychological well-being. This understanding can be extended in the future to other digital platforms, such as metaverses. Trial Registration: Clinical Research Information Service (CRIS) KCT0007657; http://tinyurl.com/yck7zxp7 %M 38252464 %R 10.2196/51596 %U https://www.jmir.org/2024/1/e51596 %U https://doi.org/10.2196/51596 %U http://www.ncbi.nlm.nih.gov/pubmed/38252464 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e49185 %T Changes to Public Health Surveillance Methods Due to the COVID-19 Pandemic: Scoping Review %A Clark,Emily C %A Neumann,Sophie %A Hopkins,Stephanie %A Kostopoulos,Alyssa %A Hagerman,Leah %A Dobbins,Maureen %+ National Collaborating Centre for Methods and Tools, 175 Longwood Rd S, Suite 210A, Hamilton, ON, L8P 0A1, Canada, 1 9055259140 ext 20450, dobbinsm@mcmaster.ca %K public health %K surveillance %K digital surveillance %K COVID-19 %K screening %K infodemiology %K big data %K mobility tracking %K wastewater %K ethics %K decision making %K public health surveillance %D 2024 %7 19.1.2024 %9 Review %J JMIR Public Health Surveill %G English %X Background: Public health surveillance plays a vital role in informing public health decision-making. The onset of the COVID-19 pandemic in early 2020 caused a widespread shift in public health priorities. Global efforts focused on COVID-19 monitoring and contact tracing. Existing public health programs were interrupted due to physical distancing measures and reallocation of resources. The onset of the COVID-19 pandemic intersected with advancements in technologies that have the potential to support public health surveillance efforts. Objective: This scoping review aims to explore emergent public health surveillance methods during the early COVID-19 pandemic to characterize the impact of the pandemic on surveillance methods. Methods: A scoping search was conducted in multiple databases and by scanning key government and public health organization websites from March 2020 to January 2022. Published papers and gray literature that described the application of new or revised approaches to public health surveillance were included. Papers that discussed the implications of novel public health surveillance approaches from ethical, legal, security, and equity perspectives were also included. The surveillance subject, method, location, and setting were extracted from each paper to identify trends in surveillance practices. Two public health epidemiologists were invited to provide their perspectives as peer reviewers. Results: Of the 14,238 unique papers, a total of 241 papers describing novel surveillance methods and changes to surveillance methods are included. Eighty papers were review papers and 161 were single studies. Overall, the literature heavily featured papers detailing surveillance of COVID-19 transmission (n=187). Surveillance of other infectious diseases was also described, including other pathogens (n=12). Other public health topics included vaccines (n=9), mental health (n=11), substance use (n=4), healthy nutrition (n=1), maternal and child health (n=3), antimicrobial resistance (n=2), and misinformation (n=6). The literature was dominated by applications of digital surveillance, for example, by using big data through mobility tracking and infodemiology (n=163). Wastewater surveillance was also heavily represented (n=48). Other papers described adaptations to programs or methods that existed prior to the COVID-19 pandemic (n=9). The scoping search also found 109 papers that discuss the ethical, legal, security, and equity implications of emerging surveillance methods. The peer reviewer public health epidemiologists noted that additional changes likely exist, beyond what has been reported and available for evidence syntheses. Conclusions: The COVID-19 pandemic accelerated advancements in surveillance and the adoption of new technologies, especially for digital and wastewater surveillance methods. Given the investments in these systems, further applications for public health surveillance are likely. The literature for surveillance methods was dominated by surveillance of infectious diseases, particularly COVID-19. A substantial amount of literature on the ethical, legal, security, and equity implications of these emerging surveillance methods also points to a need for cautious consideration of potential harm. %M 38241067 %R 10.2196/49185 %U https://publichealth.jmir.org/2024/1/e49185 %U https://doi.org/10.2196/49185 %U http://www.ncbi.nlm.nih.gov/pubmed/38241067 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e51820 %T Fatigue and Mental Illness Symptoms in Long COVID: Protocol for a Prospective Cohort Multicenter Observational Study %A Pires,Ligia %A Reis,Cláudia %A Mesquita Facão,Ana Rita %A Moniri,Armin %A Marreiros,Ana %A Drummond,Marta %A Berger-Estilita,Joana %+ Institute of Anaesthesiology and Intensive Care, Salem Spital, Hirslanden Medical Group, Schänzlistrasse 39, Bern, 3013, Switzerland, 41 788438161, joanamberger@gmail.com %K SARS-CoV-2 %K coronavirus %K COVID %K long COVID %K fatigue %K tired %K tiredness %K anxiety %K depression %K PTSD %K stress %K quality of life %K mental health %K post-COVID-condition %K neuropsychological %K neuropsychology %K psychological %K long COVID-19 %K COVID-19 %K myalgia %K correlation %K impairment %D 2024 %7 19.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: The aftermath of the COVID-19 pandemic continues to affect millions worldwide, resulting in persisting postvirus complaints and impacting peoples’ quality of life. Long COVID, characterized by lingering symptoms like fatigue and mental illness, can extend beyond a few months, necessitating further research to understand its implications. Objective: This study aims to quantify the degree of physical and psychological fatigue in patients following COVID-19 infection and examine its correlation with mental health disorders. Methods: Using a consecutive nonrandom sampling technique, we will conduct a prospective cohort multicenter observational study in 5 Portuguese hospitals. Symptomatic adult patients with previous COVID-19 attending follow-up consultations will be enrolled. We will include patients who had mild, moderate, and severe acute disease. We will assess clinical outcomes related to COVID-19, including the type of respiratory support such as high-flow nasal cannula, noninvasive ventilation, and invasive mechanical ventilation. The exclusion criteria will include previous severe psychiatric disorders confirmed by a psychiatrist; refusal or inability to respond to the questionnaire; concomitant neurological disorder; persistent fatigue symptoms during the 6 months before infection; and the need for invasive mechanical ventilation during COVID-19 infection due to a high prevalence of postintensive care syndrome. Our primary outcome is the prevalence of fatigue in patients with post–COVID-19 depression and/or anxiety, as measured by the Chalder Fatigue Scale (CFQ-11) and the Hospital Anxiety and Depression Scale (HADS). The secondary outcomes will include an assessment of health-related quality of life via the EQ-5D questionnaire and an exploration of the prevalence of symptoms of posttraumatic stress disorder (PTSD) using the 14-item Posttraumatic Stress Scale (PTSS-14). We will also examine the association between mental health symptoms and the severity of acute COVID-19. The post–COVID-19 data will be collected at least 6 months after the positive test and no longer than 9 months during the clinical appointment. Results: We expect our multicenter study on patients post COVID-19 to reveal a significant link between mental illness symptoms and both physical and psychological fatigue. Patients with heightened depression and anxiety may report increased levels of fatigue. Additionally, we expect to find persistent PTSD symptoms in a subset of participants, indicating the enduring psychological impact of the virus. Conclusions: This study may underscore the need for integrated care addressing physical and mental health in patients post COVID-19. The observed connections emphasize the importance of considering mental well-being for long-term health outcomes. Despite study limitations, our findings contribute valuable insights for future treatment strategies and highlight the necessity for comprehensive mental health support in post–COVID-19 care. This research provides valuable insights into the mental health implications of COVID-19 and its impact on post–COVID-19 fatigue and the overall well-being of affected individuals. Trial Registration: ClinicalTrials.gov NCT05323318; https://clinicaltrials.gov/study/NCT05323318 International Registered Report Identifier (IRRID): DERR1-10.2196/51820 %M 38241071 %R 10.2196/51820 %U https://www.researchprotocols.org/2024/1/e51820 %U https://doi.org/10.2196/51820 %U http://www.ncbi.nlm.nih.gov/pubmed/38241071 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 13 %N %P e52523 %T Leveraging Community Health Workers and a Responsive Digital Health System to Improve Vaccination Coverage and Timeliness in Resource-Limited Settings: Protocol for a Cluster Randomized Type 1 Effectiveness-Implementation Hybrid Study %A Vasudevan,Lavanya %A Ostermann,Jan %A Thielman,Nathan %A Baumgartner,Joy Noel %A Solomon,David %A Mosses,Anna %A Hobbie,Amy %A Hair,Nicole L %A Liang,Chen %A van Zwetselaar,Marco %A Mfinanga,Sayoki %A Ngadaya,Esther %+ Department of Health Services Policy & Management, Arnold School of Public Health, University of South Carolina, 915 Greene St, Discovery 351, Columbia, SC, 29208, United States, 1 8037778747, jano@mailbox.sc.edu %K childhood vaccinations %K timeliness %K vaccine hesitancy %K digital health %K community health workers %K Tanzania %K low- and middle-income countries %K SMS %K reminder %K conditional incentive %D 2024 %7 12.1.2024 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tanzania is 1 of 20 countries where the majority of unvaccinated and undervaccinated children reside. Prior research identified substantial rural-urban disparities in the coverage and timeliness of childhood vaccinations in Tanzania, with children in rural settings being more likely to receive delayed or no vaccinations. Further research is necessary to identify effective and scalable interventions that can bridge rural-urban gaps in childhood vaccination while accounting for multifaceted barriers to vaccination. Objective: This protocol describes a type 1 effectiveness-implementation hybrid study to evaluate Chanjo Kwa Wakati (timely vaccination in Kiswahili), a community-based digital health intervention to improve vaccination timeliness. The intervention combines human resources (community health workers), low-cost digital strategies (electronic communication, digital case management, and task automation), a vaccination knowledge intervention, and insights from behavioral economics (reminders and incentives) to promote timely childhood vaccinations. Methods: The study will be conducted in 2 predominantly rural regions in Tanzania with large numbers of unvaccinated or undervaccinated children: Shinyanga and Mwanza. Forty rural health facilities and their catchment areas (clusters) will be randomized to an early or delayed onset study arm. From each cluster, 3 cohorts of mother-child dyads (1 retrospective cohort and 2 prospective cohorts) will be enrolled in the study. The timeliness and coverage of all vaccinations recommended during the first year of life will be observed for 1200 children (n=600, 50% intervention group children and n=600, 50% nonintervention group children). The primary effectiveness outcome will be the timeliness of the third dose of the pentavalent vaccine (Penta3). Quantitative surveys, vaccination records, study logs, fidelity checklists, and qualitative interviews with mothers and key informants will inform the 5 constructs of the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework. The results will be used to develop an implementation blueprint to guide future adaptations and scale-up of Chanjo Kwa Wakati. Results: The study was funded in August 2022. Data collection is expected to last from February 2024 to July 2027. Conclusions: This study will address the lack of rigorous evidence on the effectiveness of community-based digital health interventions for promoting vaccination coverage and timeliness among children from sub-Saharan Africa and identify potential implementation strategies to facilitate the deployment of vaccination promotion interventions in low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT06024317; https://www.clinicaltrials.gov/study/NCT06024317 International Registered Report Identifier (IRRID): PRR1-10.2196/52523 %M 38214956 %R 10.2196/52523 %U https://www.researchprotocols.org/2024/1/e52523 %U https://doi.org/10.2196/52523 %U http://www.ncbi.nlm.nih.gov/pubmed/38214956 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e52134 %T Development and Validation of a Robust and Interpretable Early Triaging Support System for Patients Hospitalized With COVID-19: Predictive Algorithm Modeling and Interpretation Study %A Baek,Sangwon %A Jeong,Yeon joo %A Kim,Yun-Hyeon %A Kim,Jin Young %A Kim,Jin Hwan %A Kim,Eun Young %A Lim,Jae-Kwang %A Kim,Jungok %A Kim,Zero %A Kim,Kyunga %A Chung,Myung Jin %+ Biomedical Statistics Center, Research Institute for Future Medicine, Samsung Medical Center, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, 82 2 3410 6745, kyunga.j.kim@gmail.com %K COVID-19 %K prognosis %K prognostic %K prognostics %K prediction model %K early triaging %K interpretability %K machine learning %K predict %K prediction %K predictive %K triage %K triaging %K emergency %K severity %K biomarker %K biomarkers %K SHAP %K Shapley %K clustering %K hospital admission %K hospital admissions %K hospitalize %K hospitalization %K hospitalizations %K neural network %K neural networks %K deep learning %K Omicron %K SARS-CoV-2 %K coronavirus %D 2024 %7 11.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: Robust and accurate prediction of severity for patients with COVID-19 is crucial for patient triaging decisions. Many proposed models were prone to either high bias risk or low-to-moderate discrimination. Some also suffered from a lack of clinical interpretability and were developed based on early pandemic period data. Hence, there has been a compelling need for advancements in prediction models for better clinical applicability. Objective: The primary objective of this study was to develop and validate a machine learning–based Robust and Interpretable Early Triaging Support (RIETS) system that predicts severity progression (involving any of the following events: intensive care unit admission, in-hospital death, mechanical ventilation required, or extracorporeal membrane oxygenation required) within 15 days upon hospitalization based on routinely available clinical and laboratory biomarkers. Methods: We included data from 5945 hospitalized patients with COVID-19 from 19 hospitals in South Korea collected between January 2020 and August 2022. For model development and external validation, the whole data set was partitioned into 2 independent cohorts by stratified random cluster sampling according to hospital type (general and tertiary care) and geographical location (metropolitan and nonmetropolitan). Machine learning models were trained and internally validated through a cross-validation technique on the development cohort. They were externally validated using a bootstrapped sampling technique on the external validation cohort. The best-performing model was selected primarily based on the area under the receiver operating characteristic curve (AUROC), and its robustness was evaluated using bias risk assessment. For model interpretability, we used Shapley and patient clustering methods. Results: Our final model, RIETS, was developed based on a deep neural network of 11 clinical and laboratory biomarkers that are readily available within the first day of hospitalization. The features predictive of severity included lactate dehydrogenase, age, absolute lymphocyte count, dyspnea, respiratory rate, diabetes mellitus, c-reactive protein, absolute neutrophil count, platelet count, white blood cell count, and saturation of peripheral oxygen. RIETS demonstrated excellent discrimination (AUROC=0.937; 95% CI 0.935-0.938) with high calibration (integrated calibration index=0.041), satisfied all the criteria of low bias risk in a risk assessment tool, and provided detailed interpretations of model parameters and patient clusters. In addition, RIETS showed potential for transportability across variant periods with its sustainable prediction on Omicron cases (AUROC=0.903, 95% CI 0.897-0.910). Conclusions: RIETS was developed and validated to assist early triaging by promptly predicting the severity of hospitalized patients with COVID-19. Its high performance with low bias risk ensures considerably reliable prediction. The use of a nationwide multicenter cohort in the model development and validation implicates generalizability. The use of routinely collected features may enable wide adaptability. Interpretations of model parameters and patients can promote clinical applicability. Together, we anticipate that RIETS will facilitate the patient triaging workflow and efficient resource allocation when incorporated into a routine clinical practice. %M 38206673 %R 10.2196/52134 %U https://www.jmir.org/2024/1/e52134 %U https://doi.org/10.2196/52134 %U http://www.ncbi.nlm.nih.gov/pubmed/38206673 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47673 %T Combining Digital and Molecular Approaches Using Health and Alternate Data Sources in a Next-Generation Surveillance System for Anticipating Outbreaks of Pandemic Potential %A Ramos,Pablo Ivan P %A Marcilio,Izabel %A Bento,Ana I %A Penna,Gerson O %A de Oliveira,Juliane F %A Khouri,Ricardo %A Andrade,Roberto F S %A Carreiro,Roberto P %A Oliveira,Vinicius de A %A Galvão,Luiz Augusto C %A Landau,Luiz %A Barreto,Mauricio L %A van der Horst,Kay %A Barral-Netto,Manoel %A , %+ Center for Data and Knowledge Integration for Health (CIDACS), Instituto Gonçalo Moniz, Fundação Oswaldo Cruz (Fiocruz), Rua Mundo, 121, Parque Tecnológico da Bahia, Edf. Tecnocentro, Trobogy, Salvador, 41745-715, Brazil, 55 7131762234, manoel.barral@fiocruz.br %K data integration %K digital public health %K infectious disease surveillance %K pandemic preparedness %K prevention %K response %D 2024 %7 9.1.2024 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Globally, millions of lives are impacted every year by infectious diseases outbreaks. Comprehensive and innovative surveillance strategies aiming at early alert and timely containment of emerging and reemerging pathogens are a pressing priority. Shortcomings and delays in current pathogen surveillance practices further disturbed informing responses, interventions, and mitigation of recent pandemics, including H1N1 influenza and SARS-CoV-2. We present the design principles of the architecture for an early-alert surveillance system that leverages the vast available data landscape, including syndromic data from primary health care, drug sales, and rumors from the lay media and social media to identify areas with an increased number of cases of respiratory disease. In these potentially affected areas, an intensive and fast sample collection and advanced high-throughput genome sequencing analyses would inform on circulating known or novel pathogens by metagenomics-enabled pathogen characterization. Concurrently, the integration of bioclimatic and socioeconomic data, as well as transportation and mobility network data, into a data analytics platform, coupled with advanced mathematical modeling using artificial intelligence or machine learning, will enable more accurate estimation of outbreak spread risk. Such an approach aims to readily identify and characterize regions in the early stages of an outbreak development, as well as model risk and patterns of spread, informing targeted mitigation and control measures. A fully operational system must integrate diverse and robust data streams to translate data into actionable intelligence and actions, ultimately paving the way toward constructing next-generation surveillance systems. %M 38194263 %R 10.2196/47673 %U https://publichealth.jmir.org/2024/1/e47673 %U https://doi.org/10.2196/47673 %U http://www.ncbi.nlm.nih.gov/pubmed/38194263 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 10 %N %P e47099 %T Development of New Stringency Indices for Nonpharmacological Social Distancing Policies Implemented in Korea During the COVID-19 Pandemic: Random Forest Approach %A Apio,Catherine %A Han,Kyulhee %A Lee,Doeun %A Lee,Bogyeom %A Park,Taesung %+ Department of Statisitcs, Seoul National University, Building 25, Room 310, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 010 5557 8924, tspark@stats.snu.ac.kr %K COVID-19 %K restriction policy %K Stringency Index %K Korea Stringency Index %K social distancing %K physical distancing %K pandemic %K government %K restriction %K effectiveness %K policy %D 2024 %7 8.1.2024 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 38190233 %R 10.2196/47099 %U https://publichealth.jmir.org/2024/1/e47099 %U https://doi.org/10.2196/47099 %U http://www.ncbi.nlm.nih.gov/pubmed/38190233 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 10 %N %P e52711 %T Challenges for Medical Students in Applying Ethical Principles to Allocate Life-Saving Medical Devices During the COVID-19 Pandemic: Content Analysis %A Hsieh,Hsing-yen %A Lin,Chyi-her %A Huang,Ruyi %A Lin,Guan-chun %A Lin,Jhen-Yu %A Aldana,Clydie %+ School of Medicine for International Students, College of Medicine, I-Shou University, 8 Yida Rd, Yanchao District, Kaohsiung, 82445, Taiwan, 886 7 615 0011 ext 2547, ruyi@mail.harvard.edu %K virtual patient %K virtual patients %K medical resources distribution %K medical ethical education %K COVID-19 pandemic %K ethics %K medical student %K medical students %K medical ethics %K decision-making %K ethical dilemna %K simulation %K reasoning %K decision support %K medical guideline %K medical guidelines %K medical devices %K medical device %K life-saving %K thematic analysis %K virtual platform %D 2024 %7 5.1.2024 %9 Original Paper %J JMIR Med Educ %G English %X Background: The emergence of the COVID-19 pandemic has posed a significant ethical dilemma in the allocation of scarce, life-saving medical equipment to critically ill patients. It remains uncertain whether medical students are equipped to navigate this complex ethical process. Objective: This study aimed to assess the ability and confidence of medical students to apply principles of medical ethics in allocating critical medical devices through the scenario of virtual patients. Methods: The study recruited third- and fourth-year medical students during clinical rotation. We facilitated interactions between medical students and virtual patients experiencing respiratory failure due to COVID-19 infection. We assessed the students’ ability to ethically allocate life-saving resources. Subsequently, we analyzed their written reports using thematic analysis to identify the ethical principles guiding their decision-making. Results: We enrolled a cohort of 67 out of 71 medical students with a mean age of 34 (SD 4.7) years, 60% (n=40) of whom were female students. The principle of justice was cited by 73% (n=49) of students while analyzing this scenario. A majority of them expressed hesitancy in determining which patient should receive life-saving resources, with 46% (n=31) citing the principle of nonmaleficence, 31% (n=21) advocating for a first-come-first-served approach, and 25% (n=17) emphasizing respect for patient autonomy as key influencers in their decisions. Notably, medical students exhibited a lack of confidence in making ethical decisions concerning the distribution of medical resources. A minority, comprising 12% (n=8), proposed the exploration of legal alternatives, while 4% (n=3) suggested medical guidelines and collective decision-making as potential substitutes for individual ethical choices to alleviate the stress associated with personal decision-making. Conclusions: This study highlights the importance of improving ethical reasoning under time constraints using virtual platforms. More than 70% of medical students identified justice as the predominant principle in allocating limited medical resources to critically ill patients. However, they exhibited a lack of confidence in making ethical determinations and leaned toward principles such as nonmaleficence, patient autonomy, adherence to legal and medical standards, and collective decision-making to mitigate the pressure associated with such decisions. %M 38050366 %R 10.2196/52711 %U https://mededu.jmir.org/2024/1/e52711 %U https://doi.org/10.2196/52711 %U http://www.ncbi.nlm.nih.gov/pubmed/38050366 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 11 %N %P e44619 %T Acceptance and User Experiences of a Wearable Device for the Management of Hospitalized Patients in COVID-19–Designated Wards in Ho Chi Minh City, Vietnam: Action Learning Project %A Luu,An Phuoc %A Nguyen,Truong Thanh %A Cao,Van Thi Cam %A Ha,Trinh Hoang Diem %A Chung,Lien Thi Thu %A Truong,Trung Ngoc %A Nguyen Le Nhu,Tung %A Dao,Khoa Bach %A Nguyen,Hao Van %A Khanh,Phan Nguyen Quoc %A Le,Khanh Thuy Thuy %A Tran,Luu Hoai Bao %A Nhat,Phung Tran Huy %A Tran,Duc Minh %A Lam,Yen Minh %A Thwaites,Catherine Louise %A Mcknight,Jacob %A Vinh Chau,Nguyen Van %A Van Nuil,Jennifer Ilo %A , %+ Oxford University Clinical Research Unit, 764 Vo Van Kiet, Ho Chi Minh City, 70000, Vietnam, 84 362620124, jvannuil@oucru.org %K vital signs %K wearable devices %K action learning %K technology acceptance model %K TAM %K COVID-19 %K user-centered design %K wearables %K remote monitoring %K technology acceptance %K oximeter %D 2024 %7 5.1.2024 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Wearable devices have been used extensively both inside and outside of the hospital setting. During the COVID-19 pandemic, in some contexts, there was an increased need to remotely monitor pulse and saturated oxygen for patients due to the lack of staff and bedside monitors. Objective: A prototype of a remote monitoring system using wearable pulse oximeter devices was implemented at the Hospital for Tropical Diseases in Ho Chi Minh City, Vietnam, from August to December 2021. The aim of this work was to support the ongoing implementation of the remote monitoring system. Methods: We used an action learning approach with rapid pragmatic methods, including informal discussions and observations as well as a feedback survey form designed based on the technology acceptance model to assess the use and acceptability of the system. Based on these results, we facilitated a meeting using user-centered design principles to explore user needs and ideas about its development in more detail. Results: In total, 21 users filled in the feedback form. The mean technology acceptance model scores ranged from 3.5 (for perceived ease of use) to 4.4 (for attitude) with behavioral intention (3.8) and perceived usefulness (4.2) scoring in between. Those working as nurses scored higher on perceived usefulness, attitude, and behavioral intention than did physicians. Based on informal discussions, we realized there was a mismatch between how we (ie, the research team) and the ward teams perceived the use and wider purpose of the technology. Conclusions: Designing and implementing the devices to be more nurse-centric from their introduction could have helped to increase their efficiency and use during the complex pandemic period. %M 38180799 %R 10.2196/44619 %U https://humanfactors.jmir.org/2024/1/e44619 %U https://doi.org/10.2196/44619 %U http://www.ncbi.nlm.nih.gov/pubmed/38180799 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 26 %N %P e44249 %T Pediatric and Young Adult Household Transmission of the Initial Waves of SARS-CoV-2 in the United States: Administrative Claims Study %A Chung,Ming Kei %A Hart,Brian %A Santillana,Mauricio %A Patel,Chirag J %+ Department of Biomedical Informatics, Harvard Medical School, Harvard University, 10 Shattuck Street, Room 302, Boston, MA, 02115, United States, 1 617 432 1195, chirag_patel@hms.harvard.edu %K household transmission %K infectivity %K pediatric %K COVID-19 %K children %K claims data %K administrative data %K transmission %K risk factor %K logistic regression %K regression %K multivariable logistics regression %K multiple logistic regression statistics %K cohort %K retrospective cohort %K laboratory %K LOINC %K infant %K toddler %K newborn %D 2024 %7 4.1.2024 %9 Original Paper %J J Med Internet Res %G English %X Background: The correlates responsible for the temporal changes of intrahousehold SARS-CoV-2 transmission in the United States have been understudied mainly due to a lack of available surveillance data. Specifically, early analyses of SARS-CoV-2 household secondary attack rates (SARs) were small in sample size and conducted cross-sectionally at single time points. From these limited data, it has been difficult to assess the role that different risk factors have had on intrahousehold disease transmission in different stages of the ongoing COVID-19 pandemic, particularly in children and youth. Objective: This study aimed to estimate the transmission dynamic and infectivity of SARS-CoV-2 among pediatric and young adult index cases (age 0 to 25 years) in the United States through the initial waves of the pandemic. Methods: Using administrative claims, we analyzed 19 million SARS-CoV-2 test records between January 2020 and February 2021. We identified 36,241 households with pediatric index cases and calculated household SARs utilizing complete case information. Using a retrospective cohort design, we estimated the household SARS-CoV-2 transmission between 4 index age groups (0 to 4 years, 5 to 11 years, 12 to 17 years, and 18 to 25 years) while adjusting for sex, family size, quarter of first SARS-CoV-2 positive record, and residential regions of the index cases. Results: After filtering all household records for greater than one member in a household and missing information, only 36,241 (0.85%) of 4,270,130 households with a pediatric case remained in the analysis. Index cases aged between 0 and 17 years were a minority of the total index cases (n=11,484, 11%). The overall SAR of SARS-CoV-2 was 23.04% (95% CI 21.88-24.19). As a comparison, the SAR for all ages (0 to 65+ years) was 32.4% (95% CI 32.1-32.8), higher than the SAR for the population between 0 and 25 years of age. The highest SAR of 38.3% was observed in April 2020 (95% CI 31.6-45), while the lowest SAR of 15.6% was observed in September 2020 (95% CI 13.9-17.3). It consistently decreased from 32% to 21.1% as the age of index groups increased. In a multiple logistic regression analysis, we found that the youngest pediatric age group (0 to 4 years) had 1.69 times (95% CI 1.42-2.00) the odds of SARS-CoV-2 transmission to any family members when compared with the oldest group (18 to 25 years). Family size was significantly associated with household viral transmission (odds ratio 2.66, 95% CI 2.58-2.74). Conclusions: Using retrospective claims data, the pediatric index transmission of SARS-CoV-2 during the initial waves of the COVID-19 pandemic in the United States was associated with location and family characteristics. Pediatric SAR (0 to 25 years) was less than the SAR for all age other groups. Less than 1% (n=36,241) of all household data were retained in the retrospective study for complete case analysis, perhaps biasing our findings. We have provided measures of baseline household pediatric transmission for tracking and comparing the infectivity of later SARS-CoV-2 variants. %M 37967280 %R 10.2196/44249 %U https://www.jmir.org/2024/1/e44249 %U https://doi.org/10.2196/44249 %U http://www.ncbi.nlm.nih.gov/pubmed/37967280 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40216 %T Decreased Seasonal Influenza Rates Detected in a Crowdsourced Influenza-Like Illness Surveillance System During the COVID-19 Pandemic: Prospective Cohort Study %A Gertz,Autumn %A Rader,Benjamin %A Sewalk,Kara %A Varrelman,Tanner J %A Smolinski,Mark %A Brownstein,John S %+ Computational Epidemiology Lab, Boston Children's Hospital, 300 Longwood Avenue, Boston, MA, 02115, United States, 1 8572185188, info@outbreaksnearme.org %K participatory surveillance %K influenza %K crowdsourced data %K disease surveillance %K surveillance %K COVID-19 %K respiratory %K transmission %K detection %K survey %K sore throat %K fever %K cough %K vaccination %K diagnosis %K precautions %D 2023 %7 28.12.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Seasonal respiratory viruses had lower incidence during their 2019-2020 and 2020-2021 seasons, which overlapped with the COVID-19 pandemic. The widespread implementation of precautionary measures to prevent transmission of SARS-CoV-2 has been seen to also mitigate transmission of seasonal influenza. The COVID-19 pandemic also led to changes in care seeking and access. Participatory surveillance systems have historically captured mild illnesses that are often missed by surveillance systems that rely on encounters with a health care provider for detection. Objective: This study aimed to assess if a crowdsourced syndromic surveillance system capable of detecting mild influenza-like illness (ILI) also captured the globally observed decrease in ILI in the 2019-2020 and 2020-2021 influenza seasons, concurrent with the COVID-19 pandemic. Methods: Flu Near You (FNY) is a web-based participatory syndromic surveillance system that allows participants in the United States to report their health information using a brief weekly survey. Reminder emails are sent to registered FNY participants to report on their symptoms and the symptoms of household members. Guest participants may also report. ILI was defined as fever and sore throat or fever and cough. ILI rates were determined as the number of ILI reports over the total number of reports and assessed for the 2016-2017, 2017-2018, 2018-2019, 2019-2020, and 2020-2021 influenza seasons. Baseline season (2016-2017, 2017-2018, and 2018-2019) rates were compared to the 2019-2020 and 2020-2021 influenza seasons. Self-reported influenza diagnosis and vaccination status were captured and assessed as the total number of reported events over the total number of reports submitted. CIs for all proportions were calculated via a 1-sample test of proportions. Results: ILI was detected in 3.8% (32,239/848,878) of participants in the baseline seasons (2016-2019), 2.58% (7418/287,909) in the 2019-2020 season, and 0.27% (546/201,079) in the 2020-2021 season. Both influenza seasons that overlapped with the COVID-19 pandemic had lower ILI rates than the baseline seasons. ILI decline was observed during the months with widespread implementation of COVID-19 precautions, starting in February 2020. Self-reported influenza diagnoses decreased from early 2020 through the influenza season. Self-reported influenza positivity among ILI cases varied over the observed time period. Self-reported influenza vaccination rates in FNY were high across all observed seasons. Conclusions: A decrease in ILI was detected in the crowdsourced FNY surveillance system during the 2019-2020 and 2020-2021 influenza seasons, mirroring trends observed in other influenza surveillance systems. Specifically, the months within seasons that overlapped with widespread pandemic precautions showed decreases in ILI and confirmed influenza. Concerns persist regarding respiratory pathogens re-emerging with changes to COVID-19 guidelines. Traditional surveillance is subject to changes in health care behaviors. Systems like FNY are uniquely situated to detect disease across disease severity and care seeking, providing key insights during public health emergencies. %M 38153782 %R 10.2196/40216 %U https://publichealth.jmir.org/2023/1/e40216 %U https://doi.org/10.2196/40216 %U http://www.ncbi.nlm.nih.gov/pubmed/38153782 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e47294 %T Leveraging mHealth to Mitigate the Impact of COVID-19 in Black American Communities: Qualitative Analysis %A Harris,Kelly M %A Mayo Gamble,Tilicia %A Yoo,Madelyn G %A Spell,Lindsay A %A Minor,Timira N %A Jones,Holly %A Lynch,Donald %+ School of Medicine, Washington University in St. Louis, 660 South Euclid Avenue, MSC 8505-45-1, Saint Louis, MO, 63110-1010, United States, 1 3142733242, kmharris@wustl.edu %K COVID-19 %K mobile health %K mHealth %K information-seeking behavior %K Black communities %K cardiovascular health %K community %K qualitative analysis %K morbidity %K mortality %K develop %K pilot %K evaluate %K mHealth intervention %K cardiovascular %K racism %K health equity %D 2023 %7 22.12.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: COVID-19 remains an ongoing public health crisis. Black Americans remain underrepresented among those vaccinated and overrepresented in both COVID-19 morbidity and mortality. Medical misinformation, specifically related to COVID-19, has exacerbated the impact of the disease in Black American communities. Communication tools and strategies to build relationships and disseminate credible and trustworthy diagnostic and preventative health information are necessary to improve outcomes and equity for historically oppressed populations. Objective: As the initial phase of a larger mixed methods project to develop, pilot, and evaluate a mobile health (mHealth) intervention among a population at high risk for COVID-19 and cardiovascular comorbidities, this study sought to explore COVID-19 information behavior among Black Americans. Specifically, this study examined (1) preferences for COVID-19 education via mHealth, (2) barriers and facilitators to COVID-19 education and diagnostic testing and routine care for associated cardiovascular and respiratory comorbidities in the local community, and (3) key content for inclusion in a COVID-19 mHealth app. Methods: This qualitative study used principles of community-based participatory research and information systems research to conduct 7 focus groups across 3 sites. Focus groups were audio recorded and transcribed for thematic analysis using an abductive approach. Results: The study sample included 54 individuals across sites with a mean age of 50.24 (SD 11.76; range 20-71) years. Participants were primarily female (n=42, 78%) and Black (n=54, 100%) with varied education levels. Over half (n=29, 54%) of the participants were employed full-time, and nearly three-fourths (n=40, 74%) had household incomes 45 years in clinics. Furthermore, the standardized incidence was positively associated with movement change toward grocery and pharmacy stores in all age groups in 2022. In addition, movement changes toward residences were significantly positively associated with the standardized incidence among all age groups. Conclusions: Overall, school closure effectively suppresses COVID-19–related syndromes in students owing to the reduction of physical contact. In addition, school closure has a spillover effect on elderly people who stay at home. %M 38100192 %R 10.2196/44606 %U https://www.i-jmr.org/2023/1/e44606 %U https://doi.org/10.2196/44606 %U http://www.ncbi.nlm.nih.gov/pubmed/38100192 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45204 %T Impact of the COVID-19 Health Crisis on Key Populations at Higher Risk for, or Living With, HIV or Hepatitis C Virus and People Working With These Populations: Multicountry Community-Based Research Study Protocol (EPIC Program) %A Delabre,Rosemary M %A Di Ciaccio,Marion %A Lorente,Nicolas %A Villes,Virginie %A Castro Avila,Juliana %A Yattassaye,Adam %A Bonifaz,César %A Ben Moussa,Amal %A Sikitu,Ingrid-Zaïre %A Khodabocus,Niloufer %A Freitas,Rosa %A Spire,Bruno %A Veras,Maria Amélia %A Sagaon-Teyssier,Luis %A Girard,Gabriel %A Roux,Perrine %A Velter,Annie %A Delpech,Valérie %A Ghosn,Jade %A Riegel,Lucas %A Rojas Castro,Daniela %+ Community-based Research Laboratory, Coalition PLUS, 14 Rue Scandicci, Pantin, 13385 Marseille Cedex 5, France, 33 491324600, mdiciaccio@coalitionplus.org %K COVID-19 %K key populations %K health %K crisis %K HIV %K mobile phone %D 2023 %7 14.12.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Information concerning the impact of the COVID-19 health crisis on populations most affected by HIV and hepatitis C virus (HCV; or key populations [KP]), and those working with these populations in community settings, is limited. Community-based organizations working in the field of HIV and viral hepatitis are well placed to identify and meet the new needs of KP owing to the health crisis. Objective: This study aims to describe the development and implementation of an exploratory and descriptive multicountry, community-based research program, EPIC (Enquêtes Pour évaluer l’Impact de la crise sanitaire covid en milieu Communautaire), within an international network of community-based organizations involved in the response to HIV and viral hepatitis. The EPIC program aimed to study the impact of the COVID-19 health crisis on KP or people living with HIV or HCV and people working with these populations at the community level (community health workers [CHWs]) and to identify the key innovations and adaptations in HIV and HCV services. Methods: A general protocol and study documents were developed and shared within the Coalition PLUS network. The protocol had a built-in flexibility that allowed participating organizations to adapt the study to local needs in terms of the target population and specific themes of interest. Data were collected using surveys or interviews. Results: From July 2020 to May 2022, a total of 79 organizations participated in the EPIC program. Across 32 countries, 118 studies were conducted: 66 quantitative (n=12,060 among KP or people living with HIV or people living with HCV and n=811 among CHWs) and 52 qualitative (n=766 among KP or people living with HIV or people living with HCV and n=136 among CHWs). Conclusions: The results of the EPIC program will provide data to describe the impact of the health crisis on KP and CHWs and identify their emerging needs. Documentation of innovative solutions that were put into place in this context may help improve the provision of services after COVID-19 and for future health crises. International Registered Report Identifier (IRRID): DERR1-10.2196/45204 %M 38096016 %R 10.2196/45204 %U https://www.researchprotocols.org/2023/1/e45204 %U https://doi.org/10.2196/45204 %U http://www.ncbi.nlm.nih.gov/pubmed/38096016 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e34386 %T Manifestations and Outcomes of Intracerebral Hemorrhage During the COVID-19 Pandemic in China: Multicenter, Longitudinal Cohort Study %A Wan,Yan %A He,Quan Wei %A Chen,Shaoli %A Li,Man %A Xia,Yuanpeng %A Zhang,Lei %A Sun,Zhou %A Chen,Xiaolu %A Wang,David %A Chang,Jiang %A Hu,Bo %+ Department of Neurology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, NO.1277, Jiefang Road, Wuhan, 430022, China, 86 13707114863, hubo@mail.hust.edu.cn %K COVID-19 %K intracerebral hemorrhage %K manifestation %K outcome %K cohort study %D 2023 %7 13.12.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has inevitably affected the distribution of medical resources, and epidemic lockdowns have had a significant impact on the nursing and treatment of patients with other acute diseases, including intracerebral hemorrhage (ICH). Objective: This study aimed to investigate how the COVID-19 pandemic affected the manifestations and outcomes of patients with ICH. Methods: Patients with acute ICH before (December 1, 2018-November 30, 2019) and during (December 1, 2019-November 30, 2020) the COVID-19 pandemic at 31 centers in China from the Chinese Cerebral Hemorrhage: Mechanism and Intervention (CHEERY) study were entered into the analysis. Demographic information and clinical manifestations and outcomes were collected and compared between the 2 groups. Results: From December 1, 2018, to November 30, 2020, a total of 3460 patients with ICH from the CHEERY study were enrolled and eventually analyzed. The results showed that during the COVID-19 pandemic, patients with ICH were more likely to be older (P<.001) with a history of ischemic stroke (P=.04), shorter time from onset to admission (P<.001), higher blood pressure (P<.001), higher fasting blood glucose (P=.003), larger hematoma volume (P<.001), and more common deep ICH (P=.01) and intraventricular hemorrhage (P=.02). These patients required more intensive care unit treatment (P<.001) and preferred to go to the hospital directly rather than call an ambulance (P<.001). In addition, the COVID-19 pandemic was associated with an increased risk of pulmonary infection during hospitalization (adjusted risk ratio [RRadjusted] 1.267, 95% CI 1.065-1.509), lower probability of a 3-month good outcome (RRadjusted 0.975, 95% CI 0.956-0.995), and a higher probability of in-hospital (RRadjusted 3.103, 95% CI 2.156-4.465), 1-month (RRadjusted 1.064, 95% CI 1.042-1.087), and 3-month (RRadjusted 1.069, 95% CI 1.045-1.093) mortality. Conclusions: Our study indicated that the cloud of COVID-19 has adversely impacted the presentation and outcomes of ICH. Medical workers may pay more attention to patients with ICH, while the public should pay more attention to hypertension control and ICH prevention. Trial Registration: Chinese Clinical Trial Registry ChiCTR1900020872; https://www.chictr.org.cn/showprojEN.html?proj=33817 %M 38090794 %R 10.2196/34386 %U https://publichealth.jmir.org/2023/1/e34386 %U https://doi.org/10.2196/34386 %U http://www.ncbi.nlm.nih.gov/pubmed/38090794 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39472 %T Hepatitis C Knowledge and Self-Reported Testing Behavior in the General Population in China: Online Cross-Sectional Survey %A Liu,Yin %A Su,Juan %A Wang,Xiaoyang %A Xu,Huifang %A Wang,Hong %A Kang,Ruihua %A Zheng,Liyang %A Wang,Yixian %A Liu,Chunya %A Jing,Yiping %A Zhang,Shaokai %+ Department of Cancer Epidemiology, The Affiliated Cancer Hospital of Zhengzhou University (Henan Cancer Hospital), 127 Dongming Road, Zhengzhou, 450008, China, 86 65587361, shaokaizhang@126.com %K HCV %K hepatitis C virus %K knowledge %K testing behaviors %K general population %K cross-sectional %K online survey %K testing %K screening %K patient education %K China %K Chinese %K patient education %K health education %K hepatitis %K viral disease %K viral infection %K communicable disease %K liver %D 2023 %7 11.12.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The World Health Organization has proposed a worldwide target of eliminating hepatitis C virus (HCV) by 2030. A better understanding of HCV, testing behaviors, and associated factors in the general population is essential. Objective: This study aimed to assess HCV knowledge, self-reported HCV testing behavior, and willingness to undergo HCV screening in the general Chinese population. Methods: A cross-sectional online survey of the general Chinese population aged ≥15 years was conducted from November 2021 to May 2023. Participant characteristics were assessed based on their knowledge level and uptake of HCV testing. Participants ever having heard of HCV were recognized as being aware of HCV and asked additional HCV knowledge questions using a brief, validated 9-item scale. Participants with 0-3 points and who were unaware of HCV were categorized as having poor knowledge, and those with 4-6 points and ≥7 points were categorized as having fair and good knowledge, respectively. Participant uptake of HCV testing, testing results, reasons for undergoing or not undergoing HCV testing, and willingness to undergo HCV screening were collected through self-reports. Ordinal and binary logistic regression analyses were used to assess factors associated with the HCV knowledge level and the uptake of HCV testing, respectively. Results: A total of 1491 valid participants’ questionnaires were included. Of these, 714 (47.6%) participants were aware of HCV. The proportion of participants with poor, fair, and good HCV knowledge was 63.4% (945/1491), 9.3% (139/1491), and 27.3% (407/1491), respectively. A total of 465 (31.2%) participants reported ever undergoing HCV testing, and 4 (0.9%) were anti-HCV antibody positive. Most participants were tested for HCV following blood donation (353/465, 75.9%). The most common reasons for not undergoing HCV screening were a lack of HCV awareness (665/1026, 64.8%), followed by a low self-perceived risk of infection (176/1026, 17.2%). Of 1026 participants who had never undergone HCV testing, 937 (91.3%) were willing to undergo HCV screening if universal screening was provided at no cost. The HCV knowledge level was positively associated with the HCV testing rate. Participants who were less educated, lived in rural areas, resided in West China, and were currently alcohol drinkers had lower HCV knowledge and reduced odds of having undergone HCV testing. In contrast, participants with a blood donation history and a family history of hepatitis B virus or HCV infection had higher HCV knowledge and increased odds of prior testing. Participants aged ≥60 years had lower knowledge, and women had reduced odds of having undergone previous HCV testing. Conclusions: The general population of China has low HCV knowledge and testing rate. There is an urgent need for enhanced HCV awareness and scaled-up HCV screening and treatment. Individuals who are less well educated, reside in less-developed areas, currently drink alcohol, and are female should be prioritized for health education and interventions. %M 38079213 %R 10.2196/39472 %U https://publichealth.jmir.org/2023/1/e39472 %U https://doi.org/10.2196/39472 %U http://www.ncbi.nlm.nih.gov/pubmed/38079213 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e46009 %T Safety of COVID-19 Vaccination in Patients With Breast Cancer: Cross-Sectional Study in China %A Zhang,Shaohua %A Li,Jianbin %A Xu,Ruonan %A Chen,Qianjun %A Sun,Gang %A Lin,Ying %A Cao,Yali %A Chen,Yiding %A Geng,Cuizhi %A Teng,Yuee %A Nie,Jianyun %A Li,Xinzheng %A Xu,Guiying %A Liu,Xinlan %A Jin,Feng %A Fan,Zhimin %A Luo,Ting %A Liu,Hong %A Wang,Fu-sheng %A Jiang,Zefei %+ Fifth Medical Center of Chinese People's Liberation Army General Hospital, East street of Fengtai District, Beijing, 100071, China, 86 18518277411, jiangzefei@csco.org.cn %K breast cancer %K COVID-19 vaccines %K patients reported adverse events %K healthy population %K vaccine safety %D 2023 %7 7.12.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The widespread use of vaccines against the novel coronavirus disease (COVID-19) has become one of the most effective means to establish a population immune barrier. Patients with cancer are vulnerable to COVID-19 infection, adverse events, and high mortality, and should be the focus of epidemic prevention and treatment. However, real-world data on the safety of vaccines for patients with breast cancer are still scarce. Objective: This study aims to compare the safety of COVID-19 vaccines between patients vaccinated before or after being diagnosed with breast cancer. Methods: Patients with breast cancer who sought medical advice from October 2021 to December 2021 were screened. Those who received COVID-19 vaccines were enrolled in this study to analyze the safety of the vaccines. The primary outcome was patient-reported adverse events (AEs). All events after vaccine injection were retrospectively documented from the patients. Results: A total of 15,455 patients with breast cancer from 41 hospitals in 20 provinces in China were screened, and 5766 patients who received COVID-19 vaccines were enrolled. Of those enrolled, 45.1% (n=2599) of patients received vaccines before breast cancer diagnosis, 41.3% (n=2379) were vaccinated after diagnosis, and 13.6% (n=784) did not known the accurate date of vaccination or cancer diagnosis. Among the patients vaccinated after diagnosis, 85.4% (n=2032) were vaccinated 1 year after cancer diagnosis and 95.4% (n=2270) were vaccinated during early-stage cancer. Of all 5766 vaccinated patients, 93.9% (n=5415) received an inactivated vaccine, 3.7% (n=213) received a recombinant subunit vaccine, and 2.4% (n=138) received other vaccines, including adenovirus and mRNA vaccines. In the first injection of vaccines, 24.4% (n=10, 95% CI 11.2-37.5) of patients who received an adenovirus vaccine reported AEs, compared to only 12.5% (n=677, 95% CI 11.6-13.4) of those who received an inactivated vaccine. Patients with metastatic breast cancer reported the highest incidence of AEs (n=18, 16.5%, 95% CI 9.5-23.5). Following the second injection, patients who received an inactivated vaccine (n=464, 8.7%, 95% CI 8.0-9.5) and those who received a recombinant vaccine (n=25, 8.7%, 95% CI 5.5-12.0) reported the same incidence of AEs. No significant differences in patient-reported AEs were found between the healthy population and patients with breast cancer (16.4% vs 16.9%, respectively); the most common AEs were local pain (11.1% vs 9.1%, respectively), fatigue (5.5% vs 6.3%, respectively), and muscle soreness (2.3% vs 3.6%, respectively). The type of vaccine and time window of vaccination had little impact on patient-reported AEs. Conclusions: Compared with patients vaccinated before breast cancer diagnosis, there were no significant differences in patient-reported AEs in the patients vaccinated after diagnosis. Thus, it is safe for patients with breast cancer, especially for those in the early stage, to receive COVID-19 vaccines. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200055509; https://tinyurl.com/33zzj882 %M 38060302 %R 10.2196/46009 %U https://publichealth.jmir.org/2023/1/e46009 %U https://doi.org/10.2196/46009 %U http://www.ncbi.nlm.nih.gov/pubmed/38060302 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e50682 %T Postpandemic Evaluation of the Eco-Efficiency of Personal Protective Equipment Against COVID-19 in Emergency Departments: Proposal for a Mixed Methods Study %A Berthelot,Simon %A Longtin,Yves %A Margni,Manuele %A Guertin,Jason Robert %A LeBlanc,Annie %A Marx,Tania %A Mangou,Khadidiatou %A Bluteau,Ariane %A Mantovani,Diego %A Mikhaylin,Sergey %A Bergeron,Frédéric %A Dancause,Valérie %A Desjardins,Anne %A Lahrichi,Nadia %A Martin,Danielle %A Sossa,Charles Jérôme %A Lachapelle,Philippe %A Genest,Isabelle %A Schaal,Stéphane %A Gignac,Anne %A Tremblay,Stéphane %A Hufty,Éric %A Bélanger,Lynda %A Beatty,Erica %+ Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Bureau A0550, 2705 Boul. Laurier, Québec, QC, G2A0E1, Canada, 1 418 525 4444 ext 70553, simon.berthelot@fmed.ulaval.ca %K COVID-19 %K SARS-CoV-2 %K personal protective equipment %K emergency department %K health care workers %K systematic review %K cost-consequence analysis %K time-driven activity-based costing %K life cycle assessment %K ecological footprint %D 2023 %7 7.12.2023 %9 Proposal %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has had a profound impact on emergency department (ED) care in Canada and around the world. To prevent transmission of COVID-19, personal protective equipment (PPE) was required for all ED care providers in contact with suspected cases. With mass vaccination and improvements in several infection prevention components, our hypothesis is that the risks of transmission of COVID-19 will be significantly reduced and that current PPE use will have economic and ecological consequences that exceed its anticipated benefits. Evidence is needed to evaluate PPE use so that recommendations can ensure the clinical, economic, and environmental efficiency (ie, eco-efficiency) of its use. Objective: To support the development of recommendations for the eco-efficient use of PPE, our research objectives are to (1) estimate the clinical effectiveness (reduced transmission, hospitalizations, mortality, and work absenteeism) of PPE against COVID-19 for health care workers; (2) estimate the financial cost of using PPE in the ED for the management of suspected or confirmed COVID-19 patients; and (3) estimate the ecological footprint of PPE use against COVID-19 in the ED. Methods: We will conduct a mixed method study to evaluate the eco-efficiency of PPE use in the 5 EDs of the CHU de Québec-Université Laval (Québec, Canada). To achieve our goals, the project will include four phases: systematic review of the literature to assess the clinical effectiveness of PPE (objective 1; phase 1); cost estimation of PPE use in the ED using a time-driven activity-based costing method (objective 2; phase 2); ecological footprint estimation of PPE use using a life cycle assessment approach (objective 3; phase 3); and cost-consequence analysis and focus groups (integration of objectives 1 to 3; phase 4). Results: The first 3 phases have started. The results of these phases will be available in 2023. Phase 4 will begin in 2023 and results will be available in 2024. Conclusions: While the benefits of PPE use are likely to diminish as health care workers’ immunity increases, it is important to assess its economic and ecological impacts to develop recommendations to guide its eco-efficient use. Trial Registration: PROSPERO CRD42022302598; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302598 International Registered Report Identifier (IRRID): DERR1-10.2196/50682 %M 38060296 %R 10.2196/50682 %U https://www.researchprotocols.org/2023/1/e50682 %U https://doi.org/10.2196/50682 %U http://www.ncbi.nlm.nih.gov/pubmed/38060296 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e48511 %T Effects of SARS-CoV-2 Vaccines on Sperm Quality: Systematic Review %A Li,Guanjian %A Zhang,Rongqiu %A Song,Bing %A Wang,Chao %A Shen,Qunshan %A He,Xiaojin %A Cao,Yunxia %+ Reproductive Medicine Center, Department of Obstetrics and Gynecology, the First Affiliated Hospital of Anhui Medical University, No 81 Meishan Road, Hefei, 230022, China, 86 15395104659, caoyunxia6@126.com %K COVID-19 vaccine %K SARS-CoV-2 %K reproductive system %K fertility %K sperm quality %D 2023 %7 6.12.2023 %9 Review %J JMIR Public Health Surveill %G English %X 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. %M 37976132 %R 10.2196/48511 %U https://publichealth.jmir.org/2023/1/e48511 %U https://doi.org/10.2196/48511 %U http://www.ncbi.nlm.nih.gov/pubmed/37976132 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e37102 %T Prevalence of COVID-19 Mitigation Behaviors in US Adults (August-December 2020): Nationwide Household Probability Survey %A Sanchez,Travis %A Hall,Eric %A Siegler,Aaron J %A Prakash-Asrani,Radhika %A Bradley,Heather %A Fahimi,Mansour %A Lopman,Benjamin %A Luisi,Nicole %A Nelson,Kristin N %A Sailey,Charles %A Shioda,Kayoko %A Valentine-Graves,Mariah %A Sullivan,Patrick S %+ Rollins School of Public Health, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 404 727 8403, Travis.Sanchez@emory.edu %K COVID-19 %K mask %K social distancing %K handwashing %K hand sanitizer %K public health %K pandemic %K mitigation behavior %K risk factor %K disease prevention %K health policy %K latent class analysis %K hygiene %D 2023 %7 6.12.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 38055314 %R 10.2196/37102 %U https://publichealth.jmir.org/2023/1/e37102 %U https://doi.org/10.2196/37102 %U http://www.ncbi.nlm.nih.gov/pubmed/38055314 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44257 %T Residential Segregation and County-Level COVID-19 Booster Coverage in the Deep South: Surveillance Report and Ecological Study %A Zeng,Chengbo %A Zhang,Jiajia %A Li,Zhenlong %A Sun,Xiaowen %A Ning,Huan %A Yang,Xueying %A Weissman,Sharon %A Olatosi,Bankole %A Li,Xiaoming %+ Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 4th Floor, 915 Greene Street, Columbia, SC, 29208, United States, czeng@email.sc.edu %K Deep South %K COVID-19 %K vaccine %K booster %K residential segregation %D 2023 %7 5.12.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 had a greater impact in the Deep South compared with other regions in the United States. While vaccination remains a top priority for all eligible individuals, data regarding the progress of booster coverage in the Deep South and how the coverage varies by county and age are sparse. Despite existing evidence of racial and ethnic disparities in COVID-19 vaccinations at the individual level, there is an urgent need for evidence at the population level. Such information could highlight vulnerable communities and guide future health care policy-making and resource allocation. Objective: We aimed to evaluate county-level COVID-19 booster coverage by age group in the Deep South and explore its association with residential segregation. Methods: An ecological study was conducted at the population level by integrating COVID-19 vaccine surveillance data, residential segregation index, and county-level factors across the 418 counties of 5 Deep South states from December 15, 2021, to October 19, 2022. We analyzed the cumulative percentages of county-level COVID-19 booster uptake by age group (eg, 12 to 17 years, 18 to 64 years, and at least 65 years) by the end of the study period. The longitudinal relationships were examined between residential segregation, the interaction of time and residential segregation, and COVID-19 booster coverage using the Poisson model. Results: As of October 19, 2022, among the 418 counties, the median of booster uptake was 40% (IQR 37.8%-43%). Compared with older adults (ie, at least 65 years; median 63.1%, IQR 59.5%-66.5%), youth (ie, 12 to 17 years; median 14.1%, IQR 11.3%-17.4%) and adults (ie, 18 to 64 years; median 33.4%, IQR 30.5%-36.5%) had lower percentages of booster uptake. There was geospatial heterogeneity in the county-level COVID-19 booster coverage. We found that higher segregated counties had lower percentages of booster coverage. Such relationships attenuated as time increased. The findings were consistent across the age groups. Conclusions: The progress of county-level COVID-19 booster coverage in the Deep South was slow and varied by age group. Residential segregation precluded the county-level COVID-19 booster coverage across age groups. Future efforts regarding vaccination strategies should focus on youth and adults. Health care facilities and resources are needed in racial and ethnic minority communities. %M 38051568 %R 10.2196/44257 %U https://publichealth.jmir.org/2023/1/e44257 %U https://doi.org/10.2196/44257 %U http://www.ncbi.nlm.nih.gov/pubmed/38051568 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45870 %T Epidemic Characteristics, Spatiotemporal Pattern, and Risk Factors of Other Infectious Diarrhea in Fujian Province From 2005 to 2021: Retrospective Analysis %A Lu,Yixiao %A Zhu,Hansong %A Hu,Zhijian %A He,Fei %A Chen,Guangmin %+ Fujian Provincial Center for Disease Control and Prevention, The Practice Base on the School of Public Health, Fujian Medical University, No.386 Chong'an Road, Fuzhou, 350001, China, 86 591 87552041, cgmyf34567@163.com %K other infectious diarrhea %K spatiotemporal pattern %K disease cluster %K epidemiological trends %K spatial autocorrelation %K meteorological factors %K environmental factors %D 2023 %7 30.11.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Other infectious diarrhea (OID) continues to pose a significant public health threat to all age groups in Fujian Province. There is a need for an in-depth analysis to understand the epidemiological pattern of OID and its associated risk factors in the region. Objective: In this study, we aimed to describe the overall epidemic characteristics and spatiotemporal pattern of OID in Fujian Province from 2005 to 2021 and explore the linkage between sociodemographic and environmental factors and the occurrence of OID within the study area. Methods: Notification data for OID in Fujian were extracted from the China Information System for Disease Control and Prevention. The spatiotemporal pattern of OID was analyzed using Moran index and Kulldorff scan statistics. The seasonality of and short-term impact of meteorological factors on OID were examined using an additive decomposition model and a generalized additive model. Geographical weighted regression and generalized linear mixed model were used to identify potential risk factors. Results: A total of 388,636 OID cases were recorded in Fujian Province from January 2005 to December 2021, with an average annual incidence of 60.3 (SD 16.7) per 100,000 population. Children aged <2 years accounted for 50.7% (196,905/388,636) of all cases. There was a steady increase in OID from 2005 to 2017 and a clear seasonal shift in OID cases from autumn to winter and spring between 2005 and 2020. Higher maximum temperature, atmospheric pressure, humidity, and precipitation were linked to a higher number of deseasonalized OID cases. The spatial and temporal aggregations were concentrated in Zhangzhou City and Xiamen City for 17 study years. Furthermore, the clustered areas exhibited a dynamic spreading trend, expanding from the southernmost Fujian to the southeast and then southward over time. Factors such as densely populated areas with a large <1-year-old population, less economically developed areas, and higher pollution levels contributed to OID cases in Fujian Province. Conclusions: This study revealed a distinct distribution of OID incidence across different population groups, seasons, and regions in Fujian Province. Zhangzhou City and Xiamen City were identified as the major hot spots for OID. Therefore, prevention and control efforts should prioritize these specific hot spots and highly susceptible groups. %M 38032713 %R 10.2196/45870 %U https://publichealth.jmir.org/2023/1/e45870 %U https://doi.org/10.2196/45870 %U http://www.ncbi.nlm.nih.gov/pubmed/38032713 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e50367 %T Incivility in COVID-19 Vaccine Mandate Discourse and Moral Foundations: Natural Language Processing Approach %A Tin,Jason %A Stevens,Hannah %A Rasul,Muhammad Ehab %A Taylor,Laramie D %+ Department of Communication, University of California, Davis, 1 Shields Avenue, Davis, CA, 95616, United States, 1 530 752 1011, merasul@ucdavis.edu %K incivility %K vaccine hesitancy %K moral foundations %K COVID-19 %K vaccines %K morality %K social media %K natural language processing %K machine learning %D 2023 %7 29.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Vaccine hesitancy poses a substantial threat to efforts to mitigate the harmful effects of the COVID-19 pandemic. To combat vaccine hesitancy, officials in the United States issued vaccine mandates, which were met with strong antivaccine discourse on social media platforms such as Reddit. The politicized and polarized nature of COVID-19 on social media has fueled uncivil discourse related to vaccine mandates, which is known to decrease confidence in COVID-19 vaccines. Objective: This study examines the moral foundations underlying uncivil COVID-19 vaccine discourse. Moral foundations theory poses that individuals make decisions to express approval or disapproval (ie, uncivil discourse) based on innate moral values. We examine whether moral foundations are associated with dimensions of incivility. Further, we explore whether there are any differences in the presence of incivility between the r/coronaviruscirclejerk and r/lockdownskepticism subreddits. Methods: Natural language processing methodologies were leveraged to analyze the moral foundations underlying uncivil discourse in 2 prominent antivaccine subreddits, r/coronaviruscirclejerk and r/lockdownskepticism. All posts and comments from both of the subreddits were collected since their inception in March 2022. This was followed by filtering the data set for key terms associated with the COVID-19 vaccine (eg, “vaccinate” and “Pfizer”) and mandates (eg, “forced” and “mandating”). These key terms were selected based on a review of existing literature and because of their salience in both of the subreddits. A 10% sample of the filtered key terms was used for the final analysis. Results: Findings suggested that moral foundations play a role in the psychological processes underlying uncivil vaccine mandate discourse. Specifically, we found substantial associations between all moral foundations (ie, care and harm, fairness and cheating, loyalty and betrayal, authority and subversion, and sanctity and degradation) and dimensions of incivility (ie, toxicity, insults, profanity, threat, and identity attack) except for the authority foundation. We also found statistically significant differences between r/coronaviruscirclejerk and r/lockdownskepticism for the presence of the dimensions of incivility. Specifically, the mean of identity attack, insult, toxicity, profanity, and threat in the r/lockdownskepticism subreddit was significantly lower than that in the r/coronaviruscirclejerk subreddit (P<.001). Conclusions: This study shows that moral foundations may play a substantial role in the presence of incivility in vaccine discourse. On the basis of the findings of the study, public health practitioners should tailor messaging by addressing the moral values underlying the concerns people may have about vaccines, which could manifest as uncivil discourse. Another way to tailor public health messaging could be to direct it to parts of social media platforms with increased uncivil discourse. By integrating moral foundations, public health messaging may increase compliance and promote civil discourse surrounding COVID-19. %M 38019581 %R 10.2196/50367 %U https://formative.jmir.org/2023/1/e50367 %U https://doi.org/10.2196/50367 %U http://www.ncbi.nlm.nih.gov/pubmed/38019581 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44728 %T Evaluating the Added Value of Digital Contact Tracing Support Tools for Citizens: Framework Development %A Baron,Ruth %A Hamdiui,Nora %A Helms,Yannick B %A Crutzen,Rik %A Götz,Hannelore M %A Stein,Mart L %+ Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Postbus 1, Bilthoven, 3720 BA, Netherlands, 31 088 689 89 89, baronruth6@gmail.com %K contact tracing %K digital tools %K citizen involvement %K COVID-19 %K infectious disease outbreak %K framework %K mobile phone %D 2023 %7 29.11.2023 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic revealed that with high infection rates, health services conducting contact tracing (CT) could become overburdened, leading to limited or incomplete CT. Digital CT support (DCTS) tools are designed to mimic traditional CT, by transferring a part of or all the tasks of CT into the hands of citizens. Besides saving time for health services, these tools may help to increase the number of contacts retrieved during the contact identification process, quantity and quality of contact details, and speed of the contact notification process. The added value of DCTS tools for CT is currently unknown. Objective: To help determine whether DCTS tools could improve the effectiveness of CT, this study aims to develop a framework for the comprehensive assessment of these tools. Methods: A framework containing evaluation topics, research questions, accompanying study designs, and methods was developed based on consultations with CT experts from municipal public health services and national public health authorities, complemented with scientific literature. Results: These efforts resulted in a framework aiming to assist with the assessment of the following aspects of CT: speed; comprehensiveness; effectiveness with regard to contact notification; positive case detection; potential workload reduction of public health professionals; demographics related to adoption and reach; and user experiences of public health professionals, index cases, and contacts. Conclusions: This framework provides guidance for researchers and policy makers in designing their own evaluation studies, the findings of which can help determine how and the extent to which DCTS tools should be implemented as a CT strategy for future infectious disease outbreaks. %M 38019583 %R 10.2196/44728 %U https://www.researchprotocols.org/2023/1/e44728 %U https://doi.org/10.2196/44728 %U http://www.ncbi.nlm.nih.gov/pubmed/38019583 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41811 %T Airway Sequelae After Mechanical Ventilation for COVID-19: Protocol for a Scoping Review %A Candelo,Estephania %A Arias-Valderrama,Oriana %A Triviño-Arias,Jacobo %A Quiroz,Felipe %A Isaza-Pierotti,Daniel Francisco %A Victoria,William %A Tintinago,Luis F %+ Head and Neck Department, Fundacion Valle del Lili, Carrera 98 # 18-49, Cali, 760003, Colombia, 57 2870327, luis.tintinago@fvl.org.co %K airway %K sequelae %K COVID-19 %K mechanical ventilation %K SARS-CoV-2 %K scoping review %K pulmonary %K mortality %K voice production %K health care cost %K health intervention %D 2023 %7 29.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The epidemiology, morbidity, and burden of disease related to airway sequelae associated with invasive mechanical ventilation in the context of the COVID-19 pandemic remain unclear. Objective: This scoping review aims to summarize the current knowledge regarding airway sequelae after severe SARS-CoV-2 infection. This knowledge will help guide research endeavors and decision-making in clinical practice. Methods: This scoping review will include participants of all genders, and no particular age group who developed post–COVID-19 airway-related complication will be excluded. No exclusion criteria will be applied from country, language, or document type. The information source will include analytical observational studies. Unpublished data will not be completely covered as gray literature will be covered. A total of 2 independent reviewers will participate in the process of screening, selection, and data extraction, and the whole process will be performed blindly. Conflict between the reviewers will be solved through discussion and an additional reviewer. The results will be reported by using descriptive statistics, and information will be displayed on RedCap (Research Electronic Data Capture). Results: The literature search was conducted in May 2022 in the following databases: PubMed, Embase, SCOPUS, Cochrane Library, as well as LILACS and gray literature to identify observational studies; a total of 738 results were retrieved. The scoping review will be finished by March 2023. Conclusions: This scoping review will describe current knowledge on the most frequently encountered laryngeal or tracheal sequelae in patients exposed to mechanical ventilation due to SARS-CoV-2 infection. This scoping review will find the incidence of airway sequelae post COVID-19 and the most common sequelae such as airway granuloma, vocal fold paralysis, and airway stenoses. Future studies should evaluate the incidence of these disorders. International Registered Report Identifier (IRRID): DERR1-10.2196/41811 %M 37191952 %R 10.2196/41811 %U https://www.researchprotocols.org/2023/1/e41811 %U https://doi.org/10.2196/41811 %U http://www.ncbi.nlm.nih.gov/pubmed/37191952 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e46898 %T Application of Machine Learning Prediction of Individual SARS-CoV-2 Vaccination and Infection Status to the French Serosurveillance Survey From March 2020 to 2022: Cross-Sectional Study %A Bougeard,Stéphanie %A Huneau-Salaun,Adeline %A Attia,Mikael %A Richard,Jean-Baptiste %A Demeret,Caroline %A Platon,Johnny %A Allain,Virginie %A Le Vu,Stéphane %A Goyard,Sophie %A Gillon,Véronique %A Bernard-Stoecklin,Sibylle %A Crescenzo-Chaigne,Bernadette %A Jones,Gabrielle %A Rose,Nicolas %A van der Werf,Sylvie %A Lantz,Olivier %A Rose,Thierry %A Noël,Harold %+ Epidemiology, Health and Welfare, Laboratory of Ploufragan-Plouzané-Niort, French Agency for Food, Environmental, Occupational Health & Safety, BP 53 - Technopole Saint Brieuc Armor, Ploufragan, 22440, France, 33 296010150, stephanie.bougeard@anses.fr %K SARS-CoV-2 %K serological surveillance %K infection %K vaccination %K machine learning %K seroprevalence %K blood testing %K immunity %K survey %K vaccine response %K French population %K prediction %D 2023 %7 28.11.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The seroprevalence of SARS-CoV-2 infection in the French population was estimated with a representative, repeated cross-sectional survey based on residual sera from routine blood testing. These data contained no information on infection or vaccination status, thus limiting the ability to detail changes observed in the immunity level of the population over time. Objective: Our aim is to predict the infected or vaccinated status of individuals in the French serosurveillance survey based only on the results of serological assays. Reference data on longitudinal serological profiles of seronegative, infected, and vaccinated individuals from another French cohort were used to build the predictive model. Methods: A model of individual vaccination or infection status with respect to SARS-CoV-2 obtained from a machine learning procedure was proposed based on 3 complementary serological assays. This model was applied to the French nationwide serosurveillance survey from March 2020 to March 2022 to estimate the proportions of the population that were negative, infected, vaccinated, or infected and vaccinated. Results: From February 2021 to March 2022, the estimated percentage of infected and unvaccinated individuals in France increased from 7.5% to 16.8%. During this period, the estimated percentage increased from 3.6% to 45.2% for vaccinated and uninfected individuals and from 2.1% to 29.1% for vaccinated and infected individuals. The decrease in the seronegative population can be largely attributed to vaccination. Conclusions: Combining results from the serosurveillance survey with more complete data from another longitudinal cohort completes the information retrieved from serosurveillance while keeping its protocol simple and easy to implement. %M 38015594 %R 10.2196/46898 %U https://publichealth.jmir.org/2023/1/e46898 %U https://doi.org/10.2196/46898 %U http://www.ncbi.nlm.nih.gov/pubmed/38015594 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49435 %T Fight Against the Mandatory COVID-19 Immunity Passport on Twitter: Natural Language Processing Study %A Gable,Jessica S M %A Sauvayre,Romy %A Chauvière,Cédric %+ Polytech Clermont, Clermont Auvergne INP, Université Clermont Auvergne, 2 avenue Blaise Pascal, TSA 60 026, Aubiere, 63178, France, 33 781425636, romy.sauvayre@uca.fr %K mandatory vaccination %K public policy %K public health measures %K COVID-19 %K vaccine %K social media analysis %K Twitter %K natural language processing %K deep learning %K social media %K public health %K vaccination %K immunity %K social distancing %K neural network %K effectiveness %D 2023 %7 23.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: To contain and curb the spread of COVID-19, the governments of countries around the world have used different strategies (lockdown, mandatory vaccination, immunity passports, voluntary social distancing, etc). Objective: This study aims to examine the reactions produced by the public announcement of a binding political decision presented by the president of the French Republic, Emmanuel Macron, on July 12, 2021, which imposed vaccination on caregivers and an immunity passport on all French people to access restaurants, cinemas, bars, and so forth. Methods: To measure these announcement reactions, 901,908 unique tweets posted on Twitter (Twitter Inc) between July 12 and August 11, 2021, were extracted. A neural network was constructed to examine the arguments of the tweets and to identify the types of arguments used by Twitter users. Results: This study shows that in the debate about mandatory vaccination and immunity passports, mostly “con” arguments (399,803/847,725, 47%; χ26=952.8; P<.001) and “scientific” arguments (317,156/803,583, 39%; χ26=5006.8; P<.001) were used. Conclusions: This study shows that during July and August 2021, social events permeating the public sphere and discussions about mandatory vaccination and immunity passports collided on Twitter. Moreover, a political decision based on scientific arguments led citizens to challenge it using pseudoscientific arguments contesting the effectiveness of vaccination and the validity of these political decisions. %M 37850906 %R 10.2196/49435 %U https://www.jmir.org/2023/1/e49435 %U https://doi.org/10.2196/49435 %U http://www.ncbi.nlm.nih.gov/pubmed/37850906 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e52114 %T Assessment of Knowledge and Attitudes Over Time in Postacute COVID-19 Environments: Protocol for an Epidemiological Study %A Martínez-Baz,Iván %A Bullón-Vela,Vanessa %A Soldevila,Núria %A Torner,Núria %A Palma,David %A García Cenoz,Manuel %A Pérez,Glòria %A Burgui,Cristina %A Castilla,Jesús %A Godoy,Pere %A Domínguez,Angela %A Toledo,Diana %+ Instituto de Salud Pública de Navarra, C/ Leyre 15, Pamplona, 31003, Spain, 34 84842 8513, imartinba@navarra.es %K COVID-19 %K knowledge %K attitudes %K household contact %K vaccination %K preventive measures %K survey %D 2023 %7 23.11.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Globally, COVID-19 is in transition from the acute pandemic phase into a postacute phase, and special attention should be paid at this time to COVID-19 control strategies. Understanding public knowledge and attitudes plays a pivotal role in controlling COVID-19’s spread and provides information about the public’s adherence to preventive and control measures. Objective: This study protocol describes the planning and management of a survey to investigate the persistent or changing trends in knowledge and attitudes regarding COVID-19, vaccination, and nonpharmaceutical preventive measures among COVID-19 cases’ household contacts aged 18 years and older, after the acute phase of the pandemic in Catalonia and Navarre in Spain. The secondary objectives include investigating the rate of secondary transmission in households, taking into account the demographic characteristics, clinical manifestations, and preventive measures toward COVID-19. Methods: A telephone questionnaire was designed to assess the changing trends in knowledge, preventive measures, and attitudes toward COVID-19 in 3 rounds (after identification as a household contact, 3 months later, and 6 months later). The questionnaire was developed following an extensive literature review and through discussions with a panel of experts who designed and assessed the validity of the questionnaire in terms of relevance, consistency, completeness, and clarity. The questionnaire consists of the following 7 sections: social and demographic characteristics (ie, gender, age, educational level, and workplace), comorbidities and risk factors (according to the recommendations from the COVID-19 vaccination strategy), epidemiological data (ie, exposure time, relationship with index cases, and frequency of use of nonpharmaceutical preventive measures), COVID-19 vaccination status (ie, the number and date of doses received), knowledge and attitudes toward COVID-19 (assessed using a 5-point Likert scale—totally agree, agree, neither agree nor disagree, disagree, and totally disagree), and sources of information (including traditional mass media, social media, and official sources). Results: A pilot study was performed in May 2022 to evaluate the questionnaire with 22 household contacts. Preliminary findings indicated that the questionnaire was feasible and acceptable in the general population. The average response time was 15 minutes, with greater variations in responses by older participants. After the pilot study, recruitment of participants began and is expected to be completed at the end of the year 2023, after which the final results will be available in 2024. Conclusions: Despite the low transmission levels of SARS-CoV-2 and the relaxation of containment measures, the implementation of the survey during the postacute phase will provide valuable insight to assist public health decision-making and control the transmission of SARS-CoV-2 and other respiratory viruses, thereby attenuating the negative effects of COVID-19 at individual and population level. International Registered Report Identifier (IRRID): DERR1-10.2196/52114 %M 37995118 %R 10.2196/52114 %U https://www.researchprotocols.org/2023/1/e52114 %U https://doi.org/10.2196/52114 %U http://www.ncbi.nlm.nih.gov/pubmed/37995118 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e41207 %T Association Among Household Water, Sanitation, and Hygiene (WASH) Status and Typhoid Risk in Urban Slums: Prospective Cohort Study in Bangladesh %A Tadesse,Birkneh Tilahun %A Khanam,Farhana %A Ahmmed,Faisal %A Liu,Xinxue %A Islam,Md Taufiqul %A Kim,Deok Ryun %A Kang,Sophie SY %A Im,Justin %A Chowdhury,Fahima %A Ahmed,Tasnuva %A Aziz,Asma Binte %A Hoque,Masuma %A Park,Juyeon %A Pak,Gideok %A Jeon,Hyon Jin %A Zaman,Khalequ %A Khan,Ashraful Islam %A Kim,Jerome H %A Marks,Florian %A Qadri,Firdausi %A Clemens,John D %+ Epidemiology, Public Health, Impact Unit, International Vaccine Institute, SNU Research Park, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 1098041348, birkneh.tadesse@ivi.int %K water %K sanitation %K sanitary %K contaminated %K contamination %K hygiene %K hygienic %K WASH %K water, sanitation and hygiene %K typhoid fever %K enteric fever %K typhus %K typhoid %K enteric %K salmonella %K protection %K recursive partitioning %K Bangladesh %K low- and middle-income countries %K LMIC %K bacteria %K bacterial %K bacterial infection %K machine learning %K algorithm %K algorithms %K model %K low income %K slum %K slums %K risk %K infection control %K incidence %K prevalence %K epidemiology %K epidemiological %K poverty %D 2023 %7 20.11.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Typhoid fever, or enteric fever, is a highly fatal infectious disease that affects over 9 million people worldwide each year, resulting in more than 110,000 deaths. Reduction in the burden of typhoid in low-income countries is crucial for public health and requires the implementation of feasible water, sanitation, and hygiene (WASH) interventions, especially in densely populated urban slums. Objective: In this study, conducted in Mirpur, Bangladesh, we aimed to assess the association between household WASH status and typhoid risk in a training subpopulation of a large prospective cohort (n=98,087), and to evaluate the performance of a machine learning algorithm in creating a composite WASH variable. Further, we investigated the protection associated with living in households with improved WASH facilities and in clusters with increasing prevalence of such facilities during a 2-year follow-up period. Methods: We used a machine learning algorithm to create a dichotomous composite variable (“Better” and “Not Better”) based on 3 WASH variables: private toilet facility, safe drinking water source, and presence of water filter. The algorithm was trained using data from the training subpopulation and then validated in a distinct subpopulation (n=65,286) to assess its sensitivity and specificity. Cox regression models were used to evaluate the protective effect of living in “Better” WASH households and in clusters with increasing levels of “Better” WASH prevalence. Results: We found that residence in households with improved WASH facilities was associated with a 38% reduction in typhoid risk (adjusted hazard ratio=0.62, 95% CI 0.49-0.78; P<.001). This reduction was particularly pronounced in individuals younger than 10 years at the first census participation, with an adjusted hazard ratio of 0.49 (95% CI 0.36-0.66; P<.001). Furthermore, we observed an inverse relationship between the prevalence of “Better” WASH facilities in clusters and the incidence of typhoid, although this association was not statistically significant in the multivariable model. Specifically, the adjusted hazard of typhoid decreased by 0.996 (95% CI 0.986-1.006) for each percent increase in the prevalence of “Better” WASH in the cluster (P=.39). Conclusions: Our findings demonstrate that existing variations in household WASH are associated with differences in the risk of typhoid in densely populated urban slums. This suggests that attainable improvements in WASH facilities can contribute to enhanced typhoid control, especially in settings where major infrastructural improvements are challenging. These findings underscore the importance of implementing and promoting comprehensive WASH interventions in low-income countries as a means to reduce the burden of typhoid and improve public health outcomes in vulnerable populations. %M 37983081 %R 10.2196/41207 %U https://publichealth.jmir.org/2023/1/e41207 %U https://doi.org/10.2196/41207 %U http://www.ncbi.nlm.nih.gov/pubmed/37983081 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42545 %T Selection Bias in Digital Conversations on Depression Before and During COVID-19 %A Lee,Edward %A Agustines,Davin %A Woo,Benjamin K P %+ College of Osteopathic Medicine of the Pacific, Western University of Health Sciences, 4385 Ocean View Blvd, Montrose, CA, 91020, United States, 1 8189260488, edward.lee@westernu.edu %K depression %K COVID-19 %K treatment %K race %K ethnicity %K digital conversations %K health belief model %K artificial intelligence %K AI %K natural language processing %K NLP %D 2023 %7 20.11.2023 %9 Letter to the Editor %J JMIR Form Res %G English %X %M 37983077 %R 10.2196/42545 %U https://formative.jmir.org/2023/1/e42545 %U https://doi.org/10.2196/42545 %U http://www.ncbi.nlm.nih.gov/pubmed/37983077 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e34128 %T Feasibility of Telemedicine in the Management Strategy of Patients With Lymphoma Amid the COVID-19 Pandemic in Spain: Prospective Observational Study %A Cordoba,Raul %A Lopez-Garcia,Alberto %A Morillo,Daniel %A Perez-Saenz,Maria-Angeles %A Askari,Elham %A Prieto,Rosa Elena %A Castillo Bazan,Eva %A Llamas Sillero,Pilar %A Herrero Gonzalez,Antonio %A Short Apellaniz,Jorge %A del Olmo,Marta %A Arcos,Javier %+ Department of Hematology, Clinical and Organizational Innovation Unit (UICO), Fundacion Jimenez Diaz University Hospital, Health Research Institute IIS-FJD, Avenida Reyes Catolicos 2, Madrid, 28040, Spain, 34 915504800 ext 3854, raul.cordoba@fjd.es %K telemedicine %K lymphoma %K COVID-19 %K cancer %K telehealth %K risk factor %K patient portal %K electronic health record %K EHR %D 2023 %7 17.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: On March 14, 2020, a state of alarm was declared in Spain due to the spread of SARS-CoV-2. Beyond this date, COVID-19 in the country changed the practice of oncologic care. Objective: Since recurrent hospital visits were a potential risk factor for contagion, the aim of this prospective observational study was to analyze the consequences of the COVID-19 pandemic in the health care of patients with lymphoma. Methods: All data were obtained from the electronic medical record. Variables such as age, sex, reason of the visit, use of the patient portal, changes in management, enrollment in clinical trials, and COVID-19 infection were recorded. Results: In all, 290 patients visited the lymphoma clinic, totaling 437 appointments. The median age was 66 (range 18-94) years, and 157 (54.1%) patients were male. Of them, 214 (73.8%) patients had only 1 visit to the clinic. Only 23 (7.9%) patients did not have access to the patient portal. Amid the COVID-19 pandemic, 78 (26.9%) patients remained in active treatment, 35 (12.1%) experienced delays in their treatments, and 6 (2.1%) experienced treatment discontinuation. During the follow-up, only 7 (2.4%) patients had a COVID-19 infection (6 cases with confirmed polymerase chain reaction test and 1 case with clinical suspicion). Despite the implementation of telemedicine strategies to avoid visits to the hospital, 66 (22.8%) patients had in-person visits at the lymphoma clinic. Patients who attended in-person consultations were younger than those who preferred telemedicine consultations (62 vs 66 years; P=.10) and had less use of the patient portal (17/224, 7.6% vs 6/66, 9%; P=.10), although these differences did not reach statistical significance. Patients who attended in-person visits were more likely to have had only 1 visit to the hospital (29/66, 43.9% vs 185/224, 82.6%; P<.001). Regarding the reason of in-person consultations, more patients were on active treatment in comparison to those using telemedicine resources (37/66, 56.1% vs 42/224, 18.3%; P<.001). Patients with a preference for telemedicine strategies had more surveillance visits (147/224, 65.6% vs 24/66, 36.4%; P<.001). Regarding treatment modifications, more treatment delays (29/224, 12.9% vs 6/66, 9.1%; P=.10) and more definite treatment discontinuations (6/224, 2.7% vs 0/66, 0%; P=.10) were seen in patients using telemedicine resources when compared to patients attending in-person visits, although these differences did not reach statistical significance. Regarding the type of therapy, patients attending in-person visits were more likely to receive an intravenous treatment rather than those using telemedicine (23/66, 62.2% vs 17/224, 40.5%; P<.001). Conclusions: Telemedicine such as patient portals are feasible strategies in the management of patients with lymphoma during the COVID-19 pandemic, with a reduction of in-person visits to the hospital and a very low contagion rate. %M 36645838 %R 10.2196/34128 %U https://formative.jmir.org/2023/1/e34128 %U https://doi.org/10.2196/34128 %U http://www.ncbi.nlm.nih.gov/pubmed/36645838 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e48107 %T Trial of the Pluslife SARS-CoV-2 Nucleic Acid Rapid Test Kit: Prospective Cohort Study %A Zhu,Dandan %A Huang,Jing %A Hu,Bei %A Cao,Donglin %A Chen,Dingqiang %A Song,Xinqiang %A Chen,Jialing %A Zhou,Hao %A Cen,Aiqun %A Hou,Tieying %+ Hospital Office, Huazhong University of Science and Technology Union Shenzhen Hospital/Shenzhen Nanshan People’s Hospital, 89 Taoyuan Road, Nanshan District, Shenzhen, 518052, China, 86 075526553111, sz_houtieying@yeah.net %K SARS-CoV-2 %K COVID-19 %K RHAM %K RNase hybridization-assisted amplification %K field trial %K diagnosis %K screening %K rapid test %K cohort study %K detection %K recruitment %K infection %K Pluslife %D 2023 %7 14.11.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 37962934 %R 10.2196/48107 %U https://publichealth.jmir.org/2023/1/e48107 %U https://doi.org/10.2196/48107 %U http://www.ncbi.nlm.nih.gov/pubmed/37962934 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e51998 %T Active Tuberculosis Screening via a Mobile Health App in Myanmar: Incremental Cost-Effectiveness Evaluation %A Htet,Kyaw Ko Ko %A Phyu,Aye Nyein %A Zayar,Nyi Nyi %A Chongsuvivatwong,Virasakdi %+ Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Rd, Kho Hong, Hat Yai District, Songkhla, 90110, Thailand, 66 74 451165, cvirasak@gmail.com %K mobile app %K tuberculosis screening %K TB screening %K cost effectiveness %K mHealth %K mobile health %K app %K apps %K application %K applications %K cost %K costs %K economic %K economics %K TB %K tuberculosis %K screening %K communicable %K x-ray %K imaging %K radiography %K decision tree %K detect %K detection %K detecting %D 2023 %7 10.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: A mobile app that calculates a tuberculosis (TB) risk score based on individual social and pathological characteristics has been shown to be a better predictor of the risk of contracting TB than conventionally used TB signs and symptoms (TBSS) in Myanmar, where the TB burden is high. Its cost-effectiveness, however, has not yet been assessed. Objective: This study aimed to determine the incremental costs of this mobile app and of chest x-rays (CXRs) in averting disability-adjusted life years (DALYs) among missed cases of active TB in the population being screened. Methods: Elements of incremental costs and effectiveness of 3 initial TB screening strategies were examined, including TBSS followed by CXR, the mobile app followed by CXR, and universal CXR. The incremental cost-effectiveness ratio (ICER; ie, the additional cost for each additional DALY averted) was compared to TBSS screening. Based on the latest 2020 gross domestic product (GDP) per capita of Myanmar (US $1477.50), the ICER was compared to willingness-to-pay (WTP) thresholds of 1, 2, and 3 times the GDP per capita. Probabilistic sensitivity analysis was conducted with a Monte Carlo simulation to compute the levels of probability that the ICER for each strategy was below each WTP threshold. Results: For each 100,000 population, the incremental cost compared to TBSS of active TB screening was US $345,942 for the mobile app and US $1,810,712 for universal CXR. The incremental effectiveness was 325 DALYs averted for the mobile app and 576 DALYs averted for universal CXR. For the mobile app, the estimated ICER was US $1064 (72% of GDP per capita) per 1 DALY averted. Furthermore, 100% of the simulated values were below an additional cost of 1 times the GDP per capita for 1 additional DALY averted. The universal CXR strategy has an estimated ICER of US $3143 (2.1 times the GDP per capita) per 1 DALY averted and an additional 77.2% DALYs averted compared to the app (ie, 576 – 325 / 325 DALYs); however, 0.5% of the simulated values were higher than an additional expenditure of 3 times the GDP per capita. Conclusions: Based on the status of the economy in 2020, the mobile app strategy is affordable for Myanmar. The universal CXR strategy, although it could prevent an additional 77% of DALYs, is probably unaffordable. Compared to the TBSS strategy, the mobile app system based on social and pathological characteristics of TB has potential as a TB screening tool to identify missing TB cases and to reduce TB morbidity and mortality, thereby helping to achieve the global goal of “End TB” in resource-limited settings with a high TB burden. %M 37948119 %R 10.2196/51998 %U https://formative.jmir.org/2023/1/e51998 %U https://doi.org/10.2196/51998 %U http://www.ncbi.nlm.nih.gov/pubmed/37948119 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46203 %T Acceptability, Usefulness, and Ease of Use of an Enhanced Video Directly Observed Treatment System for Supporting Patients With Tuberculosis in Kampala, Uganda: Explanatory Qualitative Study %A Sekandi,Juliet Nabbuye %A McDonald,Adenike %A Nakkonde,Damalie %A Zalwango,Sarah %A Kasiita,Vicent %A Kaggwa,Patrick %A Kakaire,Robert %A Atuyambe,Lynn %A Buregyeya,Esther %+ Department of Epidemiology and Biostatistics, University of Georgia, 100 Foster Road, Athens, GA, 30602, United States, 1 7065425257, jsekandi@uga.edu %K digital adherence technologies %K tuberculosis %K video directly observed therapy %K acceptability %K directly observed therapy %K DOT %K Uganda %K treatment %K digital %K technology acceptance model %K social support %K privacy %K stigma %D 2023 %7 10.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In tuberculosis (TB) control, nonadherence to treatment persists as a barrier. The traditional method of ensuring adherence, that is, directly observed therapy, faces significant challenges that hinder its widespread adoption. Digital adherence technologies such as video directly observed therapy (VDOT) are emerging as promising solutions. However, as these novel technologies gain momentum, a critical gap is the lack of comprehensive studies evaluating their efficacy and the unique experiences of patients in Africa. Objective: The aim of this study was to assess patients’ experiences that affected acceptability, usefulness, and ease of use with an enhanced VDOT system during monitoring of TB treatment. Methods: We conducted individual open-ended interviews in a cross-sectional exit qualitative study in Kampala, Uganda. Thirty participants aged 18-65 years who had completed the VDOT randomized trial were purposively selected to represent variability in sex, adherence level, and HIV status. We used a hybrid process of deductive and inductive coding to identify content related to the experience of study participation with VDOT. Codes were organized into themes and subthemes, which were used to develop overarching categories guided by constructs adapted from the modified Technology Acceptance Model for Resource-Limited Settings. We explored participants’ experiences regarding the ease of use and usefulness of VDOT, thereby identifying the facilitators and barriers to its acceptability. Perceived usefulness refers to the benefits users expect from the technology, while perceived ease of use refers to how easily users navigate its various features. We adapted by shifting from assessing perceived to experienced constructs. Results: The participants’ mean age was 35.3 (SD 12) years. Of the 30 participants, 15 (50%) were females, 13 (43%) had low education levels, and 22 (73%) owned cellphones, of which 10 (45%) had smartphones. Nine (28%) were TB/HIV-coinfected, receiving antiretroviral therapy. Emergent subthemes for facilitators of experienced usefulness and ease of VDOT use were SMS text message reminders, technology training support to patients by health care providers, timely patient-provider communication, family social support, and financial incentives. TB/HIV-coinfected patients reported the added benefit of adherence support for their antiretroviral medication. The external barriers to VDOT’s usefulness and ease of use were unstable electricity, technological malfunctions in the app, and lack of cellular network coverage in rural areas. Concerns about stigma, disease disclosure, and fear of breach in privacy and confidentiality affected the ease of VDOT use. Conclusions: Overall, participants had positive experiences with the enhanced VDOT. They found the enhanced VDOT system user-friendly, beneficial, and acceptable, particularly due to the supportive features such as SMS text message reminders, incentives, technology training by health care providers, and family support. However, it is crucial to address the barriers related to technological infrastructure as well as the privacy, confidentiality, and stigma concerns related to VDOT. %M 37948121 %R 10.2196/46203 %U https://formative.jmir.org/2023/1/e46203 %U https://doi.org/10.2196/46203 %U http://www.ncbi.nlm.nih.gov/pubmed/37948121 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46588 %T Association Between Concerns About COVID-19 Infection and Blood Donation Intention: Cross-Sectional Survey Study Through a Mobile Communication Platform %A Hu,Qiuyue %A Hu,Wei %A Pan,Lingling %A Han,Wenjuan %A Zheng,Yue %+ Blood Center of Zhejiang Province, 789 Jianye Road, Binjiang District, Hangzhou, 310052, China, 86 13588707363, huwei0507@126.com %K COVID-19 %K blood donation %K worry %K concern %K intention %K blood %K blood transfusion %K cognition %K blood donor %K communication %K questionnaire %K behavior control %D 2023 %7 9.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The ongoing COVID-19 pandemic has had an unprecedented impact on blood transfusion and collection. At the beginning of the pandemic, most blood transfusion services had a tough challenge in maintaining an optimal blood inventory. Objective: This study aims to understand the public's psychological cognition and intention toward blood donation as well as the factors influencing their worries. We aimed to find a solution for increasing blood donations and provide a scientific reference for policy formulation regarding blood donation during the COVID-19 pandemic and in the future. Methods: A random survey with a 14-item scale on worries related to blood donation was conducted from December 31, 2022, to January 3, 2023, among residents aged 18-60 years in Zhejiang province via SMS text messaging. The results of 8 worry items in this study were compared with the survey results of March 2022, during which COVID-19 was not considered as an epidemic in Zhejiang province. Chi-square test and logistic regression analysis were performed to analyze the factors affecting respondents’ blood donation intention and concerns. The degree of worry about blood donation was assigned from 1 (completely disagree) to 5 (completely agree), and 2-sided t tests were performed to analyze the differences in blood donation intention and worries about blood donation. Results: In total, 1254 valid questionnaire responses were obtained. Males accounted for 62.36% (782/1254) of the sample, 78.39% (983/1254) were 18-45 years old, 60.61% (760/1254) had a university education, and 69.06% (866/1254) had no previous blood donation experience. Approximately 36.52% (458/1254) of the public clearly expressed that they had blood donation worries regarding COVID-19. The main concerns of the respondents were temporary physical weakness caused by blood donation, their own physical conditions not meeting the requirements of blood donation, inconvenient location and working hours for blood donation, and family (or friends) worrying about blood donation. Compared with the results in 2022, the results in 2023 regarding the harmful effects of blood donation on health, temporary physical weakness, infection in donated blood, and family (friends) worrying increased significantly (P<.001). The factors influencing blood donation worries regarding COVID-19 were COVID-19 infection status, adverse reactions to the donated blood, family (or friends) worrying, and unsatisfactory blood donation experience. The factors influencing blood donation intention were gender, age, previous blood donation times, blood donation worries regarding COVID-19, harmful effects of blood donation on health, and blood donation anxiety. Conclusions: Blood transfusion services should make full use of the recovery phase of COVID-19 infection as an important time point, publicize the blood donation process and operation standardization, reduce the public's concerns about blood donation, correct negative evaluations, and increase perceived behavioral control and subjective norms. %M 37943597 %R 10.2196/46588 %U https://www.jmir.org/2023/1/e46588 %U https://doi.org/10.2196/46588 %U http://www.ncbi.nlm.nih.gov/pubmed/37943597 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47219 %T Community-Based Digital Contact Tracing of Emerging Infectious Diseases: Design and Implementation Study With Empirical COVID-19 Cases %A Wang,Hsiao-Chi %A Lin,Ting-Yu %A Yao,Yu-Chin %A Hsu,Chen-Yang %A Yang,Chang-Jung %A Chen,Tony Hsiu-Hsi %A Yeh,Yen-Po %+ Changhua County Public Health Bureau, No.162, Sec. 2, Jhongshan Rd., Changhua County, 500, Taiwan, 886 4 7115141, yeh.leego@gmail.com %K COVID-19 %K digital contact tracing %K public health %K surveillance %D 2023 %7 8.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Contact tracing for containing emerging infectious diseases such as COVID-19 is resource intensive and requires digital transformation to enable timely decision-making. Objective: This study demonstrates the design and implementation of digital contact tracing using multimodal health informatics to efficiently collect personal information and contain community outbreaks. The implementation of digital contact tracing was further illustrated by 3 empirical SARS-CoV-2 infection clusters. Methods: The implementation in Changhua, Taiwan, served as a demonstration of the multisectoral informatics and connectivity between electronic health systems needed for digital contact tracing. The framework incorporates traditional travel, occupation, contact, and cluster approaches and a dynamic contact process enabled by digital technology. A centralized registry system, accessible only to authorized health personnel, ensures privacy and data security. The efficiency of the digital contact tracing system was evaluated through a field study in Changhua. Results: The digital contact tracing system integrates the immigration registry, communicable disease report system, and national health records to provide real-time information about travel, occupation, contact, and clusters for potential contacts and to facilitate a timely assessment of the risk of COVID-19 transmission. The digitalized system allows for informed decision-making regarding quarantine, isolation, and treatment, with a focus on personal privacy. In the first cluster infection, the system monitored 665 contacts and isolated 4 (0.6%) cases; none of the contacts (0/665, 0%) were infected during quarantine. The estimated reproduction number of 0.92 suggests an effective containment strategy for preventing community-acquired outbreak. The system was also used in a cluster investigation involving foreign workers, where none of the 462 contacts (0/462, 0%) tested positive for SARS-CoV-2. Conclusions: By integrating the multisectoral database, the contact tracing process can be digitalized to provide the information required for risk assessment and decision-making in a timely manner to contain a community-acquired outbreak when facing the outbreak of emerging infectious disease. %M 37938887 %R 10.2196/47219 %U https://www.jmir.org/2023/1/e47219 %U https://doi.org/10.2196/47219 %U http://www.ncbi.nlm.nih.gov/pubmed/37938887 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e47982 %T Social Determinants of Health and Patients’ Technology Acceptance of Telehealth During the COVID-19 Pandemic: Pilot Survey %A Anil Kumar Vaidhyam,Sneha %A Huang,Kuo-Ting %+ Department of Information Culture and Data Stewardship, School of Computing and Information, University of Pittsburgh, 6th Floor, 135 N Bellefield Ave, Pittsburgh, PA, 15213, United States, 1 3139135501, sav94@pitt.edu %K social determinants of health %K telehealth %K COVID-19 %K technology adoption %D 2023 %7 7.11.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Telehealth has been widely adopted by patients during the COVID-19 pandemic. Many social determinants of health influence the adoption. Objective: This pilot study aimed to understand the social determinants of patients’ adoption of telehealth in the context of the pandemic. Methods: A survey methodology was used to capture data from 215 participants using Amazon Mechanical Turk. The study was guided by the technology acceptance model and the social determinants of health framework. The questionnaire included technology acceptance model variables (eg, perceived usefulness [PU] and perceived ease of use [PEOU]), social determinants (eg, access to health care, socioeconomic status, education, and health literacy), and demographic information (eg, age, sex, race, and ethnicity). A series of ordinary least squares regressions were conducted to analyze the data using SPSS Statistics (IBM Corp). Results: The results showed that social determinant factors—safe neighborhood and built environment (P=.01) and economic stability (P=.05)—are predictors of the PEOU of telehealth adoption at a statistically significant or marginally statistically significant level. Furthermore, a moderated mediation model (PROCESS model 85) was used to analyze the effects of COVID-19 on the neighborhood, built environment, and economic stability. PEOU and PU significantly positively affected users’ intention to use technology for both variables. Conclusions: This study draws attention to 2 research frameworks that address unequal access to health technologies. It also adds empirical evidence to telehealth research on the adoption of patient technology. Finally, regarding practical implications, this study will provide government agencies, health care organizations, and health care companies with a better perspective of patients’ digital health use. This will further guide them in designing better technology by considering factors such as social determinants of health. %M 37934556 %R 10.2196/47982 %U https://humanfactors.jmir.org/2023/1/e47982 %U https://doi.org/10.2196/47982 %U http://www.ncbi.nlm.nih.gov/pubmed/37934556 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e49753 %T Deep Learning Analysis of COVID-19 Vaccine Hesitancy and Confidence Expressed on Twitter in 6 High-Income Countries: Longitudinal Observational Study %A Zhou,Xinyu %A Song,Suhang %A Zhang,Ying %A Hou,Zhiyuan %+ School of Public Health, Fudan University, 130 Dong’an Road, Shanghai, 200032, China, 86 2133563935, zyhou@fudan.edu.cn %K COVID-19 vaccine %K hesitancy %K confidence %K social media %K machine learning %D 2023 %7 6.11.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: An ongoing monitoring of national and subnational trajectory of COVID-19 vaccine hesitancy could offer support in designing tailored policies on improving vaccine uptake. Objective: We aim to track the temporal and spatial distribution of COVID-19 vaccine hesitancy and confidence expressed on Twitter during the entire pandemic period in major English-speaking countries. Methods: We collected 5,257,385 English-language tweets regarding COVID-19 vaccination between January 1, 2020, and June 30, 2022, in 6 countries—the United States, the United Kingdom, Australia, New Zealand, Canada, and Ireland. Transformer-based deep learning models were developed to classify each tweet as intent to accept or reject COVID-19 vaccination and the belief that COVID-19 vaccine is effective or unsafe. Sociodemographic factors associated with COVID-19 vaccine hesitancy and confidence in the United States were analyzed using bivariate and multivariable linear regressions. Results: The 6 countries experienced similar evolving trends of COVID-19 vaccine hesitancy and confidence. On average, the prevalence of intent to accept COVID-19 vaccination decreased from 71.38% of 44,944 tweets in March 2020 to 34.85% of 48,167 tweets in June 2022 with fluctuations. The prevalence of believing COVID-19 vaccines to be unsafe continuously rose by 7.49 times from March 2020 (2.84% of 44,944 tweets) to June 2022 (21.27% of 48,167 tweets). COVID-19 vaccine hesitancy and confidence varied by country, vaccine manufacturer, and states within a country. The democrat party and higher vaccine confidence were significantly associated with lower vaccine hesitancy across US states. Conclusions: COVID-19 vaccine hesitancy and confidence evolved and were influenced by the development of vaccines and viruses during the pandemic. Large-scale self-generated discourses on social media and deep learning models provide a cost-efficient approach to monitoring routine vaccine hesitancy. %M 37930788 %R 10.2196/49753 %U https://www.jmir.org/2023/1/e49753 %U https://doi.org/10.2196/49753 %U http://www.ncbi.nlm.nih.gov/pubmed/37930788 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e46874 %T Public Health Surveillance of Behavioral Cancer Risk Factors During the COVID-19 Pandemic: Sentiment and Emotion Analysis of Twitter Data %A Christodoulakis,Nicolette %A Abdelkader,Wael %A Lokker,Cynthia %A Cotterchio,Michelle %A Griffith,Lauren E %A Vanderloo,Leigh M %A Anderson,Laura N %+ Department of Health Research Methods, Evidence, and Impact, McMaster University, CRL-221, 1280 Main Street West, Hamilton, ON, L8S 4L8, Canada, 1 9055259140 ext 21725, ln.anderson@mcmaster.ca %K cancer risk factors %K Twitter %K sentiment analysis %K emotion analysis %K social media %K physical inactivity %K poor nutrition %K alcohol %K smoking %D 2023 %7 2.11.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic and its associated public health mitigation strategies have dramatically changed patterns of daily life activities worldwide, resulting in unintentional consequences on behavioral risk factors, including smoking, alcohol consumption, poor nutrition, and physical inactivity. The infodemic of social media data may provide novel opportunities for evaluating changes related to behavioral risk factors during the pandemic. Objective: We explored the feasibility of conducting a sentiment and emotion analysis using Twitter data to evaluate behavioral cancer risk factors (physical inactivity, poor nutrition, alcohol consumption, and smoking) over time during the first year of the COVID-19 pandemic. Methods: Tweets during 2020 relating to the COVID-19 pandemic and the 4 cancer risk factors were extracted from the George Washington University Libraries Dataverse. Tweets were defined and filtered using keywords to create 4 data sets. We trained and tested a machine learning classifier using a prelabeled Twitter data set. This was applied to determine the sentiment (positive, negative, or neutral) of each tweet. A natural language processing package was used to identify the emotions (anger, anticipation, disgust, fear, joy, sadness, surprise, and trust) based on the words contained in the tweets. Sentiments and emotions for each of the risk factors were evaluated over time and analyzed to identify keywords that emerged. Results: The sentiment analysis revealed that 56.69% (51,479/90,813) of the tweets about physical activity were positive, 16.4% (14,893/90,813) were negative, and 26.91% (24,441/90,813) were neutral. Similar patterns were observed for nutrition, where 55.44% (27,939/50,396), 15.78% (7950/50,396), and 28.79% (14,507/50,396) of the tweets were positive, negative, and neutral, respectively. For alcohol, the proportions of positive, negative, and neutral tweets were 46.85% (34,897/74,484), 22.9% (17,056/74,484), and 30.25% (22,531/74,484), respectively, and for smoking, they were 41.2% (11,628/28,220), 24.23% (6839/28,220), and 34.56% (9753/28,220), respectively. The sentiments were relatively stable over time. The emotion analysis suggests that the most common emotion expressed across physical activity and nutrition tweets was trust (69,495/320,741, 21.67% and 42,324/176,564, 23.97%, respectively); for alcohol, it was joy (49,147/273,128, 17.99%); and for smoking, it was fear (23,066/110,256, 20.92%). The emotions expressed remained relatively constant over the observed period. An analysis of the most frequent words tweeted revealed further insights into common themes expressed in relation to some of the risk factors and possible sources of bias. Conclusions: This analysis provided insight into behavioral cancer risk factors as expressed on Twitter during the first year of the COVID-19 pandemic. It was feasible to extract tweets relating to all 4 risk factors, and most tweets had a positive sentiment with varied emotions across the different data sets. Although these results can play a role in promoting public health, a deeper dive via qualitative analysis can be conducted to provide a contextual examination of each tweet. %M 37917123 %R 10.2196/46874 %U https://formative.jmir.org/2023/1/e46874 %U https://doi.org/10.2196/46874 %U http://www.ncbi.nlm.nih.gov/pubmed/37917123 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e47563 %T Behavioral Changes Associated With COVID-19 Vaccination: Cross-National Online Survey %A De Gaetano,Alessandro %A Bajardi,Paolo %A Gozzi,Nicolò %A Perra,Nicola %A Perrotta,Daniela %A Paolotti,Daniela %+ ISI Foundation, Via Chisola 5, Turin, 10126, Italy, 39 011 6603090, alessandro.degaetano@isi.it %K COVID-19 %K vaccines %K social behaviors %K online surveys %K nonpharmaceutical interventions %K survey %K vaccination %K behavior %K NPIs %K prevention %D 2023 %7 31.10.2023 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 37906219 %R 10.2196/47563 %U https://www.jmir.org/2023/1/e47563 %U https://doi.org/10.2196/47563 %U http://www.ncbi.nlm.nih.gov/pubmed/37906219 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e49859 %T Trend of the Tuberculous Pleurisy Notification Rate in Eastern China During 2017-2021: Spatiotemporal Analysis %A Zhou,Ying %A Luo,Dan %A Liu,Kui %A Chen,Bin %A Chen,Songhua %A Pan,Junhang %A Liu,Zhengwei %A Jiang,Jianmin %+ Department of Tuberculosis Control and Prevention, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, BinJiang District, Hangzhou, 310000, China, 86 057187115009, jmjiang@cdc.zj.cn %K tuberculous pleurisy %K spatio-temporal %K epidemiology %K prediction %K time series %D 2023 %7 30.10.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Tuberculous pleurisy (TP) presents a serious allergic reaction in the pleura caused by Mycobacterium tuberculosis; however, few studies have described its spatial epidemiological characteristics in eastern China. Objective: This study aimed to determine the epidemiological distribution of TP and predict its further development in Zhejiang Province. Methods: Data on all notified cases of TP in Zhejiang Province, China, from 2017 to 2021 were collected from the existing tuberculosis information management system. Analyses, including spatial autocorrelation and spatial-temporal scan analysis, were performed to identify hot spots and clusters, respectively. The prediction of TP prevalence was performed using the seasonal autoregressive integrated moving average (SARIMA), Holt-Winters exponential smoothing, and Prophet models using R (The R Foundation) and Python (Python Software Foundation). Results: The average notification rate of TP in Zhejiang Province was 7.06 cases per 100,000 population, peaking in the summer. The male-to-female ratio was 2.18:1. In terms of geographical distribution, clusters of cases were observed in the western part of Zhejiang Province, including parts of Hangzhou, Quzhou, Jinhua, Lishui, Wenzhou, and Taizhou city. Spatial-temporal analysis identified 1 most likely cluster and 4 secondary clusters. The Holt-Winters model outperformed the SARIMA and Prophet models in predicting the trend in TP prevalence. Conclusions: The western region of Zhejiang Province had the highest risk of TP. Comprehensive interventions, such as chest x-ray screening and symptom screening, should be reinforced to improve early identification. Additionally, a more systematic assessment of the prevalence trend of TP should include more predictors. %M 37902822 %R 10.2196/49859 %U https://publichealth.jmir.org/2023/1/e49859 %U https://doi.org/10.2196/49859 %U http://www.ncbi.nlm.nih.gov/pubmed/37902822 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e48112 %T Participants’ Engagement With and Results From a Web-Based Integrative Population Mental Wellness Program (CHAMindWell) During the COVID-19 Pandemic: Program Evaluation Study %A Rosansky,Joseph A %A Okst,Kayley %A Tepper,Miriam C %A Baumgart Schreck,Ana %A Fulwiler,Carl %A Wang,Philip S %A Schuman-Olivier,Zev %+ Department of Psychiatry, Cambridge Health Alliance, 1493 Cambridge St, Cambridge, MA, 02139, United States, 1 617 591 6132, zschuman@cha.harvard.edu %K COVID-19 pandemic %K digital psychiatry %K early identification %K integrative medicine %K mental wellness %K mindfulness %K population mental health %K prevention %K stratified care %D 2023 %7 26.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic involved a prolonged period of collective trauma and stress during which substantial increases in mental health concerns, like depression and anxiety, were observed across the population. In this context, CHAMindWell was developed as a web-based intervention to improve resilience and reduce symptom severity among a public health care system’s patient population. Objective: This program evaluation was conducted to explore participants’ engagement with and outcomes from CHAMindWell by retrospectively examining demographic information and mental health symptom severity scores throughout program participation. Methods: We examined participants’ symptom severity scores from repeated, web-based symptom screenings through Computerized Adaptive Testing for Mental Health (CAT-MH) surveys, and categorized participants into symptom severity-based tiers (tier 1=asymptomatic to mild; tier 2=moderate; and tier 3=severe). Participants were provided tier-based mindfulness resources, treatment recommendations, and referrals. Logistic regressions were conducted to evaluate associations between demographic variables and survey completion. The McNemar exact test and paired sample t tests were performed to evaluate changes in the numbers of participants in tier 1 versus tier 2 or 3 and changes in depression, anxiety, and posttraumatic stress disorder severity scores between baseline and follow-up. Results: The program enrolled 903 participants (664/903, 73.5% female; 556/903, 61.6% White; 113/903, 12.5% Black; 84/903, 9.3% Asian; 7/903, 0.8% Native; 36/903, 4% other; and 227/903, 25.1% Hispanic) between December 16, 2020, and March 17, 2022. Of those, 623 (69%) completed a baseline CAT-MH survey, and 196 completed at least one follow-up survey 3 to 6 months after baseline. White racial identity was associated with completing baseline CAT-MH (odds ratio [OR] 1.80, 95% CI 1.14-2.84; P=.01). Participants’ odds of having symptom severity below the clinical threshold (ie, tier 1) were significantly greater at follow-up (OR 2.60, 95% CI 1.40-5.08; P=.001), and significant reductions were observed across symptom domains over time. Conclusions: CHAMindWell is associated with reduced severity of mental health symptoms. Future work should aim to address program engagement inequities and attrition and compare the impacts of CHAMindWell to a control condition to better characterize its effects. %M 37883149 %R 10.2196/48112 %U https://mental.jmir.org/2023/1/e48112 %U https://doi.org/10.2196/48112 %U http://www.ncbi.nlm.nih.gov/pubmed/37883149 %0 Journal Article %@ 1947-2579 %I JMIR Publications %V 15 %N %P e50967 %T Intersection of Perceived COVID-19 Risk, Preparedness, and Preventive Health Behaviors: Latent Class Segmentation Analysis %A Mgbere,Osaro %A Iloanusi,Sorochi %A Yunusa,Ismaeel %A Iloanusi,Nchebe-Jah R %A Gohil,Shrey %A Essien,Ekere James %+ Institute of Community Health, University of Houston College of Pharmacy, 4349 Martin Luther King Blvd, Houston, TX, 77204, United States, 1 832 842 8393, omgbere@uh.edu %K COVID-19 %K latent class analysis %K risk perception %K preparedness %K preventive health behaviors %K Nigeria %D 2023 %7 24.10.2023 %9 Original Paper %J Online J Public Health Inform %G English %X 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 [γc]) 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 (κ=–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. %M 38046563 %R 10.2196/50967 %U https://ojphi.jmir.org/2023/1/e50967 %U https://doi.org/10.2196/50967 %U http://www.ncbi.nlm.nih.gov/pubmed/38046563 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e51861 %T Hepatitis A Vaccination Coverage Among People With Chronic Liver Disease in England (HEALD): Protocol for a Retrospective Cohort Study %A Meza-Torres,Bernardo %A Forbes,Anna %A Elson,William %A Kar,Debasish %A Jamie,Gavin %A Hinton,William %A Fan,Xuejuan %A Byford,Rachel %A Feher,Michael %A Whyte,Martin %A Joy,Mark %A de Lusignan,Simon %+ Clinical Informatics and Health Outcomes Research Group, Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Walton Well Rd, Oxford, OX2 6ED, United Kingdom, 44 01865617855, bernardo.meza-torres@phc.ox.ac.uk %K chronic liver disease %K computerized %K data accuracy %K data extract %K ethnicity %K fatty liver disease %K general practitioner %K hepatitis A vaccination %K hepatitis %K liver disease %K medical record systems %K primary care %K routine data sets %K Systematized Nomenclature of Medicine %K vaccination monitoring and surveillance %K vaccination %D 2023 %7 24.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Hepatitis A outbreaks in the United Kingdom are uncommon. Most people develop mild to moderate symptoms that resolve, without sequelae, within months. However, in high-risk groups, including those with underlying chronic liver disease (CLD), hepatitis A infection can be severe, with a higher risk of mortality and morbidity. The Health Security Agency and the National Institute of Health and Care Excellence recommend preexposure hepatitis A vaccination given in 2 doses to people with CLD, regardless of its cause. There are currently no published reports of vaccination coverage for people with CLD in England or internationally. Objective: This study aims to describe hepatitis A vaccination coverage in adults with CLD in a UK primary care setting and compare liver disease etiology, sociodemographic characteristics, and comorbidities in people who are and are not exposed to the hepatitis A vaccine. Methods: We will conduct a retrospective cohort study with data from the Primary Care Sentinel Cohort of the Oxford-Royal College of General Practitioners Clinical Informatics Digital Hub database, which is nationally representative of the English population. We will include people aged 18 years and older who have been registered in general practices in the Research and Surveillance Centre network and have a record of CLD between January 1, 2012, and December 31, 2022, including those with alcohol-related liver disease, chronic hepatitis B, chronic hepatitis C, nonalcohol fatty liver disease, Wilson disease, hemochromatosis, and autoimmune hepatitis. We will carefully curate variables using the Systematized Nomenclature of Medicine Clinical Terms. We will report the sociodemographic characteristics of those who are vaccinated. These include age, gender, ethnicity, population density, region, socioeconomic status (measured using the index of multiple deprivation), obesity, alcohol consumption, and smoking. Hepatitis A vaccination coverage for 1 and 2 doses will be calculated using an estimate of the CLD population as the denominator. We will analyze the baseline characteristics using descriptive statistics, including measures of dispersion. Pairwise comparisons of case-mix characteristics, comorbidities, and complications will be reported according to vaccination status. A multistate survival model will be fitted to estimate the transition probabilities among four states: (1) diagnosed with CLD, (2) first dose of hepatitis A vaccination, (3) second dose of hepatitis A vaccination, and (4) death. This will identify any potential disparities in how people with CLD get vaccinated. Results: The Research and Surveillance Centre population comprises over 8 million people. The reported incidence of CLD is 20.7 cases per 100,000. International estimates of hepatitis A vaccine coverage vary between 10% and 50% in this group. Conclusions: This study will describe the uptake of the hepatitis A vaccine in people with CLD and report any disparities or differences in the characteristics of the vaccinated population. International Registered Report Identifier (IRRID): PRR1-10.2196/51861 %M 37874614 %R 10.2196/51861 %U https://www.researchprotocols.org/2023/1/e51861 %U https://doi.org/10.2196/51861 %U http://www.ncbi.nlm.nih.gov/pubmed/37874614 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45549 %T Smartphone Apps for Containing the COVID-19 Pandemic in Germany: Qualitative Interview Study With Experts Based on Grounded Theory %A Krämer,Dennis %A Brachem,Elisabeth %A Schneider-Reuter,Lydia %A D'Angelo,Isabella %A Vollmann,Jochen %A Haltaufderheide,Joschka %+ Faculty of Social Sciences, Georg-August-University Göttingen, Sprangerweg 2, Göttingen, 37075, Germany, 49 5513925656, dennis.kraemer@uni-goettingen.de %K Corona-Warn-App %K COVID-19 pandemic %K eHealth %K Germany %K health technology %K mobile phone %K qualitative research %K sovereignty %K transparency %D 2023 %7 20.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Smartphone apps, including those for digital contact tracing (DCT), played a crucial role in containing infections during the COVID-19 pandemic. Their primary function is to generate and disseminate information to disrupt transmissions based on various events, such as encounters, vaccinations, locations, or infections. Although the functionality of these apps has been extensively studied, there is still a lack of qualitative research addressing critical issues. Objective: We will demonstrate that the use of DCT presents a challenge due to the tension between continuous health monitoring and uncertainties related to transparency and user sovereignty. On one hand, DCT enables the monitoring of various risk factors, including data-based calculations of infection probabilities. On the other hand, continuous risk management is intertwined with several uncertainties, including the unclear storage of personal data, who has access to it, and how it will be used in the future. Methods: We focus on the German “Corona-Warn-App” and support our argument with empirical data from 19 expert interviews conducted between 2020 and 2021. The interviews were conducted using a semistructured questionnaire and analyzed according to the principles of grounded theory. Results: Our data underscores 3 dimensions: transparency, data sovereignty, and the east-west divide. While transparency is considered an essential foundation for establishing trust in the use of DCT by providing a sense of security, data sovereignty is seen as a high value during the pandemic, protecting users from an undesired loss of control. The aspect of the east-west divide highlights the idea of incorporating sociocultural values and standards into technology, emphasizing that algorithms and data-driven elements, such as distance indicators, encounters, and isolations, are also influenced by sociocultural factors. Conclusions: The effective use of DCT for pandemic containment relies on achieving a balance between individual control and technological prevention. Maximizing the technological benefits of these tools is crucial. However, users must also be mindful of the information they share and maintain control over their shared data. %M 37862068 %R 10.2196/45549 %U https://www.jmir.org/2023/1/e45549 %U https://doi.org/10.2196/45549 %U http://www.ncbi.nlm.nih.gov/pubmed/37862068 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44155 %T Evaluation of Primary Allied Health Care in Patients Recovering From COVID-19 at 6-Month Follow-up: Dutch Nationwide Prospective Cohort Study %A Slotegraaf,Anne I %A Gerards,Marissa H G %A Verburg,Arie C %A de van der Schueren,Marian A E %A Kruizenga,Hinke M %A Graff,Maud J L %A Cup,Edith H C %A Kalf,Johanna G %A Lenssen,Antoine F %A Meijer,Willemijn M %A Kool,Renée A %A de Bie,Rob A %A van der Wees,Philip J %A Hoogeboom,Thomas J %A , %+ IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Centre, Kapittelweg 54, Nijmegen, 6525 EP, Netherlands, 31 243615305, Thomas.hoogeboom@radboudumc.nl %K COVID-19 %K allied health care %K primary care %K care %K patient %K physical %K nutritional %K cognitive %K mental functioning %K support %K recovery %K diet %K exercise %K exercise therapist %K physical therapist %K speech therapist %K language %K descriptive statistics %K regression %K linear mixed model %K statistics %K statistician %K statistical %D 2023 %7 20.10.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Patients recovering from COVID-19 often experience persistent problems in their daily activities related to limitations in physical, nutritional, cognitive, and mental functioning. To date, it is unknown what treatment is needed to support patients in their recovery from COVID-19. Objective: This study aimed to evaluate the primary allied health care of patients recovering from COVID-19 at 6-month follow-up and to explore which baseline characteristics are associated with changes in the scores of outcomes between baseline and 6-month follow-up. Methods: This Dutch nationwide prospective cohort study evaluated the recovery of patients receiving primary allied health care (ie, dietitians, exercise therapists, occupational therapists, physical therapists, and speech and language therapists) after COVID-19. All treatments offered by primary allied health professionals in daily practice were part of usual care. Patient-reported outcome measures on participation, health-related quality of life, fatigue, physical functioning, and psychological well-being were assessed at baseline and at 3- and 6-month follow-up. Linear mixed model analyses were used to evaluate recovery over time, and uni- and multivariable linear regression analyses were used to examine the association between baseline characteristics and recovery. Results: A total of 1451 adult patients recovering from COVID-19 and receiving treatment from 1 or more primary allied health professionals were included. For participation (Utrecht Scale for Evaluation of Rehabilitation—Participation range 0-100), estimated mean differences of at least 2.3 points were observed at all time points. For the health-related quality of life (EuroQol Visual Analog Scale, range 0-100), the mean increase was 12.3 (95% CI 11.1-13.6) points at 6 months. Significant improvements were found for fatigue (Fatigue Severity Scale, range 1-7): the mean decrease was –0.7 (95% CI –0.8 to –0.6) points at 6 months. However, severe fatigue was reported by 742/929 (79.9%) patients after 6 months. For physical functioning (Patient-Reported Outcomes Measurement Information System—Physical Function Short Form 10b, range 13.8-61.3), the mean increase was 5.9 (95% CI 5.9-6.4) points at 6 months. Mean differences of –0.8 (95% CI –1.0 to –0.5) points for anxiety (Hospital Anxiety and Depression Scale range 0-21) and –1.6 (95% CI –1.8 to –1.3) points for depression were found after 6 months. A worse baseline score, hospital admission, and male sex were associated with greater improvement between baseline and 6-month follow-up, whereas age, the BMI, comorbidities, and smoking status were not associated with mean changes in any outcome measures. Conclusions: Patients recovering from COVID-19 who receive primary allied health care make progress in recovery but still experience many limitations in their daily activities after 6 months. Our findings provide reference values to health care providers and health care policy makers regarding what to expect from the recovery of patients who receive health care from 1 or more primary allied health professionals. Trial Registration: ClinicalTrials.gov NCT04735744; https://tinyurl.com/3vf337pn International Registered Report Identifier (IRRID): RR2-10.2340/jrm.v54.2506 %M 37862083 %R 10.2196/44155 %U https://publichealth.jmir.org/2023/1/e44155 %U https://doi.org/10.2196/44155 %U http://www.ncbi.nlm.nih.gov/pubmed/37862083 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e48632 %T Digital Patient Reported Outcome Measures Platform for Post–COVID-19 Condition and Other Long-Term Conditions: User-Centered Development and Technical Description %A Sivan,Manoj %A Rocha Lawrence,Román %A O'Brien,Paul %+ Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Martin Wing, Leeds General Infirmary, Leeds, LS1 3EX, United Kingdom, 44 01133922564, M.Sivan@leeds.ac.uk %K post–COVID-19 condition %K post–COVID-19 syndrome %K post-acute COVID-19 syndrome %K C19-YRS %K Yorkshire Rehabilitation Scale %K ELAROS %K chronic conditions %K mobile app %K digital technology %K smartphone %K chronic %K respiratory %K COVID-19 %K Sars-CoV-2 %K coronavirus %K platform %K patient-reported %K outcome measure %K outcome measures %K health record %K health records %K report %K reports %K data sharing %K information sharing %K mobile phone %D 2023 %7 20.10.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Post–COVID-19 condition (PCC), colloquially known as long COVID, is a multisystem condition characterized by persistent symptoms beyond 4 weeks after the SARS-CoV-2 infection. More than 60 million people with PCC worldwide need prompt assessment, diagnosis, and monitoring, with many requiring specialist help from a multidisciplinary team of health care professionals (HCPs). Consequently, a scalable digital system is required for both people with PCC and HCPs to capture the breadth of symptoms and their impact on health, using patient-reported outcome measures (PROMs) and patient-reported experience measures (PREMs). Objective: We aim to develop and implement a novel PCC digital PROM (DPROM) platform for (1) securely collecting PROM and PREM data from people with PCC, (2) enabling users to monitor symptoms longitudinally and assess response to treatment, (3) generating reports for the electronic health records (EHRs), (4) providing summary reports on PCC services based on national requirements, and (5) facilitating the sharing of relevant data with authorized research teams to accelerate our understanding of this new condition and evaluate new strategies to manage PCC. Methods: We (1) undertook requirement analysis with people with PCC, HCPs, and researchers to identify the needs of the DPROM platform and determine its required functionalities; (2) designed and developed a clinically useful web portal for staff and a mobile app for patients, with a web-based alternative app to improve patient and staff choice, limit the risk of digital exclusion, and account for variability across services; (3) determined the PROMs and PREMs that PCC services would prefer to use on the platform; and (4) designed the summary report function that can be generated for each user for the EHR and for reporting to national health authorities. Results: A DPROM platform to record PCC symptom profile, condition severity, functional disability, and quality of life, based on the C19-YRS (Yorkshire Rehabilitation Scale) and other PROMs and PREMs, was developed. Individual-level medical information and details on the COVID-19 illness can be captured systematically. The platform generates easy-to-understand scores, radar plots and line graphs for people with PCC to self-monitor their condition and for HCPs to assess the natural course of the condition and the response to interventions. Clinics can configure a suite of PROMs and PREMs based on their local and national service and commissioning requirements and support research studies which require large-scale data collection on PROMs. The DPROM platform enables automatic aggregate data analysis for services to undertake service evaluation and cost-effectiveness analysis. The DPROM platform generated summary report can be uploaded to the EHRs of people with PCC. Conclusions: A multifunctional DPROM platform to assess, grade, and monitor PCC has been developed. Future research will analyze the system’s usability in specialist PCC clinical services and other long-term conditions. %M 37665334 %R 10.2196/48632 %U https://humanfactors.jmir.org/2023/1/e48632 %U https://doi.org/10.2196/48632 %U http://www.ncbi.nlm.nih.gov/pubmed/37665334 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e45085 %T Influenza Epidemic Trend Surveillance and Prediction Based on Search Engine Data: Deep Learning Model Study %A Yang,Liuyang %A Zhang,Ting %A Han,Xuan %A Yang,Jiao %A Sun,Yanxia %A Ma,Libing %A Chen,Jialong %A Li,Yanming %A Lai,Shengjie %A Li,Wei %A Feng,Luzhao %A Yang,Weizhong %+ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 9 Dong Dan San Tiao, Dongcheng District, Beijing, 100730, China, 86 010 65120552, yangweizhong@cams.cn %K early warning %K epidemic intelligence %K infectious disease %K influenza-like illness %K surveillance %D 2023 %7 17.10.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: Influenza outbreaks pose a significant threat to global public health. Traditional surveillance systems and simple algorithms often struggle to predict influenza outbreaks in an accurate and timely manner. Big data and modern technology have offered new modalities for disease surveillance and prediction. Influenza-like illness can serve as a valuable surveillance tool for emerging respiratory infectious diseases like influenza and COVID-19, especially when reported case data may not fully reflect the actual epidemic curve. Objective: This study aimed to develop a predictive model for influenza outbreaks by combining Baidu search query data with traditional virological surveillance data. The goal was to improve early detection and preparedness for influenza outbreaks in both northern and southern China, providing evidence for supplementing modern intelligence epidemic surveillance methods. Methods: We collected virological data from the National Influenza Surveillance Network and Baidu search query data from January 2011 to July 2018, totaling 3,691,865 and 1,563,361 respective samples. Relevant search terms related to influenza were identified and analyzed for their correlation with influenza-positive rates using Pearson correlation analysis. A distributed lag nonlinear model was used to assess the lag correlation of the search terms with influenza activity. Subsequently, a predictive model based on the gated recurrent unit and multiple attention mechanisms was developed to forecast the influenza-positive trend. Results: This study revealed a high correlation between specific Baidu search terms and influenza-positive rates in both northern and southern China, except for 1 term. The search terms were categorized into 4 groups: essential facts on influenza, influenza symptoms, influenza treatment and medicine, and influenza prevention, all of which showed correlation with the influenza-positive rate. The influenza prevention and influenza symptom groups had a lag correlation of 1.4-3.2 and 5.0-8.0 days, respectively. The Baidu search terms could help predict the influenza-positive rate 14-22 days in advance in southern China but interfered with influenza surveillance in northern China. Conclusions: Complementing traditional disease surveillance systems with information from web-based data sources can aid in detecting warning signs of influenza outbreaks earlier. However, supplementation of modern surveillance with search engine information should be approached cautiously. This approach provides valuable insights for digital epidemiology and has the potential for broader application in respiratory infectious disease surveillance. Further research should explore the optimization and customization of search terms for different regions and languages to improve the accuracy of influenza prediction models. %M 37847532 %R 10.2196/45085 %U https://www.jmir.org/2023/1/e45085 %U https://doi.org/10.2196/45085 %U http://www.ncbi.nlm.nih.gov/pubmed/37847532 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e46518 %T Psychological Resilience Factors and Their Association With Weekly Stressor Reactivity During the COVID-19 Outbreak in Europe: Prospective Longitudinal Study %A Bögemann,Sophie A %A Puhlmann,Lara M C %A Wackerhagen,Carolin %A Zerban,Matthias %A Riepenhausen,Antje %A Köber,Göran %A Yuen,Kenneth S L %A Pooseh,Shakoor %A Marciniak,Marta A %A Reppmann,Zala %A Uściƚko,Aleksandra %A Weermeijer,Jeroen %A Lenferink,Dionne B %A Mituniewicz,Julian %A Robak,Natalia %A Donner,Nina C %A Mestdagh,Merijn %A Verdonck,Stijn %A van Dick,Rolf %A Kleim,Birgit %A Lieb,Klaus %A van Leeuwen,Judith M C %A Kobylińska,Dorota %A Myin-Germeys,Inez %A Walter,Henrik %A Tüscher,Oliver %A Hermans,Erno J %A Veer,Ilya M %A Kalisch,Raffael %+ Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Kapittelweg 29, Nijmegen, 6525 EN, Netherlands, 31 024 3614305, Sophie.Bogemann@donders.ru.nl %K resilience %K stressor reactivity %K positive appraisal %K pandemic %K mental health %K COVID-19 %D 2023 %7 17.10.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: Cross-sectional relationships between psychosocial resilience factors (RFs) and resilience, operationalized as the outcome of low mental health reactivity to stressor exposure (low “stressor reactivity” [SR]), were reported during the first wave of the COVID-19 pandemic in 2020. Objective: Extending these findings, we here examined prospective relationships and weekly dynamics between the same RFs and SR in a longitudinal sample during the aftermath of the first wave in several European countries. Methods: Over 5 weeks of app-based assessments, participants reported weekly stressor exposure, mental health problems, RFs, and demographic data in 1 of 6 different languages. As (partly) preregistered, hypotheses were tested cross-sectionally at baseline (N=558), and longitudinally (n=200), using mixed effects models and mediation analyses. Results: RFs at baseline, including positive appraisal style (PAS), optimism (OPT), general self-efficacy (GSE), perceived good stress recovery (REC), and perceived social support (PSS), were negatively associated with SR scores, not only cross-sectionally (baseline SR scores; all P<.001) but also prospectively (average SR scores across subsequent weeks; positive appraisal (PA), P=.008; OPT, P<.001; GSE, P=.01; REC, P<.001; and PSS, P=.002). In both associations, PAS mediated the effects of PSS on SR (cross-sectionally: 95% CI –0.064 to –0.013; prospectively: 95% CI –0.074 to –0.0008). In the analyses of weekly RF-SR dynamics, the RFs PA of stressors generally and specifically related to the COVID-19 pandemic, and GSE were negatively associated with SR in a contemporaneous fashion (PA, P<.001; PAC,P=.03; and GSE, P<.001), but not in a lagged fashion (PA, P=.36; PAC, P=.52; and GSE, P=.06). Conclusions: We identified psychological RFs that prospectively predict resilience and cofluctuate with weekly SR within individuals. These prospective results endorse that the previously reported RF-SR associations do not exclusively reflect mood congruency or other temporal bias effects. We further confirm the important role of PA in resilience. %M 37847551 %R 10.2196/46518 %U https://mental.jmir.org/2023/1/e46518 %U https://doi.org/10.2196/46518 %U http://www.ncbi.nlm.nih.gov/pubmed/37847551 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48479 %T Immunological Responses of Arsenicum album 30CH to Combat COVID-19: Protocol for a Double-Blind, Randomized, Placebo-Controlled Clinical Trial in the Pathanamthitta District of Kerala %A Suhana,Panaparambil Azis %A Kusum,Lata %A Shruti,Jain Vij %A Sreekanth,Gopinathan Pillai %A Bijukumar,Damodaran %A Shaji Kumar,R T %A Muraleedharan,K C %A Kaushik,Subhash %+ Department of Clinical Research, Central Council for Research in Homoeopathy, 61-65, D Block, Janakpuri Institutional Area, New Delhi, 110058, India, 91 9810554024, suhanap@ccrhindia.nic.in %K COVID-19 %K Arsenicum album 30CH %K randomized controlled trial %K Pathanamthitta %K immunology %D 2023 %7 16.10.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19 is a recent major public health concern caused by the SARS-CoV-2 virus, with approximately 44.6 million COVID-19–positive cases and 530,000 deaths in India (as of February 1, 2023). The COVID-19 vaccination drive in India was initiated in January 2021; however, an effective preventive strategy with high efficacy and immunological safety remains elusive. Objective: The aim of this study is to assess the immunogenic responses of Arsenicum album 30CH (AA30CH) as COVID-19 prophylaxis, including assessment of immunological markers, innate and acquired immune responses, COVID-19 symptoms, and its associated antibody responses. Methods: This randomized controlled clinical trial (RCT) will include two parallel comparator groups of AA30CH and placebo with an allocation ratio of 1:1 conducted in the Pathanamthitta district of Kerala, India. The placebo or AA30CH will be administered in three intervention schedules and blood samples will be collected before and after each of the intervention schedules. Based on the inclusion and exclusion criteria, 112 participants per arm (with an expected dropout of 20%) will be screened. Immunogenic responses will be evaluated by determining the antigen density and modulation in immunological markers and lymphocyte subsets CD3, CD4, CD8, CD24, CD27, CD38, CD4 interferon-γ, CD4 CD17, CD4 CD25 (activated T lymphocytes), T cells, B cells, dendritic cells (mature and immature), and natural killer cells on days 1, 5, 23,27, 45, 49, and 66. The innate and acquired immune responses will also be evaluated by a real-time reverse-transcriptase polymerase chain reaction (RT-PCR) array profiler (84-gene set) before and after the study interventions. The toxicity status of AA30CH in study participants will be evaluated through hepatic, renal, and hematological parameters and peripheral smears on days 1, 5, 23, 27, 45, 49, and 66. The number of participants developing COVID-19–like symptoms per National Centre for Disease Control guidelines and the number of participants testing positive for COVID-19 in RT-PCR during follow-ups in any of the three intervention schedules will be identified. Moreover, a subgroup analysis will be used to assess the COVID-19 antibody responses between vaccinated and unvaccinated participants. Results: This RCT protocol has been approved by various committees and funded by the Central Council for Research in Homoeopathy, Ministry of Ayush, Government of India. The project has been implemented in collaboration with the Department of Homoeopathy, Government of Kerala. The RCT was rolled out on January 25, 2023, and enrollment was completed April 3, 2023. The immunological assays will be conducted at the Department of Biotechnology-Translational Health Science and Technology Institute, Faridabad, India. Conclusions: This study will represent the first evaluation of the immunological efficacy and safety of AA30CH in an RCT, which may significantly impact the use of homeopathy as an evidence-based medicine approach. Trial Registration: Clinical Trials Registry-India CTRI/2022/08/045089; https://tinyurl.com/mryrpkvk International Registered Report Identifier (IRRID): DERR1-10.2196/48479 %M 37843912 %R 10.2196/48479 %U https://www.researchprotocols.org/2023/1/e48479 %U https://doi.org/10.2196/48479 %U http://www.ncbi.nlm.nih.gov/pubmed/37843912 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47272 %T Immune-Boosting Effect of the COVID-19 Vaccine: Real-World Bidirectional Cohort Study %A Liu,Ming %A Zhao,Tianshuo %A Mu,Qiuyue %A Zhang,Ruizhi %A Liu,Chunting %A Xu,Fei %A Liang,Luxiang %A Zhao,Linglu %A Zhao,Suye %A Cai,Xianming %A Wang,Mingting %A Huang,Ninghua %A Feng,Tian %A Lei,Shiguang %A Yang,Guanghong %A Cui,Fuqiang %+ Guizhou Center for Disease Control and Prevention, 73 Bageyan Road, Yunyan District, Guizhou, Guiyang, 550004, China, 86 0851 86828805, ghyang_gzmu@outlook.com %K bidirectional cohort study %K booster administration %K COVID-19 vaccine %K real-world study %K SARS-CoV-2 %K vaccine efficacy %K COVID-19 %D 2023 %7 11.10.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As the SARS-CoV-2 attenuates and antibodies from the COVID-19 vaccine decline, long-term attention should be paid to the durability of primary booster administration and the preventive effect of the second or multiple booster doses of the COVID-19 vaccine. Objective: This study aimed to explore the durability of primary booster administration and the preventive effect of second or multiple booster doses of the COVID-19 vaccine. Methods: We established a bidirectional cohort in Guizhou Province, China. Eligible participants who had received the primary booster dose were enrolled for blood sample collection and administration of the second booster dose. A retrospective cohort for the time of administration was constructed to evaluate antibody attenuation 6-12 months after the primary booster dose, while a prospective cohort on the vaccine effect of the second booster dose was constructed for 4 months after the second administration. Results: Between September 21, 2022, and January 30, 2023, a total of 327 participants were included in the final statistical analysis plan. The retrospective cohort revealed that approximately 6-12 months after receiving the primary booster, immunoglobulin G (IgG) slowly declined with time, while immunoglobulin A (IgA) remained almost constant. The prospective cohort showed that 28 days after receiving the second booster, the antibody levels were significantly improved. Higher levels of IgG and IgA were associated with better protection against COVID-19 infection for vaccine recipients. Regarding the protection of antibody levels against post–COVID-19 symptoms, the increase of the IgG had a protective effect on brain fog and sleep quality, while IgA had a protective effect on shortness of breath, brain fog, impaired coordination, and physical pain. Conclusions: The IgG and IgA produced by the second booster dose of COVID-19 vaccines can protect against SARS-CoV-2 infection and may alleviate some post–COVID-19 symptoms. Further data and studies on secondary booster administration are required to confirm these conclusions. %M 37819703 %R 10.2196/47272 %U https://publichealth.jmir.org/2023/1/e47272 %U https://doi.org/10.2196/47272 %U http://www.ncbi.nlm.nih.gov/pubmed/37819703 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e47239 %T Structural Equation Model for Social Support and Quality of Life Among Individuals With Mental Health Disorders During the COVID-19 Pandemic %A Tran,Bach Xuan %A Dam,Vu Anh Trong %A Auquier,Pascal %A Boyer,Laurent %A Fond,Guillaume %A Nguyen,Hung Manh %A Nguyen,Hung Tuan %A Le,Huong Thi %A Tran,Ha Nhi Thi %A Vu,Giang Thu %A Nguyen,Manh Duc %A Nguyen,Duong Anh Thi %A Ly,Bang Viet %A Latkin,Carl A %A Zhang,Melvyn WB %A Ho,Roger CM %A Ho,Cyrus SH %+ Institute for Preventive Medicine and Public Health, Hanoi Medical University, 1 Ton That Tung Street, Dong Da district, Hanoi, 100000, Vietnam, 84 888288770, bach.ipmph2@gmail.com %K contextual %K social support %K quality of life %K mental health disorders %K Vietnam %K mental health %K mental illness %K cross-sectional %K association %D 2023 %7 11.10.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In light of the COVID-19 pandemic, the distribution of social support for mental health problems has likely become unequal. Family- and community-based social support has been recognized as a promising approach for mental disorders; however, limited global frameworks have been applied to developing countries such as Vietnam. Objective: The aim of this study was to evaluate the quality of life and social support among patients with mental health disorders in Vietnam and to investigate the factors associated with quality of life among these patients. Methods: A cross-sectional study was conducted on 222 psychiatric patients in Hanoi from 2020 to 2022. A structured questionnaire was developed based on four standardized scales: Mental Well-Being-5 scale, Multidimensional Scale of Perceived Social Support, EuroQoL-visual analog scale (EQ-VAS), and EuroQoL-5 dimensions-5 levels (EQ-5D-5L) scale. Tobit regression was used to identify factors associated with the EQ-5D-5L and EQ-VAS scores. Structural equation modeling was applied to verify the relationship between quality of life and social support. Results: The results showed that perceived support from family scored the highest compared to support from friends and significant others. Patients with depression reported the lowest quality of life and perceived social support. Structural equation modeling showed a root mean square error of approximation of 0.055 (90% CI 0.006-0.090), comparative fit index of 0.954, Tucker-Lewis index of 0.892, and standardized root mean squared error of 0.036 (P<.001). The hypothetical model indicated statistically significant correlations between EQ-VAS score and social support (P=.004), EQ-5D-5L and mental well-being (P<.001), and social support and mental well-being (P<.001). Critical deterioration of quality of life and inconsistency in social support for patients with mental illness were also recorded. Conclusions: There is a need to enhance social support and service delivery in Vietnam, focusing on occupation and quality of life. The correlations between social support, quality of life, and mental health issues suggest the potential of a clinical-social integrated intervention model of care. %M 37819706 %R 10.2196/47239 %U https://publichealth.jmir.org/2023/1/e47239 %U https://doi.org/10.2196/47239 %U http://www.ncbi.nlm.nih.gov/pubmed/37819706 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e39919 %T Perceived Effectiveness of COVID-19 Preventive Practices and Behavioral Intention: Survey of a Representative Adult Sample in the United States %A Bagasra,Anisah %A Allen,Christopher T %A Doan,Sara %+ Department of Psychological Science, Kennesaw State University, 440 Bartow Ave, Kennesaw, GA, 30144, United States, 1 470 578 5254, Abagasra@kennesaw.edu %K health promotion %K health communication %K health risk behavior %K behavioral intention %K public health %K COVID-19 %K vaccination %K prevention %K health education %D 2023 %7 10.10.2023 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 37815862 %R 10.2196/39919 %U https://humanfactors.jmir.org/2023/1/e39919 %U https://doi.org/10.2196/39919 %U http://www.ncbi.nlm.nih.gov/pubmed/37815862 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e46318 %T 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 %A Xu,Stanley %A Hong,Vennis %A Sy,Lina S %A Bruxvoort,Katia J %A Lewin,Bruno %A Han,Bing %A Holmquist,Kimberly J %A Qian,Lei %+ Department of Research & Evaluation, Southern California Permanente Medical Group, 100 S Los Robles, Pasadena, CA, 91101, United States, 1 626 564 3958, stan.xu@kp.org %K mRNA COVID-19 vaccines %K 2-dose primary series %K vaccines %K SARS-CoV-2 %K coronavirus %K respiratory %K infectious %K communicable %K immunization %K immunize %K noncompletion %K risk factors %K multiple Poisson regression model %K COVID-19 %K vaccination %K vaccine %K dose %K dosing %K regression %K risk %K risks %K health outcome %K health outcomes %K retrospective %K cohort %K dosage %K United States %K community %K inoculation %D 2023 %7 4.10.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 37792452 %R 10.2196/46318 %U https://publichealth.jmir.org/2023/1/e46318 %U https://doi.org/10.2196/46318 %U http://www.ncbi.nlm.nih.gov/pubmed/37792452 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40783 %T Testing for Hepatitis C During Pregnancy Among Persons With Medicaid and Commercial Insurance: Cohort Study %A Khan,Mohammed A %A Thompson,William W %A Osinubi,Ademola %A Meyer 3rd,William A %A Kaufman,Harvey W %A Armstrong,Paige A %A Foster,Monique A %A Nelson,Noele P %A Wester,Carolyn %+ Division of Viral Hepaitits, Centers for Disease Control and Prevention, 1600 Clifton Rd NE, Atlanta, GA, 30329, United States, 1 404 718 5807, odt5@cdc.gov %K hepatitis C %K testing %K pregnancy %K pregnant %K trend %K insurance %K insured %K HCV %K hepatitis %K Medicaid %K health coverage %K maternal %K fetus %K birth %K natal %K maternity %K liver %K communicable disease %K viral infection %D 2023 %7 27.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The reported incidence of acute hepatitis C virus (HCV) infection is increasing among persons of childbearing age in the United States. Infants born to pregnant persons with HCV infection are at risk for perinatal HCV acquisition. In 2020, the United States Preventive Services Task Force and Centers for Disease Control and Prevention recommended that all pregnant persons be screened during each pregnancy for hepatitis C. However, there are limited data on trends in hepatitis C testing during pregnancy. Objective: We estimated hepatitis C testing rates in a large cohort of patients with Medicaid and commercial insurance who gave birth during 2015-2019 and described demographic and risk-based factors associated with testing. Methods: Medicaid and commercial insurance claims for patients aged 15-44 years and who gave birth between 2015 and 2019 were included. Birth claims were identified using procedure and diagnosis codes for vaginal or cesarean delivery. Hepatitis C testing was defined as an insurance claim during the 42 weeks before delivery. Testing rates were calculated among patients who delivered and among the subset of patients who were continuously enrolled for 42 weeks before delivery. We also compared the timing of testing relative to delivery among patients with commercial or Medicaid insurance. Multivariable logistic regression was used to identify factors associated with testing. Results: Among 1,142,770 Medicaid patients and 1,207,132 commercially insured patients, 175,223 (15.3%) and 221,436 (18.3%) were tested for hepatitis C during pregnancy, respectively. Testing rates were 89,730 (21.8%) and 187,819 (21.9%) among continuously enrolled Medicaid and commercially insured patients, respectively. Rates increased from 2015 through 2019 among Medicaid (from 20,758/108,332, 19.2% to 13,971/52,330, 26.8%) and commercially insured patients (from 38,308/211,555, 18.1% to 39,152/139,972, 28%), respectively. Among Medicaid patients, non-Hispanic Black (odds ratio 0.73, 95% CI 0.71-0.74) and Hispanic (odds ratio 0.53, 95% CI 0.51-0.56) race or ethnicity were associated with lower odds of testing. Opioid use disorder, HIV infection, and high-risk pregnancy were associated with higher odds of testing in both Medicaid and commercially insured patients. Conclusions: Hepatitis C testing during pregnancy increased from 2015 through 2019 among patients with Medicaid and commercial insurance, although tremendous opportunity for improvement remains. Interventions to increase testing among pregnant persons are needed. %M 37756048 %R 10.2196/40783 %U https://publichealth.jmir.org/2023/1/e40783 %U https://doi.org/10.2196/40783 %U http://www.ncbi.nlm.nih.gov/pubmed/37756048 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e47047 %T Telehealth and In-Person Behavioral Health Services in Rural Communities Before and During the COVID-19 Pandemic: Multisite Prospective Cohort Study %A Ward,Marcia M %A Ullrich,Fred %A Bhagianadh,Divya %A Nelson,Eve-Lynn %A Marcin,James P %A Carter,Knute D %A Law,Kari Beth %A McCord,Carly %A Neufeld,Jonathan %A Merchant,Kimberly A S %+ Department of Health Management and Policy, University of Iowa, College of Public Health Building S236, 145 Riverside Dr, Iowa City, IA, 52242, United States, 1 319 384 3815, marcia-m-ward@uiowa.edu %K anxiety %K behavior %K behavioral health %K COVID-19 %K depression %K digital health %K eHealth %K mental health %K mHealth %K pandemic %K rural health services %K rural %K telehealth %K telemedicine %D 2023 %7 18.9.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic triggered widespread adjustments across the US health care system. Telehealth use showed a substantial increase in mental health conditions and services due to acute public health emergency (PHE) behavioral health needs on top of long-standing gaps in access to behavioral health services. How health systems that were already providing behavioral telehealth services adjusted services and staffing during this period has not been well documented, particularly in rural areas with chronic shortages of behavioral health providers and services. Objective: This study investigates patient and treatment characteristic changes from before the COVID-19 PHE to during the PHE within both telehealth and in-person behavioral health services provided in 95 rural communities across the United States. Methods: We used a nonrandomized, prospective, multisite research design involving 2 active treatment groups. The telehealth cohort included all patients who initiated telehealth treatment regimens during the data collection period. A comparison group included a cohort of patients who initiated in-person treatment regimen. Patient enrollment occurred on a rolling basis, and data collection was extended for 3 months after treatment initiation for each patient. Chi-square tests compared changes from pre-PHE to PHE time periods within telehealth and in-person treatment cohorts. The dependent measures included patient diagnosis, clinicians providing treatment services, and type of treatment services provided at each encounter. The 4780 patients in the telehealth cohort and the 6457 patients in the in-person cohort had an average of 3.5 encounters during the 3-month follow-up period. Results: The encounters involving anxiety, dissociative, and stress-related disorders in the telehealth cohort increased from 30% (698/2352) in the pre-PHE period to 35% (4632/12,853) in the PHE period (P<.001), and encounters involving substance use disorders in the in-person cohort increased from 11% (468/4249) in the pre-PHE period to 18% (3048/17,047) in the PHE period (P<.001). The encounters involving treatment service codes for alcohol, drug, and medication-assisted therapy in the telehealth cohort increased from 1% (22/2352) in the pre-PHE period to 11% (1470/13,387) in the PHE period (P<.001); likewise, encounters for this type of service in the in-person cohort increased from 0% (0/4249) in the pre-PHE period to 16% (2687/17,047) in the PHE period (P<.001). From the pre-PHE to the PHE period, encounters involving 60-minute psychotherapy in the telehealth cohort increased from 8% (190/2352) to 14% (1802/13,387; P<.001), while encounters involving group therapy in the in-person cohort decreased from 12% (502/4249) to 4% (739/17,047; P<.001). Conclusions: The COVID-19 pandemic challenged health service providers, and they adjusted the way both telehealth and in-person behavioral therapy services were delivered. Looking forward, future research is needed to explicate the interaction of patient, provider, setting, and intervention factors that influenced the patterns observed as a result of the COVID-19 pandemic. %M 37721793 %R 10.2196/47047 %U https://mental.jmir.org/2023/1/e47047 %U https://doi.org/10.2196/47047 %U http://www.ncbi.nlm.nih.gov/pubmed/37721793 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41364 %T Potential Determinants Contributing to COVID-19 Vaccine Acceptance and Hesitancy in Taiwan: Rapid Qualitative Mixed Methods Study %A Lin,Li-Yin %A Lin,Chun-Ji %A Kuan,Chen-I %A Chiou,Hung-Yi %+ Institute of Population Health Sciences, National Health Research Institutes, No 35, Keyan Road, Zhunan Town, Miaoli County, 35053, Taiwan, 886 37 206166 ext 36300, hychiou@nhri.edu.tw %K COVID-19 %K vaccine acceptance %K vaccine hesitancy %K google trends %K public health %K vaccination %K health promotion %K thematic analysis %K infoveillance %D 2023 %7 12.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Although vaccination has been shown to be one of the most important interventions, COVID-19 vaccine hesitancy remains one of the top 10 global public health challenges worldwide. Objective: The objective of this study is to investigate (1) major determinants of vaccine hesitancy, (2) changes in the determinants of vaccine hesitancy at different time periods, and (3) the potential factors affecting vaccine acceptance. Methods: This study applied a mixed methods approach to explore the potential determinants contributing to vaccine hesitancy among the Taiwanese population. The quantitative design of this study involved using Google Trends search query data. We chose the search term “疫苗“ (vaccine), selected ”台灣” (Taiwan) as the location, and selected the period between December 18, 2020, and July 31, 2021. The rising keywords related to vaccine acceptance and hesitancy were collected. Based on the responses obtained from the qualitative study and the rising keywords obtained in Google Trends, the 3 most popular keywords related to vaccine hesitancy were identified and used as search queries in Google Trends between December 18, 2020, and July 31, 2021, to generate relative search volumes (RSVs). Lastly, autoregressive integrated moving average modeling was used to forecast the RSVs for the 3 keywords between May 29 and July 31, 2021. The estimated RSVs were compared to the observed RSVs in Google Trends within the same time frame. Results: The 4 prevailing factors responsible for COVID-19 vaccine acceptance and hesitancy were doubts about the government and manufacturers, side effects, deaths associated with vaccination, and efficacy of vaccination. During the vaccine observation period, “political role” was the overarching consideration leading to vaccine hesitancy. During the peak of the pandemic, side effects, death, and vaccine protection were the main factors contributing to vaccine hesitancy. The popularity of the 3 frequently searched keywords “side effects,” “vaccine associated deaths,” and “vaccine protection” continued to rise throughout the pandemic outbreak. Lastly, the highest Google search queries related to COVID-19 vaccines emerged as “side effects” prior to vaccination, deaths associated with vaccines during the period when single vaccines were available, and “side effects” and “vaccine protection” during the period when multiple vaccines were available. Conclusions: Investigating the key factors influencing COVID-19 vaccine hesitancy appears to be a fundamental task that needs to be undertaken to ensure effective implementation of COVID-19 vaccination. Google Trends may be used as a complementary infoveillance tool by government agencies for future vaccine policy implementation and communication. %M 37698904 %R 10.2196/41364 %U https://formative.jmir.org/2023/1/e41364 %U https://doi.org/10.2196/41364 %U http://www.ncbi.nlm.nih.gov/pubmed/37698904 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42446 %T Enhancing the Predictive Power of Google Trends Data Through Network Analysis: Infodemiology Study of COVID-19 %A Chu,Amanda MY %A Chong,Andy C Y %A Lai,Nick H T %A Tiwari,Agnes %A So,Mike K P %+ Department of Information Systems, Business Statistics and Operations Management, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong, Hong Kong, 852 23587726, immkpso@ust.hk %K internet search volumes %K network analysis %K pandemic risk %K health care analytics %K network connectedness %K infodemiology %K infoveillance %K mobile phone %K COVID-19 %D 2023 %7 7.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 outbreak has revealed a high demand for timely surveillance of pandemic developments. Google Trends (GT), which provides freely available search volume data, has been proven to be a reliable forecast and nowcast measure for public health issues. Previous studies have tended to use relative search volumes from GT directly to analyze associations and predict the progression of pandemic. However, GT’s normalization of the search volumes data and data retrieval restrictions affect the data resolution in reflecting the actual search behaviors, thus limiting the potential for using GT data to predict disease outbreaks. Objective: This study aimed to introduce a merged algorithm that helps recover the resolution and accuracy of the search volume data extracted from GT over long observation periods. In addition, this study also aimed to demonstrate the extended application of merged search volumes (MSVs) in combination of network analysis, via tracking the COVID-19 pandemic risk. Methods: We collected relative search volumes from GT and transformed them into MSVs using our proposed merged algorithm. The MSVs of the selected coronavirus-related keywords were compiled using the rolling window method. The correlations between the MSVs were calculated to form a dynamic network. The network statistics, including network density and the global clustering coefficients between the MSVs, were also calculated. Results: Our research findings suggested that although GT restricts the search data retrieval into weekly data points over a long period, our proposed approach could recover the daily search volume over the same investigation period to facilitate subsequent research analyses. In addition, the dynamic time warping diagrams show that the dynamic networks were capable of predicting the COVID-19 pandemic trends, in terms of the number of COVID-19 confirmed cases and severity risk scores. Conclusions: The innovative method for handling GT search data and the application of MSVs and network analysis to broaden the potential for GT data are useful for predicting the pandemic risk. Further investigation of the GT dynamic network can focus on noncommunicable diseases, health-related behaviors, and misinformation on the internet. %M 37676701 %R 10.2196/42446 %U https://publichealth.jmir.org/2023/1/e42446 %U https://doi.org/10.2196/42446 %U http://www.ncbi.nlm.nih.gov/pubmed/37676701 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45664 %T Unmet Psychosocial Needs of Health Care Professionals in Europe During the COVID-19 Pandemic: Mixed Methods Approach %A Hummel,Svenja %A Michelsen,Ina %A Zafar,Ali %A Moritz,Steffen %A Benoy,Charles %A Lemogne,Cédric %A Almeida,Rosa %A Losada,Raquel %A Ribeiro,Oscar %A Frisardi,Vincenza %A Tarricone,Ilaria %A Ferrari,Silvia %A Dechent,Frieder %A Huber,Christian G %A Weidt,Steffi %A Mayer,Gwendolyn %A Schultz,Jobst-Hendrik %+ Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Im Neuenheimer Feld 410, Heidelberg, Germany, 49 62215634170, svenja.hummel@med.uni-heidelberg.de %K COVID-19 %K mental health %K health care professionals %K health care workers %K pandemic preparedness %K mixed methods %K coping %K stressors %K psychosocial %D 2023 %7 6.9.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic severely affected everyday life and working conditions for most Europeans, particularly health care professionals (HCPs). Over the past 3 years, various policies have been implemented in various European countries. Studies have reported on the worsening of mental health, work-related stress, and helpful coping strategies. However, having a closer look is still necessary to gain more information on the psychosocial stressors and unmet needs of HCPs as well as nonmedical staff. Objective: This study aimed to obtain quantitative information on job-related stressors of physicians and nurses and the coping strategies of HCPs and nonmedical staff at 2 periods of the COVID-19 pandemic. By further analyzing qualitative comments, we wanted to gain more information on the psychosocial stressors and unmet needs of HCPs as well as nonmedical staff on different levels of experience. Methods: A cross-sectional survey was conducted at 2 time points during the COVID-19 pandemic in several European countries. The first study period (T1) lasted between April 1 and June 20, 2020, and the second study period (T2) lasted between November 25, 2021, and February 28, 2022. On a quantitative level, we used a questionnaire on stressors for physicians and nurses and a questionnaire on coping strategies for HCPs and nonmedical staff. Quantitative data were descriptively analyzed for mean values and differences in stressors and coping strategies. Qualitative data of free-text boxes of HCPs and nonmedical staff were analyzed via thematic analysis to explore the experiences of the individuals. Results: T1 comprised 609 participants, and T2 comprised 1398 participants. Overall, 296 participants made 438 qualitative comments. The uncertainty about when the pandemic would be controlled (T1: mean 2.28, SD 0.85; T2: mean 2.08, SD 0.90) and the fear of infecting the family (T1: mean 2.26, SD 0.98; T2: mean 2.02, SD 1.02) were the most severe stressors identified by physicians and nurses in both periods. Overall, the use of protective measures (T1: mean 2.66, SD 0.60; T2: mean 2.66, SD 0.60) and acquiring information about COVID-19 (T1: mean 2.29, SD 0.82; T2: mean 1.99, SD 0.89) were identified as the most common coping strategies for the entire study population. Using thematic analysis, we identified 8 themes of personal experiences on the micro, meso, and macro levels. Measures, working conditions, feelings and emotions, and social climate were frequently mentioned topics of the participants. In T1, feelings of isolation and uncertainty were prominent. In T2, feelings of exhaustion were expressed and vaccination was frequently discussed. Moreover, unmet psychosocial needs were identified. Conclusions: There is a need for improvement in pandemic preparedness. Targeted vocational education measures and setting up of web-based mental health support could be useful to bridge gaps in psychosocial support needs in future crises. %M 37672320 %R 10.2196/45664 %U https://publichealth.jmir.org/2023/1/e45664 %U https://doi.org/10.2196/45664 %U http://www.ncbi.nlm.nih.gov/pubmed/37672320 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e47702 %T Coping Strategies Used by Health Care Workers in Ecuador During the COVID-19 Pandemic: Observational Study to Enhance Resilience and Develop Training Tools %A Vicente,María Asunción %A Gil Hernández,Eva %A Carrillo,Irene %A Fernández,César %A López-Pineda,Adriana %A Guilabert,Mercedes %A Martín-Delgado,Jimmy %A Solis,Carlos %A Camba,Karla %A Cañizares Fuentes,Wilson Ricardo %A Mira,José Joaquín %+ Health Psychology Department, Miguel Hernandez University, Avda de la Universidad s/n, Edificio Altamira, Elche, 03202, Spain, 34 966658385, suni@umh.es %K COVID-19 %K coping %K mental health %K social support %K health professionals %K psychological well-being %K resilience %K coping strategy %K used %K health care worker %K pandemic %K well-being %K professional %K intervention %D 2023 %7 6.9.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic has generated immense health care pressure, forcing critical decisions to be made in a socially alarmed environment. Adverse conditions have led to acute stress reactions, affective pathologies, and psychosomatic reactions among health personnel, which have been exacerbated by the successive waves of the pandemic. The recovery of the entire health system and its professionals has been hindered, making it essential to increase their resilience. Objective: This study aimed to achieve 2 primary objectives. First, it sought to identify coping strategies, both individual and organizational, used by health care workers in Ecuador to navigate the acute stress during the early waves of the pandemic. Second, it aimed to develop training materials to enhance team leaders' capabilities in effectively managing high-stress situations. Methods: The study used qualitative research techniques to collect information on institutional and personal coping strategies, as well as consensus-building techniques to develop a multimedia psychological tool that reinforces the resilience of professionals and teams in facing future crises. Results: The findings from the actions taken by health care workers in Ecuador were categorized into 4 types of coping strategies based on Lazarus' theories on coping strategies. As a result of this study, a new audiovisual tool was created, comprising a series of podcasts, designed to disseminate these strategies globally within the Spanish-speaking world. The tool features testimonials from health care professionals in Ecuador, narrating their experiences under the pressures of providing care during the pandemic, with a particular emphasis on the coping strategies used. Conclusions: Ensuring the preparedness of health professionals for potential future outbreaks is imperative to maintain quality and patient safety. Interventions such as this one offer valuable insights and generate new tools for health professionals, serving as a case study approach to train leaders and improve the resilience capacity and skills of their teams. %M 37672317 %R 10.2196/47702 %U https://humanfactors.jmir.org/2023/1/e47702 %U https://doi.org/10.2196/47702 %U http://www.ncbi.nlm.nih.gov/pubmed/37672317 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e45867 %T Influence of Tweets Indicating False Rumors on COVID-19 Vaccination: Case Study %A Hirabayashi,Mai %A Shibata,Daisaku %A Shinohara,Emiko %A Kawazoe,Yoshimasa %+ Artificial Intelligence in Healthcare, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo Bunkyo-ku, Tokyo, 113−8655, Japan, 81 03 3815 5411, kawazoe@m.u-tokyo.ac.jp %K coronavirus %K correlation %K COVID-19 %K disinformation %K false information %K infodemiology %K misinformation %K rumor %K rumor-indication %K SARS-CoV-2 %K social media %K tweet %K Twitter %K vaccination %K vaccine %D 2023 %7 5.9.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: As of December 2022, the outbreak of COVID-19 showed no sign of abating, continuing to impact people’s lives, livelihoods, economies, and more. Vaccination is an effective way to achieve mass immunity. However, in places such as Japan, where vaccination is voluntary, there are people who choose not to receive the vaccine, even if an effective vaccine is offered. To promote vaccination, it is necessary to clarify what kind of information on social media can influence attitudes toward vaccines. Objective: False rumors and counterrumors are often posted and spread in large numbers on social media, especially during emergencies. In this paper, we regard tweets that contain questions or point out errors in information as counterrumors. We analyze counterrumors tweets related to the COVID-19 vaccine on Twitter. We aimed to answer the following questions: (1) what kinds of COVID-19 vaccine–related counterrumors were posted on Twitter, and (2) are the posted counterrumors related to social conditions such as vaccination status? Methods: We use the following data sets: (1) counterrumors automatically collected by the “rumor cloud” (18,593 tweets); and (2) the number of COVID-19 vaccine inoculators from September 27, 2021, to August 15, 2022, published on the Prime Minister’s Office’s website. First, we classified the contents contained in counterrumors. Second, we counted the number of COVID-19 vaccine–related counterrumors from data set 1. Then, we examined the cross-correlation coefficients between the numbers of data sets 1 and 2. Through this verification, we examined the correlation coefficients for the following three periods: (1) the same period of data; (2) the case where the occurrence of the suggestion of counterrumors precedes the vaccination (negative time lag); and (3) the case where the vaccination precedes the occurrence of counterrumors (positive time lag). The data period used for the validation was from October 4, 2021, to April 18, 2022. Results: Our classification results showed that most counterrumors about the COVID-19 vaccine were negative. Moreover, the correlation coefficients between the number of counterrumors and vaccine inoculators showed significant and strong positive correlations. The correlation coefficient was over 0.7 at −8, −7, and −1 weeks of lag. Results suggest that the number of vaccine inoculators tended to increase with an increase in the number of counterrumors. Significant correlation coefficients of 0.5 to 0.6 were observed for lags of 1 week or more and 2 weeks or more. This implies that an increase in vaccine inoculators increases the number of counterrumors. These results suggest that the increase in the number of counterrumors may have been a factor in inducing vaccination behavior. Conclusions: Using quantitative data, we were able to reveal how counterrumors influence the vaccination status of the COVID-19 vaccine. We think that our findings would be a foundation for considering countermeasures of vaccination. %M 37669092 %R 10.2196/45867 %U https://formative.jmir.org/2023/1/e45867 %U https://doi.org/10.2196/45867 %U http://www.ncbi.nlm.nih.gov/pubmed/37669092 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46435 %T Adapting Effective mHealth Interventions to Improve Uptake and Adherence to HIV Pre-Exposure Prophylaxis Among Thai Young Men Who Have Sex With Men: Protocol for a Randomized Controlled Trial %A Wang,Bo %A Janamnuaysook,Rena %A MacDonell,Karen %A Rongkavilit,Chokechai %A Schieber,Elizabeth %A Naar,Sylvie %A Phanuphak,Nittaya %+ Department of Population and Quantitative Health Sciences, University of Massachusetts Chan Medical School, 55 N Lake Avenue, Worcester, MA, 01655, United States, 1 7744554672, Bo.Wang@umassmed.edu %K young men who have sex with men %K pre-exposure prophylaxis %K PrEP %K HIV prevention %K mHealth %K motivational interviewing %K motivational text messaging %K Thailand %D 2023 %7 4.9.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Young men who have sex with men (YMSM) are the fastest-growing HIV-positive population worldwide. Thailand has the highest adult HIV seroprevalence in Asia; over 25% of men having sex with men in Bangkok are HIV positive. Pre-exposure prophylaxis (PrEP) is an efficacious HIV prevention strategy recommended for all at-risk individuals. PrEP is highly effective when taken as prescribed, but PrEP utilization rate has been low, and adherence is often inadequate. Objective: We propose to develop and pilot a multicomponent, technology-based intervention to promote motivation to begin PrEP (“uptake”) and sustained adherence to PrEP among HIV-negative Thai YMSM. We will adapt an existing 2-session technology-delivered, motivational interviewing–based intervention to focus on PrEP use in YMSM in Thailand. The resulting intervention is called the Motivational Enhancement System for PrEP Uptake and Adherence (MES-PrEP). We will also develop motivational text messaging (MTM) to send two-way motivational messages to promote PrEP use. Methods: The proposed study includes 3 phases. Phase 1 includes in-depth interviews with HIV-negative Thai YMSM and providers to explore barriers and facilitators of PrEP initiation and adherence, aiming to inform intervention content. Phase 2 consists of adapting and beta-testing MES-PrEP and MTM for functionality and feasibility using a youth advisory board of Thai YMSM. In Phase 3, we will conduct a pilot randomized controlled trial to evaluate the feasibility, acceptability, and preliminary efficacy of MES-PrEP and MTM to increase PrEP uptake and adherence among Thai YMSM. A total of 60 HIV-negative Thai YMSM who have not started PrEP and 60 YMSM who are on PrEP but not adherent to it will be randomized 2:1 to receive MES-PrEP and MTM (n=40) or standard PrEP counseling (n=20). The feasibility and acceptability of the intervention will be assessed through usage patterns and the System Usability Scale. The preliminary impact will be assessed by evaluating the proportion of PrEP initiation and level of adherence to PrEP. Participants will complete the assessments at baseline and at 1-, 3-, and 6-month postintervention. Biomarkers of adherence to PrEP and biomarkers of HIV and sexually transmitted infections will be collected. Results: Recruitment for this study began in January 2022 for phase 1. Qualitative interviews were completed with 30 YMSM and 5 clinical providers in May 2022. Phase 3, the pilot feasibility and acceptability trial, began in July 2023. Upon project completion, we shall have developed a highly innovative mobile health intervention to support YMSM using PrEP, which will be ready for testing in a larger efficacy trial. Conclusions: This study addresses a critical problem (ie, high HIV incidence and low PrEP use) among Thai YMSM. We are developing 2 potentially synergistic technology-based, theory-driven interventions aimed at maximizing PrEP use. The proposed project has the potential to make significant contributions to advancing HIV prevention research and implementation science. Trial Registration: ClinicalTrials.gov NCT05243030; https://clinicaltrials.gov/ct2/show/NCT05243030 International Registered Report Identifier (IRRID): DERR1-10.2196/46435 %M 37665622 %R 10.2196/46435 %U https://www.researchprotocols.org/2023/1/e46435 %U https://doi.org/10.2196/46435 %U http://www.ncbi.nlm.nih.gov/pubmed/37665622 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e46644 %T Enabling Multicentric Participatory Disease Surveillance for Global Health Enhancement: Viewpoint on Global Flu View %A Leal Neto,Onicio %A Paolotti,Daniela %A Dalton,Craig %A Carlson,Sandra %A Susumpow,Patipat %A Parker,Matt %A Phetra,Polowat %A Lau,Eric H Y %A Colizza,Vittoria %A Jan van Hoek,Albert %A Kjelsø,Charlotte %A Brownstein,John S %A Smolinski,Mark S %+ Ending Pandemics, 870 Market Street, Suite 528, San Francisco, CA, 94102, United States, 1 5106938359, onicio@gmail.com %K participatory surveillance %K digital epidemiology %K influenza-like illness %K data transfer %K surveillance %K digital platform %K Global Flu View %K program %K data sharing %K public health %K innovative %K flu %D 2023 %7 1.9.2023 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Participatory surveillance (PS) has been defined as the bidirectional process of transmitting and receiving data for action by directly engaging the target population. Often represented as self-reported symptoms directly from the public, PS can provide evidence of an emerging disease or concentration of symptoms in certain areas, potentially identifying signs of an early outbreak. The construction of sets of symptoms to represent various disease syndromes provides a mechanism for the early detection of multiple health threats. Global Flu View (GFV) is the first-ever system that merges influenza-like illness (ILI) data from more than 8 countries plus 1 region (Hong Kong) on 4 continents for global monitoring of this annual health threat. GFV provides a digital ecosystem for spatial and temporal visualization of syndromic aggregates compatible with ILI from the various systems currently participating in GFV in near real time, updated weekly. In 2018, the first prototype of a digital platform to combine data from several ILI PS programs was created. At that time, the priority was to have a digital environment that brought together different programs through an application program interface, providing a real time map of syndromic trends that could demonstrate where and when ILI was spreading in various regions of the globe. After 2 years running as an experimental model and incorporating feedback from partner programs, GFV was restructured to empower the community of public health practitioners, data scientists, and researchers by providing an open data channel among these contributors for sharing experiences across the network. GFV was redesigned to serve not only as a data hub but also as a dynamic knowledge network around participatory ILI surveillance by providing knowledge exchange among programs. Connectivity between existing PS systems enables a network of cooperation and collaboration with great potential for continuous public health impact. The exchange of knowledge within this network is not limited only to health professionals and researchers but also provides an opportunity for the general public to have an active voice in the collective construction of health settings. The focus on preparing the next generation of epidemiologists will be of great importance to scale innovative approaches like PS. GFV provides a useful example of the value of globally integrated PS data to help reduce the risks and damages of the next pandemic. %M 37490846 %R 10.2196/46644 %U https://publichealth.jmir.org/2023/1/e46644 %U https://doi.org/10.2196/46644 %U http://www.ncbi.nlm.nih.gov/pubmed/37490846 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e46383 %T Reported Global Avian Influenza Detections Among Humans and Animals During 2013-2022: Comprehensive Review and Analysis of Available Surveillance Data %A Szablewski,Christine M %A Iwamoto,Chelsea %A Olsen,Sonja J %A Greene,Carolyn M %A Duca,Lindsey M %A Davis,C Todd %A Coggeshall,Kira C %A Davis,William W %A Emukule,Gideon O %A Gould,Philip L %A Fry,Alicia M %A Wentworth,David E %A Dugan,Vivien G %A Kile,James C %A Azziz-Baumgartner,Eduardo %+ Influenza Division, National Center for Immunization and Respiratory Diseases, United States Centers for Disease Control and Prevention, 1600 Clifton Road NE, Atlanta, GA, 30333, United States, 1 470 998 1990, LQZ9@cdc.gov %K avian influenza %K novel influenza %K pandemic influenza %K One Health %K zoonotic influenza %K surveillance %D 2023 %7 31.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Avian influenza (AI) virus detections occurred frequently in 2022 and continue to pose a health, economic, and food security risk. The most recent global analysis of official reports of animal outbreaks and human infections with all reportable AI viruses was published almost a decade ago. Increased or renewed reports of AI viruses, especially high pathogenicity H5N8 and H5N1 in birds and H5N1, H5N8, and H5N6 in humans globally, have established the need for a comprehensive review of current global AI virus surveillance data to assess the pandemic risk of AI viruses. Objective: This study aims to provide an analysis of global AI animal outbreak and human case surveillance information from the last decade by describing the circulating virus subtypes, regions and temporal trends in reporting, and country characteristics associated with AI virus outbreak reporting in animals; surveillance and reporting gaps for animals and humans are identified. Methods: We analyzed AI virus infection reports among animals and humans submitted to animal and public health authorities from January 2013 to June 2022 and compared them with reports from January 2005 to December 2012. A multivariable regression analysis was used to evaluate associations between variables of interest and reported AI virus animal outbreaks. Results: From 2013 to 2022, 52.2% (95/182) of World Organisation for Animal Health (WOAH) Member Countries identified 34 AI virus subtypes during 21,249 outbreaks. The most frequently reported subtypes were high pathogenicity AI H5N1 (10,079/21,249, 47.43%) and H5N8 (6722/21,249, 31.63%). A total of 10 high pathogenicity AI and 6 low pathogenicity AI virus subtypes were reported to the WOAH for the first time during 2013-2022. AI outbreaks in animals occurred in 26 more Member Countries than reported in the previous 8 years. Decreasing World Bank income classification was significantly associated with decreases in reported AI outbreaks (P<.001-.02). Between January 2013 and June 2022, 17/194 (8.8%) World Health Organization (WHO) Member States reported 2000 human AI virus infections of 10 virus subtypes. H7N9 (1568/2000, 78.40%) and H5N1 (254/2000, 12.70%) viruses accounted for the most human infections. As many as 8 of these 17 Member States did not report a human case prior to 2013. Of 1953 human cases with available information, 74.81% (n=1461) had a known animal exposure before onset of illness. The median time from illness onset to the notification posted on the WHO event information site was 15 days (IQR 9-30 days; mean 24 days). Seasonality patterns of animal outbreaks and human infections with AI viruses were very similar, occurred year-round, and peaked during November through May. Conclusions: Our analysis suggests that AI outbreaks are more frequently reported and geographically widespread than in the past. Global surveillance gaps include inconsistent reporting from all regions and human infection reporting delays. Continued monitoring for AI virus outbreaks in animals and human infections with AI viruses is crucial for pandemic preparedness. %M 37651182 %R 10.2196/46383 %U https://publichealth.jmir.org/2023/1/e46383 %U https://doi.org/10.2196/46383 %U http://www.ncbi.nlm.nih.gov/pubmed/37651182 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44657 %T Wastewater Surveillance for SARS-CoV-2 at Long-Term Care Facilities: Mixed Methods Evaluation %A Keck,James W %A Lindner,Jess %A Liversedge,Matthew %A Mijatovic,Blazan %A Olsson,Cullen %A Strike,William %A Noble,Anni %A Adatorwovor,Reuben %A Lacy,Parker %A Smith,Ted %A Berry,Scott M %+ Department of Family & Community Medicine, University of Kentucky, 2195 Harrodsburg Rd, Suite 125, Lexington, KY, 40504, United States, 1 907 729 2924, jameswkeck@gmail.com %K wastewater surveillance %K wastewater-based epidemiology %K evaluation %K long-term care facility %K COVID-19 %K SARS-CoV-2 %D 2023 %7 29.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %R 10.2196/44657 %U https://publichealth.jmir.org/2023/1/e44657 %U https://doi.org/10.2196/44657 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e43492 %T Mobile Health–Supported Active Syndrome Surveillance for COVID-19 Early Case Finding in Addis Ababa, Ethiopia: Comparative Study %A Bisrat,Haileleul %A Manyazewal,Tsegahun %A Fekadu,Abebaw %+ Center for Innovative Drug Development and Therapeutic Trials for Africa (CDT-Africa), College of Health Sciences, Addis Ababa University, BL_03_420 St., Addis Abeba, 9086, Ethiopia, 251 911940459, haylishb2@gmail.com %K mobile health %K mHealth %K digital health %K COVID-19 %K syndrome assessment %K surveillance %K Ethiopia %K public health %K syndrome surveillance %K self-care %K telemedicine %K telecom, SARS-CoV-2 %D 2023 %7 28.8.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Since most people in low-income countries do not have access to reliable laboratory services, early diagnosis of life-threatening diseases like COVID-19 remains challenging. Facilitating real-time assessment of the health status in a given population, mobile health (mHealth)–supported syndrome surveillance might help identify disease conditions earlier and save lives cost-effectively. Objective: This study aimed to evaluate the potential use of mHealth-supported active syndrome surveillance for COVID-19 early case finding in Addis Ababa, Ethiopia. Methods: A comparative cross-sectional study was conducted among adults randomly selected from the Ethio telecom list of mobile phone numbers. Participants underwent a comprehensive phone interview for COVID-19 syndromic assessments, and their symptoms were scored and interpreted based on national guidelines. Participants who exhibited COVID-19 syndromes were advised to have COVID-19 diagnostic testing at nearby health care facilities and seek treatment accordingly. Participants were asked about their test results, and these were cross-checked against the actual facility-based data. Estimates of COVID-19 detection by mHealth-supported syndromic assessments and facility-based tests were compared using Cohen Kappa (κ), the receiver operating characteristic curve, sensitivity, and specificity analysis. Results: A total of 2741 adults (n=1476, 53.8% men and n=1265, 46.2% women) were interviewed through the mHealth platform during the period from December 2021 to February 2022. Among them, 1371 (50%) had COVID-19 symptoms at least once and underwent facility-based COVID-19 diagnostic testing as self-reported, with 884 (64.5%) confirmed cases recorded in facility-based registries. The syndrome assessment model had an optimal likelihood cut-off point sensitivity of 46% (95% CI 38.4-54.6) and specificity of 98% (95% CI 96.7-98.9). The area under the receiver operating characteristic curve was 0.87 (95% CI 0.83-0.91). The level of agreement between the mHealth-supported syndrome assessment and the COVID-19 test results was moderate (κ=0.54, 95% CI 0.46-0.60). Conclusions: In this study, the level of agreement between the mHealth-supported syndromic assessment and the actual laboratory-confirmed results for COVID-19 was found to be reasonable, at 89%. The mHealth-supported syndromic assessment of COVID-19 represents a potential alternative method to the standard laboratory-based confirmatory diagnosis, enabling the early detection of COVID-19 cases in hard-to-reach communities, and informing patients about self-care and disease management in a cost-effective manner. These findings can guide future research efforts in developing and integrating digital health into continuous active surveillance of emerging infectious diseases. %M 37556182 %R 10.2196/43492 %U https://www.i-jmr.org/2023/1/e43492 %U https://doi.org/10.2196/43492 %U http://www.ncbi.nlm.nih.gov/pubmed/37556182 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46955 %T Efficacy and Safety of the Smallpox Vaccine for Postexposure Prophylaxis in Monkeypox: Protocol for an Open-Labeled, Single-Armed Study %A Yano,Rina %A Terada-Hirashima,Junko %A Uemura,Yukari %A Tomita,Noriko %A Shimizu,Yosuke %A Iwasaki,Haruka %A Okumura,Nobumasa %A Suzuki,Tetsuya %A Saito,Sho %A Ujiie,Mugen %A Sugiura,Wataru %A Ohmagari,Norio %+ Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan, 81 3 3202 7181, jterada@hosp.ncgm.go.jp %K monkeypox %K post-exposure prophylaxis %K smallpox vaccine %K vaccinia virus %K LC16 %K poxvirus %K smallpox %K vaccination %K smallpox virus %K orthopoxvirus %K immunity %K epidemiology %K zoonosis %K virus %K vaccine %K Disease Control and Prevention %K inoculation %K injection site %K body temperature %K headache %K rash %K lymphadenopathy %K infectious disease %K endpoint analysis %D 2023 %7 25.8.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: In May 2022, a case of monkeypox (currently known as “mpox”) with no history of overseas travel was reported in the United Kingdom, followed by reports of infections reported in Europe, the United States, and other countries worldwide. Due to the significant overlap in immune responses among viruses of the genus Orthopoxvirus (including smallpox virus, mpox virus, and vaccinia virus), it is believed that cross-immunity can be achieved by administering the smallpox virus vaccine. In Japan, a smallpox vaccine (LC16m8 strain vaccine) has been approved; however, there was no regulatory approval for the mpox vaccine during the design of this study. Although it is believed that individuals exposed to the mpox virus may receive smallpox vaccination as mpox prophylaxis, the existing evidence is not clear. Objective: The primary objective was to evaluate the efficacy of the LC16m8 strain vaccine, approved for smallpox in Japan, for postexposure prophylaxis against mpox when administered to close contacts of individuals with mpox. The secondary objective was to investigate the safety of the vaccine for postexposure prophylaxis against mpox. Methods: The study aimed to enroll 100 vaccinated participants who had been identified as close contacts of individuals with mpox. Consent was obtained, and the participants are inoculated with the vaccine. Daily recordings of symptoms (body temperature, headache, rash, and side effects) were made until day 21 and then again on day 28. Furthermore, additional evaluations of adverse events were performed by the investigators on days 7, 14, 21, and 28. Considering that the maximum incubation period for mpox is 21 days, the primary end point is the presence or absence of the disease 21 days after close contact. The primary analysis focused on cases within 4 days of intense contact as it has been reported that vaccination within this timeframe can reduce the incidence of the disease. Results: The first trial participant was enrolled on July 28, 2022, and the research period concluded in March 2023. The study results will be published in a peer-reviewed scientific journal. Conclusions: This study allowed us to investigate the efficacy and safety of the LC16m8 strain vaccine in postexposure prophylaxis against mpox. Trial Registration: Japan Registry of Clinical Trials jRCTs031220137; https://jrct.niph.go.jp/en-latest-detail/jRCTs031220137 International Registered Report Identifier (IRRID): DERR1-10.2196/46955 %M 37624623 %R 10.2196/46955 %U https://www.researchprotocols.org/2023/1/e46955 %U https://doi.org/10.2196/46955 %U http://www.ncbi.nlm.nih.gov/pubmed/37624623 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43790 %T Improving Surveillance of Human Tick-Borne Disease Risks: Spatial Analysis Using Multimodal Databases %A Maxwell,Sarah P %A Brooks,Chris %A Kim,Dohyeong %A McNeely,Connie L %A Cho,Seonga %A Thomas,Kevin C %+ School of Economic, Political and Policy Sciences, University of Texas at Dallas, 800 West Campbell Avenue, Richardson, TX, 75080, United States, 1 972 883 6469, sarah.maxwell@utdallas.edu %K tick-borne disease surveillance %K Lyme disease %K tick bite encounter %K One Health model %K triangulation %K entomology %K entomological %K tick %K thematic mapping %K spatial %K risk %K surveillance %K vector %D 2023 %7 23.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The extent of tick-borne disease (TBD) risk in the United States is generally unknown. Active surveillance using entomological measures, such as presence and density of infected nymphal Ixodes scapularis ticks, have served as indicators for assessing human risk, but results have been inconsistent and passive surveillance via public health systems suggests TBDs are underreported. Objective: Research using various data sources and collection methods (eg, Google Trends, apps, and tick bite encounters [TBEs] reports) has shown promise for assessing human TBD risk. In that vein, and engaging a One Health perspective, this study used multimodal databases, geographically overlaying patient survey data on TBEs and concomitant reports of TBDs with data drawn from other sources, such as canine serological reports, to glean insights and to determine and assess the use of various indicators as proxies for human TBD risk. Methods: This study used a mixed methods research strategy, relying on triangulation techniques and drawing on multiple data sources to provide insights into various aspects of human disease risk from TBEs and TBDs in the United States. A web-based survey was conducted over a 15-month period beginning in December 2020 to collect data on TBEs. To maximize the value of the covariate data, related analyses included TBE reports that occurred in the United States between January 1, 2000, and March 31, 2021. TBEs among patients diagnosed with Lyme disease were analyzed at the county level and compared to I scapularis and I pacificus tick presence, human cases identified by the Centers for Disease Control and Prevention (CDC), and canine serological data. Spatial analyses employed multilayer thematic mapping and other techniques. Results: After cleaning, survey results showed a total of 249 (75.7%) TBEs spread across 148 respondents (61.9% of all respondents, 81.7% of TBE-positive respondents); 144 (4.7%) counties in 30 states (60%) remained eligible for analysis, with an average of 1.68 (SD 1.00) and median of 1 (IQR 1) TBEs per respondent. Analysis revealed significant spatial matching at the county level among patient survey reports of TBEs and disease risk indicators from the CDC and other official sources. Thematic mapping results included one-for-one county-level matching of reported TBEs with at least 1 designated source of human disease risk (ie, positive canine serological tests, CDC-reported Lyme disease, or known tick presence). Conclusions: Use of triangulation methods to integrate patient data on TBE recall with established canine serological reports, tick presence, and official human TBD information offers more granular, county-level information regarding TBD risk to inform clinicians and public health officials. Such data may supplement public health sources to offer improved surveillance and provide bases for developing robust proxies for TBD risk among humans. %M 37610812 %R 10.2196/43790 %U https://publichealth.jmir.org/2023/1/e43790 %U https://doi.org/10.2196/43790 %U http://www.ncbi.nlm.nih.gov/pubmed/37610812 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44204 %T Comparison of Four Active SARS-CoV-2 Surveillance Strategies in Representative Population Sample Points: Two-Factor Factorial Randomized Controlled Trial %A Deckert,Andreas %A Anders,Simon %A Morales,Ivonne %A De Allegri,Manuela %A Nguyen,Hoa Thi %A Souares,Aurélia %A McMahon,Shannon %A Meurer,Matthias %A Burk,Robin %A Lou,Dan %A Brugnara,Lucia %A Sand,Matthias %A Koeppel,Lisa %A Maier-Hein,Lena %A Ross,Tobias %A Adler,Tim J %A Brenner,Stephan %A Dyer,Christopher %A Herbst,Konrad %A Ovchinnikova,Svetlana %A Marx,Michael %A Schnitzler,Paul %A Knop,Michael %A Bärnighausen,Till %A Denkinger,Claudia M %+ Heidelberg Institute of Global Health, INF 324, Heidelberg, 69120, Germany, 49 6221 4537260, a.deckert@uni-heidelberg.de %K COVID-19 %K SARS-CoV-2 %K randomized controlled trial %K multiarm %K cluster sampling %K surveillance %K effectiveness %K pandemic %D 2023 %7 17.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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 %M 37235704 %R 10.2196/44204 %U https://publichealth.jmir.org/2023/1/e44204 %U https://doi.org/10.2196/44204 %U http://www.ncbi.nlm.nih.gov/pubmed/37235704 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39754 %T Using Bandit Algorithms to Maximize SARS-CoV-2 Case-Finding: Evaluation and Feasibility Study %A Rayo,Michael F %A Faulkner,Daria %A Kline,David %A Thornhill IV,Thomas %A Malloy,Samuel %A Della Vella,Dante %A Morey,Dane A %A Zhang,Net %A Gonsalves,Gregg %+ Public Health Modeling Unit, Department of the Epidemiology of Microbial Diseases, Yale School of Public Health, 350 George Street, 3rd Floor, New Haven, CT, 06511, United States, 1 2036069149, gregg.gonsalves@yale.edu %K active surveillance %K bandit algorithms %K infectious disease %K community health %K reinforcement learning %K COVID-19 %K SARS-CoV-2 %D 2023 %7 15.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Flexible Adaptive Algorithmic Surveillance Testing (FAAST) program represents an innovative approach for improving the detection of new cases of infectious disease; it is deployed here to screen and diagnose SARS-CoV-2. With the advent of treatment for COVID-19, finding individuals infected with SARS-CoV-2 is an urgent clinical and public health priority. While these kinds of Bayesian search algorithms are used widely in other settings (eg, to find downed aircraft, in submarine recovery, and to aid in oil exploration), this is the first time that Bayesian adaptive approaches have been used for active disease surveillance in the field. Objective: This study’s objective was to evaluate a Bayesian search algorithm to target hotspots of SARS-CoV-2 transmission in the community with the goal of detecting the most cases over time across multiple locations in Columbus, Ohio, from August to October 2021. Methods: The algorithm used to direct pop-up SARS-CoV-2 testing for this project is based on Thompson sampling, in which the aim is to maximize the average number of new cases of SARS-CoV-2 diagnosed among a set of testing locations based on sampling from prior probability distributions for each testing site. An academic-governmental partnership between Yale University, The Ohio State University, Wake Forest University, the Ohio Department of Health, the Ohio National Guard, and the Columbus Metropolitan Libraries conducted a study of bandit algorithms to maximize the detection of new cases of SARS-CoV-2 in this Ohio city in 2021. The initiative established pop-up COVID-19 testing sites at 13 Columbus locations, including library branches, recreational and community centers, movie theaters, homeless shelters, family services centers, and community event sites. Our team conducted between 0 and 56 tests at the 16 testing events, with an overall average of 25.3 tests conducted per event and a moving average that increased over time. Small incentives—including gift cards and take-home rapid antigen tests—were offered to those who approached the pop-up sites to encourage their participation. Results: Over time, as expected, the Bayesian search algorithm directed testing efforts to locations with higher yields of new diagnoses. Surprisingly, the use of the algorithm also maximized the identification of cases among minority residents of underserved communities, particularly African Americans, with the pool of participants overrepresenting these people relative to the demographic profile of the local zip code in which testing sites were located. Conclusions: This study demonstrated that a pop-up testing strategy using a bandit algorithm can be feasibly deployed in an urban setting during a pandemic. It is the first real-world use of these kinds of algorithms for disease surveillance and represents a key step in evaluating the effectiveness of their use in maximizing the detection of undiagnosed cases of SARS-CoV-2 and other infections, such as HIV. %M 37581924 %R 10.2196/39754 %U https://publichealth.jmir.org/2023/1/e39754 %U https://doi.org/10.2196/39754 %U http://www.ncbi.nlm.nih.gov/pubmed/37581924 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43000 %T Frontline Health Care Workers’ Mental Health and Well-Being During the First Year of the COVID-19 Pandemic: Analysis of Interviews and Social Media Data %A Vera San Juan,Norha %A Martin,Sam %A Badley,Anna %A Maio,Laura %A Gronholm,Petra C %A Buck,Caroline %A Flores,Elaine C %A Vanderslott,Samantha %A Syversen,Aron %A Symmons,Sophie Mulcahy %A Uddin,Inayah %A Karia,Amelia %A Iqbal,Syka %A Vindrola-Padros,Cecilia %+ Rapid Research Evaluation and Appraisal Lab (RREAL), Department of Targeted Intervention, University College London, Gower Street, London, WC1E 6BT, United Kingdom, 44 20 7679 2000, n.verasanjuan@ucl.ac.uk %K mental health %K frontline %K health care workers %K COVID-19 %K health services research %K Collaborative and Digital Analysis of Big Qualitative Data in Time Sensitive Contexts %K LISTEN method %D 2023 %7 14.8.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has shed light on fractures in health care systems worldwide and continues to have a significant impact, particularly in relation to the health care workforce. Frontline staff have been exposed to unprecedented strain, and delivering care during the pandemic has affected their safety, mental health, and well-being. Objective: This study aimed to explore the experiences of health care workers (HCWs) delivering care in the United Kingdom during the COVID-19 pandemic to understand their well-being needs, experiences, and strategies used to maintain well-being (at individual and organizational levels). Methods: We analyzed 94 telephone interviews with HCWs and 2000 tweets about HCWs’ mental health during the first year of the COVID-19 pandemic. Results: The results were grouped under 6 themes: redeployment, clinical work, and sense of duty; well-being support and HCW’s coping strategies; negative mental health effects; organizational support; social network and support; and public and government support. Conclusions: These findings demonstrate the need for open conversations, where staff’s well-being needs and the strategies they adopted can be shared and encouraged, rather than implementing top-down psychological interventions alone. At the macro level, the findings also highlighted the impact on HCW’s well-being of public and government support as well as the need to ensure protection through personal protective equipment, testing, and vaccines for frontline workers. %M 37402283 %R 10.2196/43000 %U https://www.jmir.org/2023/1/e43000 %U https://doi.org/10.2196/43000 %U http://www.ncbi.nlm.nih.gov/pubmed/37402283 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44822 %T Dynamic Trends and Underlying Factors of COVID-19 Vaccine Booster Hesitancy in Adults: Cross-Sectional Observational Study %A Wu,Jian %A Ma,Mingze %A Li,Quanman %A Guo,Xinghong %A Tarimo,Clifford Silver %A Jia,Shiyu %A Zhou,Xue %A Wang,Meiyun %A Gu,Jianqin %A Miao,Yudong %A Ye,Beizhu %+ Department of Health Management, College of Public Health, Zhengzhou University, No.100, Science Avenue, Gaoxin District, Zhengzhou, Henan, 450001, China, 86 67739815, yebeizhu@zzu.edu.cn %K COVID-19 vaccine %K vaccine hesitancy %K COVID-19 booster vaccination %K influencing factors %K China %D 2023 %7 1.8.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 vaccine hesitancy reduces vaccination rates, which is detrimental to building herd immunity and halting the spread of COVID-19 and its variations. Most researches have simply identified the reasons affecting COVID-19 vaccination reluctance without delving into its dynamics, which makes forecasting future trends difficult. Objective: This study aimed to examine the current COVID-19 vaccine booster hesitancy rate in Chinese adults as well as the dynamics of vaccine hesitancy and its influencing factors. The results of this study will have practical implications for policy responses in mainland China, and effective COVID-19 booster vaccination in specific populations. Methods: The web-based survey was completed by creating questionnaires and using a stratified random sampling method to collect information from adults (≥18 years old) among 2556 households in 4 geographical regions of China. We collected sociodemographic information, health status, awareness of COVID-19 and its vaccine, self-perceptions, trust in medical staff and vaccine developers, and so on. The odds ratios and 95% CI for the statistical associations were estimated using logistic regression models. Results: Overall, 6659 participants (females: n=3540, 53.2%; males: n=3119, 46.8%) responded. In total, 533 (8%; 95% CI 7.4%-8.7%) participants presented a clear hesitancy in receiving the COVID-19 booster vaccination, while 736 (11.1%; 95% CI 10.3%-11.8%) expressed hesitancy in regular booster vaccination. A higher prevalence of vaccine hesitancy in both booster vaccination and regular booster vaccination was observed among participants with a history of allergies, experiencing chronic disease, lower levels of public health prevention measures or susceptibility or benefits or self-efficiency, higher levels of severity or barriers, and lower trust in both medical staff and vaccine developers (P<.05). The females and participants with higher education levels, higher levels of barriers, lower levels of susceptibility, and lower trust in vaccine developers preferred to have attitudinal changes from acceptance to hesitancy, while people with higher education levels, lower self-report health conditions, experiencing chronic disease, history of allergies, and lower trust in medical staff and developers were all positively associated with constant COVID-19 booster hesitancy. Conclusions: The prevalence of COVID-19 vaccine booster hesitancy is not high in mainland China. However, there is a slight increment in hesitancy on regular booster vaccination. Conducting targeted information guidance for people with higher education levels and chronic diseases, as well as improving accessibility to booster vaccination and increasing trust in medical staff and vaccine producers may be highly effective in reducing vaccine hesitancy. %M 37526963 %R 10.2196/44822 %U https://publichealth.jmir.org/2023/1/e44822 %U https://doi.org/10.2196/44822 %U http://www.ncbi.nlm.nih.gov/pubmed/37526963 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43720 %T The Use of Travel as an Appeal to Motivate Millennial Parents on Facebook to Get Vaccinated Against COVID-19: Message Framing Evaluation %A Arshanapally,Suraj %A Starr,Tiearra %A Elsberry,Lauren Blackmun %A Rinker,Robin %+ National Center for Emerging and Zoonotic Infectious Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, Mailstop H16-4, Atlanta, GA, 30329, United States, 1 404 498 1007, otv1@cdc.gov %K COVID-19 %K coronavirus %K vaccination %K travel %K parents %K millennial %K appeal %K health communication %K social media %K Facebook %K infectious disease %K message testing %K public health %K messaging %K parenting %K program %D 2023 %7 1.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: In summer 2021, the Centers for Disease Control and Prevention recommended that people get fully vaccinated against COVID-19 before fall travel to protect themselves and others from getting and spreading COVID-19 and new variants. Only 61% of parents had reported receiving at least 1 dose of the COVID-19 vaccine, according to a Kaiser Family Foundation study. Millennial parents, ages 25 to 40 years, were a particularly important parent population because they were likely to have children aged 12 years or younger (the age cutoff for COVID-19 vaccine eligibility during this time period) and were still planning to travel. Since Facebook has been identified as a popular platform for millennials and parents, the Centers for Disease Control and Prevention’s Travelers’ Health Branch determined an evaluation of public health messages was needed to identify which message appeals would resonate best with this population on Facebook. Objective: The objective was to evaluate which travel-based public health message appeals aimed at addressing parental concerns and sentiments about COVID-19 vaccination would resonate most with Millennial parents (25 to 40 years old) using Facebook Ads Manager and social media metrics. Methods: Six travel-based public health message appeals on parental concerns and sentiments around COVID-19 were developed and disseminated to millennial parents using Facebook Ads Manager. The messages ran from October 23, 2021, to November 8, 2021. Primary outcomes included the number of people reached and the number of impressions delivered. Secondary outcomes included engagements, clicks, click-through rate, and audience sentiments. A thematic analysis was conducted to analyze comments. The advertisement budget was evaluated by cost-per-mille and cost-per-click metrics. Results: All messages reached a total of 6,619,882 people and garnered 7,748,375 impressions. The Family (n=3,572,140 people reached, 53.96%; 4,515,836 impressions, 58.28%) and Return to normalcy (n=1,639,476 people reached, 24.77%; 1,754,227 impressions, 22.64%) message appeals reached the greatest number of people and garnered the most impressions out of all 6 message appeals. The Family message appeal received 3255 engagements (60.46%), and the Return to normalcy message appeal received 1148 engagements (21.28%). The Family appeal also received the highest number of positive post reactions (n=82, 28.37%). Most of the comments portrayed negative opinions about COVID-19 vaccination (n=46, 68.66%). All 6 message appeals were either on par with or outperformed cost-per-mille benchmarks set by other similar public health campaigns. Conclusions: Health communicators can use travel, specifically the Family and Return to normalcy message appeals, to successfully reach parents in their future COVID-19 vaccination campaigns and potentially inform health communication messaging efforts for other vaccine-preventable infectious disease campaigns. Public health programs can also utilize the lessons learned from this evaluation to communicate important COVID-19 information to their parent populations through travel messaging. %M 37437085 %R 10.2196/43720 %U https://formative.jmir.org/2023/1/e43720 %U https://doi.org/10.2196/43720 %U http://www.ncbi.nlm.nih.gov/pubmed/37437085 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41959 %T Effects of Prosocial and Hope-Promoting Communication Strategies on COVID-19 Worry and Intentions for Risk-Reducing Behaviors and Vaccination: Experimental Study %A Scharnetzki,Elizabeth %A Waterston,Leo %A Scherer,Aaron M %A Thorpe,Alistair %A Fagerlin,Angela %A Han,Paul K J %+ Center for Interdisciplinary Population and Health Research, MaineHealth Institute for Research, 509 Forest Ave., Suite 200, Portland, ME, 04101, United States, 1 8053409716, elizabeth.scharnetzki@mainehealth.org %K COVID-19 %K communication %K hope %K prosocial %K vaccination %K risk %K behavior %K vaccine %K effect %K communication %K effectiveness %K social %K messages %K public %K web-based %K survey %D 2023 %7 1.8.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has engendered widespread fear and skepticism about recommended risk-reducing behaviors including vaccination. Health agencies are faced with the need to communicate to the public in ways that both provide reassurance and promote risk-reducing behaviors. Communication strategies that promote prosocial (PS) values and hope are being widely used; however, the existing research on the persuasiveness of these strategies has offered mixed evidence. There is also very little research examining the comparative effectiveness of PS and hope-promoting (HP) strategies. Objective: The aim of this study is to evaluate the comparative effectiveness of PS and HP messages in reassuring the public and motivating COVID-19 risk–reducing behaviors. Methods: A web-based factorial experiment was conducted in which a diverse sample of the US public was randomized to read messages which adapted existing COVID-19 information from a public website produced by a state government public health department to include alternative framing language: PS, HP, or no additional framing (control). Participants then completed surveys measuring COVID-19 worry and intentions for COVID-19 risk–reducing behaviors and vaccination. Results: COVID-19 worry was unexpectedly higher in the HP than in the control and PS conditions. Intentions for COVID-19 risk–reducing behaviors did not differ between groups; however, intentions for COVID-19 vaccination were higher in the HP than in the control condition, and this effect was mediated by COVID-19 worry. Conclusions: It appears that HP communication strategies may be more effective than PS strategies in motivating risk-reducing behaviors in some contexts but with the paradoxical cost of promoting worry. %M 37379364 %R 10.2196/41959 %U https://formative.jmir.org/2023/1/e41959 %U https://doi.org/10.2196/41959 %U http://www.ncbi.nlm.nih.gov/pubmed/37379364 %0 Journal Article %@ 2291-9694 %I %V 11 %N %P e45496 %T Interoperable, Domain-Specific Extensions for the German Corona Consensus (GECCO) COVID-19 Research Data Set Using an Interdisciplinary, Consensus-Based Workflow: Data Set Development Study %A Lichtner,Gregor %A Haese,Thomas %A Brose,Sally %A Röhrig,Larissa %A Lysyakova,Liudmila %A Rudolph,Stefanie %A Uebe,Maria %A Sass,Julian %A Bartschke,Alexander %A Hillus,David %A Kurth,Florian %A Sander,Leif Erik %A Eckart,Falk %A Toepfner,Nicole %A Berner,Reinhard %A Frey,Anna %A Dörr,Marcus %A Vehreschild,Jörg Janne %A von Kalle,Christof %A Thun,Sylvia %K interoperability %K research data set %K Fast Healthcare Interoperability Resources %K FHIR %K FAIR principle %K COVID-19 %K interoperable %K SARS-CoV-2 %K pediatric %K immunization %K cardiology %K standard %D 2023 %7 18.7.2023 %9 %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic has spurred large-scale, interinstitutional research efforts. To enable these efforts, researchers must agree on data set definitions that not only cover all elements relevant to the respective medical specialty but also are syntactically and semantically interoperable. Therefore, the German Corona Consensus (GECCO) data set was developed as a harmonized, interoperable collection of the most relevant data elements for COVID-19–related patient research. As the GECCO data set is a compact core data set comprising data across all medical fields, the focused research within particular medical domains demands the definition of extension modules that include data elements that are the most relevant to the research performed in those individual medical specialties. Objective: We aimed to (1) specify a workflow for the development of interoperable data set definitions that involves close collaboration between medical experts and information scientists and (2) apply the workflow to develop data set definitions that include data elements that are the most relevant to COVID-19–related patient research regarding immunization, pediatrics, and cardiology. Methods: We developed a workflow to create data set definitions that were (1) content-wise as relevant as possible to a specific field of study and (2) universally usable across computer systems, institutions, and countries (ie, interoperable). We then gathered medical experts from 3 specialties—infectious diseases (with a focus on immunization), pediatrics, and cardiology—to select data elements that were the most relevant to COVID-19–related patient research in the respective specialty. We mapped the data elements to international standardized vocabularies and created data exchange specifications, using Health Level Seven International (HL7) Fast Healthcare Interoperability Resources (FHIR). All steps were performed in close interdisciplinary collaboration with medical domain experts and medical information specialists. Profiles and vocabulary mappings were syntactically and semantically validated in a 2-stage process. Results: We created GECCO extension modules for the immunization, pediatrics, and cardiology domains according to pandemic-related requests. The data elements included in each module were selected, according to the developed consensus-based workflow, by medical experts from these specialties to ensure that the contents aligned with their research needs. We defined data set specifications for 48 immunization, 150 pediatrics, and 52 cardiology data elements that complement the GECCO core data set. We created and published implementation guides, example implementations, and data set annotations for each extension module. Conclusions: The GECCO extension modules, which contain data elements that are the most relevant to COVID-19–related patient research on infectious diseases (with a focus on immunization), pediatrics, and cardiology, were defined in an interdisciplinary, iterative, consensus-based workflow that may serve as a blueprint for developing further data set definitions. The GECCO extension modules provide standardized and harmonized definitions of specialty-related data sets that can help enable interinstitutional and cross-country COVID-19 research in these specialties. %R 10.2196/45496 %U https://medinform.jmir.org/2023/1/e45496 %U https://doi.org/10.2196/45496 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e46489 %T Evaluation of Mpox Knowledge, Stigma, and Willingness to Vaccinate for Mpox: Cross-Sectional Web-Based Survey Among Sexual and Gender Minorities %A Torres,Thiago Silva %A Silva,Mayara Secco Torres %A Coutinho,Carolina %A Hoagland,Brenda %A Jalil,Emilia Moreira %A Cardoso,Sandra Wagner %A Moreira,Julio %A Magalhaes,Monica Avelar %A Luz,Paula Mendes %A Veloso,Valdilea G %A Grinsztejn,Beatriz %+ Instituto Nacional de Infectologia Evandro Chagas, Fundação Oswaldo Cruz, Av Brasil 4365 Manguinhos, Rio de Janeiro, 21040360, Brazil, 55 21996022998, thiago.torres@ini.fiocruz.br %K sexual and gender minorities %K mpox %K Brazil %K Latin America and Caribbean %K community %K LGBT %K gay %K lesbian %K minority %K minorities %K survey %K emergency %K stigma %K discrimination %K Latin America %K sociodemographic %K behavioral %K diagnosis %K application %K social media %K infection %K gender %K MSM %K monkeypox %K infectious disease %K awareness %K patient education %K health knowledge %K patient knowledge %K knowledge translation %K access to care %K viral %D 2023 %7 17.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The 2022 multicountry mpox outbreak positioned the condition as a public health emergency of international concern. By May 2023, Brazil ranked second globally in the cumulative number of mpox cases and deaths. The higher incidence of mpox among gay and other men who have sex with men in the current mpox outbreak deepens the stigma and discrimination against sexual and gender minorities (SGM). This might worsen the structural barriers impacting access to health services, which ultimately leads to undertesting and underreporting of cases. There are no data available on mpox knowledge and stigma in Latin America. Objective: We aimed to evaluate mpox knowledge, stigma, and willingness to vaccinate for mpox among SGM, and to describe sociodemographic and behavioral characteristics according to self-reported mpox diagnosis. Methods: A cross-sectional, internet-based survey was conducted in a convenience sample of adults (aged >18 years) living in Brazil recruited through advertisements on dating apps, social media, referral institutions for infectious diseases websites, and mass media (October-November 2022). We compared participants’ characteristics according to self-reported mpox diagnosis using chi-square test or Fisher exact test for qualitative variables and Kruskal-Wallis test for quantitative variables. Results: We enrolled 6236 participants: 5685 (91.2%) were cisgender men; 6032 (96.7%) were gay, bisexual, or pansexual; 3877 (62.2%) were White; 4902 (78.7%) had tertiary education; and 4070 (65.2%) reported low or middle income. Most participants (n=5258, 84.4%) agreed or strongly agreed that “LGBTQIA+ individuals are being discriminated and stigmatized due to mpox.” Mpox awareness was 96.9% (n=6044), and 5008 (95.1%) were willing to get vaccinated for mpox. Overall, 324 (5.2%) reported an mpox diagnosis. Among these, 318 (98.1%) reported lesions, 178 (56%) local pain, and 316 (99.4%) sought health care. Among participants not reporting a diagnosis, 288 (4.9%) had a suspicious lesion, but only 158 (54.9%) of these had sought health care. Compared to participants with no diagnosis, those reporting an mpox diagnosis were younger (P<.001), reported more sex partners (P<.001), and changes in sexual behavior after mpox onset (P=.002). Moreover, participants diagnosed with mpox reported more frequently being tested for HIV in the prior 3 months (P<.001), living with HIV (P<.001), currently using HIV pre-exposure prophylaxis (P<.001), and previous sexually transmitted infection diagnosis (P<.001). Conclusions: Our results point to high mpox knowledge and willingness to vaccinate among SGM in Brazil. Participants self-reporting mpox diagnosis more frequently reported to be living with HIV, STI diagnosis, and current pre-exposure prophylaxis use, highlighting the importance of an mpox assessment that includes comprehensive sexual health screenings. Efforts to decrease stigma related to mpox among SGM are necessary to avoid mpox underdiagnosis. %M 37459174 %R 10.2196/46489 %U https://publichealth.jmir.org/2023/1/e46489 %U https://doi.org/10.2196/46489 %U http://www.ncbi.nlm.nih.gov/pubmed/37459174 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45263 %T Safety Signal Generation for Sudden Sensorineural Hearing Loss Following Messenger RNA COVID-19 Vaccination: Postmarketing Surveillance Using the French Pharmacovigilance Spontaneous Reporting Database %A Thai-Van,Hung %A Valnet-Rabier,Marie-Blanche %A Anciaux,Maëva %A Lambert,Aude %A Maurier,Anaïs %A Cottin,Judith %A Pietri,Tessa %A Destère,Alexandre %A Damin-Pernik,Marlène %A Perrouin,Fanny %A Bagheri,Haleh %+ Department of Medical and Clinical Pharmacology, Regional Pharmacovigilance Center of Toulouse, CIC1436, Toulouse University Hospital, 37 Allées Jules Guesde, Toulouse, 31000, France, 33 561145902, haleh.bagheri@univ-tlse3.fr %K mRNA COVID-19 vaccine %K COVID-19 %K messenger RNA %K tozinameran %K elasomeran %K sudden sensorineural hearing loss %K audiogram %K positive rechallenge %K spontaneous reporting %K postmarketing %K surveillance %K pharmacovigilance %D 2023 %7 14.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The World Health Organization recently described sudden sensorineural hearing loss (SSNHL) as a possible adverse effect of COVID-19 vaccines. Recent discordant pharmacoepidemiologic studies invite robust clinical investigations of SSNHL after COVID-19 messenger RNA (mRNA) vaccines. This postmarketing surveillance study, overseen by French public health authorities, is the first to clinically document postvaccination SSNHL and examine the role of potential risk factors. Objective: This nationwide study aimed to assess the relationship between SSNHL and exposure to mRNA COVID-19 vaccines and estimate the reporting rate (Rr) of SSNHL after mRNA vaccination per 1 million doses (primary outcome). Methods: We performed a retrospective review of all suspected cases of SSNHL after mRNA COVID-19 vaccination spontaneously reported in France between January 2021 and February 2022 based on a comprehensive medical evaluation, including the evaluation of patient medical history, side and range of hearing loss, and hearing recovery outcomes after a minimum period of 3 months. The quantification of hearing loss and assessment of hearing recovery outcomes were performed according to a grading system modified from the Siegel criteria. A cutoff of 21 days was used for the delay onset of SSNHL. The primary outcome was estimated using the total number of doses of each vaccine administered during the study period in France as the denominator. Results: From 400 extracted cases for tozinameran and elasomeran, 345 (86.3%) spontaneous reports were selected. After reviewing complementary data, 49.6% (171/345) of documented cases of SSNHL were identified. Of these, 83% (142/171) of SSNHL cases occurred after tozinameran vaccination: Rr=1.45/1,000,000 injections; no difference for the rank of injections; complete recovery in 22.5% (32/142) of cases; median delay onset before day 21=4 days (median age 51, IQR 13-83 years); and no effects of sex. A total of 16.9% (29/171) of SSNHL cases occurred after elasomeran vaccination: Rr=1.67/1,000,000 injections; rank effect in favor of the first injection (P=.03); complete recovery in 24% (7/29) of cases; median delay onset before day 21=8 days (median age 47, IQR 33-81 years); and no effects of sex. Autoimmune, cardiovascular, or audiovestibular risk factors were present in approximately 29.8% (51/171) of the cases. SSNHL was more often unilateral than bilateral for both mRNA vaccines (P<.001 for tozinameran; P<.003 for elasomeran). There were 13.5% (23/142) of cases of profound hearing loss, among which 74% (17/23) did not recover a serviceable ear. A positive rechallenge was documented for 8 cases. Conclusions: SSNHL after COVID-19 mRNA vaccines are very rare adverse events that do not call into question the benefits of mRNA vaccines but deserve to be known given the potentially disabling impact of sudden deafness. Therefore, it is essential to properly characterize postinjection SSNHL, especially in the case of a positive rechallenge, to provide appropriate individualized recommendations. %M 37071555 %R 10.2196/45263 %U https://publichealth.jmir.org/2023/1/e45263 %U https://doi.org/10.2196/45263 %U http://www.ncbi.nlm.nih.gov/pubmed/37071555 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e46723 %T Impact of the COVID-19 Pandemic on the Public Perceptions of the Roles and Functions of Community Pharmacies in South Korea: Updated Cross-Sectional Self-Reported Web-Based Survey %A Yang,Dong-Wook %A Son,Kyung-Bok %+ College of Pharmacy, Hanyang University, 55 Hanyangdeahak-ro, Sangnok-gu, Ansan, Gyeonggi-do, 15588, Republic of Korea, 82 31 400 5812, sonkyungbok@gmail.com %K community pharmacy %K pharmaceutical practice %K COVID-19 %K South Korea %K pandemic %K survey %K pharmacists %K pharmacy %K primary care %K medicine-centered services %D 2023 %7 13.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Community pharmacists confronted dual burdens in response to the COVID-19 pandemic by expanding the scope of pharmaceutical practices. Objective: This study aimed to assess the perceived roles and functions of community pharmacies during the pandemic and to explore their updated roles after the pandemic began. Methods: We conducted a self-reported web-based survey in October 2022. Based on Korean census data, we recruited the study participants (n=1000) through quota sampling stratified by age, sex, and region, yielding a 7.45% (1000/13,423) response rate. The questionnaires were composed of 3 sections: demographics, the roles and functions of community pharmacies during the pandemic, and the updated roles of community pharmacies during disasters. Each question in the second and third sections was rated on a 5-point Likert scale from 1 (strongly disagree) to 5 (strongly agree), and each item’s mean scores and SDs were reported. The study participants were categorized into 2 groups: individuals who had a family pharmacy and those who did not. A chi-square test and ordered logistic regression analyses were conducted. Results: Out of 1000 respondents, 418 (41.8%) had a history of COVID-19, and 639 (63.9%) had a family pharmacy. Assigning specific roles and functions to community pharmacies during the pandemic contributed to positive assessments. Respondents gave higher scores to community pharmacies that had responded appropriately (a mean Likert score of 3.66, SD .077 out of 5) and provided continuous pharmaceutical services (mean 3.67, SD 0.87) during the pandemic. The pandemic served as an opportunity to positively recognize the role of community pharmacies (mean 3.59, SD 0.83). In the ordered logistic model, having a family pharmacy was consistently associated with positive perceptions. Respondents perceived that community pharmacies collaborated with general practitioners and health authorities. However, community pharmacies need to function appropriately in terms of knowledge. The mean score of the 4 domains of community pharmacy functions was the highest for collaboration (mean 3.66, SD 0.83), followed by communication (mean 3.57, SD 0.87), responsiveness (mean 3.54, SD 0.87), and knowledge (mean 3.41, SD 0.91). Conclusions: The pandemic resulted in interprofessional collaboration between community pharmacists and general practitioners. Family pharmacies could be a valuable asset to the comprehensive case management of patients. However, community pharmacists should have the expertise to build solid interprofessional collaborations and fulfill their expanded and updated roles. %M 37390391 %R 10.2196/46723 %U https://publichealth.jmir.org/2023/1/e46723 %U https://doi.org/10.2196/46723 %U http://www.ncbi.nlm.nih.gov/pubmed/37390391 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e46867 %T Investigating COVID-19’s Impact on Mental Health: Trend and Thematic Analysis of Reddit Users’ Discourse %A Zhu,Jianfeng %A Yalamanchi,Neha %A Jin,Ruoming %A Kenne,Deric R %A Phan,NhatHai %+ Department of Computer Science, Kent State University, 800 E Summit St, Kent, OH, 44240, United States, 1 2348639445, jzhu10@kent.edu %K COVID-19 %K Reddit %K r/Depression %K r/Anxiety %K pandemic %K mental health %K trend analysis %K thematic analysis %K natural language processing (NLP) %K Word2Vec %D 2023 %7 12.7.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has resulted in heightened levels of depression, anxiety, and other mental health issues due to sudden changes in daily life, such as economic stress, social isolation, and educational irregularity. Accurately assessing emotional and behavioral changes in response to the pandemic can be challenging, but it is essential to understand the evolving emotions, themes, and discussions surrounding the impact of COVID-19 on mental health. Objective: This study aims to understand the evolving emotions and themes associated with the impact of COVID-19 on mental health support groups (eg, r/Depression and r/Anxiety) on Reddit (Reddit Inc) during the initial phase and after the peak of the pandemic using natural language processing techniques and statistical methods. Methods: This study used data from the r/Depression and r/Anxiety Reddit communities, which consisted of posts contributed by 351,409 distinct users over a period spanning from 2019 to 2022. Topic modeling and Word2Vec embedding models were used to identify key terms associated with the targeted themes within the data set. A range of trend and thematic analysis techniques, including time-to-event analysis, heat map analysis, factor analysis, regression analysis, and k-means clustering analysis, were used to analyze the data. Results: The time-to-event analysis revealed that the first 28 days following a major event could be considered a critical window for mental health concerns to become more prominent. The theme trend analysis revealed key themes such as economic stress, social stress, suicide, and substance use, with varying trends and impacts in each community. The factor analysis highlighted pandemic-related stress, economic concerns, and social factors as primary themes during the analyzed period. Regression analysis showed that economic stress consistently demonstrated the strongest association with the suicide theme, whereas the substance theme had a notable association in both data sets. Finally, the k-means clustering analysis showed that in r/Depression, the number of posts related to the “depression, anxiety, and medication” cluster decreased after 2020, whereas the “social relationships and friendship” cluster showed a steady decrease. In r/Anxiety, the “general anxiety and feelings of unease” cluster peaked in April 2020 and remained high, whereas the “physical symptoms of anxiety” cluster showed a slight increase. Conclusions: This study sheds light on the impact of COVID-19 on mental health and the related themes discussed in 2 web-based communities during the pandemic. The results offer valuable insights for developing targeted interventions and policies to support individuals and communities in similar crises. %M 37436793 %R 10.2196/46867 %U https://www.jmir.org/2023/1/e46867 %U https://doi.org/10.2196/46867 %U http://www.ncbi.nlm.nih.gov/pubmed/37436793 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e41376 %T COVID-19 Conceptual Modeling: Single-Center Cross-Sectional Study %A Abuauf,Mawahib %A Raboe,Enaam Hassan %A Alshareef,Muneera %A Rabie,Nada %A Zailaie,Roaa %A Alharbi,Abdullah %A Felemban,Walaa %A Alnasser,Ibrahim %A Shalaby,Hanin %+ Pediatric Department, King Fahad Armed Forces Hospital, Al Kurnaysh Br Rd, Al Andalus, Jeddah, 23341-7384, Saudi Arabia, 966 505653268, maabuaufmd@hotmail.com %K conceptual model %K conceptual framework %K modeling %K Saudi Arabia %K COVID-19 %K SARS-CoV-2 %K mortality %K morbidity %K CURB-65 %K socioeconomic %K health care %K hospital database %K electronic record %K medical decision-making %K hospital admission %K hospitalization %K cross-sectional %K death %K intensive care %D 2023 %7 11.7.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Conceptual models are abstract representations of the real world. They are used to refine medical and nonmedical health care scopes of service. During the COVID-19 pandemic, numerous analytic predictive models were generated aiming to evaluate the impact of implemented policies on mitigating the spread of the virus. The models also aimed to examine the psychosocial factors that might govern the general population’s adherence to these policies and to identify factors that could affect COVID-19 vaccine uptake and allocation. The outcomes of these analytic models helped set priorities when vaccines were available and predicted readiness to resume non–COVID-19 health care services. Objective: The objective of our research was to implement a descriptive-analytical conceptual model that analyzes the data of all COVID-19–positive cases admitted to our hospital from March 1 to May 31, 2020, the initial wave of the pandemic, the time interval during which local policies and clinical guidelines were constantly updated to mitigate the local effects of COVID-19, minimize mortality, reduce intensive care unit (ICU) admission, and ensure the safety of health care providers. The primary outcome of interest was to identify factors that might affect mortality and ICU admission rates and the impact of the implemented policy on COVID-19 positivity among health care providers. The secondary outcome of interest was to evaluate the sensitivity of the COVID-19 visual score, implemented by the Saudi Arabia Ministry of Health for COVID-19 risk assessment, and CURB-65 (confusion, urea, respiratory rate, blood pressure, and age >65 years) scores in predicting ICU admission or mortality among the study population. Methods: This was a cross-sectional study. The relevant attributes were constructed based on research findings from the first wave of the pandemic and were electronically retrieved from the hospital database. Analysis of the conceptual model was based on the International Society for Pharmacoeconomics and Outcomes Research guidelines and the Society for Medical Decision-Making. Results: A total of 275 individuals tested positive for COVID-19 within the study design interval. The conceptualization model revealed a low-risk population based on the following attributes: a mean age of 42 (SD 19.2) years; 19% (51/275) of the study population being older adults ≥60 years of age; 80% (220/275) having a CURB-65 score <4; 53% (147/275) having no comorbidities; 5% (13/275) having extreme obesity; and 20% (55/275) having a significant hematological abnormality. The overall rate of ICU admission for the study population was 5% (13/275), and the overall mortality rate was 1.5% (4/275). The multivariate correlation analysis revealed that a high-selectivity approach was adopted, resulting in patients with complex medical problems not being sent to MOH isolation facilities. Furthermore, 5% of health care providers tested positive for COVID-19, none of whom were health care providers allocated to the COVID-19 screening areas, indicating the effectiveness of the policy implemented to ensure the safety of health care providers. Conclusions: Based on the conceptual model outcome, the selectivity applied in retaining high-risk populations within the hospital might have contributed to the observed low mortality rate, without increasing the risk to attending health care providers. %M 37256829 %R 10.2196/41376 %U https://formative.jmir.org/2023/1/e41376 %U https://doi.org/10.2196/41376 %U http://www.ncbi.nlm.nih.gov/pubmed/37256829 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42143 %T The Impact of Priority Settings at the Start of COVID-19 Mass Vaccination on Subsequent Vaccine Uptake in Japan: One-Year Prospective Cohort Study %A Hori,Daisuke %A Takahashi,Tsukasa %A Ozaki,Akihiko %A Tabuchi,Takahiro %+ Institute of Medicine, University of Tsukuba, 1-1-1 Tennodai, Tsukuba, 305-8575, Japan, 81 29 853 6025, daisuke_hori@md.tsukuba.ac.jp %K cohort studies %K SARS-CoV-2 %K COVID-19 %K Japan %K vaccination %K vaccination hesitancy %K vaccines %D 2023 %7 10.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 37235691 %R 10.2196/42143 %U https://publichealth.jmir.org/2023/1/e42143 %U https://doi.org/10.2196/42143 %U http://www.ncbi.nlm.nih.gov/pubmed/37235691 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e41435 %T Effect of Rapid Urbanization in Mainland China on the Seasonal Influenza Epidemic: Spatiotemporal Analysis of Surveillance Data From 2010 to 2017 %A Lei,Hao %A Zhang,Nan %A Niu,Beidi %A Wang,Xiao %A Xiao,Shenglan %A Du,Xiangjun %A Chen,Tao %A Yang,Lei %A Wang,Dayan %A Cowling,Benjamin %A Li,Yuguo %A Shu,Yuelong %+ School of Public Health, Zhejiang University, 866 Yu-hang-tang Road, Hangzhou, 310058, China, 86 0571 8707 6051, leolei@zju.edu.cn %K seasonal influenza %K attack rate %K urbanization %K urban population %K human contact %K agent-based model %K influenza %K seasonal flu %K spatiotemporal %K epidemic %K disease transmission %K disease spread %K epidemiology %K influenza transmission %K epidemics %D 2023 %7 7.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The world is undergoing an unprecedented wave of urbanization. However, the effect of rapid urbanization during the early or middle stages of urbanization on seasonal influenza transmission remains unknown. Since about 70% of the world population live in low-income countries, exploring the impact of urbanization on influenza transmission in urbanized countries is significant for global infection prediction and prevention. Objective: The aim of this study was to explore the effect of rapid urbanization on influenza transmission in China. Methods: We performed spatiotemporal analyses of province-level influenza surveillance data collected in Mainland China from April 1, 2010, to March 31, 2017. An agent-based model based on hourly human contact–related behaviors was built to simulate the influenza transmission dynamics and to explore the potential mechanism of the impact of urbanization on influenza transmission. Results: We observed persistent differences in the influenza epidemic attack rates among the provinces of Mainland China across the 7-year study period, and the attack rate in the winter waves exhibited a U-shaped relationship with the urbanization rates, with a turning point at 50%-60% urbanization across Mainland China. Rapid Chinese urbanization has led to increases in the urban population density and percentage of the workforce but decreases in household size and the percentage of student population. The net effect of increased influenza transmission in the community and workplaces but decreased transmission in households and schools yielded the observed U-shaped relationship. Conclusions: Our results highlight the complicated effects of urbanization on the seasonal influenza epidemic in China. As the current urbanization rate in China is approximately 59%, further urbanization with no relevant interventions suggests a worrisome increasing future trend in the influenza epidemic attack rate. %M 37418298 %R 10.2196/41435 %U https://publichealth.jmir.org/2023/1/e41435 %U https://doi.org/10.2196/41435 %U http://www.ncbi.nlm.nih.gov/pubmed/37418298 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e43154 %T Machine and Deep Learning for Tuberculosis Detection on Chest X-Rays: Systematic Literature Review %A Hansun,Seng %A Argha,Ahmadreza %A Liaw,Siaw-Teng %A Celler,Branko G %A Marks,Guy B %+ South West Sydney (SWS), School of Clinical Medicine, University of New South Wales, Burnside Drive, Warwick Farm, New South Wales, Sydney, 2170, Australia, 61 456541224, s.hansun@unsw.edu.au %K chest x-rays %K convolutional neural networks %K diagnostic test accuracy %K machine and deep learning %K PRISMA guidelines %K risk of bias %K QUADAS-2 %K sensitivity and specificity %K systematic literature review %K tuberculosis detection %D 2023 %7 3.7.2023 %9 Review %J J Med Internet Res %G English %X Background: Tuberculosis (TB) was the leading infectious cause of mortality globally prior to COVID-19 and chest radiography has an important role in the detection, and subsequent diagnosis, of patients with this disease. The conventional experts reading has substantial within- and between-observer variability, indicating poor reliability of human readers. Substantial efforts have been made in utilizing various artificial intelligence–based algorithms to address the limitations of human reading of chest radiographs for diagnosing TB. Objective: This systematic literature review (SLR) aims to assess the performance of machine learning (ML) and deep learning (DL) in the detection of TB using chest radiography (chest x-ray [CXR]). Methods: In conducting and reporting the SLR, we followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A total of 309 records were identified from Scopus, PubMed, and IEEE (Institute of Electrical and Electronics Engineers) databases. We independently screened, reviewed, and assessed all available records and included 47 studies that met the inclusion criteria in this SLR. We also performed the risk of bias assessment using Quality Assessment of Diagnostic Accuracy Studies version 2 (QUADAS-2) and meta-analysis of 10 included studies that provided confusion matrix results. Results: Various CXR data sets have been used in the included studies, with 2 of the most popular ones being Montgomery County (n=29) and Shenzhen (n=36) data sets. DL (n=34) was more commonly used than ML (n=7) in the included studies. Most studies used human radiologist’s report as the reference standard. Support vector machine (n=5), k-nearest neighbors (n=3), and random forest (n=2) were the most popular ML approaches. Meanwhile, convolutional neural networks were the most commonly used DL techniques, with the 4 most popular applications being ResNet-50 (n=11), VGG-16 (n=8), VGG-19 (n=7), and AlexNet (n=6). Four performance metrics were popularly used, namely, accuracy (n=35), area under the curve (AUC; n=34), sensitivity (n=27), and specificity (n=23). In terms of the performance results, ML showed higher accuracy (mean ~93.71%) and sensitivity (mean ~92.55%), while on average DL models achieved better AUC (mean ~92.12%) and specificity (mean ~91.54%). Based on data from 10 studies that provided confusion matrix results, we estimated the pooled sensitivity and specificity of ML and DL methods to be 0.9857 (95% CI 0.9477-1.00) and 0.9805 (95% CI 0.9255-1.00), respectively. From the risk of bias assessment, 17 studies were regarded as having unclear risks for the reference standard aspect and 6 studies were regarded as having unclear risks for the flow and timing aspect. Only 2 included studies had built applications based on the proposed solutions. Conclusions: Findings from this SLR confirm the high potential of both ML and DL for TB detection using CXR. Future studies need to pay a close attention on 2 aspects of risk of bias, namely, the reference standard and the flow and timing aspects. Trial Registration: PROSPERO CRD42021277155; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=277155 %M 37399055 %R 10.2196/43154 %U https://www.jmir.org/2023/1/e43154 %U https://doi.org/10.2196/43154 %U http://www.ncbi.nlm.nih.gov/pubmed/37399055 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42958 %T COVID-19 Vaccine Hesitancy Among Patients Recovered From COVID-19 Infection in Wuhan, China: Cross-Sectional Questionnaire Study %A Huang,Yiman %A Zhang,Ling %A Fu,Jiaqi %A Wu,Yijin %A Wang,Hao %A Xiao,Weijun %A Xin,You %A Dai,Zhenwei %A Si,Mingyu %A Chen,Xu %A Jia,Mengmeng %A Leng,Zhiwei %A Cui,Dan %A Su,Xiaoyou %+ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, 31 BeiJiGe San Tiao, Dongcheng District, Beijing, 100730, China, 86 65105830, suxiaoyou@hotmail.com %K COVID-19 %K COVID-19 survivors %K vaccine hesitancy %K complacency %K confidence %K convenience %K cross-sectional questionnaire %K health education %K health promotion %K public health %D 2023 %7 3.7.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 37247615 %R 10.2196/42958 %U https://publichealth.jmir.org/2023/1/e42958 %U https://doi.org/10.2196/42958 %U http://www.ncbi.nlm.nih.gov/pubmed/37247615 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e45600 %T Impact of a Serious Game (#RedPingüiNO) to Reduce Facial Self-Touches and Prevent Exposure to Pathogens Transmitted via Hands: Quasi-Experimental Intervention %A Arévalo-Baeza,Marta %A Viuda-Serrano,Alejandro %A Juan-Llamas,Carmen %A Sotoca-Orgaz,Pablo %A Asín-Izquierdo,Iván %+ Department of Education Sciences, Faculty of Medicine and Health Science, Universidad de Alcalá, Campus Universitario C/ 19, Av. de Madrid, Km 33,600, Alcalá de Henares, Madrid, 28871, Spain, 34 651569136, marta.arevalo@uah.es %K self-touching %K face %K serious game %K health %K pathogen transmission %K hazard scenarios %K body language %D 2023 %7 30.6.2023 %9 Original Paper %J JMIR Serious Games %G English %X 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. #RedPingüiNO 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. %M 37389910 %R 10.2196/45600 %U https://games.jmir.org/2023/1/e45600 %U https://doi.org/10.2196/45600 %U http://www.ncbi.nlm.nih.gov/pubmed/37389910 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40441 %T Addressing Behavioral Barriers to COVID-19 Testing With Health Literacy–Sensitive eHealth Interventions: Results From 2 National Surveys and 2 Randomized Experiments %A Bonner,Carissa %A Batcup,Carys %A Cvejic,Erin %A Ayre,Julie %A Pickles,Kristen %A Copp,Tessa %A Cornell,Samuel %A Nickel,Brooke %A Dhahir,Mustafa %A McCaffery,Kirsten %+ School of Public Health, Faculty of Medicine and Health, University of Sydney, Edward Ford Building A27, Sydney, 2006, Australia, 61 2 9351 7125, carissa.bonner@sydney.edu.au %K behavior change %K health literacy %K COVID-19 %K testing %K infectious disease %K public health %D 2023 %7 29.6.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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 %M 37172319 %R 10.2196/40441 %U https://publichealth.jmir.org/2023/1/e40441 %U https://doi.org/10.2196/40441 %U http://www.ncbi.nlm.nih.gov/pubmed/37172319 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42678 %T COVID-19 Contact Tracing Strategies During the First Wave of the Pandemic: Systematic Review of Published Studies %A Amicosante,Anna Maria Vincenza %A Rosso,Annalisa %A Bernardini,Fabio %A Guglielmi,Elisa %A Eugeni,Erica %A Da Re,Filippo %A Baglio,Giovanni %+ Research and International Relations Unit, Italian National Agency for Regional Healthcare Services, Via Piemonte, 60, Rome, 00187, Italy, 39 06 427491, baglio@agenas.it %K COVID-19 %K SARS-CoV-2 %K contact tracing %K public health %K infectious disease %K disease control %K community engagement %K digital tool %D 2023 %7 23.6.2023 %9 Review %J JMIR Public Health Surveill %G English %X 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. %M 37351939 %R 10.2196/42678 %U https://publichealth.jmir.org/2023/1/e42678 %U https://doi.org/10.2196/42678 %U http://www.ncbi.nlm.nih.gov/pubmed/37351939 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44286 %T Convergence in Mobility Data Sets From Apple, Google, and Meta %A Sganzerla Martinez,Gustavo %A Kelvin,David J %+ Department of Microbiology and Immunology, Dalhousie University, 5850 College street, Halifax, NS, B3H4H7, Canada, 1 647 529 3556, david.kelvin@dal.ca %K Google %K Apple %K Meta %K COVID-19 mobility %K COVID-19 %K mobility %K data set %K data %K pattern %K pandemic %K mobile %K operating system %K system %K validation %K tool %K asset %D 2023 %7 22.6.2023 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Background: The higher movement of people was one of the variables that contributed to the spread of the infectious agent SARS-CoV-2 during the COVID-19 pandemic. Governments worldwide responded to the virus by implementing measures that would restrict people’s movements, and consequently, the spread of the disease. During the onset of the pandemic, the technology companies Apple, Google, and Meta used their infrastructure to anonymously gather mobility reports from their users. Objective: This study aims to compare mobility data reports collected by Apple, Google, and Meta (formerly Facebook) during the COVID-19 pandemic and a major winter storm in Texas in 2021. We aim to explore the hypothesis that different people exhibit similar mobility trends during dramatic events and to emphasize the importance of this type of data for public health measures. The study also aims to promote evidence for companies to continue releasing mobility trends data, given that all 3 companies have discontinued these services. Methods: In this study, we collected mobility data spanning from 2020 to 2022 from 3 major tech companies: Apple, Google, and Meta. Our analysis focused on 58 countries that are common to all 3 databases, enabling us to conduct a comprehensive global-scale analysis. By using the winter storm that occurred in Texas in 20201 as a benchmark, we were able to assess the robustness of the mobility data obtained from the 3 companies and ensure the integrity of our findings. Results: Our study revealed convergence in the mobility trends observed across different companies during the onset of significant disasters, such as the first year of the COVID-19 pandemic and the winter storm that impacted Texas in 2021. Specifically, we observed strong positive correlations (r=0.96) in the mobility data collected from different tech companies during the first year of the pandemic. Furthermore, our analysis of mobility data during the 2021 winter storm in Texas showed a similar convergence of trends. Additionally, we found that periods of stay-at-home orders were reflected in the data, with record-low mobility and record-high stay-at-home figures. Conclusions: Our findings provide valuable insights into the ways in which major disruptive events can impact patterns of human mobility; moreover, the convergence of data across distinct methodologies highlights the potential value of leveraging mobility data from multiple sources for informing public health decision-making. Therefore, we conclude that the use of mobility data is an asset for health authorities to consider during natural disasters, as we determined that the data sets from 3 companies yielded convergent mobility patterns. Comparatively, data obtained from a single source would be limited, and therefore, more difficult to interpret, requiring careful analysis. %M 37347516 %R 10.2196/44286 %U https://publichealth.jmir.org/2023/1/e44286 %U https://doi.org/10.2196/44286 %U http://www.ncbi.nlm.nih.gov/pubmed/37347516 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44465 %T Accuracy of Self-Reported COVID-19 Vaccination Status Compared With a Public Health Vaccination Registry in Québec: Observational Diagnostic Study %A Archambault,Patrick M %A Rosychuk,Rhonda J %A Audet,Martyne %A Bola,Rajan %A Vatanpour,Shabnam %A Brooks,Steven C %A Daoust,Raoul %A Clark,Gregory %A Grant,Lars %A Vaillancourt,Samuel %A Welsford,Michelle %A Morrison,Laurie J %A Hohl,Corinne M %A , %A , %A , %+ Department of Family Medicine and Emergency Medicine, Université Laval, Pavillon Vandry, Avenue de la Médecine, Québec, QC, G1V 0A6, Canada, 1 4189552552, patrick.archambault@fmed.ulaval.ca %K electronic vaccination registry %K self-reported vaccination status %K COVID-19 %K accuracy %K diagnostic study %K interrater agreement %D 2023 %7 16.6.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The accuracy of self-reported vaccination status is important to guide real-world vaccine effectiveness studies and policy making in jurisdictions where access to electronic vaccine registries is restricted. Objective: This study aimed to determine the accuracy of self-reported vaccination status and reliability of the self-reported number of doses, brand, and time of vaccine administration. Methods: This diagnostic accuracy study was completed by the Canadian COVID-19 Emergency Department Rapid Response Network. We enrolled consecutive patients presenting to 4 emergency departments (EDs) in Québec between March 24, 2020, and December 25, 2021. We included adult patients who were able to consent, could speak English or French, and had a proven COVID-19 infection. We compared the self-reported vaccination status of the patients with their vaccination status in the electronic Québec Vaccination Registry. Our primary outcome was the accuracy of the self-reported vaccination status (index test) ascertained during telephone follow-up compared with the Québec Vaccination Registry (reference standard). The accuracy was calculated by dividing all correctly self-reported vaccinated and unvaccinated participants by the sum of all correctly and incorrectly self-reported vaccinated and unvaccinated participants. We also reported interrater agreement with the reference standard as measured by unweighted Cohen κ for self-reported vaccination status at telephone follow-up and at the time of their index ED visit, number of vaccine doses, and brand. Results: During the study period, we included 1361 participants. At the time of the follow-up interview, 932 participants reported at least 1 dose of a COVID-19 vaccine. The accuracy of the self-reported vaccination status was 96% (95% CI 95%-97%). Cohen κ for self-reported vaccination status at phone follow-up was 0.91 (95% CI 0.89-0.93) and 0.85 (95% CI 0.77-0.92) at the time of their index ED visit. Cohen κ was 0.89 (95% CI 0.87-0.91) for the number of doses, 0.80 (95% CI 0.75-0.84) for the brand of the first dose, 0.76 (95% CI 0.70-0.83) for the brand of the second dose, and 0.59 (95% CI 0.34-0.83) for the brand of the third dose. Conclusions: We reported a high accuracy of self-reported vaccination status for adult patients without cognitive disorders who can express themselves in English or French. Researchers can use self-reported COVID-19 vaccination data on the number of doses received, vaccine brand name, and timing of vaccination to guide future research with patients who are capable of self-reporting their vaccination data. However, access to official electronic vaccine registries is still needed to determine the vaccination status in certain susceptible populations where self-reported vaccination data remain missing or impossible to obtain. Trial Registration: Clinicaltrials.gov NCT04702945; https://clinicaltrials.gov/ct2/show/NCT04702945 %M 37327046 %R 10.2196/44465 %U https://publichealth.jmir.org/2023/1/e44465 %U https://doi.org/10.2196/44465 %U http://www.ncbi.nlm.nih.gov/pubmed/37327046 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43972 %T Gender-Specific Association Between Perceived Stigma Toward Tuberculosis and Acceptance of Preventive Treatment Among College Students With Latent Tuberculosis Infection: Cross-Sectional Analysis %A Yuan,Yemin %A Jin,Jin %A Bi,Xiuli %A Geng,Hong %A Li,Shixue %A Zhou,Chengchao %+ Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wenhuaxi Road Jinan, Shandong, Jinan, 250012, China, 86 0531 8838 1567, zhouchengchao@sdu.edu.cn %K gender differences %K perceived stigma %K latent tuberculosis %K treatment %K acceptance %K college students %D 2023 %7 14.6.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With the increasing enrollment scale of colleges, the number of students on campus has risen sharply in China. The number of students with tuberculosis (TB) and rifampicin-resistant TB in colleges has increased significantly. Preventive treatment of latent tuberculosis infection (LTBI) is an important means for TB prevention and control in colleges. At present, the acceptance of LTBI treatment among college students remains unclear. In addition, evidence shows stigma may be one of the key factors affecting acceptance of LTBI treatment. To date, there is little direct evidence on the gender-specific association between perceived stigma toward TB and acceptance of LTBI treatment among college students. Objective: This study aimed to describe the acceptance of LTBI treatment among college students in an eastern province of China to explore the association between perceived stigma toward TB and acceptance of LTBI treatment and to examine the moderating effect of gender on the association. Methods: Data were derived from the project on the evaluation of LTBI treatment and its effectiveness among college students in Shandong, China. In total, 1547 college students were included in the analysis. We considered covariates at the individual and family levels. Multilevel mixed-effects logistic regression was used to examine the moderating role of gender and also explore the association between perceived stigma toward TB and acceptance of LTBI treatment. Results: The acceptance rate of LTBI treatment among the diagnosed college students was 46.7% (n=723). The proportion of female students (n=361, 51.5%) accepting LTBI treatment was higher than that of male students (n=362, 42.8%; P=.001). There was an interaction between perceived stigma toward TB and gender (OR 0.93, 95% CI 0.87-1.00; P=.06). Among college students with LTBI, perceived stigma toward TB was positively associated with acceptance of preventive treatment (OR 1.03, 95% CI 1.00-1.08, P=.05). Perceived stigma toward TB was positively associated with accepting LTBI treatment only among male students (OR 1.07, 95% CI 1.02-1.12; P=.005). Conclusions: The acceptance rate of preventive treatment among college students with LTBI was low. Contrary to our expectations, perceived stigma toward TB was positively associated with acceptance of preventive treatment. Gender moderated this association; high perceived stigma toward TB was associated with acceptance of preventive treatment only in male gender. Gender-specific strategies are effective in improving the acceptability of LTBI treatment in colleges. %M 37314847 %R 10.2196/43972 %U https://publichealth.jmir.org/2023/1/e43972 %U https://doi.org/10.2196/43972 %U http://www.ncbi.nlm.nih.gov/pubmed/37314847 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44970 %T Seesaw Effect Between COVID-19 and Influenza From 2020 to 2023 in World Health Organization Regions: Correlation Analysis %A Wang,Qing %A Jia,Mengmeng %A Jiang,Mingyue %A Liu,Wei %A Yang,Jin %A Dai,Peixi %A Sun,Yanxia %A Qian,Jie %A Yang,Weizhong %A Feng,Luzhao %+ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, No 9, Dongdan Santiao, Dongcheng District, Beijing, 100730, China, 86 10 65120716, fengluzhao@cams.cn %K COVID-19 %K influenza %K negative correlation %K seesaw effect %K respiratory infectious disease %K epidemiological trends %D 2023 %7 12.6.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Seasonal influenza activity showed a sharp decline in activity at the beginning of the emergence of COVID-19. Whether there is an epidemiological correlation between the dynamic of these 2 respiratory infectious diseases and their future trends needs to be explored. Objective: We aimed to assess the correlation between COVID-19 and influenza activity and estimate later epidemiological trends. Methods: We retrospectively described the dynamics of COVID-19 and influenza in 6 World Health Organization (WHO) regions from January 2020 to March 2023 and used the long short-term memory machine learning model to learn potential patterns in previously observed activity and predict trends for the following 16 weeks. Finally, we used Spearman correlation coefficients to assess the past and future epidemiological correlation between these 2 respiratory infectious diseases. Results: With the emergence of the original strain of SARS-CoV-2 and other variants, influenza activity stayed below 10% for more than 1 year in the 6 WHO regions. Subsequently, it gradually rose as Delta activity dropped, but still peaked below Delta. During the Omicron pandemic and the following period, the activity of each disease increased as the other decreased, alternating in dominance more than once, with each alternation lasting for 3 to 4 months. Correlation analysis showed that COVID-19 and influenza activity presented a predominantly negative correlation, with coefficients above –0.3 in WHO regions, especially during the Omicron pandemic and the following estimated period. The diseases had a transient positive correlation in the European region of the WHO and the Western Pacific region of the WHO when multiple dominant strains created a mixed pandemic. Conclusions: Influenza activity and past seasonal epidemiological patterns were shaken by the COVID-19 pandemic. The activity of these diseases was moderately or greater than moderately inversely correlated, and they suppressed and competed with each other, showing a seesaw effect. In the postpandemic era, this seesaw trend may be more prominent, suggesting the possibility of using one disease as an early warning signal for the other when making future estimates and conducting optimized annual vaccine campaigns. %M 37191650 %R 10.2196/44970 %U https://publichealth.jmir.org/2023/1/e44970 %U https://doi.org/10.2196/44970 %U http://www.ncbi.nlm.nih.gov/pubmed/37191650 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 4 %N %P e40673 %T Genomic Insights Into the Evolution and Demographic History of the SARS-CoV-2 Omicron Variant: Population Genomics Approach %A Garg,Kritika M %A Lamba,Vinita %A Chattopadhyay,Balaji %+ Trivedi School of Biosciences, Ashoka University, Rajiv Gandhi Education City, Sonipat, 131029, India, 91 8073119246, balaji.chattopadhyay@ashoka.edu.in %K SARS-CoV-2 %K Omicron %K evolutionary network %K population subdivision %K genome evolution %K COVID-19 %K microevolution %D 2023 %7 12.6.2023 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: A thorough understanding of the patterns of genetic subdivision in a pathogen can provide crucial information that is necessary to prevent disease spread. For SARS-CoV-2, the availability of millions of genomes makes this task analytically challenging, and traditional methods for understanding genetic subdivision often fail. Objective: The aim of our study was to use population genomics methods to identify the subtle subdivisions and demographic history of the Omicron variant, in addition to those captured by the Pango lineage. Methods: We used a combination of an evolutionary network approach and multivariate statistical protocols to understand the subdivision and spread of the Omicron variant. We identified subdivisions within the BA.1 and BA.2 lineages and further identified the mutations associated with each cluster. We further characterized the overall genomic diversity of the Omicron variant and assessed the selection pressure for each of the genetic clusters identified. Results: We observed concordant results, using two different methods to understand genetic subdivision. The overall pattern of subdivision in the Omicron variant was in broad agreement with the Pango lineage definition. Further, 1 cluster of the BA.1 lineage and 3 clusters of the BA.2 lineage revealed statistically significant signatures of selection or demographic expansion (Tajima’s D<−2), suggesting the role of microevolutionary processes in the spread of the virus. Conclusions: We provide an easy framework for assessing the genetic structure and demographic history of SARS-CoV-2, which can be particularly useful for understanding the local history of the virus. We identified important mutations that are advantageous to some lineages of Omicron and aid in the transmission of the virus. This is crucial information for policy makers, as preventive measures can be designed to mitigate further spread based on a holistic understanding of the variability of the virus and the evolutionary processes aiding its spread. %M 37456139 %R 10.2196/40673 %U https://bioinform.jmir.org/2023/1/e40673 %U https://doi.org/10.2196/40673 %U http://www.ncbi.nlm.nih.gov/pubmed/37456139 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e46643 %T Capturing and Documenting the Wider Health Impacts of the COVID-19 Pandemic Through the Remember Rebuild Saskatchewan Initiative: Protocol for a Mixed Methods Interdisciplinary Project %A Muhajarine,Nazeem %A Dixon,James %A Dyck,Erika %A Clifford,Jim %A Chassé,Patrick %A Gupta,Suvadra Datta %A Christopherson-Cote,Colleen %A , %+ Department of Community Health and Epidemiology, Saskatchewan Population Health and Evaluation Research Unit, University of Saskatchewan, 104 Clinic Place, Health Sciences Bldg, U of Saskatchewan, Saskatoon, SK, S7N 2ZW, Canada, 1 3069667940, nazeem.muhajarine@usask.ca %K COVID-19 %K Saskatchewan, Canada %K mixed methods %K interdisciplinary %K mental health and substance use %K food insecurity %K housing precarity %K archive %D 2023 %7 6.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the Canadian province of Saskatchewan, the global COVID-19 pandemic appeared amidst existing social health challenges in food insecurity, housing precarity and homelessness, poor mental health, and substance misuse. These chronic features intersected with the pandemic, producing a moment in time when the urgency of COVID-19 brought attention to underlying shortcomings in public health services. Objective: The objectives of the program of research are (1) to identify and measure relationships between the pandemic and wider health and social impacts, namely, food insecurity, housing precarity and homelessness, and mental health and substance use in Saskatchewan, and (2) to create an oral history of the pandemic in Saskatchewan in an accessible digital public archive. Methods: We are using a mixed methods approach to identify the impacts of the pandemic on specific equity-seeking groups and areas of social health concern by developing cross-sectional population-based surveys and producing results based on statistical analysis. We augmented the quantitative analysis by conducting qualitative interviews and oral histories to generate more granular details of people’s experiences of the pandemic. We are focusing on frontline workers, other service providers, and individuals within equity-seeking groups. We are capturing digital evidence and social media posts; we are collecting and organizing key threads using a free open-source research tool, Zotero, to trace the digital evidence of the pandemic in Saskatchewan. This study is approved by the Research Ethics Board at the University of Saskatchewan (Beh-1945). Results: Funding for this program of research was received in March and April 2022. Survey data were collected between July and November 2022. The collection of oral histories began in June 2022 and concluded in March 2023. In total, 30 oral histories have been collected at the time of this writing. Qualitative interviews began in April 2022 and will continue until March 2024. Survey analysis began in January 2023, and results are expected to be published in mid-2023. All data and stories collected in this work are archived for preservation and freely accessible on the Remember Rebuild Saskatchewan project’s website. We will share results in academic journals and conferences, town halls and community gatherings, social and digital media reports, and through collaborative exhibitions with public library systems. Conclusions: The pandemic’s ephemeral nature poses a risk of us “forgetting” this moment and the attendant social inequities. These challenges inspired a novel fusion among health researchers, historians, librarians, and service providers in the creation of the Remember Rebuild Saskatchewan project, which focuses on preserving the legacy of the pandemic and capturing data to support an equitable recovery in Saskatchewan. International Registered Report Identifier (IRRID): DERR1-10.2196/46643 %M 37279056 %R 10.2196/46643 %U https://www.researchprotocols.org/2023/1/e46643 %U https://doi.org/10.2196/46643 %U http://www.ncbi.nlm.nih.gov/pubmed/37279056 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e48183 %T Optimal Dosing and Timing of High-Dose Corticosteroid Therapy in Hospitalized Patients With COVID-19: Study Protocol for a Retrospective Observational Multicenter Study (SELECT) %A Daenen,Katrijn %A Huijben,Jilske A %A Boyd,Anders %A Bos,Lieuwe D J %A Stoof,Sara C M %A van Willigen,Hugo %A Gommers,Diederik A M P J %A Moeniralam,Hazra S %A den Uil,Corstiaan A %A Juffermans,Nicole P %A Kant,Merijn %A Valkenburg,Abraham J %A Pillay,Janesh %A van Meenen,David M P %A Paulus,Frederique %A Schultz,Marcus J %A Dalm,Virgil A S H %A van Gorp,Eric C M %A Schinkel,Janke %A Endeman,Henrik %A , %+ Department of Intensive Care, Erasmus University Medical Center, Dr. Molewaterplein 40, Rotterdam, 3015 GD, Netherlands, 31 107038737, k.daenen@erasmusmc.nl %K COVID-19 %K corticosteroid %K infectious diseases %K virology %D 2023 %7 2.6.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: In hospitalized patients with COVID-19, the dosing and timing of corticosteroids vary widely. Low-dose dexamethasone therapy reduces mortality in patients requiring respiratory support, but it remains unclear how to treat patients when this therapy fails. In critically ill patients, high-dose corticosteroids are often administered as salvage late in the disease course, whereas earlier administration may be more beneficial in preventing disease progression. Previous research has revealed that increased levels of various biomarkers are associated with mortality, and whole blood transcriptome sequencing has the ability to identify host factors predisposing to critical illness in patients with COVID-19. Objective: Our goal is to determine the most optimal dosing and timing of corticosteroid therapy and to provide a basis for personalized corticosteroid treatment regimens to reduce morbidity and mortality in hospitalized patients with COVID-19. Methods: This is a retrospective, observational, multicenter study that includes adult patients who were hospitalized due to COVID-19 in the Netherlands. We will use the differences in therapeutic strategies between hospitals (per protocol high-dose corticosteroids or not) over time to determine whether high-dose corticosteroids have an effect on the following outcome measures: mechanical ventilation or high-flow nasal cannula therapy, in-hospital mortality, and 28-day survival. We will also explore biomarker profiles in serum and bronchoalveolar lavage fluid and use whole blood transcriptome analysis to determine factors that influence the relationship between high-dose corticosteroids and outcome. Existing databases that contain routinely collected electronic data during ward and intensive care admissions, as well as existing biobanks, will be used. We will apply longitudinal modeling appropriate for each data structure to answer the research questions at hand. Results: As of April 2023, data have been collected for a total of 1500 patients, with data collection anticipated to be completed by December 2023. We expect the first results to be available in early 2024. Conclusions: This study protocol presents a strategy to investigate the effect of high-dose corticosteroids throughout the entire clinical course of hospitalized patients with COVID-19, from hospital admission to the ward or intensive care unit until hospital discharge. Moreover, our exploration of biomarker and gene expression profiles for targeted corticosteroid therapy represents a first step towards personalized COVID-19 corticosteroid treatment. Trial Registration: ClinicalTrials.gov NCT05403359; https://clinicaltrials.gov/ct2/show/NCT05403359 International Registered Report Identifier (IRRID): DERR1-10.2196/48183 %M 37266993 %R 10.2196/48183 %U https://www.researchprotocols.org/2023/1/e48183 %U https://doi.org/10.2196/48183 %U http://www.ncbi.nlm.nih.gov/pubmed/37266993 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47079 %T Characterizing Symptoms and Identifying Biomarkers of Long COVID in People With and Without HIV: Protocol for a Remotely Conducted Prospective Observational Cohort Study %A Márquez,Nuria Gallego %A Jamal,Armaan %A Johnston,Rowena %A Richter,E India %A Gorbach,Pamina M %A Vannorsdall,Tracy D %A Rubin,Leah H %A Jennings,Cheryl %A Landay,Alan L %A Peluso,Michael J %A Antar,Annukka A R %+ Department of Medicine, Johns Hopkins University School of Medicine, 720 Rutland Avenue, Ross Research Building Room 1064, Baltimore, MD, 21205, United States, 1 (410) 614 9140, aantar1@jhmi.edu %K HIV %K SARS-CoV-2 %K COVID-19 %K long COVID %K post–acute COVID-19 syndrome %K postacute sequelae of SARS-CoV-2 infection %K prospective observational cohort study %K remote study %K remote participation %D 2023 %7 31.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 37104709 %R 10.2196/47079 %U https://www.researchprotocols.org/2023/1/e47079 %U https://doi.org/10.2196/47079 %U http://www.ncbi.nlm.nih.gov/pubmed/37104709 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40650 %T The COVID-19 Pandemic and Daily Steps in the General Population: Meta-analysis of Observational Studies %A Wu,Ziying %A Wang,Yilun %A Zhang,Yuqing %A Bennell,Kim L %A White,Daniel K %A Shen,Liusong %A Ren,Wei %A Wei,Jie %A Zeng,Chao %A Lei,Guanghua %+ Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, China, 86 073184327326, lei_guanghua@csu.edu.cn %K COVID-19 %K daily steps %K physical activity %K meta-analysis %D 2023 %7 30.5.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has the potential to accelerate another pandemic: physical inactivity. Daily steps, a proxy of physical activity, are closely related to health. Recent studies indicate that over 7000 steps per day is the critical physical activity standard for minimizing the risk of all-cause mortality. Moreover, the risk of cardiovascular events has been found to increase by 8% for every 2000 steps per day decrement. Objective: To quantify the impact of the COVID-19 pandemic on daily steps in the general adult population. Methods: This study follows the guidelines of the MOOSE (Meta-analysis Of Observational Studies in Epidemiology) checklist. PubMed, EMBASE, and Web of Science were searched from inception to February 11, 2023. Eligible studies were observational studies reporting monitor-assessed daily steps before and during the confinement period of the COVID-19 pandemic in the general adult population. Two reviewers performed study selection and data extraction independently. The modified Newcastle-Ottawa Scale was used to assess the study quality. A random effects meta-analysis was conducted. The primary outcome of interest was the number of daily steps before (ie, January 2019 to February 2020) and during (ie, after January 2020) the confinement period of COVID-19. Publication bias was assessed with a funnel plot and further evaluated with the Egger test. Sensitivity analyses were performed by excluding studies with low methodological quality or small sample sizes to test the robustness of the findings. Other outcomes included subgroup analyses by geographic location and gender. Results: A total of 20 studies (19,253 participants) were included. The proportion of studies with subjects with optimal daily steps (ie, ≥7000 steps/day) declined from 70% before the pandemic to 25% during the confinement period. The change in daily steps between the 2 periods ranged from –5771 to –683 across studies, and the pooled mean difference was –2012 (95% CI –2805 to –1218). The asymmetry in the funnel plot and Egger test results did not indicate any significant publication bias. Results remained stable in sensitivity analyses, suggesting that the observed differences were robust. Subgroup analyses revealed that the decline in daily steps clearly varied by region worldwide but that there was no apparent difference between men and women. Conclusions: Our findings indicate that daily steps declined substantially during the confinement period of the COVID-19 pandemic. The pandemic further exacerbated the ever-increasing prevalence of low levels of physical activity, emphasizing the necessity of adopting appropriate measures to reverse this trend. Further research is required to monitor the consequence of long-term physical inactivity. Trial Registration: PROSPERO CRD42021291684; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=291684 %M 37252779 %R 10.2196/40650 %U https://publichealth.jmir.org/2023/1/e40650 %U https://doi.org/10.2196/40650 %U http://www.ncbi.nlm.nih.gov/pubmed/37252779 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e47160 %T Voluntary Medical Male Circumcision and Incident HIV Infection Among Men Who Have Sex With Men in China (The CoM Study): Protocol for a Randomized Controlled Trial %A Gao,Yanxiao %A Zheng,Weiran %A Sun,Yinghui %A Yang,Luoyao %A Guo,Zhihui %A Li,Yuwei %A Lin,Yi-Fan %A Lu,Zhen %A Yuan,Tanwei %A Zhan,Yuewei %A Qian,Han-Zhu %A Su,Bin %A Zhu,Zhiqiang %A Duan,Junyi %A Wang,Guanghui %A Cui,Xin %A Ouyang,Lin %A Sheng,Genshen %A Zhou,Yepeng %A Long,Ao %A Yao,Yuming %A Fitzpatrick,Thomas %A Yu,Maohe %A Wu,Guohui %A Zou,Huachun %+ School of Public Health, Sun Yat-sen University, No. 66, Gongchang Road, Guangming District, Shenzhen, 518107, China, 86 8733 5651, zouhuachun@mail.sysu.edu.cn %K voluntary medical male circumcision %K HIV %K men who have sex with men %K randomized controlled trial %K China %D 2023 %7 29.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Systematic reviews and meta-analyses based on observational studies have shown voluntary medical male circumcision (VMMC) may reduce HIV risk among men who have sex with men (MSM). There is a lack of randomized controlled trial (RCT) data assessing the efficacy of VMMC. Objective: The primary objective of this study is to assess the efficacy of VMMC for preventing HIV acquisition among MSM who primarily engage in insertive anal sex. Methods: A multicenter RCT will be conducted among MSM in 8 cities in China. Eligible participants are men aged 18-49 years who self-report ≥2 male sex partners in the past 6 months, predominantly practice insertive anal sex, and are willing to undergo circumcision. Interested men who satisfy inclusion criteria will be tested for HIV 1 month before enrollment and at enrollment, and only those who are HIV negative will be enrolled. At baseline, all enrolled participants will be asked to report sociodemographic characteristics and sexual behaviors; provide a blood sample for HIV, syphilis, and herpes simplex virus type 2 testing; and provide a penile swab for human papillomavirus testing. Participants will be randomly assigned to the intervention or control group. Those in the intervention group will receive VMMC and undergo a web-based weekly follow-up assessment of postsurgery healing for 6 consecutive weeks. All participants will be tested for HIV at 3-, 6-, 9-, and 12-month follow-ups. All participants will also be asked to report sexual behaviors and undergo repeat herpes simplex virus type 2 and human papillomavirus testing at 6- and 12-month follow-ups. The primary end point is HIV seroconversion. Secondary end points are the safety and satisfaction with VMMC and the changes in sexual behaviors after VMMC. The grouped censored data will be analyzed by intention-to-treat approach. Results: Recruitment for the RCT began in August 2020 and continued through July 2022. Data collection is expected to be completed by July 2023, and full data analysis is going to be completed by September 2023. Conclusions: This study will be the first RCT to assess the efficacy of VMMC in preventing HIV infection among MSM. Results from this trial will provide preliminary evidence for the potential efficacy of VMMC to reduce incident HIV infection among MSM. Trial Registration: Chinese Clinical Trial Registry ChiCTR2000039436; https://www.chictr.org.cn/showproj.html?proj=63369 International Registered Report Identifier (IRRID): DERR1-10.2196/47160 %M 37247211 %R 10.2196/47160 %U https://www.researchprotocols.org/2023/1/e47160 %U https://doi.org/10.2196/47160 %U http://www.ncbi.nlm.nih.gov/pubmed/37247211 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40514 %T Joint Analysis of the Epidemic Evolution and Human Mobility During the First Wave of COVID-19 in Spain: Retrospective Study %A Steinegger,Benjamin %A Granell,Clara %A Rapisardi,Giacomo %A Gómez,Sergio %A Matamalas,Joan %A Soriano-Paños,David %A Gómez-Gardeñes,Jesús %A Arenas,Alex %+ Universitat Rovira i Virgili, Avda Paisos Catalans 26, Tarragona, 43007, Spain, 34 977559687, alexandre.arenas@urv.cat %K epidemics %K NPIs %K nonpharmaceutical intervention %K human behavior %K Spain %K COVID-19 %K mobility data %K epidemic evolution %K public health %K surveillance %K public health intervention %K model-based inference %D 2023 %7 22.5.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The initial wave of the COVID-19 pandemic placed a tremendous strain on health care systems worldwide. To mitigate the spread of the virus, many countries implemented stringent nonpharmaceutical interventions (NPIs), which significantly altered human behavior both before and after their enactment. Despite these efforts, a precise assessment of the impact and efficacy of these NPIs, as well as the extent of human behavioral changes, remained elusive. Objective: In this study, we conducted a retrospective analysis of the initial wave of COVID-19 in Spain to better comprehend the influence of NPIs and their interaction with human behavior. Such investigations are vital for devising future mitigation strategies to combat COVID-19 and enhance epidemic preparedness more broadly. Methods: We used a combination of national and regional retrospective analyses of pandemic incidence alongside large-scale mobility data to assess the impact and timing of government-implemented NPIs in combating COVID-19. Additionally, we compared these findings with a model-based inference of hospitalizations and fatalities. This model-based approach enabled us to construct counterfactual scenarios that gauged the consequences of delayed initiation of epidemic response measures. Results: Our analysis demonstrated that the pre–national lockdown epidemic response, encompassing regional measures and heightened individual awareness, significantly contributed to reducing the disease burden in Spain. The mobility data indicated that people adjusted their behavior in response to the regional epidemiological situation before the nationwide lockdown was implemented. Counterfactual scenarios suggested that without this early epidemic response, there would have been an estimated 45,400 (95% CI 37,400-58,000) fatalities and 182,600 (95% CI 150,400-233,800) hospitalizations compared to the reported figures of 27,800 fatalities and 107,600 hospitalizations, respectively. Conclusions: Our findings underscore the significance of self-implemented prevention measures by the population and regional NPIs before the national lockdown in Spain. The study also emphasizes the necessity for prompt and precise data quantification prior to enacting enforced measures. This highlights the critical interplay between NPIs, epidemic progression, and human behavior. This interdependence presents a challenge in predicting the impact of NPIs before they are implemented. %M 37213190 %R 10.2196/40514 %U https://publichealth.jmir.org/2023/1/e40514 %U https://doi.org/10.2196/40514 %U http://www.ncbi.nlm.nih.gov/pubmed/37213190 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42673 %T The Spatiotemporal Pattern and Its Determinants of Hemorrhagic Fever With Renal Syndrome in Northeastern China: Spatiotemporal Analysis %A Wang,Yanding %A Wei,Xianyu %A Jia,Ruizhong %A Peng,XingYu %A Zhang,Xiushan %A Yang,Meitao %A Li,Zhiqiang %A Guo,Jinpeng %A Chen,Yong %A Yin,Wenwu %A Zhang,Wenyi %A Wang,Yong %+ Chinese PLA Center for Disease Control and Prevention, 20 East street, Fengtai District, Beijing, China, 86 13693013596, ywang7508@sina.com %K HFRS %K climate change %K Northeastern China %K spatiotemporal dynamic %K Geodetector %D 2023 %7 18.5.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Hemorrhagic fever with renal syndrome (HFRS) is a significant zoonotic disease mainly transmitted by rodents. However, the determinants of its spatiotemporal patterns in Northeast China remain unclear. Objective: This study aimed to investigate the spatiotemporal dynamics and epidemiological characteristics of HFRS and detect the meteorological effect of the HFRS epidemic in Northeastern China. Methods: The HFRS cases of Northeastern China were collected from the Chinese Center for Disease Control and Prevention, and meteorological data were collected from the National Basic Geographic Information Center. Times series analyses, wavelet analysis, Geodetector model, and SARIMA model were performed to identify the epidemiological characteristics, periodical fluctuation, and meteorological effect of HFRS in Northeastern China. Results: A total of 52,655 HFRS cases were reported in Northeastern China from 2006 to 2020, and most patients with HFRS (n=36,558, 69.43%) were aged between 30-59 years. HFRS occurred most frequently in June and November and had a significant 4- to 6-month periodicity. The explanatory power of the meteorological factors to HFRS varies from 0.15 ≤ q ≤ 0.01. In Heilongjiang province, mean temperature with a 4-month lag, mean ground temperature with a 4-month lag, and mean pressure with a 5-month lag had the most explanatory power on HFRS. In Liaoning province, mean temperature with a 1-month lag, mean ground temperature with a 1-month lag, and mean wind speed with a 4-month lag were found to have an effect on HFRS, but in Jilin province, the most important meteorological factors for HFRS were precipitation with a 6-month lag and maximum evaporation with a 5-month lag. The interaction analysis of meteorological factors mostly showed nonlinear enhancement. The SARIMA model predicted that 8,343 cases of HFRS are expected to occur in Northeastern China. Conclusions: HFRS showed significant inequality in epidemic and meteorological effects in Northeastern China, and eastern prefecture-level cities presented a high risk of epidemic. This study quantifies the hysteresis effects of different meteorological factors and prompts us to focus on the influence of ground temperature and precipitation on HFRS transmission in future studies, which could assist local health authorities in developing HFRS-climate surveillance, prevention, and control strategies targeting high-risk populations in China. %M 37200083 %R 10.2196/42673 %U https://publichealth.jmir.org/2023/1/e42673 %U https://doi.org/10.2196/42673 %U http://www.ncbi.nlm.nih.gov/pubmed/37200083 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44051 %T Knowledge and Practice of Personal Protective Measures Against COVID-19 in Africa: Systematic Review %A Kawuki,Joseph %A Chan,Paul Shing-fong %A Fang,Yuan %A Chen,Siyu %A Mo,Phoenix K H %A Wang,Zixin %+ Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, NT, China (Hong Kong), 852 22528740, wangzx@cuhk.edu.hk %K personal protective measures %K mask use %K social distancing %K hand hygiene %K COVID-19 %K Africa %K nonpharmaceutical interventions %D 2023 %7 16.5.2023 %9 Review %J JMIR Public Health Surveill %G English %X 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 %M 37058578 %R 10.2196/44051 %U https://publichealth.jmir.org/2023/1/e44051 %U https://doi.org/10.2196/44051 %U http://www.ncbi.nlm.nih.gov/pubmed/37058578 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39700 %T Comparing the Use of a Mobile App and a Web-Based Notification Platform for Surveillance of Adverse Events Following Influenza Immunization: Randomized Controlled Trial %A Bota,A Brianne %A Bettinger,Julie A %A Sarfo-Mensah,Shirley %A Lopez,Jimmy %A Smith,David P %A Atkinson,Katherine M %A Bell,Cameron %A Marty,Kim %A Serhan,Mohamed %A Zhu,David T %A McCarthy,Anne E %A Wilson,Kumanan %+ Clinical Epidemiology Program, Ottawa Hospital Research Institute, 1053 Carling Avenue, Administrative Service Building, Box 684, Ottawa, ON, K1Y 4E9, Canada, 1 6137985555 ext 17921, kwilson@toh.ca %K active participant–centered reporting %K health technology %K adverse event reporting %K mobile apps %K immunization %K vaccine %K safety %K influenza %K campaign %K apps %K mobile %K surveillance %K pharmacovigilance %D 2023 %7 8.5.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Vaccine safety surveillance is a core component of vaccine pharmacovigilance. In Canada, active, participant-centered vaccine surveillance is available for influenza vaccines and has been used for COVID-19 vaccines. Objective: The objective of this study is to evaluate the effectiveness and feasibility of using a mobile app for reporting participant-centered seasonal influenza adverse events following immunization (AEFIs) compared to a web-based notification system. Methods: Participants were randomized to influenza vaccine safety reporting via a mobile app or a web-based notification platform. All participants were invited to complete a user experience survey. Results: Among the 2408 randomized participants, 1319 (54%) completed their safety survey 1 week after vaccination, with a higher completion rate among the web-based notification platform users (767/1196, 64%) than among mobile app users (552/1212, 45%; P<.001). Ease-of-use ratings were high for the web-based notification platform users (99% strongly agree or agree) and 88.8% of them strongly agreed or agreed that the system made reporting AEFIs easier. Web-based notification platform users supported the statement that a web-based notification-only approach would make it easier for public health professionals to detect vaccine safety signals (91.4%, agreed or strongly agreed). Conclusions: Participants in this study were significantly more likely to respond to a web-based safety survey rather than within a mobile app. These results suggest that mobile apps present an additional barrier for use compared to the web-based notification–only approach. Trial Registration: ClinicalTrials.gov NCT05794113; https://clinicaltrials.gov/show/NCT05794113 %M 37155240 %R 10.2196/39700 %U https://publichealth.jmir.org/2023/1/e39700 %U https://doi.org/10.2196/39700 %U http://www.ncbi.nlm.nih.gov/pubmed/37155240 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e45109 %T Impact of California’s Senate Bill 27 on Antimicrobial-Resistant Escherichia coli Urinary Tract Infection in Humans: Protocol for a Study of Methods and Baseline Data %A Florea,Ana %A Casey,Joan A %A Nachman,Keeve %A Price,Lance B %A Pomichowski,Magdalena E %A Takhar,Harpreet S %A Quinlivan,Vanessa %A Childs,Lee D %A Davis,Meghan F %A Wei,Rong %A Hong,Vennis %A Ku,Jennifer H %A Liu,Cindy M %A Pressman,Alice %A Robinson,Sarah %A Bruxvoort,Katia J %A Salas,S Bianca %A Tartof,Sara Y %+ Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles, 2nd Floor, Pasadena, CA, 91101, United States, 1 626 720 9479, ana.florea@kp.org %K AMR %K antimicrobial resistance %K E coli %K Escherichia coli %K urinary tract infection %K UTI %D 2023 %7 5.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Overuse of antibiotics contributes to antimicrobial resistance (AMR) and is a growing threat to human health worldwide. Previous work suggests a link between antimicrobial use in poultry and human AMR extraintestinal pathogenic Escherichia coli (E coli) urinary tract infections (UTIs). However, few US-based studies exist, and none have comprehensively assessed both foodborne and environmental pathways using advanced molecular and spatial epidemiologic methods in a quasi-experimental design. Recently, California enacted Senate Bill 27 (SB27), which changed previous policy to require a veterinarian’s prescription for the use of antibiotic drugs, and which banned antibiotic use for disease prevention in livestock. This provided an opportunity to evaluate whether SB27 will result in a reduction in antimicrobial-resistant infections in humans. Objective: We describe in detail the methods implemented to achieve the overarching objective of this study to evaluate the impact of SB27 on downstream antibiotic resistance rates in human UTIs. Methods: A summary of the overall approach and the partnerships between Columbia University, George Washington University (GWU), Johns Hopkins Bloomberg School of Public Health, Kaiser Permanente Southern California (KPSC) Research and Evaluation, the Natural Resources Defense Council, Sanger Institute at Stanford University, Sutter Health Center for Health Systems Research, the University of Cambridge, and the University of Oxford is presented. The collection, quality control testing, and shipment of retail meat and clinical samples are described. Retail meat (chicken, beef, turkey, and pork) was purchased from stores throughout Southern California from 2017 to 2021. After processing at KPSC, it was shipped to GWU for testing. From 2016 to 2021, after clinical specimens were processed for routine clinical purposes and immediately before discarding, those with isolated colonies of E coli, Campylobacter, and Salmonella from KPSC members were collected and processed to be shipped for testing at GWU. Detailed methods of the isolation and testing as well as the whole-genome sequencing of the meat and clinical samples at GWU are described. KPSC electronic health record data were used to track UTI cases and AMR patterns among the cultured specimens. Similarly, Sutter Health electronic health record data were used to track UTI cases in its Northern California patient population. Results: From 2017 to 2021, overall, 12,616 retail meat samples were purchased from 472 unique stores across Southern California. In addition, 31,643 positive clinical cultures were collected from KPSC members during the same study period. Conclusions: Here, we presented data collection methods for the study, which was conducted to evaluate the impact of SB27 on downstream antibiotic resistance rates in human UTI. To date, it is one of the largest studies of its kind to be conducted. The data collected during this study will be used as the foundation for future analyses specific to the various objectives of this large body of work. International Registered Report Identifier (IRRID): DERR1-10.2196/45109 %M 37145842 %R 10.2196/45109 %U https://www.researchprotocols.org/2023/1/e45109 %U https://doi.org/10.2196/45109 %U http://www.ncbi.nlm.nih.gov/pubmed/37145842 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e38236 %T Characteristics of Inclusive Web-Based Leisure Activities for Children With Disabilities: Qualitative Descriptive Study %A Movahed,Mehrnoosh %A Rue,Ishana %A Yoo,Paul Yejong %A Sogomonian,Tamara %A Majnemer,Annette %A Shikako,Keiko %+ School of Physical and Occupational Therapy, McGill University, 3654 Prom Sir-William-Osler, Montreal, QC, H3G 1Y5, Canada, 1 514 488 5552 ext 1141, keiko.thomas@mcgill.ca %K children with disabilities %K social inclusion %K participation %K accessibility %K leisure %K web-based activities %K pandemic %D 2023 %7 4.5.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: The participation of children with disabilities in leisure activities is a key determinant of their physical and mental health. The COVID-19 pandemic has limited participation in leisure activities for all children, particularly those with disabilities. As a result, children with disabilities may be less active while feeling more isolated and stressed. Web-based communities and activities have become increasingly important. Understanding how web-based activities include or exclude children with disabilities can contribute to the development of inclusive communities that may support participation after the pandemic. Objective: This study aimed to identify factors that may facilitate or prevent the participation of children with disabilities in web-based leisure activities. Methods: We adopted a qualitative descriptive interpretative methodology and conducted interviews with 2 groups of participants: service providers offering inclusive web-based leisure activities and parents of children with disabilities who have engaged in web-based leisure activities during the COVID-19 pandemic. A semistructured interview format was created based on the Theoretical Domains Framework. The questions focused on the description of the web-based activities offered by the service provider (eg, age range, frequency, cost, target population, and type of activity offered) and any adaptations to make the web-based activity accessible to children and youth with disabilities, and their perceptions and beliefs about what supported or deterred participation in the activities. Results: A total of 17 participants described their experiences in participating in and creating web-based leisure programs and the factors preventing or facilitating children’s participation in web-based activities. Environment and context factors included accommodations, the format of activities and the web-based setting, stakeholder involvement, and materials and resources available. Activities that had flexible schedules, both recorded and live options for joining, and that provided clear instructions and information were perceived as more accessible. Beliefs involved the characteristics of the child and the family environment, as well as the characteristics of the organizations providing the activity. Activity facilitators who were familiar with the web-based environment and knew the specific characteristics of the child facilitated their participation. Engagement in community champions and respect for children’s individual preferences were perceived as positive. Access to technology, funding, and caregivers’ ability to facilitate child engagement are crucial factors that must be considered when offering web-based programs. Conclusions: Web-based environments offer an accessible and safe option for leisure participation when public health conditions prevent children with disabilities from participating in in-person activities. However, to make web-based activities accessible to children with a variety of disabilities, there needs to be a clear plan toward universal web-based accessibility that accounts for individual needs and collective approaches to web-based leisure. Future work should consider developing and testing guidelines for web-based accessibility, equity, public policy, and programming considerations in offering these activities for all children. %M 36668903 %R 10.2196/38236 %U https://pediatrics.jmir.org/2023/1/e38236 %U https://doi.org/10.2196/38236 %U http://www.ncbi.nlm.nih.gov/pubmed/36668903 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40591 %T The Impact of COVID-19 Lockdown on Cases of and Deaths From AIDS, Gonorrhea, Syphilis, Hepatitis B, and Hepatitis C: Interrupted Time Series Analysis %A Wu,Xinsheng %A Zhou,Xinyi %A Chen,Yuanyi %A Zhai,Ke %A Sun,Ruoyao %A Luo,Ganfeng %A Lin,Yi-Fan %A Li,Yuwei %A Yang,Chongguang %A Zou,Huachun %+ School of Public Health (Shenzhen), Sun Yat-sen University, 66 Gongchang Road, Guangming District, Shenzhen, Guangdong, 518107, China, 86 20 8733 5651, zouhuachun@mail.sysu.edu.cn %K COVID-19 %K AIDS %K gonorrhea %K syphilis %K hepatitis B %K hepatitis C %K China %K nonpharmaceutical %K intervention %K STD %K disease %K virus %K cases %K deaths %K fatality %K data %D 2023 %7 3.5.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: China implemented a nationwide lockdown to contain COVID-19 from an early stage. Previous studies of the impact of COVID-19 on sexually transmitted diseases (STDs) and diseases caused by blood-borne viruses (BBVs) in China have yielded widely disparate results, and studies on deaths attributable to STDs and BBVs are scarce. Objective: We aimed to elucidate the impact of COVID-19 lockdown on cases, deaths, and case-fatality ratios of STDs and BBVs. Methods: We extracted monthly data on cases and deaths for AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C between January 2015 and December 2021 from the notifiable disease reporting database on the official website of the National Health Commission of China. We used descriptive statistics to summarize the number of cases and deaths and calculated incidence and case-fatality ratios before and after the implementation of a nationwide lockdown (in January 2020). We used negative binominal segmented regression models to estimate the immediate and long-term impacts of lockdown on cases, deaths, and case-fatality ratios in January 2020 and December 2021, respectively. Results: A total of 14,800,330 cases of and 127,030 deaths from AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C were reported from January 2015 to December 2021, with an incidence of 149.11/100,000 before lockdown and 151.41/100,000 after lockdown and a case-fatality ratio of 8.21/1000 before lockdown and 9.50/1000 after lockdown. The negative binominal model showed significant decreases in January 2020 in AIDS cases (–23.4%; incidence rate ratio [IRR] 0.766, 95% CI 0.626-0.939) and deaths (–23.9%; IRR 0.761, 95% CI 0.647-0.896), gonorrhea cases (–34.3%; IRR 0.657, 95% CI 0.524-0.823), syphilis cases (–15.4%; IRR 0.846, 95% CI 0.763-0.937), hepatitis B cases (–17.5%; IRR 0.825, 95% CI 0.726-0.937), and hepatitis C cases (–19.6%; IRR 0.804, 95% CI 0.693-0.933). Gonorrhea, syphilis, and hepatitis C showed small increases in the number of deaths and case-fatality ratios in January 2020. By December 2021, the cases, deaths, and case-fatality ratios for each disease had either reached or remained below expected levels. Conclusions: COVID-19 lockdown may have contributed to fewer reported cases of AIDS, gonorrhea, syphilis, hepatitis B, and hepatitis C and more reported deaths and case-fatality ratios of gonorrhea, syphilis, and hepatitis C in China. %M 36634257 %R 10.2196/40591 %U https://publichealth.jmir.org/2023/1/e40591 %U https://doi.org/10.2196/40591 %U http://www.ncbi.nlm.nih.gov/pubmed/36634257 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42548 %T Do Infrared Thermometers Hold Promise for an Effective Early Warning System for Emerging Respiratory Infectious Diseases? %A Li,Rui %A Shen,Mingwang %A Liu,Hanting %A Bai,Lu %A Zhang,Lei %+ China-Australia Joint Research Center for Infectious Diseases, School of Public Health, Xi'an Jiaotong University Health Science Center, 76 Yanta West Road, Xi'an, 710061, China, 86 02982655108, lei.zhang1@monash.edu %K respiratory infectious diseases %K early warning %K infrared thermometer %K theoretical framework %K economic burden %K outbreak prevention %K warning system %K community health %K infectious disease %K smartphone device %K digital health surveillance %D 2023 %7 3.5.2023 %9 Viewpoint %J JMIR Form Res %G English %X 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. %M 37133929 %R 10.2196/42548 %U https://formative.jmir.org/2023/1/e42548 %U https://doi.org/10.2196/42548 %U http://www.ncbi.nlm.nih.gov/pubmed/37133929 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e44664 %T Sociocultural and Behavioral Features of Anticipated COVID-19 Vaccine Acceptance in Papua New Guinea: Protocol for a Mixed Methods Study %A Giduthuri,Joseph Gnanouday %A Manineng,Clement %A Schuele,Elisabeth %+ Population Health and Demography Research Unit, Papua New Guinea Institute of Medical Research, Homate Street, Goroka, 441, Papua New Guinea, 675 5314200 ext 253, joseph.giduthuri@swisstph.ch %K COVID-19 vaccine %K vaccine acceptance %K vaccine demand %K community views on vaccine %K vaccine stakeholders %K health care workers %K Papua New Guinea %K emergency preparedness %K public health intervention %K COVID-19 %K health promotion %K community health %K Melanesian culture %K vaccine uptake %K vaccine awareness %K vaccine priorities %D 2023 %7 2.5.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19 was characterized by the World Health Organization (WHO) as a pandemic in 2020. Papua New Guinea (PNG) has remained on high alert ever since, and its National Control Centre continues to coordinate national preparedness and response measures, guided by its Emergency Preparedness and Response Plan for COVID-19. As part of the WHO and the Global Alliance for Vaccines and Immunization's COVID-19 Vaccines Global Access (COVAX) program, PNG received several shipments of COVID-19 vaccine doses. A nationwide vaccine rollout for COVID-19 was initiated in PNG in May 2021. Despite the availability of vaccines and the capacity of health systems to vaccinate frontline workers and community members, including high-risk groups, there are still critical issues related to vaccine safety, confidence, and acceptance to ensure the effectiveness of the COVID-19 vaccination campaign. Evidence from studies on COVID-19 vaccine acceptance and demand in low- and middle-income countries (LMICs) suggests that sociocultural characteristics of the community and the behaviors of different vaccine stakeholders, including vaccine recipients, vaccine providers, and policymakers, determine the effectiveness of vaccination interventions or strategies. Objective: This study will examine sociocultural determinants of anticipated acceptance of the COVID-19 vaccine in urban and rural areas of different regions in PNG and health care providers’ views on vaccine acceptance. Methods: The study design uses a mixed methods approach in PNG’s coastal and highlands regions. The first research activity will use a qualitative methodology with an epistemological foundation based on constructivism. This design elicits and listens to community members’ accounts of ways culture is a rich resource that provides meaning to the COVID-19 pandemic; the design also measures adherence to niupela pasin (“new normal” in Tok Pidgin) and vaccination acceptance. The second activity will be a cross-sectional survey to assess the distribution of features of vaccine acceptance, priorities, and practices. The third activity will be in-depth interviews of health care providers actively involved in either COVID-19 clinical management or public health–related pandemic control activities. Results: The project proposal has been reviewed and approved by the Medical Research Advisory Committee of Papua New Guinea. Qualitative data collection started in December 2022, and the survey will begin in May 2023. The findings will be disseminated to the participating communities later this year, followed by publication. Conclusions: The proposed research on community views and experiences concerning sociocultural and behavioral features of acceptance of the vaccine will provide a better understanding of communication and education needs for vaccine action for COVID-19 control in PNG and other LMICs. The research also considers the influence of health care providers’ and policy makers’ roles in the awareness and use of the COVID-19 vaccine. International Registered Report Identifier (IRRID): PRR1-10.2196/44664 %M 37071828 %R 10.2196/44664 %U https://www.researchprotocols.org/2023/1/e44664 %U https://doi.org/10.2196/44664 %U http://www.ncbi.nlm.nih.gov/pubmed/37071828 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43941 %T Epidemiological Characteristics of Respiratory Syncytial Virus Infection Among Hospitalized Children With Acute Respiratory Tract Infections From 2014 to 2022 in a Hospital in Hubei Province, China: Longitudinal Surveillance Study %A Hu,Xing-Wen %A Zhou,Yiguo %A Yi,Song %A Zhang,Wan-Xue %A Wang,Xin-Rui %A Du,Juan %A Lu,Qing-Bin %+ Department of Laboratorial Science and Technology & Vaccine Research Center, School of Public Health, Peking University, 38th Xueyuan Road, Haidian District, Beijing, China, 86 10 82805327, qingbinlu@bjmu.edu.cn %K respiratory syncytial virus %K acute respiratory tract infection %K epidemiological characteristics %K China %K COVID-19 %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Longitudinal studies characterizing the epidemic trend of respiratory syncytial virus (RSV) in Hubei Province are scarce. Objective: We aimed to depict the dynamics of the RSV epidemic among hospitalized children with acute respiratory tract infections (ARTIs) during 2014 to 2022 in the Maternal and Child Health Hospital of Hubei Province and investigate the influence of the 2-child policy and the COVID-19 pandemic on RSV prevalence. Methods: The medical records and testing results of hospitalized children with ARTI from January 2014 to June 2022 were extracted. Nasopharyngeal samples were tested with direct immunofluorescence assay. Detection rates of RSV were categorized according to the diagnosis of patients: (1) overall, (2) upper respiratory tract infection (URTI), and (3) lower respiratory tract infection (LRTI). Poisson regression models were used to investigate the association between RSV detection rate and age, gender, or diagnosis. The detection rates of RSV before and after the implementation of the universal 2-child policy were compared using a Poisson regression model. Multiple comparisons of RSV detection rates were conducted among 3 stages of the COVID-19 pandemic using chi-square tests. Seasonal autoregressive integrated moving average was performed to predict RSV behaviors from February 2020 to June 2020 under the assumption of a non-COVID-19 scenario. Results: Among 75,128 hospitalized children with ARTI, 11.1% (8336/75,128) were RSV-positive. Children aged <1 year had higher detection rates than older children (4204/26,498, 15.9% vs 74/5504, 1.3%; P<.001), and children with LRTI had higher detection rates than children with URTI (7733/53,145, 14.6% vs 603/21,983, 2.7%; P<.001). Among all the children, a clear seasonal pattern of the RSV epidemic was observed before 2021. Most of the highest detection rates were concentrated between December and February. The yearly detection rate of RSV remained at a relatively low level (about 8%) from 2014 to 2017, then increased to 12% and above from 2018. The highest monthly detection rate was in December 2018 (539/1493, 36.1%), and the highest yearly rate was in 2021 (1372/9328, 14.7%). There was a moderate increase in the RSV detection rate after the 2-child policy was implemented (before: 860/10,446, 8.2% vs after: 4920/43,916, 11.2%; P<.001). The largest increase, by 5.83%, occurred in children aged <1 year. The RSV epidemic level decreased sharply in the short term after the COVID-19 outbreak (detection rate before: 1600/17,010, 9.4% vs after: 32/1135, 2.8%; P<.001). The largest decrease, by 12.0%, occurred in children aged <1 year, but a rebounding epidemic occurred after 2020 (680/5744, 11.8%; P<.001). Conclusions: Children have been experiencing increased prevalence of RSV since 2018 based on surveillance from a hospital in Hubei Province with a large sample size. The 2-child policy might have increased the RSV prevalence, and the COVID-19 epidemic had a temporary inhibitory effect on RSV transmission. Vaccines against RSV are urgently needed. %M 36975172 %R 10.2196/43941 %U https://publichealth.jmir.org/2023/1/e43941 %U https://doi.org/10.2196/43941 %U http://www.ncbi.nlm.nih.gov/pubmed/36975172 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42820 %T Spatiotemporal and Seasonal Trends of Class A and B Notifiable Infectious Diseases in China: Retrospective Analysis %A Zheng,Junyao %A Zhang,Ning %A Shen,Guoquan %A Liang,Fengchao %A Zhao,Yang %A He,Xiaochen %A Wang,Ying %A He,Rongxin %A Chen,Wenna %A Xue,Hao %A Shen,Yue %A Fu,Yang %A Zhang,Wei-Hong %A Zhang,Lei %A Bhatt,Samir %A Mao,Ying %A Zhu,Bin %+ School of Public Health and Emergency Management, Southern University of Science and Technology, No.1088, Xueyuan Avenue, Shenzhen, 518000, China, 86 13530405020, zhub6@sustech.edu.cn %K notifiable infectious diseases %K spatial epidemiology %K temporal trends %K seasonal feature %K spatial disparities %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: China is the most populous country globally and has made significant achievements in the control of infectious diseases over the last decades. The 2003 SARS epidemic triggered the initiation of the China Information System for Disease Control and Prevention (CISDCP). Since then, numerous studies have investigated the epidemiological features and trends of individual infectious diseases in China; however, few considered the changing spatiotemporal trends and seasonality of these infectious diseases over time. Objective: This study aims to systematically review the spatiotemporal trends and seasonal characteristics of class A and class B notifiable infectious diseases in China during 2005-2020. Methods: We extracted the incidence and mortality data of 8 types (27 diseases) of notifiable infectious diseases from the CISDCP. We used the Mann-Kendall and Sen’s methods to investigate the diseases’ temporal trends, Moran I statistic for their geographical distribution, and circular distribution analysis for their seasonality. Results: Between January 2005 and December 2020, 51,028,733 incident cases and 261,851 attributable deaths were recorded. Pertussis (P=.03), dengue fever (P=.01), brucellosis (P=.001), scarlet fever (P=.02), AIDS (P<.001), syphilis (P<.001), hepatitis C (P<.001) and hepatitis E (P=.04) exhibited significant upward trends. Furthermore, measles (P<.001), bacillary and amebic dysentery (P<.001), malaria (P=.04), dengue fever (P=.006), brucellosis (P=.03), and tuberculosis (P=.003) exhibited significant seasonal patterns. We observed marked disease burden–related geographic disparities and heterogeneities. Notably, high-risk areas for various infectious diseases have remained relatively unchanged since 2005. In particular, hemorrhagic fever and brucellosis were largely concentrated in Northeast China; neonatal tetanus, typhoid and paratyphoid, Japanese encephalitis, leptospirosis, and AIDS in Southwest China; BAD in North China; schistosomiasis in Central China; anthrax, tuberculosis, and hepatitis A in Northwest China; rabies in South China; and gonorrhea in East China. However, the geographical distribution of syphilis, scarlet fever, and hepatitis E drifted from coastal to inland provinces during 2005-2020. Conclusions: The overall infectious disease burden in China is declining; however, hepatitis C and E, bacterial infections, and sexually transmitted infections continue to multiply, many of which have spread from coastal to inland provinces %M 37103994 %R 10.2196/42820 %U https://publichealth.jmir.org/2023/1/e42820 %U https://doi.org/10.2196/42820 %U http://www.ncbi.nlm.nih.gov/pubmed/37103994 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e34163 %T Demographic Determinants and Geographical Variability of COVID-19 Vaccine Hesitancy in Underserved Communities: Cross-sectional Study %A Matas,Jennifer L %A Landry,Latrice G %A Lee,LaTasha %A Hansel,Shantoy %A Coudray,Makella S %A Mata-McMurry,Lina V %A Chalasani,Nishanth %A Xu,Liou %A Stair,Taylor %A Edwards,Christina %A Puckrein,Gary %A Meyer,William %A Wiltz,Gary %A Sampson,Marian %A Gregerson,Paul %A Barron,Charles %A Marable,Jeffrey %A Akinboboye,Olakunle %A Il'yasova,Dora %+ National Minority Quality Forum, 1201 15th Street, NW, Suite 340, Washington, DC, 20005, United States, 1 202 223 7560 ext 175, dilyasova@nmqf.org %K COVID-19 vaccine %K vaccine hesitancy %K underrepresented in research %K minority populations %K federally qualified health center (FQHC) %K public health %K COVID-19 %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 hospitalizations and deaths disproportionately affect underserved and minority populations, emphasizing that vaccine hesitancy can be an especially important public health risk factor in these populations. Objective: This study aims to characterize COVID-19 vaccine hesitancy in underserved diverse populations. Methods: The Minority and Rural Coronavirus Insights Study (MRCIS) recruited a convenience sample of adults (age≥18, N=3735) from federally qualified health centers (FQHCs) in California, the Midwest (Illinois/Ohio), Florida, and Louisiana and collected baseline data in November 2020-April 2021. Vaccine hesitancy status was defined as a response of “no” or “undecided” to the question “Would you get a coronavirus vaccine if it was available?” (“yes” categorized as not hesitant). Cross-sectional descriptive analyses and logistic regression models examined vaccine hesitancy prevalence by age, gender, race/ethnicity, and geography. The expected vaccine hesitancy estimates for the general population were calculated for the study counties using published county-level data. Crude associations with demographic characteristics within each region were assessed using the chi-square test. The main effect model included age, gender, race/ethnicity, and geographical region to estimate adjusted odds ratios (ORs) and 95% CIs. Interactions between geography and each demographic characteristic were evaluated in separate models. Results: The strongest vaccine hesitancy variability was by geographic region: California, 27.8% (range 25.0%-30.6%); the Midwest, 31.4% (range 27.3%-35.4%); Louisiana, 59.1% (range 56.1%-62.1%); and Florida, 67.3% (range 64.3%-70.2%). The expected estimates for the general population were lower: 9.7% (California), 15.3% (Midwest), 18.2% (Florida), and 27.0% (Louisiana). The demographic patterns also varied by geography. An inverted U-shaped age pattern was found, with the highest prevalence among ages 25-34 years in Florida (n=88, 80.0%,) and Louisiana (n=54, 79.4%; P<.05). Females were more hesitant than males in the Midwest (n= 110, 36.4% vs n= 48, 23.5%), Florida (n=458, 71.6% vs n=195, 59.3%), and Louisiana (n= 425, 66.5% vs. n=172, 46.5%; P<.05). Racial/ethnic differences were found in California, with the highest prevalence among non-Hispanic Black participants (n=86, 45.5%), and in Florida, with the highest among Hispanic (n=567, 69.3%) participants (P<.05), but not in the Midwest and Louisiana. The main effect model confirmed the U-shaped association with age: strongest association with age 25-34 years (OR 2.29, 95% CI 1.74-3.01). Statistical interactions of gender and race/ethnicity with the region were significant, following the pattern found by the crude analysis. Compared to males in California, the associations with the female gender were strongest in Florida (OR=7.88, 95% CI 5.96-10.41) and Louisiana (OR=6.09, 95% CI 4.55-8.14). Compared to non-Hispanic White participants in California, the strongest associations were found with being Hispanic in Florida (OR=11.18, 95% CI 7.01-17.85) and Black in Louisiana (OR=8.94, 95% CI 5.53-14.47). However, the strongest race/ethnicity variability was observed within California and Florida: the ORs varied 4.6- and 2-fold between racial/ethnic groups in these regions, respectively. Conclusions: These findings highlight the role of local contextual factors in driving vaccine hesitancy and its demographic patterns. %M 36811869 %R 10.2196/34163 %U https://publichealth.jmir.org/2023/1/e34163 %U https://doi.org/10.2196/34163 %U http://www.ncbi.nlm.nih.gov/pubmed/36811869 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e39697 %T Eliciting Opinions on Health Messaging During the COVID-19 Pandemic: Qualitative Survey Study %A Ruiz,Sienna %A Okere,Uzoma Charles %A Eggers,Michelle %A O'Leary,Catina %A Politi,Mary %A Wan,Fei %A Housten,Ashley J %+ Division of Public Health Sciences, Department of Surgery, Washington University in St. Louis, 660 S Euclid Ave, MSC 8100-0094-02, St. Louis, MO, 63110, United States, 1 (314) 454 7958, ahousten@wustl.edu %K COVID-19 %K health messaging %K rural populations %K urban populations %K communication %K health information %K messaging %K dissemination %K health equity %K prevention %K implementation %D 2023 %7 27.4.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Effective public health messaging has been necessary throughout the COVID-19 pandemic, but stakeholders have struggled to communicate critical information to the public, especially in different types of locations such as urban and rural areas. Objective: This study aimed to identify opportunities to improve COVID-19 messages for community distribution in rural and urban settings and to summarize the findings to inform future messaging. Methods: We purposively sampled by region (urban or rural) and participant type (general public or health care professional) to survey participants about their opinions on 4 COVID-19 health messages. We designed open-ended survey questions and analyzed the data using pragmatic health equity implementation science approaches. Following the qualitative analysis of the survey responses, we designed refined COVID-19 messages incorporating participant feedback and redistributed them via a short survey. Results: In total, 67 participants consented and enrolled: 31 (46%) community participants from the rural Southeast Missouri Bootheel, 27 (40%) community participants from urban St Louis, and 9 (13%) health care professionals from St Louis. Overall, we found no qualitative differences between the responses of our urban and rural samples to the open-ended questions. Participants across groups wanted familiar COVID-19 protocols, personal choice in COVID-19 preventive behaviors, and clear source information. Health care professionals contextualized their suggestions within the specific needs of their patients. All groups suggested practices consistent with health-literate communications. We reached 83% (54/65) of the participants for message redistribution, and most had overwhelmingly positive responses to the refined messages. Conclusions: We suggest convenient methods for community involvement in the creation of health messages by using a brief web-based survey. We identified areas of improvement for future health messaging, such as reaffirming the preventive practices advertised early in a crisis, framing messages such that they allow for personal choice of preventive behavior, highlighting well-known source information, using plain language, and crafting messages that are applicable to the readers’ circumstances. %M 36848256 %R 10.2196/39697 %U https://humanfactors.jmir.org/2023/1/e39697 %U https://doi.org/10.2196/39697 %U http://www.ncbi.nlm.nih.gov/pubmed/36848256 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44517 %T Participatory Surveillance for COVID-19 Trend Detection in Brazil: Cross-sectional Study %A Wittwer,Salome %A Paolotti,Daniela %A Lichand,Guilherme %A Leal Neto,Onicio %+ Institute for Information Security, Department of Computer Science, ETH Zürich, Universitätstrasse 6, Zurich, 8092, Switzerland, 41 44 632 50 94, onicio.batistalealneto@inf.ethz.ch %K participatory surveillance %K COVID-19 %K digital epidemiology %K coronavirus %K infectious disease %K epidemic %K pandemic %K SARS-CoV-2 %K forecast %K trend %K reporting %K self-report %K surveillance %D 2023 %7 26.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The ongoing COVID-19 pandemic has emphasized the necessity of a well-functioning surveillance system to detect and mitigate disease outbreaks. Traditional surveillance (TS) usually relies on health care providers and generally suffers from reporting lags that prevent immediate response plans. Participatory surveillance (PS), an innovative digital approach whereby individuals voluntarily monitor and report on their own health status via web-based surveys, has emerged in the past decade to complement traditional data collection approaches. Objective: This study compared novel PS data on COVID-19 infection rates across 9 Brazilian cities with official TS data to examine the opportunities and challenges of using PS data, and the potential advantages of combining the 2 approaches. Methods: The TS data for Brazil are publicly accessible on GitHub. The PS data were collected through the Brazil Sem Corona platform, a Colab platform. To gather information on an individual’s health status, each participant was asked to fill out a daily questionnaire on symptoms and exposure in the Colab app. Results: We found that high participation rates are key for PS data to adequately mirror TS infection rates. Where participation was high, we documented a significant trend correlation between lagged PS data and TS infection rates, suggesting that PS data could be used for early detection. In our data, forecasting models integrating both approaches increased accuracy up to 3% relative to a 14-day forecast model based exclusively on TS data. Furthermore, we showed that PS data captured a population that significantly differed from a traditional observation. Conclusions: In the traditional system, the new recorded COVID-19 cases per day are aggregated based on positive laboratory-confirmed tests. In contrast, PS data show a significant share of reports categorized as potential COVID-19 cases that are not laboratory confirmed. Quantifying the economic value of PS system implementation remains difficult. However, scarce public funds and persisting constraints to the TS system provide motivation for a PS system, making it an important avenue for future research. The decision to set up a PS system requires careful evaluation of its expected benefits, relative to the costs of setting up platforms and incentivizing engagement to increase both coverage and consistent reporting over time. The ability to compute such economic tradeoffs might be key to have PS become a more integral part of policy toolkits moving forward. These results corroborate previous studies when it comes to the benefits of an integrated and comprehensive surveillance system, and shed light on its limitations and on the need for additional research to improve future implementations of PS platforms. %M 36888908 %R 10.2196/44517 %U https://publichealth.jmir.org/2023/1/e44517 %U https://doi.org/10.2196/44517 %U http://www.ncbi.nlm.nih.gov/pubmed/36888908 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40138 %T Maintaining Adherence to COVID-19 Preventive Practices and Policies Pertaining to Masking and Distancing in the District of Columbia and Other US States: Systematic Observational Study %A Ruiz,Monica S %A McMahon,Mercedes V %A Latif,Hannah %A Vyas,Amita %+ Department of Prevention and Community Health, Milken Institute School of Public Health, George Washington University, 950 New Hampshire Ave NW, Suite 300, Washington, DC, 20052, United States, 1 202 994 3676, msruiz@gwu.edu %K COVID-19 %K mask adherence %K social distancing %K public health %K health policy %K public health mandates %D 2023 %7 25.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Prior to the development of effective vaccines against SARS-CoV-2, masking and social distancing emerged as important strategies for infection control. Locations across the United States required or recommended face coverings where distancing was not possible, but it is unclear to what extent people complied with these policies. Objective: This study provides descriptive information about adherence to public health policies pertaining to mask wearing and social distancing and examines differences in adherence to these policies among different population groups in the District of Columbia and 8 US states. Methods: This study was part of a national systematic observational study using a validated research protocol for recording adherence to correct mask wearing and maintaining social distance (6 feet/1.83 meters) from other individuals. Data were collected from December 2020 to August 2021 by research team members who stationed themselves in outdoor areas with high pedestrian traffic, observed individuals crossing their paths, and collected data on whether individuals’ masks were present (visible or not visible) or worn (correctly, incorrectly, not at all) and whether social distance was maintained if other individuals were present. Observational data were entered electronically into Google Forms and were exported in Excel format for analysis. All data analyses were conducted using SPSS. Information on local COVID-19 protection policies (eg, mask wearing requirements) was obtained by examining city and state health department websites for the locations where data were being collected. Results: At the time these data were collected, most locations in our study required (5937/10,308, 57.6%) or recommended (4207/10,308, 40.8%) masking. Despite this, more than 30% of our sample were unmasked (2889/10136, 28.5%) or masked incorrectly (636/10136, 6.3%). Masking policy was significantly related to correct masking with locations that required or recommended masking (66% correct masking vs 28/164, 17.1% in locations that did not require masking, P<.001). Participants who maintained social distance from others were more likely to be correctly masked than those who were not (P<.001). Adherence to masking policy by location was significant (P<.001); however, this was driven by 100% compliance in Georgia, which did not require masks at any point during the data collection period. When the same analysis was conducted for compliance with mask requirements and recommendations, there was no significant difference by location. Overall adherence to masking policies was 66.9% Conclusions: Despite a clear relationship between mask policies and masking behavior, one-third of our sample was nonadherent to those policies, and approximately 23% of our sample did not have any mask, either on or visible. This may speak to the confusion surrounding “risk” and protective behaviors, as well as pandemic fatigue. These results underscore the importance of clear public health communication, particularly given variations in public health policies across states and localities. %M 36888910 %R 10.2196/40138 %U https://publichealth.jmir.org/2023/1/e40138 %U https://doi.org/10.2196/40138 %U http://www.ncbi.nlm.nih.gov/pubmed/36888910 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e34579 %T COVID-19 Testing Practices, Preventive Behaviors, and Factors Associated With Test Positivity: Population-Based Statewide Survey Study %A Kanyangarara,Mufaro %A Daguise,Virginie %A Gual-Gonzalez,Lídia %A Litwin,Alain H %A Korte,Jeffrey %A Ross,Connor %A Nolan,Melissa S %A , %+ Department of Epidemiology and Biostatistics, University of South Carolina Arnold School of Public Health, 915 Greene Street, Columbia, SC, 29208, United States, 1 8037777563, mufaro@mailbox.sc.edu %K SARS-CoV-2 %K South Carolina %K surveillance %K attitude %K behavior %K COVID-19 %K testing %K prevention %K United States %K population %K survey %K risk %K perception %K risk factor %D 2023 %7 19.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has challenged public health efforts globally. Timely population-based surveillance is crucial to support public health programs and policies to limit the spread of COVID-19. The South Carolina (SC) Sampling and Testing Representative Outreach for Novel Coronavirus Guidance (SC STRONG) statewide initiative was established to estimate population-level prevalence and immunity and characterize the transmission dynamics of SARS-CoV-2 using community testing and online surveys. Objective: This paper aimed to leverage the survey data collected as part of the initiative to understand risk perceptions, testing practices, and preventive behaviors and identify risk factors for COVID-19 test positivity in SC over time. Methods: Probability proportionate to size cluster random sampling was used to select SC residents to participate in testing for COVID-19 infection and antibodies and to complete an online survey. This paper focuses on data from the online surveys completed between November 2020 and June 2021. Descriptive statistics were used to describe risk perceptions, attitudes and behaviors, and associated changes over time. Univariate and multivariate logistic regression models were used to identify factors associated with self-reported COVID-19 test positivity. Results: Among the 7170 online survey respondents, 58.7% (4213/7170) self-reported ever testing for COVID-19. The most commonly cited barriers to testing were inconvenient dates, time, and location, as well as discomfort. Overall, 18.7% (790/7170) of respondents reported a history of COVID-19 test positivity. Multivariate logistic regression results indicated that individuals who were aged 50 years or older, self-identified as Black/African American, were obese, and were employed as frontline health care workers or nursing home staff were more likely to self-report COVID-19 test positivity. By contrast, there was a decreased likelihood of test positivity among respondents who were concerned about the burden of COVID-19 in their community and about being infected. Conclusions: Strategies to remove testing barriers should be implemented to improve access. Our findings provide insights on statewide testing patterns, adoption of prevention behaviors, and risk factors for infection and may inform public health strategies to curb transmission. %M 36720159 %R 10.2196/34579 %U https://publichealth.jmir.org/2023/1/e34579 %U https://doi.org/10.2196/34579 %U http://www.ncbi.nlm.nih.gov/pubmed/36720159 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e41822 %T Changes in Online Food Access During the COVID-19 Pandemic and Associations With Deprivation: Longitudinal Analysis %A Keeble,Matthew %A Adams,Jean %A Burgoine,Thomas %+ MRC Epidemiology Unit, Institute of Metabolic Science, University of Cambridge School of Clinical Medicine, Level 3, Institute of Metabolic Science, Cambridge, CB2 0SL, United Kingdom, 44 1223 330315, matthew.keeble@mrc-epid.cam.ac.uk %K COVID-19 %K digital food environment %K fast foods %K online food delivery services %K public health %D 2023 %7 17.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Food prepared out of home is typically energy-dense and nutrient-poor. Online food delivery services have become a popular way to purchase such food. The number of accessible food outlets through these services can influence how frequently they are used. Anecdotally, food outlet access through online food delivery services increased in England between 2020 and 2022, in the context of the COVID-19 pandemic. However, the extent to which this access changed is poorly understood. Objective: We aimed to investigate monthly changes in online access to food prepared out of home in England in the context of the first 2 years of the COVID-19 pandemic compared with November 2019 and the extent to which any changes were associated with deprivation. Methods: In November 2019 and monthly between June 2020 and March 2022, we used automated data collection to construct a data set containing information about all food outlets in England registered to accept orders through the leading online food delivery service. Across postcode districts, we identified the number and percentage of food outlets registered to accept orders and the number that was accessible. We used generalized estimating equations (adjusted for population density, the number of food outlets in the physical food environment, and rural/urban classification) to investigate the change in outcomes compared with prepandemic levels (November 2019). We stratified analyses by deprivation quintile (Q). Results: Across England, the summed number of food outlets registered to accept orders online increased from 29,232 in November 2019 to 49,752 in March 2022. Across postcode districts, the median percentage of food outlets registered to accept orders online increased from 14.3 (IQR 3.8-26.0) in November 2019 to 24.0 (IQR 6.2-43.5) in March 2022. The median number of food outlets accessible online decreased from 63.5 (IQR 16.0-156.0) in November 2019 to 57.0 (IQR 11.0-163.0) in March 2022. However, we observed variation by deprivation. In March 2022, the median number of outlets accessible online was 175.0 (IQR 104.0-292.0) in the most deprived areas (Q5) compared with 27.0 (IQR 8.5-60.5) in the least deprived (Q1). In adjusted analyses, we estimated that the number of outlets accessible online in the most deprived areas was 10% higher in March 2022 compared with November 2019 (incidence rate ratios: 1.10, 95% CI 1.07-1.13). In the least deprived areas, we estimated a 19% decrease (incidence rate ratios: 0.81, 95% CI 0.79-0.83). Conclusions: The number of food outlets accessible online increased only in the most deprived areas in England. Future research might attempt to understand the extent to which changes in online food access were associated with changes in online food delivery service use and the possible implications on diet quality and health. %M 36848236 %R 10.2196/41822 %U https://publichealth.jmir.org/2023/1/e41822 %U https://doi.org/10.2196/41822 %U http://www.ncbi.nlm.nih.gov/pubmed/36848236 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45110 %T The Role of Community Cohesion in Older Adults During the COVID-19 Epidemic: Cross-sectional Study %A Li,Ying %A Ding,XiWen %A Aierken,Ayizuhere %A Pan,YiYang %A Chen,Yuan %A Hu,DongBin %+ Department of Social Medicine, School of Public Health, Zhejiang University, 866 Yu-hang-tang Road, HangZhou, 310058, China, 86 0571(8820)8590, liying2012@zju.edu.cn %K community cohesion %K physical and mental health %K community services %K environmental resources %K COVID-19 epidemic %K older adults %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The community environment plays a vital role in the health of older adults. During the COVID-19 epidemic, older adults, who were considered the most impacted and most vulnerable social group, were confined to their homes during the implementation of management and control measures for the epidemic. In such situations, older adults may have to contend with a lack of resources and experience anxiety. Therefore, identifying the environmental factors that are beneficial for their physical and mental health is critical. Objective: This study aimed to assess the association between community cohesion and the physical and mental health of older adults and to identify the related community services and environmental factors that may promote community cohesion. Methods: This community-based cross-sectional study was designed during the COVID-19 epidemic. A multistage sampling method was applied to this study. A total of 2036 participants aged ≥60 years were sampled from 27 locations in China. Data were collected through face-to-face interviews. The neighborhood cohesion instrument consisting of scales on 3 dimensions was used to assess community cohesion. Self-efficacy and life satisfaction, cognitive function and depression, and community services and environmental factors were also measured using standard instruments. Statistical analyses were restricted to 99.07% (2017/2036) of the participants. Separate logistic regression analysis was conducted to assess the association among community cohesion and physical and mental health factors, related community services, and environmental factors among older adults. Results: The results showed that high levels of community cohesion were associated with good self-perceived health status and life satisfaction (odds ratio [OR] 1.27, 95% CI 1.01-1.59 and OR 1.20, 95% CI 1.15-1.27, respectively) and high levels of self-efficacy and psychological resilience (OR 1.09, 95% CI 1.05-1.13 and OR 1.05, 95% CI 1.03-1.06, respectively). The length of stay in the community and the level of physical activity were positively associated with community cohesion scores, whereas the education level was negatively associated with community cohesion scores (P=.009). Community cohesion was also associated with low levels of depression and high levels of cognitive function. Community cohesion was significantly associated with community services and environmental factors on 4 dimensions. High levels of community cohesion were associated with transportation services and rehabilitation equipment rental services as well as high levels of satisfaction with community physicians’ technical expertise and community waste disposal (OR 3.14, 95% CI 1.87-5.28; OR 3.62, 95% CI 2.38-5.52; OR 1.37, 95% CI 1.08-1.73; and OR 1.23, 95% CI 1.01-1.50, respectively). Conclusions: Community cohesion was found to be associated with the physical and mental health of older adults. Our research suggests that enhancing community services and environmental resources may be an effective strategy to increase community cohesion during major infectious disease epidemics. %M 36921236 %R 10.2196/45110 %U https://publichealth.jmir.org/2023/1/e45110 %U https://doi.org/10.2196/45110 %U http://www.ncbi.nlm.nih.gov/pubmed/36921236 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e40821 %T The Relationship Between a History of High-risk and Destructive Behaviors and COVID-19 Infection: Preliminary Study %A Vike,Nicole L %A Bari,Sumra %A Stetsiv,Khrystyna %A Woodward,Sean %A Lalvani,Shamal %A Stefanopoulos,Leandros %A Kim,Byoung Woo %A Maglaveras,Nicos %A Katsaggelos,Aggelos K %A Breiter,Hans C %+ Department of Computer Science, University of Cincinnati, 2901 Woodside Drive, Cincinnati, OH, 45219, United States, 1 617 413 0953, breitehs@ucmail.uc.edu %K substance use %K gambling %K violent behaviors %K COVID-19 %K destructive behaviors %K mental health %D 2023 %7 14.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has heightened mental health concerns, but the temporal relationship between mental health conditions and SARS-CoV-2 infection has not yet been investigated. Specifically, psychological issues, violent behaviors, and substance use were reported more during the COVID-19 pandemic than before the pandemic. However, it is unknown whether a prepandemic history of these conditions increases an individual’s susceptibility to SARS-CoV-2. Objective: This study aimed to better understand the psychological risks underlying COVID-19, as it is important to investigate how destructive and risky behaviors may increase a person’s susceptibility to COVID-19. Methods: In this study, we analyzed data from a survey of 366 adults across the United States (aged 18 to 70 years); this survey was administered between February and March of 2021. The participants were asked to complete the Global Appraisal of Individual Needs–Short Screener (GAIN-SS) questionnaire, which indicates an individual’s history of high-risk and destructive behaviors and likelihood of meeting diagnostic criteria. The GAIN-SS includes 7 questions related to externalizing behaviors, 8 related to substance use, and 5 related to crime and violence; responses were given on a temporal scale. The participants were also asked whether they ever tested positive for COVID-19 and whether they ever received a clinical diagnosis of COVID-19. GAIN-SS responses were compared between those who reported and those who did not report COVID-19 to determine if those who reported COVID-19 also reported GAIN-SS behaviors (Wilcoxon rank sum test, α=.05). In total, 3 hypotheses surrounding the temporal relationships between the recency of GAIN-SS behaviors and COVID-19 infection were tested using proportion tests (α=.05). GAIN-SS behaviors that significantly differed (proportion tests, α=.05) between COVID-19 responses were included as independent variables in multivariable logistic regression models with iterative downsampling. This was performed to assess how well a history of GAIN-SS behaviors statistically discriminated between those who reported and those who did not report COVID-19. Results: Those who reported COVID-19 more frequently indicated past GAIN-SS behaviors (Q<0.05). Furthermore, the proportion of those who reported COVID-19 was higher (Q<0.05) among those who reported a history of GAIN-SS behaviors; specifically, gambling and selling drugs were common across the 3 proportion tests. Multivariable logistic regression revealed that GAIN-SS behaviors, particularly gambling, selling drugs, and attention problems, accurately modeled self-reported COVID-19, with model accuracies ranging from 77.42% to 99.55%. That is, those who exhibited destructive and high-risk behaviors before and during the pandemic could be discriminated from those who did not exhibit these behaviors when modeling self-reported COVID-19. Conclusions: This preliminary study provides insights into how a history of destructive and risky behaviors influences infection susceptibility, offering possible explanations for why some persons may be more susceptible to COVID-19, potentially in relation to reduced adherence to prevention guidelines or not seeking vaccination. %M 36888554 %R 10.2196/40821 %U https://formative.jmir.org/2023/1/e40821 %U https://doi.org/10.2196/40821 %U http://www.ncbi.nlm.nih.gov/pubmed/36888554 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40186 %T COVID-19 Vaccine Acceptance and Uptake in Bangkok, Thailand: Cross-sectional Online Survey %A Remmel,Christopher %A Tuli,Gaurav %A Varrelman,Tanner J %A Han,Aimee R %A Angkab,Pakkanan %A Kosiyaporn,Hathairat %A Netrpukdee,Chanikarn %A Sorndamrih,Supatnuj %A Thamarangsi,Thaksaphon %A Brownstein,John S %A Astley,Christina M %+ Computational Epidemiology Lab, Boston Children’s Hospital, 300 Longwood Ave, Boston, MA, 02115, United States, 1 617 355 6000, Christopher.Remmel@childrens.harvard.edu %K COVID-19 vaccines %K Thailand %K survey %K vaccines %K COVID-19 %K pandemic %K public health %K health policy %K epidemiology %K social media %K vaccine hesitancy %D 2023 %7 13.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The third most severe COVID-19 wave in the middle of 2021 coincided with the dual challenges of limited vaccine supply and lagging acceptance in Bangkok, Thailand. Understanding of persistent vaccine hesitancy during the “608” campaign to vaccinate those aged over 60 years and 8 medical risk groups was needed. On-the-ground surveys place further demands on resources and are scale limited. We leveraged the University of Maryland COVID-19 Trends and Impact Survey (UMD-CTIS), a digital health survey conducted among daily Facebook user samples, to fill this need and inform regional vaccine rollout policy. Objective: The aims of this study were to characterize COVID-19 vaccine hesitancy, frequent reasons for hesitancy, mitigating risk behaviors, and the most trusted sources of COVID-19 information through which to combat vaccine hesitancy in Bangkok, Thailand during the 608 vaccine campaign. Methods: We analyzed 34,423 Bangkok UMD-CTIS responses between June and October 2021, coinciding with the third COVID-19 wave. Sampling consistency and representativeness of the UMD-CTIS respondents were evaluated by comparing distributions of demographics, 608 priority groups, and vaccine uptake over time with source population data. Estimates of vaccine hesitancy in Bangkok and 608 priority groups were tracked over time. Frequently cited hesitancy reasons and trusted information sources were identified according to the 608 group and degree of hesitancy. Kendall tau was used to test statistical associations between vaccine acceptance and vaccine hesitancy. Results: The Bangkok UMD-CTIS respondents had similar demographics over weekly samples and compared to the Bangkok source population. Respondents self-reported fewer pre-existing health conditions compared to census data overall but had a similar prevalence of the important COVID-19 risk factor diabetes. UMD-CTIS vaccine uptake rose in parallel with national vaccination statistics, while vaccine hesitancy and degree of hesitancy declined (−7% hesitant per week). Concerns about vaccination side effects (2334/3883, 60.1%) and wanting to wait and see (2410/3883, 62.1%) were selected most frequently, while “not liking vaccines” (281/3883, 7.2%) and “religious objections” (52/3883, 1.3%) were selected least frequently. Greater vaccine acceptance was associated positively with wanting to “wait and see” and negatively with “don’t believe I need (the vaccine)” (Kendall tau 0.21 and −0.22, respectively; adjusted P<.001). Scientists and health experts were most frequently cited as trusted COVID-19 information sources (13,600/14,033, 96.9%), even among vaccine hesitant respondents. Conclusions: Our findings provide policy and health experts with evidence that vaccine hesitancy was declining over the study timeframe. Hesitancy and trust analyses among the unvaccinated support Bangkok policy measures to address vaccine safety and efficacy concerns through health experts rather than government or religious officials. Large-scale surveys enabled by existing widespread digital networks offer an insightful minimal-infrastructure resource for informing region-specific health policy needs. %M 36811852 %R 10.2196/40186 %U https://publichealth.jmir.org/2023/1/e40186 %U https://doi.org/10.2196/40186 %U http://www.ncbi.nlm.nih.gov/pubmed/36811852 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 12 %N %P e39455 %T Effects of Antidepressants on COVID-19 Outcomes: Retrospective Study on Large-Scale Electronic Health Record Data %A Rahman,Md Mahmudur %A Mahi,Atqiya Munawara %A Melamed,Rachel %A Alam,Mohammad Arif Ul %+ The Richard A Miner School of Computer & Information Sciences, University of Massachusetts, 220 Pawtucket St, Lowell, MA, 01854, United States, 1 978 934 1971, mohammadariful_alam@uml.edu %K causal inference %K treatment effect %K drug effect %K COVID-19 outcomes %K COVID-19 severity %K drug repurposing %K COVID-19 %K depression %K mental health %K data mining %K electronic health record %K machine learning %K antidepressant %K causal inference method %D 2023 %7 11.4.2023 %9 Original Paper %J Interact J Med Res %G English %X Background: Antidepressants exert an anticholinergic effect in varying degrees, and various classes of antidepressants can produce a different effect on immune function. While the early use of antidepressants has a notional effect on COVID-19 outcomes, the relationship between the risk of COVID-19 severity and the use of antidepressants has not been properly investigated previously owing to the high costs involved with clinical trials. Large-scale observational data and recent advancements in statistical analysis provide ample opportunity to virtualize a clinical trial to discover the detrimental effects of the early use of antidepressants. Objective: We primarily aimed to investigate electronic health records for causal effect estimation and use the data for discovering the causal effects of early antidepressant use on COVID-19 outcomes. As a secondary aim, we developed methods for validating our causal effect estimation pipeline. Methods: We used the National COVID Cohort Collaborative (N3C), a database aggregating health history for over 12 million people in the United States, including over 5 million with a positive COVID-19 test. We selected 241,952 COVID-19–positive patients (age >13 years) with at least 1 year of medical history. The study included a 18,584-dimensional covariate vector for each person and 16 different antidepressants. We used propensity score weighting based on the logistic regression method to estimate causal effects on the entire data. Then, we used the Node2Vec embedding method to encode SNOMED-CT (Systematized Nomenclature of Medicine-Clinical Terms) medical codes and applied random forest regression to estimate causal effects. We used both methods to estimate causal effects of antidepressants on COVID-19 outcomes. We also selected few negatively effective conditions for COVID-19 outcomes and estimated their effects using our proposed methods to validate their efficacy. Results: The average treatment effect (ATE) of using any one of the antidepressants was −0.076 (95% CI −0.082 to −0.069; P<.001) with the propensity score weighting method. For the method using SNOMED-CT medical embedding, the ATE of using any one of the antidepressants was −0.423 (95% CI −0.382 to −0.463; P<.001). Conclusions: We applied multiple causal inference methods with novel application of health embeddings to investigate the effects of antidepressants on COVID-19 outcomes. Additionally, we proposed a novel drug effect analysis–based evaluation technique to justify the efficacy of the proposed method. This study offers causal inference methods on large-scale electronic health record data to discover the effects of common antidepressants on COVID-19 hospitalization or a worse outcome. We found that common antidepressants may increase the risk of COVID-19 complications and uncovered a pattern where certain antidepressants were associated with a lower risk of hospitalization. While discovering the detrimental effects of these drugs on outcomes could guide preventive care, identification of beneficial effects would allow us to propose drug repurposing for COVID-19 treatment. %M 36881541 %R 10.2196/39455 %U https://www.i-jmr.org/2023/1/e39455 %U https://doi.org/10.2196/39455 %U http://www.ncbi.nlm.nih.gov/pubmed/36881541 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41010 %T The Evaluation of Health Care Services for Children and Adolescents With Post–COVID-19 Condition: Protocol for a Prospective Longitudinal Study %A Rathgeb,Chiara %A Pawellek,Maja %A Behrends,Uta %A Alberer,Martin %A Kabesch,Michael %A Gerling,Stephan %A Brandstetter,Susanne %A Apfelbacher,Christian %+ Institute of Social Medicine and Health Systems Research, Otto von Guericke University Magdeburg, Leipziger Str 44, Magdeburg, 39120, Germany, 49 0391 6724316, christian.apfelbacher@med.ovgu.de %K post-COVID %K long COVID %K post–COVID-19 condition %K PCC %K post–COVID-19 syndrome %K PCS %K CFS/ME %K children and adolescents %K health care services %K EQ-5D %K SDQ %K PROMIS %K DSQ-PEM %K COVID-19 %K pediatrics %K child %K adolescent %K service delivery %K healthcare delivery %K healthcare service %K care network %K healthcare %K therapeutic service %K healthcare utilization %K patient reported outcome %D 2023 %7 11.4.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Some children and adolescents suffer from late effects of a SARS-CoV-2 infection despite a frequently mild course of the disease. Nevertheless, extensive care for post–COVID-19 condition, also known as post–COVID-19 syndrome, in children and young people is not yet available. A comprehensive care network, Post-COVID Kids Bavaria (PoCo), for children and adolescents with post–COVID-19 condition has been set up as a model project in Bavaria, Germany. Objective: The aim of this study is to evaluate the health care services provided within this network structure of care for children and adolescents with post–COVID-19 condition in a pre-post study design. Methods: We have already recruited 117 children and adolescents aged up to 17 years with post–COVID-19 condition who were diagnosed and treated in 16 participating outpatient clinics. Health care use, treatment satisfaction, patient-reported outcomes related to health-related quality of life (the primary endpoint), fatigue, postexertional malaise, and mental health are being assessed at different time points (at baseline and after 4 weeks, 3 months, and 6 months) using routine data, interviews, and self-report questionnaires. Results: The study recruitment process ran from April 2022 until December 2022. Interim analyses will be carried out. A full analysis of the data will be conducted after follow-up assessment is completed, and the results will be published. Conclusions: The results will contribute to the evaluation of therapeutic services provided for post–COVID-19 condition in children and adolescents, and avenues for optimizing care may be identified. International Registered Report Identifier (IRRID): DERR1-10.2196/41010 %M 36867709 %R 10.2196/41010 %U https://www.researchprotocols.org/2023/1/e41010 %U https://doi.org/10.2196/41010 %U http://www.ncbi.nlm.nih.gov/pubmed/36867709 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43061 %T Defining County-Level Terrestrial Rabies Freedom Using the US National Rabies Surveillance System: Surveillance Data Analysis %A Kunkel,Amber %A Veytsel,Gabriella %A Bonaparte,Sarah %A Meek,Haillie %A Ma,Xiaoyue %A Davis,Amy J %A Bonwitt,Jesse %A Wallace,Ryan M %+ Division of High-Consequence Pathogens and Pathology, National Center for Emerging & Zoonotic Infectious Diseases, US Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, United States, 1 4046393538, sarahcbonaparte@gmail.com %K rabies %K surveillance %K zoonoses %K zoonosis %K model %K disease spread %K infection spread %K animal %K predict %K public health %D 2023 %7 7.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 37027194 %R 10.2196/43061 %U https://publichealth.jmir.org/2023/1/e43061 %U https://doi.org/10.2196/43061 %U http://www.ncbi.nlm.nih.gov/pubmed/37027194 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43836 %T COVID-19 Contact Tracing as an Indicator for Evaluating a Pandemic Situation: Simulation Study %A Marques-Cruz,Manuel %A Nogueira-Leite,Diogo %A Alves,João Miguel %A Fernandes,Francisco %A Fernandes,José Miguel %A Almeida,Miguel Ângelo %A Cunha Correia,Patrícia %A Perestrelo,Paula %A Cruz-Correia,Ricardo %A Pita Barros,Pedro %+ Department of Community Medicine, Information and Decision in Health, Faculty of Medicine, University of Porto, Faculdade de Medicina da Universidade do Porto, Rua Dr. Plácido da Costa, Porto, 4200-450, Portugal, 351 225513622, up201000048@up.pt %K COVID-19 %K public health %K public health surveillance %K quarantine %K infection transmission %K epidemiological models %D 2023 %7 6.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 36877958 %R 10.2196/43836 %U https://publichealth.jmir.org/2023/1/e43836 %U https://doi.org/10.2196/43836 %U http://www.ncbi.nlm.nih.gov/pubmed/36877958 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e42832 %T Predicting Measles Outbreaks in the United States: Evaluation of Machine Learning Approaches %A Ru,Boshu %A Kujawski,Stephanie %A Lee Afanador,Nelson %A Baumgartner,Richard %A Pawaskar,Manjiri %A Das,Amar %+ Merck & Co, Inc, 770 Sumneytown Pike, Main Stop: WP37A, West Point, PA, 19486, United States, 1 2156524301, boshu.ru@merck.com %K measles %K measles outbreaks %K measles epidemiology %K machine learning %K epidemiology %K hybrid machine learning %K infectious disease modeling %K infectious disease outbreak prediction %K unsupervised machine learning %K supervised machine learning %K infectious disease %K model %K predict %K outbreak %D 2023 %7 4.4.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Measles, a highly contagious viral infection, is resurging in the United States, driven by international importation and declining domestic vaccination coverage. Despite this resurgence, measles outbreaks are still rare events that are difficult to predict. Improved methods to predict outbreaks at the county level would facilitate the optimal allocation of public health resources. Objective: We aimed to validate and compare extreme gradient boosting (XGBoost) and logistic regression, 2 supervised learning approaches, to predict the US counties most likely to experience measles cases. We also aimed to assess the performance of hybrid versions of these models that incorporated additional predictors generated by 2 clustering algorithms, hierarchical density-based spatial clustering of applications with noise (HDBSCAN) and unsupervised random forest (uRF). Methods: We constructed a supervised machine learning model based on XGBoost and unsupervised models based on HDBSCAN and uRF. The unsupervised models were used to investigate clustering patterns among counties with measles outbreaks; these clustering data were also incorporated into hybrid XGBoost models as additional input variables. The machine learning models were then compared to logistic regression models with and without input from the unsupervised models. Results: Both HDBSCAN and uRF identified clusters that included a high percentage of counties with measles outbreaks. XGBoost and XGBoost hybrid models outperformed logistic regression and logistic regression hybrid models, with the area under the receiver operating curve values of 0.920-0.926 versus 0.900-0.908, the area under the precision-recall curve values of 0.522-0.532 versus 0.485-0.513, and F2 scores of 0.595-0.601 versus 0.385-0.426. Logistic regression or logistic regression hybrid models had higher sensitivity than XGBoost or XGBoost hybrid models (0.837-0.857 vs 0.704-0.735) but a lower positive predictive value (0.122-0.141 vs 0.340-0.367) and specificity (0.793-0.821 vs 0.952-0.958). The hybrid versions of the logistic regression and XGBoost models had slightly higher areas under the precision-recall curve, specificity, and positive predictive values than the respective models that did not include any unsupervised features. Conclusions: XGBoost provided more accurate predictions of measles cases at the county level compared with logistic regression. The threshold of prediction in this model can be adjusted to align with each county’s resources, priorities, and risk for measles. While clustering pattern data from unsupervised machine learning approaches improved some aspects of model performance in this imbalanced data set, the optimal approach for the integration of such approaches with supervised machine learning models requires further investigation. %M 37014694 %R 10.2196/42832 %U https://formative.jmir.org/2023/1/e42832 %U https://doi.org/10.2196/42832 %U http://www.ncbi.nlm.nih.gov/pubmed/37014694 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44491 %T Enhancing Public Health Communication Regarding Vaccine Trials: Design and Development of the Pan-European VACCELERATE Toolkit %A Argyropoulos,Christos D %A Leckler,Janina %A Salmanton-García,Jon %A Constantinou,Marinos %A Alexandrou,Alexandra %A Themistocleous,Sophia %A Noula,Evgenia %A Shiamakkides,George %A Nearchou,Andria %A Stewart,Fiona A %A Albus,Kerstin %A Koniordou,Markela %A Kopsidas,Ioannis %A Spivak,Orly %A Hellemans,Margot %A Hendrickx,Greet %A Davis,Ruth Joanna %A Azzini,Anna Maria %A Simon,Paula Valle %A Carcas-Sansuan,Antonio Javier %A Askling,Helena Hervius %A Vene,Sirkka %A Prellezo,Jana Baranda %A Álvarez-Barco,Elena %A Macken,Alan J %A Di Marzo,Romina %A Luís,Catarina %A Olesen,Ole F %A Frias Iniesta,Jesus A %A Barta,Imre %A Tóth,Krisztina %A Akova,Murat %A Bonten,Marc M J %A Cohen-Kandli,Miriam %A Cox,Rebecca Jane %A Součková,Lenka %A Husa,Petr %A Jancoriene,Ligita %A Launay,Odile %A Lundgren,Jens %A Mallon,Patrick %A Armeftis,Charis %A Marques,Laura %A Naucler,Pontus %A Ochando,Jordi %A Tacconelli,Evelina %A van Damme,Pierre %A Zaoutis,Theoklis %A Hofstraat,Sanne %A Bruijning-Verhagen,Patricia %A Zeitlinger,Markus %A Cornely,Oliver A %A Pana,Zoi Dorothea %+ School of Medicine, European University Cyprus, 6 Diogenis Str, Egkomi, Nicosia, 2404, Cyprus, 357 94049474, z.pana@euc.ac.cy %K vaccine trials %K volunteer registry %K educational material %K promotional material %K patient education %K health communication %K health promotion %K public health %K COVID-19 %K coronavirus %K SARS-CoV-2 %K pandemic %K vaccine %K vaccination %K hesitancy %K campaign %K misinformation %D 2023 %7 3.4.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The pan-European VACCELERATE network aims to implement the first transnational harmonized and sustainable vaccine trial Volunteer Registry, being a single entry point for potential volunteers of large-scale vaccine trials across Europe. This work exhibits a set of harmonized vaccine trial–related educational and promotional tools for the general public, designed and disseminated by the pan-European VACCELERATE network. Objective: This study primarily aimed to design and develop a standard toolkit to increase positive attitudes and access to trustworthy information for better access and increased recruitment to vaccine trials for the public. More specifically, the produced tools are focused on inclusiveness and equity, and are targeting different population groups, including underserved ones, as potential volunteers for the VACCELERATE Volunteer Registry (older individuals, migrants, children, and adolescents). The promotional and educational material is aligned with the main objectives of the Volunteer Registry to increase public literacy and awareness regarding vaccine-related clinical research or trials and trial participation, including informed consent and legal issues, side effects, and frequently asked questions regarding vaccine trial design. Methods: Tools were developed per the aims and principles of the VACCELERATE project, focusing on trial inclusiveness and equity, and are adjusted to local country-wise requirements to improve public health communication. The produced tools are selected based on the cognitive theory, inclusiveness, and equity of differently aged and underrepresented groups, and standardized material from several official trustworthy sources (eg, COVID-19 Vaccines Global Access; the European Centre for Disease Prevention and Control; the European Patients’ Academy on Therapeutic Innovation; Gavi, the Vaccine Alliance; and the World Health Organization). A team of multidisciplinary specialists (infectious diseases, vaccine research, medicine, and education) edited and reviewed the subtitles and scripts of the educational videos, extended brochures, interactive cards, and puzzles. Graphic designers selected the color palette, audio settings, and dubbing for the video story-tales and implemented QR codes. Results: This study presents the first set of harmonized promotional and educational materials and tools (ie, educational cards, educational and promotional videos, extended brochures, flyers, posters, and puzzles) for vaccine clinical research (eg, COVID-19 vaccines). These tools inform the public about possible benefits and disadvantages of trial participation and build confidence among participants about the safety and efficacy of COVID-19 vaccines and the health care system. This material has been translated into several languages and is intended to be freely and easily accessible to facilitate dissemination among VACCELERATE network participant countries and the European and global scientific, industrial, and public community. Conclusions: The produced material could help fill knowledge gaps of health care personnel, providing the appropriate future patient education for vaccine trials, and tackling vaccine hesitancy and parents’ concerns for potential participation of children in vaccine trials. %M 36878478 %R 10.2196/44491 %U https://publichealth.jmir.org/2023/1/e44491 %U https://doi.org/10.2196/44491 %U http://www.ncbi.nlm.nih.gov/pubmed/36878478 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e45697 %T US Adults Practicing Healthy Lifestyles Before and During COVID-19: Comparative Analysis of National Surveys %A Tam,Hon Lon %A Chair,Sek Ying %A Leung,Isaac Sze Him %A Leung,Leona Yuen Ling %A Chan,Alex Siu Wing %+ The Nethersole School of Nursing, The Chinese University of Hong Kong, Rm 704B, 7/F, Esther Lee Building, Shatin, NT, China (Hong Kong), 852 39439306, hltam@cuhk.edu.hk %K healthy lifestyle %K health risk behaviors %K habits %K noncommunicable diseases %K population surveillance %K Behavioural Risk Factor Surveillance System %K BRFSS %D 2023 %7 31.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Practicing healthy lifestyles can reduce the risk to develop noncommunicable diseases and the related mortality. Studies showed that practicing healthy lifestyles could enhance disease-free life expectancy and preserve bodily functions. However, engagement in healthy lifestyle behavior was suboptimal. Objective: This study aimed to define individuals’ lifestyle characteristics before and during COVID-19 and determine the factors associated with practicing a healthy lifestyle. This cross-sectional study was conducted using data from the 2019 and 2021 Behavioral Risk Factor Surveillance System surveys. Methods: US individuals aged ≥18 years were interviewed via phone call. Healthy lifestyles were assessed through corresponding questions regarding the maintenance of optimal body weight, physical activity, daily consumption of at least five portions of fruits and vegetables, current smoking status, and alcohol consumption. Missing data were imputed using a package in the R statistical software. The effects of practicing a healthy lifestyle on cases without missing data and those with imputation were reported. Results: There were 550,607 respondents (272,543 and 278,064 from 2019 and 2021, respectively) included in this analysis. The rates of practicing a healthy lifestyle were 4% (10,955/272,543) and 3.6% (10,139/278,064) in 2019 and 2021, respectively. Although 36.6% (160,629/438,693) of all 2021 respondents had missing data, the results of the logistic regression analysis for cases without missing data and those with imputation were similar. Of the cases with imputation, women (odds ratio [OR] 1.87) residing in urban areas (OR 1.24) with high education levels (OR 1.73) and good or better health status (OR 1.59) were more likely to practice healthier lifestyles than young individuals (OR 0.51-0.67) with a low household income (OR 0.74-0.78) and chronic health conditions (OR 0.48-0.74). Conclusions: A healthy lifestyle should be strongly promoted at the community level. In particular, factors associated with a low rate of practice of healthy lifestyles should be targeted. %M 36940169 %R 10.2196/45697 %U https://publichealth.jmir.org/2023/1/e45697 %U https://doi.org/10.2196/45697 %U http://www.ncbi.nlm.nih.gov/pubmed/36940169 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40587 %T COVID-19 Vaccination Preferences Among Non-Chinese Migrants in Hong Kong: Discrete Choice Experiment %A Asim,Saba %A Wang,Kailu %A Nichini,Elena %A Yip,Faustina Fu %A Zhu,Liling %A Fung,Hin Chung Eddy %A Zeng,Yan %A Fang,Zhilan %A Cheung,Annie Wai-Ling %A Wong,Eliza Lai-yi %A Dong,Dong %A Yeoh,Eng-Kiong %+ Centre for Health Systems and Policy Research, The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, 4/F School of Public Health Building, Prince of Wales Hospital, Shatin, Hong Kong, 852 22528461, dongdong@cuhk.edu.hk %K COVID-19 vaccination %K migrants %K discrete choice experiment %K ethnic minorities %K vaccine attributes %K Hong Kong %K COVID-19 %D 2023 %7 27.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 36848242 %R 10.2196/40587 %U https://publichealth.jmir.org/2023/1/e40587 %U https://doi.org/10.2196/40587 %U http://www.ncbi.nlm.nih.gov/pubmed/36848242 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43652 %T Decisions and Decisional Needs of Canadians From all Provinces and Territories During the COVID-19 Pandemic: Population-Based Cross-sectional Surveys %A Stacey,Dawn %A Ludwig,Claire %A Archambault,Patrick %A Smith,Maureen %A Taljaard,Monica %A Carley,Meg %A Plourde,Karine %A Boland,Laura %A Gogovor,Amédé %A Graham,Ian %A Kobewka,Daniel %A McLean,Robert K D %A Nelson,Michelle L A %A Vanderspank-Wright,Brandi %A Légaré,France %+ School of Nursing, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON, K1H 8M5, Canada, 1 613 562 5800 ext 8413, dstacey@uottawa.ca %K health care decisions %K decisional conflict %K decision regret %K shared decision-making %K COVID-19 %K older adults %K caregivers %K parents %K public health decision %K health care %K health outcome %K pandemic preparedness %K public health policy %D 2023 %7 21.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Never before COVID-19 had Canadians faced making health-related decisions in a context of significant uncertainty. However, little is known about which type of decisions and the types of difficulties that they faced. Objective: We sought to identify the health-related decisions and decisional needs of Canadians. Methods: Our study was codesigned by researchers and knowledge users (eg, patients, clinicians). Informed by the CHERRIES (the Checklist for Reporting Results of Internet E-Surveys) reporting guideline, we conducted 2 online surveys of random samples drawn from the Leger consumer panel of 400,000 Canadians. Eligible participants were adults (≥18 years) who received or were receiving any health services in the past 12 months for themselves (adults) or for their child (parent) or senior with cognitive impairment (caregiver). We assessed decisions and decisional needs using questions informed by the Ottawa Decision Support Framework, including decisional conflict and decision regret using the Decision Conflict Scale (DCS) and the Decision Regret Scale (DRS), respectively. Descriptive statistics were conducted for adults who had decided for themselves or on behalf of someone else. Significant decisional conflict (SDC) was defined as a total DCS score of >37.5 out of 100, and significant decision regret was defined as a total DRS score of >25 out of 100. Results: From May 18 to June 4, 2021, 14,459 adults and 6542 parents/caregivers were invited to participate. The invitation view rate was 15.5% (2236/14,459) and 28.3% (1850/6542); participation rate, 69.3% (1549/2236) and 28.7% (531/1850); and completion rate, 97.3% (1507/1549) and 95.1% (505/531), respectively. The survey was completed by 1454 (97.3%) adults and 438 (95.1%) parents/caregivers in English (1598/1892, 84.5%) or French (294/1892, 15.5%). Respondents from all 10 Canadian provinces and the northern territories represented a range of ages, education levels, civil statuses, ethnicities, and annual household income. Of 1892 respondents, 541 (28.6%) self-identified as members of marginalized groups. The most frequent decisions were (adults vs parents/caregivers) as follows: COVID-19 vaccination (490/1454, 33.7%, vs 87/438, 19.9%), managing a health condition (253/1454, 17.4%, vs 47/438, 10.7%), other COVID-19 decisions (158/1454, 10.9%, vs 85/438, 19.4%), mental health care (128/1454, 8.8%, vs 27/438, 6.2%), and medication treatments (115/1454, 7.9%, vs 23/438, 5.3%). Caregivers also reported decisions about moving family members to/from nursing or retirement homes (48/438, 11.0%). Adults (323/1454, 22.2%) and parents/caregivers (95/438, 21.7%) had SDC. Factors making decisions difficult were worrying about choosing the wrong option (557/1454, 38.3%, vs 184/438, 42.0%), worrying about getting COVID-19 (506/1454, 34.8%, vs 173/438, 39.5%), public health restrictions (427/1454, 29.4%, vs 158/438, 36.1%), information overload (300/1454, 20.6%, vs 77/438, 17.6%), difficulty separating misinformation from scientific evidence (297/1454, 20.4%, vs 77/438, 17.6%), and difficulty discussing decisions with clinicians (224/1454, 15.4%, vs 51/438, 11.6%). For 1318 (90.6%) adults and 366 (83.6%) parents/caregivers who had decided, 353 (26.8%) and 125 (34.2%) had significant decision regret, respectively. In addition, 1028 (50%) respondents made their decision alone without considering the opinions of clinicians. Conclusions: During COVID-19, Canadians who responded to the survey faced several new health-related decisions. Many reported unmet decision-making needs, resulting in SDC and decision regret. Interventions can be designed to address their decisional needs and support patients facing new health-related decisions. %M 36688986 %R 10.2196/43652 %U https://publichealth.jmir.org/2023/1/e43652 %U https://doi.org/10.2196/43652 %U http://www.ncbi.nlm.nih.gov/pubmed/36688986 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 10 %N %P e43819 %T Web-Based COVID-19 Dashboards and Trackers in the United States: Survey Study %A Clarkson,Melissa D %+ Division of Biomedical Informatics, University of Kentucky, 725 Rose Street, Lexington, KY, 40536, United States, 1 859 323 7232, mclarkson@uky.edu %K COVID-19 %K data visualization %K data dashboard %K public health reporting %K human information interaction %K transparency %K trust %D 2023 %7 20.3.2023 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The SARS-CoV-2 pandemic provided an opportunity to use public-facing web data visualization tools to help citizens understand the evolving status of the outbreak. Given the heterogeneity of data sources, developers, tools, and designs used in this effort, it raised questions about how visualizations were constructed during a time when daily batches of data were available, but issues of data quality and standardization were unresolved. Objective: This paper surveyed web-based COVID-19 dashboards and trackers that are likely to be used by the residents of the United States to monitor the spread of infection on a local, national, and global scale. This study is intended to provide insights that will help application developers increase the usefulness, transparency, and trustworthiness of dashboards and trackers for public health data in the future. Methods: Websites of coronavirus dashboards and trackers were identified in August 2020 using the Google search engine. They were examined to determine the data sources used, types of data presented, types of data visualizations, characteristics of the visualizations, and issues with messy data. The websites were surveyed 3 more times for changes in design and data sources with the final survey conducted in June 2022. Themes were developed to highlight the issues concerning challenges in presenting COVID-19 data and techniques of effective visualization. Results: In total, 111 websites were identified and examined (84 state focused, 11 nationwide, and 16 with global data), and this study found an additional 17 websites providing access to the state vaccination data. This study documents how data aggregators have played a central role in making data accessible to visualization developers. The designs of dashboards and tracker visualizations vary in type and quality, with some well-designed displays supporting the interpretation of the data and others obscuring the meaning of the data and potentially misleading the viewers. Five themes were identified to describe challenges in presenting COVID-19 data and techniques of effective visualization. Conclusions: This analysis reveals the extent to which dashboards and trackers informing the American public about the COVID-19 pandemic relied on an ad hoc pipeline of data sources and data aggregators. The dashboards and trackers identified in this survey offer an opportunity to compare different approaches for the display of similar data. %M 36696270 %R 10.2196/43819 %U https://humanfactors.jmir.org/2023/1/e43819 %U https://doi.org/10.2196/43819 %U http://www.ncbi.nlm.nih.gov/pubmed/36696270 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41197 %T Repeat Ivermectin Mass Drug Administrations for Malaria Control II: Protocol for a Double-blind, Cluster-Randomized, Placebo-Controlled Trial for the Integrated Control of Malaria %A Foy,Brian D %A Some,Anthony %A Magalhaes,Tereza %A Gray,Lyndsey %A Rao,Sangeeta %A Sougue,Emmanuel %A Jackson,Conner L %A Kittelson,John %A Slater,Hannah C %A Bousema,Teun %A Da,Ollo %A Coulidiaty,A Gafar V %A Colt,McKenzie %A Wade,Martina %A Richards,Kacey %A Some,A Fabrice %A Dabire,Roch K %A Parikh,Sunil %+ Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, Room 724, New Haven, CT, 06520, United States, 1 2037377906, sunil.parikh@yale.edu %K malaria %K ivermectin %K mass drug administration %K mosquito %K Anopheles %K endectocide %K cluster-randomized %K clinical trial %K seasonal malaria chemoprevention %K transmission %D 2023 %7 20.3.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: The gains made against malaria have stagnated since 2015, threatened further by increasing resistance to insecticides and antimalarials. Improvement in malaria control necessitates a multipronged strategy, which includes the development of novel tools. One such tool is mass drug administration (MDA) with endectocides, primarily ivermectin, which has shown promise in reducing malaria transmission through lethal and sublethal impacts on the mosquito vector. Objective: The primary objective of the study is to assess the impact of repeated ivermectin MDA on malaria incidence in children aged ≤10 years. Methods: Repeat Ivermectin MDA for Malaria Control II is a double-blind, placebo-controlled, cluster-randomized, and parallel-group trial conducted in a setting with intense seasonal malaria transmission in Southwest Burkina Faso. The study included 14 discrete villages: 7 (50%) randomized to receive standard measures (seasonal malaria chemoprevention [SMC] and bed net use for children aged 3 to 59 months) and placebo, and 7 (50%) randomized to receive standard measures and monthly ivermectin MDA at 300 μg/kg for 3 consecutive days, provided under supervision to all eligible village inhabitants, over 2 successive rainy seasons. Nonpregnant individuals >90 cm in height were eligible for ivermectin MDA, and cotreatment with ivermectin and SMC was not permitted. The primary outcome is malaria incidence in children aged ≤10 years, as assessed by active case surveillance. The secondary safety outcome of repeated ivermectin MDA was assessed through active and passive adverse event monitoring. Results: The trial intervention was conducted from July to November in 2019 and 2020, with additional sampling of humans and mosquitoes occurring through February 2022 to assess postintervention changes in transmission patterns. Additional human and entomological assessments were performed over the 2 years in a subset of households from 6 cross-sectional villages. A subset of individuals underwent additional sampling in 2020 to characterize ivermectin pharmacokinetics and pharmacodynamics. Analysis and unblinding will commence once the database has been completed, cleaned, and locked. Conclusions: Our trial represents the first study to directly assess the impact of a novel approach for malaria control, ivermectin MDA as a mosquitocidal agent, layered into existing standard-of-care interventions. The study was designed to leverage the current SMC deployment infrastructure and will provide evidence regarding the additional benefit of ivermectin MDA in reducing malaria incidence in children. Trial Registrations: ClinicalTrials.gov NCT03967054; https://clinicaltrials.gov/ct2/show/NCT03967054 and Pan African Clinical Trials Registry PACT201907479787308; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=8219 International Registered Report Identifier (IRRID): DERR1-10.2196/41197 %M 36939832 %R 10.2196/41197 %U https://www.researchprotocols.org/2023/1/e41197 %U https://doi.org/10.2196/41197 %U http://www.ncbi.nlm.nih.gov/pubmed/36939832 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e43183 %T Rapid SARS-CoV-2 Antigen Detection Self-Tests to Increase COVID-19 Case Detection in Peru: Qualitative Study %A Torres-Slimming,Paola A %A Carcamo,Cesar %A Martínez-Pérez,Guillermo Z %A Mallma,Patricia %A Pflucker,Cristina %A Shilton,Sonjelle %+ Universidad Peruana Cayetano Heredia, Av Honorio Delgado 430, San Martín de Porres, Lima, 15102, Peru, 51 3190000, paola.torres.s@upch.pe %K Peru, COVID-19 %K self-testing %K diagnostics %K qualitative research %K testing %K virus %K detection %K health %K decision-making %K public %K willingness %K health system %D 2023 %7 17.3.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic heavily impacted many low- and middle-income countries (LMICs), such as Peru, overwhelming their health systems. Rapid antigen detection self-tests for SARS-CoV-2, the virus that causes COVID-19, have been proposed as a portable, safe, affordable, and easy-to-perform approach to improve early detection and surveillance of SARS-CoV-2 in resource-constrained populations where there are gaps in access to health care. Objective: This study aims to explore decision makers’ values and attitudes around SARS-CoV-2 self-testing. Methods: In 2021, we conducted a qualitative study in 2 areas of Peru (urban Lima and rural Valle del Mantaro). Purposive sampling was used to identify representatives of civil society groups (RSCs), health care workers (HCWs), and potential implementers (PIs) to act as informants whose voices would provide a proxy for the public’s attitudes around self-testing. Results: In total, 30 informants participated in individual, semistructured interviews (SSIs) and 29 informants participated in 5 focus group discussions (FGDs). Self-tests were considered to represent an approach to increase access to testing that both the rural and urban public in Peru would accept. Results showed that the public would prefer saliva-based self-tests and would prefer to access them in their community pharmacies. In addition, information about how to perform a self-test should be clear for each population subgroup in Peru. The tests should be of high quality and low cost. Health-informed communication strategies must also accompany any introduction of self-testing. Conclusions: In Peru, decision makers consider that the public would be willing to accept SARS-CoV-2 self-tests if they are accurate, safe to use, easily available, and affordable. Adequate information about the self-tests’ features and instructions, as well as about postuse access to counseling and care, must be made available through the Ministry of Health in Peru. %M 36867689 %R 10.2196/43183 %U https://formative.jmir.org/2023/1/e43183 %U https://doi.org/10.2196/43183 %U http://www.ncbi.nlm.nih.gov/pubmed/36867689 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43762 %T Community-Level Social Support to Mitigate the Impact of Combined Frailty and Multimorbidity on Psychological Distress Among Rural Chinese Older Adults During the COVID-19 Pandemic: Multilevel Modeling Study %A Wang,Yi %A Fu,Peipei %A Li,Jie %A Gao,Tingting %A Jing,Zhengyue %A Wang,Qiong %A Zhao,Dan %A Zhou,Chengchao %+ Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 Wen-hua-xi Road, Jinan, 250012, China, 86 531 8838 1567, zhouchengchao@sdu.edu.cn %K psychological distress %K frailty %K multimorbidity %K community-level social support %K COVID-19 pandemic %K psychological %K rural %K older adults %K community %K support %K effectiveness %D 2023 %7 9.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Accumulating research provides evidence that the psychological health of older people deteriorated from before to during the COVID-19 pandemic. Unlike robust individuals, coexisting frailty and multimorbidity expose older adults to more complicated and wide-ranging stressors. Community-level social support (CSS) is also an important impetus for age-friendly interventions, and it is 1 of the components of social capital that is seen as an ecological-level property. To date, we have not found research that examines whether CSS buffered the adverse impacts of combined frailty and multimorbidity on psychological distress in a rural setting during COVID-19 in China. Objective: This study explores the combined effect of frailty and multimorbidity on psychological distress in rural Chinese older adults during the COVID-19 pandemic and examines whether CSS would buffer the aforementioned association. Methods: Data used in this study were extracted from 2 waves of the Shandong Rural Elderly Health Cohort (SREHC), and the final analytic sample included 2785 respondents who participated in both baseline and follow-up surveys. Multilevel linear mixed effects models were used to quantify the strength of the longitudinal association between frailty and multimorbidity combinations and psychological distress using 2 waves of data for each participant, and then, cross-level interactions between CSS and combined frailty and multimorbidity were included to test whether CSS would buffer the adverse impact of coexisting frailty and multimorbidity on psychological distress. Results: Frail older adults with multimorbidity reported the most psychological distress compared to individuals with only 1 or none of the conditions (β=.68, 95% CI 0.60-0.77, P<.001), and baseline coexisting frailty and multimorbidity predicted the most psychological distress during the COVID-19 pandemic (β=.32, 95% CI 0.22-0.43, P<.001). Further, CSS moderated the aforementioned association (β=–.16, 95% CI –0.23 to –0.09, P<.001), and increased CSS buffered the adverse effect of coexisting frailty and multimorbidity on psychological distress during the COVID-19 pandemic (β=–.11, 95% CI –0.22 to –0.01, P=.035). Conclusions: Our findings suggest that more public health and clinical attention should be paid to psychological distress among multimorbid older adults with frailty when facing public health emergencies. This research also suggests that community-level interventions prioritizing social support mechanisms, specifically improving the average levels of social support within communities, may be an effective approach to alleviate psychological distress for rural older adults who concurrently manifest frailty and multimorbidity. %M 36811848 %R 10.2196/43762 %U https://publichealth.jmir.org/2023/1/e43762 %U https://doi.org/10.2196/43762 %U http://www.ncbi.nlm.nih.gov/pubmed/36811848 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42425 %T Spatiotemporal Changes in Pulmonary Tuberculosis Incidence in a Low-Epidemic Area of China in 2005-2020: Retrospective Spatiotemporal Analysis %A Zhang,Qi %A Ding,Huan %A Gao,Song %A Zhang,Shipeng %A Shen,Shiya %A Chen,Xiaoyan %A Xu,Zhuping %+ Department of Chronic Communicable Disease, The Affiliated Wuxi Center for Disease Control and Prevention of Nanjing Medical University, Wuxi Center for Disease Control and Prevention, 499 Jin Cheng Road, Wuxi, 214023, China, 86 0510 82726760, Xzp15951589696@163.com %K pulmonary tuberculosis %K spatial analysis %K temporal analysis %K epidemiology %K China %D 2023 %7 8.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In China, tuberculosis (TB) is still a major public health problem, and the incidence of TB has significant spatial heterogeneity. Objective: This study aimed to investigate the temporal trends and spatial patterns of pulmonary tuberculosis (PTB) in a low-epidemic area of eastern China, Wuxi city, from 2005 to 2020. Methods: The data of PTB cases from 2005 to 2020 were obtained from the Tuberculosis Information Management System. The joinpoint regression model was used to identify the changes in the secular temporal trend. Kernel density analysis and hot spot analysis were used to explore the spatial distribution characteristics and clusters of the PTB incidence rate. Results: A total of 37,592 cases were registered during 2005-2020, with an average annual incidence rate of 34.6 per 100,000 population. The population older than 60 years had the highest incidence rate of 59.0 per 100,000 population. In the study period, the incidence rate decreased from 50.4 to 23.9 per 100,000 population, with an average annual percent change of –4.9% (95% CI –6.8% to –2.9%). The incidence rate of pathogen-positive patients increased during 2017-2020, with an annual percent change of 13.4% (95% CI 4.3%-23.2%). The TB cases were mainly concentrated in the city center, and the incidence of hot spots areas gradually changed from rural areas to urban areas during the study period. Conclusions: The PTB incidence rate in Wuxi city has been declining rapidly with the effective implementation of strategies and projects. The populated urban centers will become key areas of TB prevention and control, especially in the older population. %M 36884278 %R 10.2196/42425 %U https://publichealth.jmir.org/2023/1/e42425 %U https://doi.org/10.2196/42425 %U http://www.ncbi.nlm.nih.gov/pubmed/36884278 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e38072 %T Tracking Changes in Mobility Before and After the First SARS-CoV-2 Vaccination Using Global Positioning System Data in England and Wales (Virus Watch): Prospective Observational Community Cohort Study %A Nguyen,Vincent %A Liu,Yunzhe %A Mumford,Richard %A Flanagan,Benjamin %A Patel,Parth %A Braithwaite,Isobel %A Shrotri,Madhumita %A Byrne,Thomas %A Beale,Sarah %A Aryee,Anna %A Fong,Wing Lam Erica %A Fragaszy,Ellen %A Geismar,Cyril %A Navaratnam,Annalan M D %A Hardelid,Pia %A Kovar,Jana %A Pope,Addy %A Cheng,Tao %A Hayward,Andrew %A Aldridge,Robert %A , %+ Centre for Public Health Data Science, Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, United Kingdom, 44 20 3549 5541, r.aldridge@ucl.ac.uk %K COVID-19 %K SARS-CoV-2 %K vaccination %K global positioning system %K GPS %K movement tracking %K geographical tracking %K mobile app %K health application %K surveillance %K public health %K mHealth %K mobile surveillance %K tracking device %K geolocation %D 2023 %7 8.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Evidence suggests that individuals may change adherence to public health policies aimed at reducing the contact, transmission, and spread of the SARS-CoV-2 virus after they receive their first SARS-CoV-2 vaccination when they are not fully vaccinated. Objective: We aimed to estimate changes in median daily travel distance of our cohort from their registered addresses before and after receiving a SARS-CoV-2 vaccine. Methods: Participants were recruited into Virus Watch starting in June 2020. Weekly surveys were sent out to participants, and vaccination status was collected from January 2021 onward. Between September 2020 and February 2021, we invited 13,120 adult Virus Watch participants to contribute toward our tracker subcohort, which uses the GPS via a smartphone app to collect data on movement. We used segmented linear regression to estimate the median daily travel distance before and after the first self-reported SARS-CoV-2 vaccine dose. Results: We analyzed the daily travel distance of 249 vaccinated adults. From 157 days prior to vaccination until the day before vaccination, the median daily travel distance was 9.05 (IQR 8.06-10.09) km. From the day of vaccination to 105 days after vaccination, the median daily travel distance was 10.08 (IQR 8.60-12.42) km. From 157 days prior to vaccination until the vaccination date, there was a daily median decrease in mobility of 40.09 m (95% CI –50.08 to –31.10; P<.001). After vaccination, there was a median daily increase in movement of 60.60 m (95% CI 20.90-100; P<.001). Restricting the analysis to the third national lockdown (January 4, 2021, to April 5, 2021), we found a median daily movement increase of 18.30 m (95% CI –19.20 to 55.80; P=.57) in the 30 days prior to vaccination and a median daily movement increase of 9.36 m (95% CI 38.6-149.00; P=.69) in the 30 days after vaccination. Conclusions: Our study demonstrates the feasibility of collecting high-volume geolocation data as part of research projects and the utility of these data for understanding public health issues. Our various analyses produced results that ranged from no change in movement after vaccination (during the third national lock down) to an increase in movement after vaccination (considering all periods, up to 105 days after vaccination), suggesting that, among Virus Watch participants, any changes in movement distances after vaccination are small. Our findings may be attributable to public health measures in place at the time such as movement restrictions and home working that applied to the Virus Watch cohort participants during the study period. %M 36884272 %R 10.2196/38072 %U https://publichealth.jmir.org/2023/1/e38072 %U https://doi.org/10.2196/38072 %U http://www.ncbi.nlm.nih.gov/pubmed/36884272 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e44251 %T Dining-Out Behavior as a Proxy for the Superspreading Potential of SARS-CoV-2 Infections: Modeling Analysis %A Chong,Ka Chun %A Li,Kehang %A Guo,Zihao %A Jia,Katherine Min %A Leung,Eman Yee Man %A Zhao,Shi %A Hung,Chi Tim %A Yam,Carrie Ho Kwan %A Chow,Tsz Yu %A Dong,Dong %A Wang,Huwen %A Wei,Yuchen %A Yeoh,Eng Kiong %+ Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 415, School of Public Health Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, 852 22528702, yeoh_ek@cuhk.edu.hk %K COVID-19 %K contact tracing %K unlinked %K superspreading %K dispersion %K public health %K surveillance %K digital health surveillance %K digital surveillance %K disease spread %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: While many studies evaluated the reliability of digital mobility metrics as a proxy of SARS-CoV-2 transmission potential, none examined the relationship between dining-out behavior and the superspreading potential of COVID-19. Objective: We employed the mobility proxy of dining out in eateries to examine this association in Hong Kong with COVID-19 outbreaks highly characterized by superspreading events. Methods: We retrieved the illness onset date and contact-tracing history of all laboratory-confirmed cases of COVID-19 from February 16, 2020, to April 30, 2021. We estimated the time-varying reproduction number (Rt) and dispersion parameter (k), a measure of superspreading potential, and related them to the mobility proxy of dining out in eateries. We compared the relative contribution to the superspreading potential with other common proxies derived by Google LLC and Apple Inc. Results: A total of 6391 clusters involving 8375 cases were used in the estimation. A high correlation between dining-out mobility and superspreading potential was observed. Compared to other mobility proxies derived by Google and Apple, the mobility of dining-out behavior explained the highest variability of k (ΔR-sq=9.7%, 95% credible interval: 5.7% to 13.2%) and Rt (ΔR-sq=15.7%, 95% credible interval: 13.6% to 17.7%). Conclusions: We demonstrated that there was a strong link between dining-out behaviors and the superspreading potential of COVID-19. The methodological innovation suggests a further development using digital mobility proxies of dining-out patterns to generate early warnings of superspreading events. %M 36811849 %R 10.2196/44251 %U https://publichealth.jmir.org/2023/1/e44251 %U https://doi.org/10.2196/44251 %U http://www.ncbi.nlm.nih.gov/pubmed/36811849 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42315 %T Epidemiology, Symptomatology, and Risk Factors for Long COVID Symptoms: Population-Based, Multicenter Study %A Wong,Martin Chi-Sang %A Huang,Junjie %A Wong,Yuet-Yan %A Wong,Grace Lai-Hung %A Yip,Terry Cheuk-Fung %A Chan,Rachel Ngan-Yin %A Chau,Steven Wai-Ho %A Ng,Siew-Chien %A Wing,Yun-Kwok %A Chan,Francis Ka-Leung %+ Department of Medicine and Therapeutics, Faculty of Medicine, The Chinese University of Hong Kong, Room 41028, 2/F, Special Block E, Sha Tin, China, 852 35051339, fklchan@cuhk.edu.hk %K COVID-19 %K epidemiology %K symptom %K risk factor %K long COVID %K multicenter survey %K general population %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Long COVID induces a substantial global burden of disease. The pathogenesis, complications, and epidemiological and clinical characteristics of patients with COVID-19 in the acute phase have been evaluated, while few studies have characterized the epidemiology, symptomatology, and risk factors of long COVID symptoms. Its characteristics among patients with COVID-19 in the general population remain unaddressed. Objective: We examined the prevalence of long COVID symptoms, its symptom patterns, and its risk factors in 4 major Chinese cities in order to fill the knowledge gap. Methods: We performed a population-based, multicenter survey using a representative sampling strategy via the Qualtrics platform in Beijing, Shanghai, Guangzhou, and Hong Kong in June 2022. We included 2712 community-dwelling patients with COVID-19 and measured the prevalence of long COVID symptoms defined by the World Health Organization (WHO), and their risk factors. The primary outcomes were the symptoms of long COVID, with various levels of impact. A descriptive analysis of the prevalence and distribution of long COVID symptoms according to disease severity was conducted. A sensitivity analysis of increasing the number of long COVID symptoms was also conducted. Univariate and multivariate regression analyses were performed to examine the risk factors of severe long COVID symptoms, including age, gender, marital status, current occupation, educational level, living status, smoking habits, monthly household income, self-perceived health status, the presence of chronic diseases, the use of chronic medication, COVID-19 vaccination status, and the severity of COVID-19. Results: The response rate was 63.6% (n=2712). The prevalence of long COVID, moderate or severe long COVID, and severe long COVID was 90.4% (n=2452), 62.4% (n=1692), and 31.0% (n=841), respectively. Fatigue (n=914, 33.7%), cough (n=865, 31.9%), sore throat (n=841, 31.0%), difficulty in concentrating (n=828, 30.5%), feeling of anxiety (n=817, 30.2%), myalgia (n=811, 29.9%), and arthralgia (n=811, 29.9%) were the most common severe long COVID symptoms. From multivariate regression analysis, female gender (adjusted odds ratio [aOR]=1.49, 95% CI 1.13-1.95); engagement in transportation, logistics, or the discipline workforce (aOR=2.52, 95% CI 1.58-4.03); living with domestic workers (aOR=2.37, 95% CI 1.39-4.03); smoking (aOR=1.55, 95% CI 1.17-2.05); poor or very poor self-perceived health status (aOR=15.4, 95% CI 7.88-30.00); ≥3 chronic diseases (aOR=2.71, 95% CI 1.54-4.79); chronic medication use (aOR=4.38, 95% CI 1.66-11.53); and critical severity of COVID-19 (aOR=1.52, 95% CI 1.07-2.15) were associated with severe long COVID. Prior vaccination with ≥2 doses of COVID-19 vaccines was a protective factor (aOR=0.35-0.22, 95% CI 0.08-0.90). Conclusions: We examined the prevalence of long COVID symptoms in 4 Chinese cities according to the severity of COVID-19. We also evaluated the pattern of long COVID symptoms and their risk factors. These findings may inform early identification of patients with COVID-19 at risk of long COVID and planning of rehabilitative services. %M 36645453 %R 10.2196/42315 %U https://publichealth.jmir.org/2023/1/e42315 %U https://doi.org/10.2196/42315 %U http://www.ncbi.nlm.nih.gov/pubmed/36645453 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e43047 %T A Gamified Real-time Video Observed Therapies (GRVOTS) Mobile App via the Modified Nominal Group Technique: Development and Validation Study %A Abas,Siti Aishah %A Ismail,Nurhuda %A Zakaria,Yuslina %A Ismail,Ismassabah %A Mat Zain,Nurul Hidayah %A Yasin,Siti Munira %A Ibrahim,Khalid %A Razali,Asmah %A Mohd Yusoff,Mas Ahmad Sherzkawee %A Ahmad,Norliza %A Chinnayah,Thilaka %+ Department of Public Health Medicine, Faculty of Medicine, Universiti Teknologi MARA Sungai Buloh Campus, Sungai Buloh, 47000, Malaysia, 60 361267174, yuda@uitm.edu.my %K video directly observed therapy %K VDOT %K mobile health %K mHealth %K tuberculosis %K medication adherence %K directly observed therapy %K video-observed therapy %K mobile app %K mobile health app %K gamification %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: The success rate of tuberculosis (TB) treatment in Malaysia remains below the recommended World Health Organization target of 90% despite the implementation of directly observed therapy, short-course, a physical drug monitoring system, since 1994. With increasing numbers of patients with TB in Malaysia defaulting on treatment, exploring another method to improve TB treatment adherence is vital. The use of gamification and real-time elements via video-observed therapies in mobile apps is one such method expected to induce motivation toward TB treatment adherence. Objective: This study aimed to document the process of designing, developing, and validating the gamification, motivation, and real-time elements in the Gamified Real-time Video Observed Therapies (GRVOTS) mobile app. Methods: The modified nominal group technique via a panel of 11 experts was used to validate the presence of the gamification and motivation elements inside the app, which were assessed based on the percentage of agreement among the experts. Results: The GRVOTS mobile app, which can be used by patients, supervisors, and administrators, was successfully developed. For validation purposes, the gamification and motivation features of the app were validated as they achieved a total mean percentage of agreement of 97.95% (SD 2.51%), which was significantly higher than the minimum agreement score of 70% (P<.001). Further, each component of gamification, motivation, and technology was also rated at 70% or more. Among the gamification elements, fun received the lowest scores, possibly because the nature of serious games does not prioritize the fun element and because the perception of fun varies by personality. The least popular element in motivation was relatedness, as stigma and discrimination hinder interaction features, such as leaderboards and chats, in the mobile app. Conclusions: It has been validated that the GRVOTS mobile app contains gamification and motivation elements, which are intended to encourage medication adherence to TB treatment. %M 36881449 %R 10.2196/43047 %U https://games.jmir.org/2023/1/e43047 %U https://doi.org/10.2196/43047 %U http://www.ncbi.nlm.nih.gov/pubmed/36881449 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 11 %N %P e41766 %T Games in Times of a Pandemic: Structured Overview of COVID-19 Serious Games %A Kermavnar,Tjaša %A Visch,Valentijn T %A Desmet,Pieter M A %+ Human-Centered Design, Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628 CE, Netherlands, 31 648921936, T.Kermavnar@tudelft.nl %K COVID-19 %K serious game %K game-based intervention %D 2023 %7 7.3.2023 %9 Original Paper %J JMIR Serious Games %G English %X Background: The COVID-19 pandemic introduced an urgent need for effective strategies to disseminate crucial knowledge and improve people’s subjective well-being. Complementing more conventional approaches to knowledge dissemination, game-based interventions were developed to create awareness and educate people about the pandemic, hoping to change their attitudes and behavior. Objective: This study provided an overview and analysis of digital and analog game-based interventions in the context of the COVID-19 pandemic. As major pandemics and other large-scale disruptive events are expected to increase in frequency in the coming decades, this analysis aimed to inform the design, uptake, and effects of similar future interventions. Methods: From November 2021 to April 2022, Scopus, Google, and YouTube were searched for articles and videos describing COVID-19–themed game-based interventions. Information regarding authorship, year of development or launch, country of origin, license, deployment, genre or type, target audience, player interaction, in-game goal, and intended transfer effects was extracted. Information regarding intervention effectiveness was retrieved where possible. Results: A diverse assortment of 23 analog and 43 digital serious games was identified, approximately one-third of them (25/66, 38%) through scientific articles. Most of these games were developed by research institutions in 2020 (13/66, 20%) and originated in Europe and North America (38/66, 58%). A limited number (20/66, 30%) were tested on relatively small samples, using a diversity of research methods to assess the potential changes in participants’ knowledge, attitudes, and behaviors as well as their gameplay experience. Although most of the evaluated games (11/20, 55%) effectively engaged and motivated the players, increased awareness, and improved their understanding of COVID-19–related issues, the games’ success in influencing people’s behavior was often unclear or limited. Conclusions: To increase the impact of similar future interventions aimed at disseminating knowledge and influencing people’s attitudes and behaviors during a large-scale crisis, some considerations are suggested. On the basis of the study results and informed by existing game theories, recommendations are made in relation to game development, deployment, and distribution; game users, design, and use; game design terminology; and effectiveness testing for serious games. %M 36634265 %R 10.2196/41766 %U https://games.jmir.org/2023/1/e41766 %U https://doi.org/10.2196/41766 %U http://www.ncbi.nlm.nih.gov/pubmed/36634265 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42128 %T Spatiotemporal Trends in Self-Reported Mask-Wearing Behavior in the United States: Analysis of a Large Cross-sectional Survey %A Taube,Juliana C %A Susswein,Zachary %A Bansal,Shweta %+ Department of Biology, Georgetown University, Reiss Science Building, Room 406, 37th and O Streets, NW, Washington, DC, 20057, United States, 1 202 687 9256, shweta.bansal@georgetown.edu %K COVID-19 %K face mask %K nonpharmaceutical interventions %K spatiotemporal %K United States %K survey bias %K survey %K US %K behavior %K effectiveness %K disease %K decision-making %K community %K surveillance %D 2023 %7 6.3.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Face mask wearing has been identified as an effective strategy to prevent the transmission of SARS-CoV-2, yet mask mandates were never imposed nationally in the United States. This decision resulted in a patchwork of local policies and varying compliance, potentially generating heterogeneities in the local trajectories of COVID-19 in the United States. Although numerous studies have investigated the patterns and predictors of masking behavior nationally, most suffer from survey biases and none have been able to characterize mask wearing at fine spatial scales across the United States through different phases of the pandemic. Objective: Urgently needed is a debiased spatiotemporal characterization of mask-wearing behavior in the United States. This information is critical to further assess the effectiveness of masking, evaluate the drivers of transmission at different time points during the pandemic, and guide future public health decisions through, for example, forecasting disease surges. Methods: We analyzed spatiotemporal masking patterns in over 8 million behavioral survey responses from across the United States, starting in September 2020 through May 2021. We adjusted for sample size and representation using binomial regression models and survey raking, respectively, to produce county-level monthly estimates of masking behavior. We additionally debiased self-reported masking estimates using bias measures derived by comparing vaccination data from the same survey to official records at the county level. Lastly, we evaluated whether individuals’ perceptions of their social environment can serve as a less biased form of behavioral surveillance than self-reported data. Results: We found that county-level masking behavior was spatially heterogeneous along an urban-rural gradient, with mask wearing peaking in winter 2021 and declining sharply through May 2021. Our results identified regions where targeted public health efforts could have been most effective and suggest that individuals’ frequency of mask wearing may be influenced by national guidance and disease prevalence. We validated our bias correction approach by comparing debiased self-reported mask-wearing estimates with community-reported estimates, after addressing issues of a small sample size and representation. Self-reported behavior estimates were especially prone to social desirability and nonresponse biases, and our findings demonstrated that these biases can be reduced if individuals are asked to report on community rather than self behaviors. Conclusions: Our work highlights the importance of characterizing public health behaviors at fine spatiotemporal scales to capture heterogeneities that may drive outbreak trajectories. Our findings also emphasize the need for a standardized approach to incorporating behavioral big data into public health response efforts. Even large surveys are prone to bias; thus, we advocate for a social sensing approach to behavioral surveillance to enable more accurate estimates of health behaviors. Finally, we invite the public health and behavioral research communities to use our publicly available estimates to consider how bias-corrected behavioral estimates may improve our understanding of protective behaviors during crises and their impact on disease dynamics. %M 36877548 %R 10.2196/42128 %U https://publichealth.jmir.org/2023/1/e42128 %U https://doi.org/10.2196/42128 %U http://www.ncbi.nlm.nih.gov/pubmed/36877548 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 10 %N %P e41304 %T Digital Practices by Citizens During the COVID-19 Pandemic: Findings From an International Multisite Study %A Marston,Hannah Ramsden %A Ko,Pei-Chun %A Girishan Prabhu,Vishnunarayan %A Freeman,Shannon %A Ross,Christopher %A Sharaievska,Iryna %A Browning,Matthew HEM %A Earle,Sarah %A Ivan,Loredana %A Kanozia,Rubal %A Öztürk Çalıkoğlu,Halime %A Arslan,Hasan %A Bilir-Koca,Burcu %A Alexandra Silva,Paula %A Buttigieg,Sandra C %A Großschädl,Franziska %A Schüttengruber,Gerhilde %+ School of Health, Wellbeing and Social Care, The Open University, Horlock Building, Walton Hall, Milton Keynes, MK7 6AA, United Kingdom, 44 7815507547, Hannah.Marston@open.ac.uk %K COVID-19 %K communication %K gerontology %K community living %K technology %K social media %D 2023 %7 6.3.2023 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic brought digital practices and engagement to the forefront of society, which were based on behavioral changes associated with adhering to different government mandates. Further behavioral changes included transitioning from working in the office to working from home, with the use of various social media and communication platforms to maintain a level of social connectedness, especially given that many people who were living in different types of communities, such as rural, urban, and city spaces, were socially isolated from friends, family members, and community groups. Although there is a growing body of research exploring how technology is being used by people, there is limited information and insight about the digital practices employed across different age cohorts living in different physical spaces and residing in different countries. Objective: This paper presents the findings from an international multisite study exploring the impact of social media and the internet on the health and well-being of individuals in different countries during the COVID-19 pandemic. Methods: Data were collected via a series of online surveys deployed between April 4, 2020, and September 30, 2021. The age of respondents varied from 18 years to over 60 years across the 3 regions of Europe, Asia, and North America. On exploring the associations of technology use, social connectedness, and sociodemographic factors with loneliness and well-being through bivariate and multivariate analyses, significant differences were observed. Results: The levels of loneliness were higher among respondents who used social media messengers or many social media apps than among those who did not use social media messengers or used ≤1 social media app. Additionally, the levels of loneliness were higher among respondents who were not members of an online community support group than among those who were members of an online community support group. Psychological well-being was significantly lower and loneliness was significantly higher among people living in small towns and rural areas than among those living in suburban and urban communities. Younger respondents (18-29 years old), single adults, unemployed individuals, and those with lower levels of education were more likely to experience loneliness. Conclusions: From an international and interdisciplinary perspective, policymakers and stakeholders should extend and explore interventions targeting loneliness experienced by single young adults and further examine how this may vary across geographies. The study findings have implications across the fields of gerontechnology, health sciences, social sciences, media communication, computers, and information technology. International Registered Report Identifier (IRRID): RR2-10.3389/fsoc.2020.574811 %M 36877558 %R 10.2196/41304 %U https://mental.jmir.org/2023/1/e41304 %U https://doi.org/10.2196/41304 %U http://www.ncbi.nlm.nih.gov/pubmed/36877558 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e36023 %T Clinical Outcomes After Use of Inhaled Corticosteroids or Oral Steroids in a COVID-19 Telemedicine Clinic Cohort: Retrospective Chart Review %A Cellai,Michele %A Roberts,Jodi %A Moore,Miranda A %A Gandrakota,Nikhila %+ General Internal Medicine Seavey Clinic, School of Nursing, Emory University, 1365 General Internal Medicine, Atlanta, GA, 30338, United States, 1 404 778 0972, michele.cellai@emoryhealthcare.org %K COVID-19 %K lung %K post-acute sequela %K steroid use %K ICS %K pandemic %K therapy %K treatment %K steroid treatment %K COVID-19 treatment %K patient outcome %K pulmonary %K COVID symptoms %K telehealth %D 2023 %7 23.2.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 concerns remain among health care providers, as there are few outpatient treatment options. In the early days of the pandemic, treatment options for nonhospitalized patients were limited, and symptomatic treatment and home-grown guidelines that used recommendations from the Global Initiative for Asthma Management and Treatment were used. Objective: The possibility that inhaled corticosteroids (ICS) might reduce the risk of respiratory symptoms and promote recovery was the impetus for this review, as it has already been shown that in the nonhospitalized patient population, oral corticosteroids (OCS) in the acute phase could have an adverse effect on recovery. We investigated if (1) patients treated with ICS were less likely to require referral to a post–COVID-19 clinic or pulmonary specialist than patients without ICS treatment or with OCS therapy, and (2) if OCS use was associated with worse health outcomes. Methods: In a retrospective chart review, we identified all patients with acute illness due to COVID-19 that were followed and managed by a telemedicine clinic team between June and December 2020. The data were electronically pulled from electronic medical records through April 2021 and reviewed to determine which patients eventually required referral to a post–COVID-19 clinic or pulmonary specialist due to persistent respiratory symptoms of COVID-19. The data were then analyzed to compare outcomes between patients prescribed OCS and those prescribed ICS. We specifically looked at patients treated acutely with ICS or OCS that then required referral to a pulmonary specialist or post–COVID-19 clinic. We excluded any patients with a history of chronic OCS or ICS use for any reason. Results: Prescribing ICS during the acute phase did not reduce the possibility of developing persistent symptoms. There was no difference in the referral rate to a pulmonary specialist or post–COVID-19 clinic between patients treated with OCS versus ICS. However, our data may not be generalizable to other populations, as it represents a patient population enrolled in a telemedicine program at a single center. Conclusions: We found that ICS, as compared to OCS, did not reduce the risk of developing persistent respiratory symptoms. This finding adds to the body of knowledge that ICS and OCS medications remain potent treatments in patients with acute and postacute COVID-19 seen in an outpatient setting. %M 36480687 %R 10.2196/36023 %U https://formative.jmir.org/2023/1/e36023 %U https://doi.org/10.2196/36023 %U http://www.ncbi.nlm.nih.gov/pubmed/36480687 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42677 %T Association of Depression With Precautionary Behavior Compliance, COVID-19 Fear, and Health Behaviors in South Korea: National Cross-sectional Study %A Shin,Hyerine %A Kim,Ji-Su %A Lee,HyunHae %+ Department of Nursing, Chung-ang University, 84 Heukseok-ro, Dongjak-gu, Seoul, 06974, Republic of Korea, 82 10 7117 5088, jisu80@cau.ac.kr %K COVID-19 %K precautionary behaviors %K COVID-19 fear %K health behavior deterioration %K gender differences %D 2023 %7 22.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As of January 2022, the number of people infected with COVID-19 worldwide has exceeded 350 million. As the COVID-19 pandemic continues, people are affected in a wide range of areas of life, which in turn causes numerous psychological problems. Depression is a serious problem for people who have suffered from COVID-19. Depression can worsen COVID-19 precautionary behavior compliance or the health behavior itself. In addition, these depressive symptoms may have different characteristics depending on the individual’s gender. Objective: The aim of this study was to determine whether depression is a factor that may affect COVID-19 fear, precautionary behavior compliance, and health behavior, and how these characteristic trends differ by gender. Methods: This was a secondary analysis of data from the 2020 Korea Community Health Survey (KCHS), a national cross-sectional survey conducted with complex sampling analysis. In 2020, the KCHS included COVID-19–related questions. For this study, we used the KCHS data from both the COVID-19–related questions and the Patient Health Questionnaire-9 scale. After weighting the data according to the KCHS guidelines, we calculated the distribution of men and women according to depression level. The data were collected using multiple-choice questions related to precautionary behavior compliance, COVID-19–related fears, and health behavior changes. Results: Of the 204,787 participants, those who were clinically depressed had a greater tendency to not comply with precautionary behaviors. Regarding COVID-19, “fear” showed a decreasing trend in both men (adjusted odds ratio [AOR] 0.72, 95% CI 0.61-0.83) and women (AOR 0.74, 95% CI 0.63-0.86) with clinically relevant depression. Moreover, for both men and women, health behaviors deteriorated as depression intensified; the AOR for sleep duration changes was 2.28 (95% CI 2.00-2.59) in men and was 2.15 (95% CI 1.96-2.36) in women. Notably, the responses of clinically depressed women revealed a doubled increase in both their drinking (AOR 2.25, 95% CI 1.88-2.70) and smoking (AOR 2.71, 95% CI 1.95-3.77) habits compared with those of nondepressed women. Conclusions: Both men and women with more severe depression were more likely to violate precautionary health behaviors as their depression worsened. Health behaviors also deteriorated for both genders, but women tended to show a greater change. Therefore, additional studies and interventions for vulnerable groups such as severely depressed people are needed. More research is also necessary to develop interventions based on statistical comparisons of men and women. %M 36716130 %R 10.2196/42677 %U https://publichealth.jmir.org/2023/1/e42677 %U https://doi.org/10.2196/42677 %U http://www.ncbi.nlm.nih.gov/pubmed/36716130 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e39992 %T Regional Difference in the Impact of COVID-19 Pandemic on Domain-Specific Physical Activity, Sedentary Behavior, Sleeping Time, and Step Count: Web-Based Cross-sectional Nationwide Survey and Accelerometer-Based Observational Study %A Yamada,Yosuke %A Namba,Hideyuki %A Date,Heiwa %A Kitayama,Shinobu %A Nakayama,Yui %A Kimura,Misaka %A Fujita,Hiroyuki %A Miyachi,Motohiko %+ Department of Physical Activity Research, National Institute of Biomedical Innovation, Health and Nutrition, 3-17, Senrioka-shinmachi, Settsu-shi, Osaka, 5660002, Japan, 81 9078318291, yamaday@nibiohn.go.jp %K web-based survey %K social distancing measure %K transportation %K physical activity record system %K physical activity %K sedentary %K sleep %K sleeping time %K COVID-19 %K impact %K pandemic %K sleeping pattern %K surveillance %K demographic %K regional %K differences %D 2023 %7 20.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Physical activity (PA) and sedentary behavior (SB) have been affected by the COVID-19 pandemic and its restrictive environments, such as social distancing and lockdown measures. However, regional differences in the changes in domain-specific PA and SB in response to the COVID-19 pandemic are not clearly understood. Objective: This study aimed to examine regional differences in domain-specific PA and SB, as well as sleeping time in response to the COVID-19 pandemic in Japan. Methods: A web-based cross-sectional nationwide survey and an accelerometer-based longitudinal observation were conducted. In the web-based survey, we recruited 150 Japanese men and 150 Japanese women for each of the following age groups: 20s, 30s, 40s, 50s, 60s, and 70s (n=1800). A total of 1627 adults provided valid responses to web-based surveillance from June to July 2020. Participants were recruited from urban (Greater Tokyo Area, n=1028), urban-rural (regional core cities, n=459), or rural (regional small and medium cities, n=140) areas. They answered sociodemographic and health-related questions and retrospectively registered the PA data of their average day before and during the COVID-19 pandemic in a web-based PA record system. In the accelerometer-based observation, PA and step count data were obtained using a triaxial accelerometer on people living in urban (n=370) and rural (n=308) areas. Results: Before the COVID-19 pandemic, there were no significant differences between these 3 regions in the time spent sleeping, staying at home, working or studying, and exercising (P>.05). By contrast, people living in urban areas had a longer duration of SB and transportation and a shorter duration of moderate-to-vigorous PA and lying or napping time compared with people living in rural areas (P>.05). During the COVID-19 pandemic, a significant decrease was observed in transportation time in urban (–7.2 min/day, P<.001) and urban-rural (–2.0 min/day, P=.009) areas but not in rural (–0.4 min/day, P=.52) areas. The moderate-to-vigorous PA was decreased in urban (–31.3 min/day, P<.001) and urban-rural (–30.0 min/day, P<.001) areas but not in rural areas (–17.3 min/day, P=.08). A significant increase was observed in time spent sleeping in urban (+22.4 min/day, P<.001) and urban-rural (+24.2 min/day, P<.001) but not in rural areas (+3.9 min/day, P=.74). Lying or napping was increased in urban (+14.9 min/day, P<.001) but not in rural areas (−6.9 min/day, P=.68). PA and step count obtained using an accelerometer significantly decreased in urban (P<.05) but not in rural areas (P>.05). Conclusions: The effect of the COVID-19 pandemic on PA and SB was significantly dependent on living area, even in a single country. The effects of PA and SB were greater in the Greater Tokyo Area and regional core cities but were not observed in regional small and medium cities in Japan. %M 36634262 %R 10.2196/39992 %U https://publichealth.jmir.org/2023/1/e39992 %U https://doi.org/10.2196/39992 %U http://www.ncbi.nlm.nih.gov/pubmed/36634262 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e38163 %T Substance Use From Social Distancing and Isolation by US Nativity During the Time of COVID-19: Cross-sectional Study %A Montiel Ishino,Francisco Alejandro %A Villalobos,Kevin %A Williams,Faustine %+ Division of Intramural Research, National Institute of Environmental Health Sciences, National Institutes of Health, 111 TW Alexander Dr, Durham, NC, 27709, United States, 1 6143643314, francisco.montielishino@nih.gov %K substance use %K COVID-19 %K US nativity %D 2023 %7 17.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic had many unprecedented secondary outcomes resulting in various mental health issues leading to substance use as a coping behavior. The extent of changes in substance use in a US sample by nativity has not been previously described. Objective: This study aimed to design a web-based survey to assess the social distancing and isolation issues exacerbated by the COVID-19 pandemic to describe substance use as a coping behavior by comparing substance use changes before and during the pandemic. Methods: A comprehensive 116-item survey was designed to understand the impact of COVID-19 and social distancing on physical and psychosocial mental health and chronic diseases. Approximately 10,000 web-based surveys were distributed by Qualtrics LLC between May 13, 2021, and January 09, 2022, across the United States (ie, continental United States, Hawaii, Alaska, and territories) to adults aged ≥18 years. We oversampled low-income and rural adults among non-Hispanic White, non-Hispanic Black, Hispanic or Latino, and foreign-born participants. Of the 5938 surveys returned, 5413 (91.16%) surveys were used after proprietary expert review fraud detection (Qualtrics) and detailed assessments of the completion rate and the timing to complete the survey. Participant demographics, substance use coping behaviors, and substance use before and during the pandemic are described by the overall US resident sample, followed by US-born and foreign-born self-reports. Substance use included the use of tobacco, e-cigarettes or nicotine vapes, alcohol, marijuana, and other illicit substances. Marginal homogeneity based on the Stuart-Maxwell test was used to assess changes in self-reported substance use before and during the pandemic. Results: The sample mostly included White (2182/5413, 40.31%) and women participants (3369/5406, 62.32%) who identified as straight or heterosexual (4805/5406, 88.88%), reported making ≥US $75,000 (1405/5355, 26.23%), and had vocational or technical training (1746/5404, 32.31%). Similarities were observed between the US-born and the foreign-born participants on increased alcohol consumption: from no alcohol consumption before the pandemic to consuming alcohol once to several times a month and from once to several times per week to every day to several times per day. Although significant changes were observed from no prior alcohol use to some level of increased use, the opposite was also observed and was more pronounced among foreign-born participants. That is, there was a 5.1% overall change in some level of alcohol use before the pandemic to no alcohol use during the pandemic among foreign-born individuals, compared with a 4.3% change among US-born individuals. Conclusions: To better prepare for the inadvertent effects of public health policies meant to protect individuals, we must understand the mental health burdens that can precipitate into substance use coping mechanisms that not only have a deleterious effect on physical and mental health but also exacerbate morbidity and mortality in a disease like COVID-19. %M 36265162 %R 10.2196/38163 %U https://publichealth.jmir.org/2023/1/e38163 %U https://doi.org/10.2196/38163 %U http://www.ncbi.nlm.nih.gov/pubmed/36265162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 25 %N %P e44238 %T Deep-Learning Model for Influenza Prediction From Multisource Heterogeneous Data in a Megacity: Model Development and Evaluation %A Yang,Liuyang %A Li,Gang %A Yang,Jin %A Zhang,Ting %A Du,Jing %A Liu,Tian %A Zhang,Xingxing %A Han,Xuan %A Li,Wei %A Ma,Libing %A Feng,Luzhao %A Yang,Weizhong %+ School of Population Medicine and Public Health, Chinese Academy of Medical Sciences & Peking Union Medical College, No. 9, Dongdan Santiao, Dongcheng District, Beijing, Beijing, 100730, China, 86 1 391 181 9068, yangweizhong@cams.cn %K influenza %K ILI %K multisource heterogeneous data %K deep learning %K MAL model %K megacity %D 2023 %7 13.2.2023 %9 Original Paper %J J Med Internet Res %G English %X Background: In megacities, there is an urgent need to establish more sensitive forecasting and early warning methods for acute respiratory infectious diseases. Existing prediction and early warning models for influenza and other acute respiratory infectious diseases have limitations and therefore there is room for improvement. Objective: The aim of this study was to explore a new and better-performing deep-learning model to predict influenza trends from multisource heterogeneous data in a megacity. Methods: We collected multisource heterogeneous data from the 26th week of 2012 to the 25th week of 2019, including influenza-like illness (ILI) cases and virological surveillance, data of climate and demography, and search engines data. To avoid collinearity, we selected the best predictor according to the weight and correlation of each factor. We established a new multiattention-long short-term memory (LSTM) deep-learning model (MAL model), which was used to predict the percentage of ILI (ILI%) cases and the product of ILI% and the influenza-positive rate (ILI%×positive%), respectively. We also combined the data in different forms and added several machine-learning and deep-learning models commonly used in the past to predict influenza trends for comparison. The R2 value, explained variance scores, mean absolute error, and mean square error were used to evaluate the quality of the models. Results: The highest correlation coefficients were found for the Baidu search data for ILI% and for air quality for ILI%×positive%. We first used the MAL model to calculate the ILI%, and then combined ILI% with climate, demographic, and Baidu data in different forms. The ILI%+climate+demography+Baidu model had the best prediction effect, with the explained variance score reaching 0.78, R2 reaching 0.76, mean absolute error of 0.08, and mean squared error of 0.01. Similarly, we used the MAL model to calculate the ILI%×positive% and combined this prediction with different data forms. The ILI%×positive%+climate+demography+Baidu model had the best prediction effect, with an explained variance score reaching 0.74, R2 reaching 0.70, mean absolute error of 0.02, and mean squared error of 0.02. Comparisons with random forest, extreme gradient boosting, LSTM, and gated current unit models showed that the MAL model had the best prediction effect. Conclusions: The newly established MAL model outperformed existing models. Natural factors and search engine query data were more helpful in forecasting ILI patterns in megacities. With more timely and effective prediction of influenza and other respiratory infectious diseases and the epidemic intensity, early and better preparedness can be achieved to reduce the health damage to the population. %M 36780207 %R 10.2196/44238 %U https://www.jmir.org/2023/1/e44238 %U https://doi.org/10.2196/44238 %U http://www.ncbi.nlm.nih.gov/pubmed/36780207 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e41240 %T Tough Talks COVID-19 Digital Health Intervention for Vaccine Hesitancy Among Black Young Adults: Protocol for a Hybrid Type 1 Effectiveness Implementation Randomized Controlled Trial %A Budhwani,Henna %A Maragh-Bass,Allysha C %A Tolley,Elizabeth E %A Comello,Maria Leonora G %A Stoner,Marie C D %A Adams Larsen,Margo %A Brambilla,Donald %A Muessig,Kathryn E %A Pettifor,Audrey %A Bond,Christyenne L %A Toval,Christina %A Hightow-Weidman,Lisa B %+ Intervention Research and Implementation Science Lab, College of Nursing, Florida State University, 98 Varsity Way, Tallahassee, FL, 32306, United States, 1 8506443296, hbudhwani@fsu.edu %K COVID-19 %K COVID %K vaccine hesitancy framework %K African American %K young adults %K implementation science %K digital health %K mHealth %K behavioral intervention %K vaccination %K intervention %K mortality %K USA %D 2023 %7 13.2.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Interventions for increasing the uptake of COVID-19 vaccination among Black young adults are central to ending the pandemic. Black young adults experience harms from structural forces, such as racism and stigma, that reduce receptivity to traditional public health messaging due to skepticism and distrust. As such, Black young adults continue to represent a priority population on which to focus efforts for promoting COVID-19 vaccine uptake. Objective: In aims 1 and 2, the Tough Talks digital health intervention for HIV disclosure will be adapted to address COVID-19 vaccine hesitancy and tailored to the experiences of Black young adults in the southern United States (Tough Talks for COVID-19). In aim 3, the newly adapted Tough Talks for COVID-19 digital health intervention will be tested across the following three southern states: Alabama, Georgia, and North Carolina. Methods: Our innovative digital health intervention study will include qualitative and quantitative assessments. A unique combination of methodological techniques, including web-based surveys, choose-your-own-adventures, digital storytelling, user acceptability testing, and community-based participatory approaches, will culminate in a 2-arm hybrid type 1 effectiveness implementation randomized controlled trial, wherein participants will be randomized to the Tough Talks for COVID-19 intervention arm or a standard-of-care control condition (N=360). Logistic regression will be used to determine the effect of the treatment arm on the probability of vaccination uptake (primary COVID-19 vaccine series or recommended boosters). Concurrently, the inner and outer contexts of implementation will be ascertained and catalogued to inform future scale-up. Florida State University’s institutional review board approved the study (STUDY00003617). Results: Our study was funded at the end of April 2021. Aim 1 data collection concluded in early 2022. The entire study is expected to conclude in January 2025. Conclusions: If effective, our digital health intervention will be poised for broad, rapid dissemination to reduce COVID-19 mortality among unvaccinated Black young adults in the southern United States. Our findings will have the potential to inform efforts that seek to address medical mistrust through participatory approaches. The lessons learned from the conduct of our study could be instrumental in improving health care engagement among Black young adults for several critical areas that disproportionately harm this community, such as tobacco control and diabetes prevention. Trial Registration: ClinicalTrials.gov NCT05490329; https://clinicaltrials.gov/ct2/show/NCT05490329 International Registered Report Identifier (IRRID): DERR1-10.2196/41240 %M 36689557 %R 10.2196/41240 %U https://www.researchprotocols.org/2023/1/e41240 %U https://doi.org/10.2196/41240 %U http://www.ncbi.nlm.nih.gov/pubmed/36689557 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40311 %T Identifying Hot Spots of Tuberculosis in Nigeria Using an Early Warning Outbreak Recognition System: Retrospective Analysis of Implications for Active Case Finding Interventions %A Ogbudebe,Chidubem %A Jeong,Dohyo %A Odume,Bethrand %A Chukwuogo,Ogoamaka %A Dim,Cyril %A Useni,Sani %A Okuzu,Okey %A Malolan,Chenchita %A Kim,Dohyeong %A Nwariaku,Fiemu %A Nwokoye,Nkiru %A Gande,Stephanie %A Nongo,Debby %A Eneogu,Rupert %A Odusote,Temitayo %A Oyelaran,Salewa %A Chijioke-Akaniro,Obioma %A Nihalani,Nrip %A Anyaike,Chukwuma %A Gidado,Mustapha %+ Technical Division, KNCV Tuberculosis Foundation, Plot 564/565 Independence Avenue, Central Business District, Abuja, Nigeria, 234 8038926544, cogbudebe@kncvnigeria.org %K early warning outbreak recognition system %K active case finding %K WHO-four-symptom screen %K GeneXpert %K active case %K cluster %K early warning %K hot spot %K mapping %K disease spread %K infection spread %K retrospective study %K retrospective analysis %K surveillance %K outbreak %K TB %K tuberculosis %K infectious disease %K case finding %K communicable disease %D 2023 %7 8.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Undiagnosed tuberculosis (TB) cases are the major challenge to TB control in Nigeria. An early warning outbreak recognition system (EWORS) is a system that is primarily used to detect infectious disease outbreaks; this system can be used as a case-based geospatial tool for the real-time identification of hot spot areas with clusters of TB patients. TB screening targeted at such hot spots should yield more TB cases than screening targeted at non–hot spots. Objective: We aimed to demonstrate the effectiveness of an EWORS for TB hot spot mapping as a tool for detecting areas with increased TB case yields in high TB-burden states of Nigeria. Methods: KNCV Tuberculosis Foundation Nigeria deployed an EWORS to 14 high-burden states in Nigeria. The system used an advanced surveillance mechanism to identify TB patients’ residences in clusters, enabling it to predict areas with elevated disease spread (ie, hot spots) at the ward level. TB screening outreach using the World Health Organization 4-symptom screening method was conducted in 121 hot spot wards and 213 non–hot spot wards selected from the same communities. Presumptive cases identified were evaluated for TB using the GeneXpert instrument or chest X-ray. Confirmed TB cases from both areas were linked to treatment. Data from the hot spot and non–hot spot wards were analyzed retrospectively for this study. Results: During the 16-month intervention, a total of 1,962,042 persons (n=734,384, 37.4% male, n=1,227,658, 62.6% female) and 2,025,286 persons (n=701,103, 34.6% male, n=1,324,183, 65.4% female) participated in the community TB screening outreaches in the hot spot and non–hot spot areas, respectively. Presumptive cases among all patients screened were 268,264 (N=3,987,328, 6.7%) and confirmed TB cases were 22,618 (N=222,270, 10.1%). The number needed to screen to diagnose a TB case in the hot spot and non–hot spot areas was 146 and 193 per 10,000 people, respectively. Conclusions: Active TB case finding in EWORS-mapped hot spot areas yielded higher TB cases than the non–hot spot areas in the 14 high-burden states of Nigeria. With the application of EWORS, the precision of diagnosing TB among presumptive cases increased from 0.077 to 0.103, and the number of presumptive cases needed to diagnose a TB case decreased from 14.047 to 10.255 per 10,000 people. %M 36753328 %R 10.2196/40311 %U https://publichealth.jmir.org/2023/1/e40311 %U https://doi.org/10.2196/40311 %U http://www.ncbi.nlm.nih.gov/pubmed/36753328 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43689 %T Caregiver Perceptions of Children’s and Adolescents’ Psychosocial Functioning During the Stringent COVID-19 Lockdown Restrictions in Shanghai: Cross-sectional Study %A Liu,Xu %A Wu,Jing %A Yang,Hongyang %A Zhao,Fangjie %A Qin,Yuchen %A Wu,Jiali %A Yan,Hongli %A Xu,Yan %A Zhang,Lulu %+ College of Health Service, Second Military Medical University, 800# Xiangyin Road, Yangpu, Shanghai, 200433, China, 86 02181871421, zllrmit@163.com %K COVID-19 exposure %K psychosocial function %K parenting %K children and adolescents %K China %D 2023 %7 7.2.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic represents a global health crisis. The Shanghai municipal government in China implemented strict and comprehensive pandemic control strategies in the first half of 2022 to eliminate a wave of COVID-19 infection. The pandemic and the resulting government responses have led to abrupt changes to families’ daily lives, including the mental health of children and adolescents. Objective: The aim of this paper is to examine the impact of COVID-19 exposure and the stringent lockdown measures on the daily life and mental health of children and adolescents and to provide suggestions on maintaining their mental health when similar public health emergencies occur in the future. Methods: In this cross-sectional study, an anonymous survey was distributed online in May 1-15, 2022, in Shanghai. Individuals were eligible to participate if they were currently the caregiver of a child or adolescent (aged 4-17 years). Outcomes were psychosocial functioning of children and adolescents, as reported by parents, using the Pediatric Symptom Checklist-17. COVID-19 exposure and life changes were also reported. Multivariate logistic regression was used to analyze risk factors for poor psychosocial functioning. Results: In total, 2493 valid questionnaires were analyzed. The rate of positive scores on the global Pediatric Symptom Checklist-17 scale was 16.5% (n=411). Internalizing, attention, and externalizing problem subscale positivity rates were 17.3% (n=431), 10.9% (n=272), and 8.9% (n=221), respectively. Caregivers reported that 64.2% (n=1601) and 20.7% (n=516) of the children’s interactions with friends or peers and parents deteriorated, respectively. Compared with male caregivers, female caregivers were less likely to report psychosocial problems in children and adolescents (adjusted odds ratio [aOR] 0.68; 95% CI 0.53-0.88). Older children and those with lower COVID-19 Exposure and Family Impact Scales scores were less likely to have psychological problems (aOR 1.15; 95% CI 1.10-1.21). Compared with children with screen times <1 hour per day for recreation, those using screens for >3 hours had higher odds of psychological distress (aOR 2.09; 95% CI 1.47-1.97). Children who spent 1-2 hours exercising and had better interactions with friends or peers and parents showed a trend toward lower odds of psychological problems. Children and adolescents with worse sleep compared with preclosure were more likely to have psychological problems. Conclusions: The prevalence of psychosocial problems among children and adolescents is relatively high. Being young, having more COVID-19 exposure, and having more screen times (>3 h/day), less exercise time (<30 min), worse sleep, and deteriorated interactions with friends or peers and parents were risk factors for poor psychosocial functioning. It is necessary for governments, communities, schools, and families to take appropriate countermeasures to reduce the negative impact of the stringent control measures on caregivers’ parenting and psychosocial functioning of children and adolescents. %M 36749625 %R 10.2196/43689 %U https://publichealth.jmir.org/2023/1/e43689 %U https://doi.org/10.2196/43689 %U http://www.ncbi.nlm.nih.gov/pubmed/36749625 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43055 %T Preference and Willingness to Pay for the Regular COVID-19 Booster Shot in the Vietnamese Population: Theory-Driven Discrete Choice Experiment %A Tran,Bach Xuan %A Do,Anh Linh %A Boyer,Laurent %A Auquier,Pascal %A Le,Huong Thi %A Le Vu,Minh Ngoc %A Dang,Trang Huyen Thi %A Cao,Khuy Minh %A Le,Linh Dieu Thi %A Cu,Lam Tung Ngoc %A Ly,Bang Viet %A Nguyen,Duong Anh Thi %A Nguyen,Manh Duc %A Latkin,Carl A %A Ho,Roger C M %A Ho,Cyrus S H %A Zhang,Melvyn W B %+ Institute for Preventive Medicine and Public Health, Hanoi Medical University, 1 Ton That Tung Street, Kim Lien Ward, Dong Da District, Hanoi, 100000, Vietnam, 84 888288399, bach.ipmph@gmail.com %K COVID-19 %K epidemic %K vaccine %K booster %K willingness to take %K willingness to pay %K Vietnam %K policy %K feasibility %K acceptability %K infection %K vaccination %K social media %K intervention %D 2023 %7 31.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 36599156 %R 10.2196/43055 %U https://publichealth.jmir.org/2023/1/e43055 %U https://doi.org/10.2196/43055 %U http://www.ncbi.nlm.nih.gov/pubmed/36599156 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e43003 %T The Association of Acute Signs and Symptoms of COVID-19 and Exacerbation of Depression and Anxiety in Patients With Clinically Mild COVID-19: Retrospective Observational Study %A Sung,Sumi %A Kim,Su Hwan %A Lee,Changwoo %A Kim,Youlim %A Bae,Ye Seul %A Chie,Eui Kyu %+ Office of Hospital Information, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 2072 7600, ekchie93@snu.ac.kr %K COVID-19 %K depression %K anxiety %K vital signs %K symptoms %K electronic health records %D 2023 %7 30.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: To date, the association between acute signs and symptoms of COVID-19 and the exacerbation of depression and anxiety in patients with clinically mild COVID-19 has not been evaluated. Objective: This study was designed to assess the correlation between acute signs and symptoms of COVID-19 and the exacerbation of depression and anxiety in patients with clinically mild COVID-19 at a residential treatment center in South Korea. Methods: This retrospective study assessed 2671 patients with COVID-19 admitted to 4 residential treatment centers operated by Seoul National University Hospital, South Korea, from March 2020 to April 2022. Depression and anxiety were assessed using the 2-item Patient Health Questionnaire (PHQ-2) and 2-item Generalized Anxiety Disorder (GAD-2) scale, respectively. The exacerbation of depression and anxiety symptoms was identified from the differences in PHQ-2 and GAD-2 scores between admission and discharge, respectively. The patients’ clinical characteristics, including acute signs and symptoms of COVID-19, GAD-2 and PHQ-2 scores, were obtained from electronic health records. Demographic characteristics, a summary of vital signs, and COVID-19 symptoms were analyzed and compared between the patient groups with and those without exacerbated PHQ-2 and GAD-2 scores using the chi-square test. We applied logistic regression to identify the association between acute signs and symptoms of COVID-19 and the exacerbation of depression and anxiety. Results: Sleep disorders were associated with exacerbated depression (odds ratio [OR] 1.09, 95% CI 1.05-1.13) and anxiety (OR 1.1, 95% CI 1.06-1.14), and the sore throat symptom was associated with exacerbated anxiety symptoms (OR 1.03, 95% CI 1.00-1.07). Patients with abnormal oxygen saturation during quarantine were more likely to have exacerbated depression (OR 1.27, 95% CI 1.00-1.62), and those with an abnormal body temperature during quarantine were more likely to experience anxiety (OR 1.08, 95% CI 1.01-1.16). As anticipated, patients who experienced psychological symptoms at admission were more likely to experience depression (OR 1.91, 95% CI 1.52-2.41) and anxiety (OR 1.98, 95% CI 1.54-2.53). Meanwhile, the PHQ-2 and GAD-2 scores measured at admission revealed that lower the score, higher the possibility of exacerbation of both depression (OR 0.15, 95% CI 0.11-0.22) and anxiety (OR 0.13, 95% CI 0.10-0.19). Conclusions: Results from this study suggest the importance of further interventions for patients with abnormal oxygen saturation, abnormal body temperatures, sore throat, and sleep disorder symptoms or initial psychological symptoms to mitigate the exacerbation of depression and anxiety. In addition, this study highlights the usability of short and efficient scales such as the PHQ-2 and GAD-2 in the assessment of the mental health of patients with clinically mild COVID-19 symptoms who were quarantined at home during the pandemic era. %M 36645439 %R 10.2196/43003 %U https://publichealth.jmir.org/2023/1/e43003 %U https://doi.org/10.2196/43003 %U http://www.ncbi.nlm.nih.gov/pubmed/36645439 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 6 %N %P e40940 %T Feasibility of Video Consultation for Preterm Neurodevelopmental Follow-up Care During the COVID-19 Pandemic: Cohort Study %A Albayrak,Bilge %A Cordier,Larissa Jane %A Greve,Sandra %A Teschler,Uta %A Dathe,Anne-Kathrin %A Felderhoff-Müser,Ursula %A Hüning,Britta Maria %+ Department of Pediatrics I, Neonatology, Pediatric Intensive Care and Pediatric Neurology, University Hospital Essen, University of Duisburg-Essen, Department of Pediatrics I, Hufelandstraße 55, Essen, 45147, Germany, 49 201723 ext 82831, larissa.cordier@uk-essen.de %K COVID-19 %K very preterm infant %K video consultation %K follow-up care %K COVID-19 pandemic %K neurodevelopmental outcome %D 2023 %7 25.1.2023 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: During the COVID-19 pandemic, parents of infants born very preterm or at risk were exceptionally worried about being infected. The only means of protection during the onset of the pandemic was social distancing. Video consultations for neurodevelopmental follow-up care were offered as an alternative way to stay in contact with patients and their families, to provide expert support, and to monitor and assess children’s development. Objective: To assess the feasibility of and family satisfaction with video consultations, interviews were conducted after video and in-person consultations. Methods: An interview with 28 questions was created to evaluate parental satisfaction with the consultations (eg, their confidentiality and the children’s behavior). A total of 93 interviews with parents were conducted between March 2020 and February 2021 and compared (58 after video consultations and 35 after in-person consultations). The interviews were conducted at the end of the consultations by a trained professional. The video consultations were conducted using a certified platform created by Zava Sprechstunde Online, maintaining data protection with end-to-end encryption. Follow-up consultations (video or in-person) were performed at corrected ages of 3, 6, and 12 months as well as 2, 3, 4, and 5 years. The rate of total follow-up appointments attended during the survey period was evaluated and compared with the previous year. Results: There were no significant differences between the video and in-person consultation groups in satisfaction, attitudes on the confidentiality of the consultation, or discussion of private and sensitive information. Following video consultations, parents were significantly more likely to report that they were avoiding contact with medical professionals during the pandemic (P=.045; Shapiro-Wilk W=1094.5, Cohen d=–0.1782146) than the in-person consultation group. Parents in the video-consultation group stated that performing a guided examination on their child was comfortable and helped them understand their child’s development. In fact, they agreed to take advantage of future video consultations. The rate of total follow-up appointments increased compared to the previous year. Between March 2019 and February 2020, 782 of 984 (79.5%) children born at Essen University Hospital attended a follow-up appointment. During the survey period, between March 2020 and February 2021, a total of 788 of 1086 children (73%) attended a follow-up appointment, of which 117 (14.9%) were video consultations. Conclusions: The feasibility of attending video consultations for follow-up care of very preterm or at-risk infants and parental satisfaction with these consultations were as high as for in-person consultations. Parents rated video consultations as being as confidential as in-person appointments. Telemedicine can be offered as an equivalent alternative to in-person consultations and is particularly useful under certain circumstances, such as for very sick children who require assistive devices or respiratory support and oxygen or for those living a long distance away. %M 36409307 %R 10.2196/40940 %U https://pediatrics.jmir.org/2023/1/e40940 %U https://doi.org/10.2196/40940 %U http://www.ncbi.nlm.nih.gov/pubmed/36409307 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40036 %T Syndromic Surveillance Using Structured Telehealth Data: Case Study of the First Wave of COVID-19 in Brazil %A Boaventura,Viviane S %A Grave,Malú %A Cerqueira-Silva,Thiago %A Carreiro,Roberto %A Pinheiro,Adélia %A Coutinho,Alvaro %A Barral Netto,Manoel %+ Laboratório de Doenças Infecciosas Transmitidas por Vetores, Instituto Gonçalo Moniz, Fundação Oswaldo Cruz, Rua Waldemar Falcao, 121, Salvador, 40296-710, Brazil, 55 71 9619 4245, viviane.boaventura@fiocruz.br %K telehealth %K telemedicine %K disease surveillance %K mathematical model %K COVID-19 %K prediction %K cases %K detection %K monitoring %K surveillance %K computational modeling %K spread %K transmission %K disease %K infectious diseases %K syndromic %D 2023 %7 24.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Telehealth has been widely used for new case detection and telemonitoring during the COVID-19 pandemic. It safely provides access to health care services and expands assistance to remote, rural areas and underserved communities in situations of shortage of specialized health professionals. Qualified data are systematically collected by health care workers containing information on suspected cases and can be used as a proxy of disease spread for surveillance purposes. However, the use of this approach for syndromic surveillance has yet to be explored. Besides, the mathematical modeling of epidemics is a well-established field that has been successfully used for tracking the spread of SARS-CoV-2 infection, supporting the decision-making process on diverse aspects of public health response to the COVID-19 pandemic. The response of the current models depends on the quality of input data, particularly the transmission rate, initial conditions, and other parameters present in compartmental models. Telehealth systems may feed numerical models developed to model virus spread in a specific region. Objective: Herein, we evaluated whether a high-quality data set obtained from a state-based telehealth service could be used to forecast the geographical spread of new cases of COVID-19 and to feed computational models of disease spread. Methods: We analyzed structured data obtained from a statewide toll-free telehealth service during 4 months following the first notification of COVID-19 in the Bahia state, Brazil. Structured data were collected during teletriage by a health team of medical students supervised by physicians. Data were registered in a responsive web application for planning and surveillance purposes. The data set was designed to quickly identify users, city, residence neighborhood, date, sex, age, and COVID-19–like symptoms. We performed a temporal-spatial comparison of calls reporting COVID-19–like symptoms and notification of COVID-19 cases. The number of calls was used as a proxy of exposed individuals to feed a mathematical model called “susceptible, exposed, infected, recovered, deceased.” Results: For 181 (43%) out of 417 municipalities of Bahia, the first call to the telehealth service reporting COVID-19–like symptoms preceded the first notification of the disease. The calls preceded, on average, 30 days of the notification of COVID-19 in the municipalities of the state of Bahia, Brazil. Additionally, data obtained by the telehealth service were used to effectively reproduce the spread of COVID-19 in Salvador, the capital of the state, using the “susceptible, exposed, infected, recovered, deceased” model to simulate the spatiotemporal spread of the disease. Conclusions: Data from telehealth services confer high effectiveness in anticipating new waves of COVID-19 and may help understand the epidemic dynamics. %M 36692925 %R 10.2196/40036 %U https://publichealth.jmir.org/2023/1/e40036 %U https://doi.org/10.2196/40036 %U http://www.ncbi.nlm.nih.gov/pubmed/36692925 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e35748 %T Social Support and Technology Use and Their Association With Mental and Physical Health During the COVID-19 Pandemic Among Asian Americans: The COMPASS Cross-sectional Study %A Park,Linda G %A Meyer,Oanh L %A Dougan,Marcelle M %A Golden,Bethany %A Ta,Kevin %A Nam,Bora %A Tsoh,Janice Y %A Tzuang,Marian %A Park,Van M Ta %+ Department of Community Health Systems, School of Nursing, University of California, San Francisco, 2 Koret Way, San Francisco, CA, 94143, United States, 1 415 502 6616, Linda.Park@ucsf.edu %K health disparities %K mental health %K depression %K anxiety %K social support technology %K COVID-19 %K pandemic %K disparity %K support %K technology %K physical health %K race %K survey %K population %K discrimination %K outcome %K AAPI %D 2023 %7 23.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The global COVID-19 pandemic disproportionately affected Asian Americans and Pacific Islanders (AAPIs) and revealed significant health disparities with reports of increased discrimination and xenophobia. Among AAPIs, the pandemic exacerbated their social, linguistic, and geographic isolation. Social support may be especially important for AAPIs given the salience of collectivism as a cultural value. Another mechanism for support among AAPIs was technology use, as it is generally widespread among this population. However, older adults may not perceive the same benefits. Objective: We examined social support and technology use and their relationships with mental and physical health outcomes through the COVID-19 pandemic among AAPIs. Methods: Data were drawn from the COVID-19 Effects on the Mental and Physical Health of AAPI Survey Study (COMPASS) for the time period of October 2020 to February 2021. COMPASS was a cross-sectional, multilingual, national survey conducted online, by phone, and in person with AAPI adults who were ≥18 years of age, in collaboration with academic and community partners in the United States. Data were analyzed using multivariable linear regression using the outcome variables of mental and physical health with various predictors such as social support and technology use. We tested for interactions specific to age and ethnicity. Results: Among 4631 AAPIs (mean age 45.9, SD 16.3 years; 2992/4631, 63.1% female), we found that (1) increased social support was associated with better physical health, (2) total social support was positively associated with better mental health, (3) higher technology use was associated with poorer mental health and inversely associated with poorer physical health, (4) the association of technology use with mental health was weaker among those with low social support (vs those with high social support), (5) adults younger than 60 years old (vs ≥60 years old) were more negatively affected with social support and mental health, and (6) Korean Americans appeared to be a high-risk group for poor physical health with increased technology use. Conclusions: Our paper identified mental and physical health needs along with supportive therapies observed among AAPIs during the pandemic. Future research on how social support can be leveraged, especially among AAPIs younger than 60 years old, and how various types of technology are being utilized are important to guide the recovery efforts to address both mental and physical disparities across communities as a result of the COVID-19 pandemic. %M 36395324 %R 10.2196/35748 %U https://publichealth.jmir.org/2023/1/e35748 %U https://doi.org/10.2196/35748 %U http://www.ncbi.nlm.nih.gov/pubmed/36395324 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 7 %N %P e39231 %T Accuracy of COVID-19–Like Illness Diagnoses in Electronic Health Record Data: Retrospective Cohort Study %A Rao,Suchitra %A Bozio,Catherine %A Butterfield,Kristen %A Reynolds,Sue %A Reese,Sarah E %A Ball,Sarah %A Steffens,Andrea %A Demarco,Maria %A McEvoy,Charlene %A Thompson,Mark %A Rowley,Elizabeth %A Porter,Rachael M %A Fink,Rebecca V %A Irving,Stephanie A %A Naleway,Allison %+ Department of Pediatrics, Hospital Medicine and Infectious Diseases, University of Colorado School of Medicine, 13123 E 16th Ave, Aurora, CO, 80045, United States, 1 7207772823, suchitra.rao@childrenscolorado.org %K COVID-19 %K COVID-like illness %K COVID-19 case definition %K sensitivity %K specificity %K positive predictive value %K negative predictive value %D 2023 %7 17.1.2023 %9 Original Paper %J JMIR Form Res %G English %X Background: Electronic health record (EHR) data provide a unique opportunity to study the epidemiology of COVID-19, clinical outcomes of the infection, comparative effectiveness of therapies, and vaccine effectiveness but require a well-defined computable phenotype of COVID-19–like illness (CLI). Objective: The objective of this study was to evaluate the performance of pathogen-specific and other acute respiratory illness (ARI) International Statistical Classification of Diseases-9 and -10 codes in identifying COVID-19 cases in emergency department (ED) or urgent care (UC) and inpatient settings. Methods: We conducted a retrospective observational cohort study using EHR, claims, and laboratory information system data of ED or UC and inpatient encounters from 4 health systems in the United States. Patients who were aged ≥18 years, had an ED or UC or inpatient encounter for an ARI, and underwent a SARS-CoV-2 polymerase chain reaction test between March 1, 2020, and March 31, 2021, were included. We evaluated various CLI definitions using combinations of International Statistical Classification of Diseases-10 codes as follows: COVID-19–specific codes; CLI definition used in VISION network studies; ARI signs, symptoms, and diagnosis codes only; signs and symptoms of ARI only; and random forest model definitions. We evaluated the sensitivity, specificity, positive predictive value, and negative predictive value of each CLI definition using a positive SARS-CoV-2 polymerase chain reaction test as the reference standard. We evaluated the performance of each CLI definition for distinct hospitalization and ED or UC cohorts. Results: Among 90,952 hospitalizations and 137,067 ED or UC visits, 5627 (6.19%) and 9866 (7.20%) were positive for SARS-CoV-2, respectively. COVID-19–specific codes had high sensitivity (91.6%) and specificity (99.6%) in identifying patients with SARS-CoV-2 positivity among hospitalized patients. The VISION CLI definition maintained high sensitivity (95.8%) but lowered specificity (45.5%). By contrast, signs and symptoms of ARI had low sensitivity and positive predictive value (28.9% and 11.8%, respectively) but higher specificity and negative predictive value (85.3% and 94.7%, respectively). ARI diagnoses, signs, and symptoms alone had low predictive performance. All CLI definitions had lower sensitivity for ED or UC encounters. Random forest approaches identified distinct CLI definitions with high performance for hospital encounters and moderate performance for ED or UC encounters. Conclusions: COVID-19–specific codes have high sensitivity and specificity in identifying adults with positive SARS-CoV-2 test results. Separate combinations of COVID-19-specific codes and ARI codes enhance the utility of CLI definitions in studies using EHR data in hospital and ED or UC settings. %M 36383633 %R 10.2196/39231 %U https://formative.jmir.org/2023/1/e39231 %U https://doi.org/10.2196/39231 %U http://www.ncbi.nlm.nih.gov/pubmed/36383633 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e40659 %T The Environmental and Socioeconomic Effects and Prediction of Patients With Tuberculosis in Different Age Groups in Southwest China: A Population-Based Study %A Wei,Wen %A Xia,Lan %A Wu,Jianlin %A Zhou,Zonglei %A Zhang,Wenqiang %A Luan,Rongsheng %+ Department of Epidemiology and Biostatistics, West China School of Public Health and West China Fourth Hospital, Sichuan University, 16#, Section 3, Renmin Nan Lu, Chengdu, 610041, China, 86 028 85501604, luan_rs@scu.edu.cn %K tuberculosis %K risk factors %K age %K sex %K prediction %K TB control %K tuberculosis control %D 2023 %7 13.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: While the End Tuberculosis (TB) Strategy has been implemented worldwide, the cause of the TB epidemic is multifactorial and not fully understood. Objective: This study aims to investigate the risk factors of TB and incorporate these factors to forecast the incidence of TB infection across different age groups in Sichuan, China. Methods: Correlation and linear regression analyses were conducted to assess the relationships between TB cases and ecological factors, including environmental, economic, and social factors, in Sichuan Province from 2006 to 2017. The transfer function-noise model was used to forecast trends, considering both time and multifactor effects. Results: From 2006 to 2017, Sichuan Province had a reported cumulative incidence rate of 1321.08 cases per 100,000 individuals in male patients and 583.04 cases per 100,000 individuals in female patients. There were significant sex differences in the distribution of cases among age groups (trend χ225=12,544.4; P<.001). Ganzi Tibetan Autonomous Prefecture had the highest incidence rates of TB in both male and female patients in Sichuan. Correlation and regression analyses showed that the total illiteracy rate and average pressure at each measuring station (for individuals aged 15-24 years) were risk factors for TB. The protective factors were as follows: the number of families with the minimum living standard guarantee in urban areas, the average wind speed, the number of discharged patients with invasive TB, the number of people with the minimum living standard guarantee in rural areas, the total health expenditure as a percentage of regional gross domestic product, and being a single male individual (for those aged 0-14 years); the number of hospitals and number of health workers in infectious disease hospitals (for individuals aged 25-64 years); and the amount of daily morning and evening exercise, the number of people with the urban minimum living standard guarantee, and being married (for female individuals aged ≥65 years). The transfer function-noise model indicated that the incidence of TB in male patients aged 0-14 and 15-24 years will continue to increase, and the incidence of TB in female patients aged 0-14 and ≥65 years will continue to increase rapidly in Sichuan by 2035. Conclusions: The End TB Strategy in Sichuan should consider environmental, educational, medical, social, personal, and other conditions, and further substantial efforts are needed especially for male patients aged 0-24 years, female patients aged 0-14 years, and female patients older than 64 years. %M 36456535 %R 10.2196/40659 %U https://publichealth.jmir.org/2023/1/e40659 %U https://doi.org/10.2196/40659 %U http://www.ncbi.nlm.nih.gov/pubmed/36456535 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 12 %N %P e43084 %T Examining Drug-Resistant Tuberculosis Stigma Among Health Care Workers Toward the Development of a Stigma-Reduction Intervention: Protocol for a Scoping Review %A Aranas,Lolita Liboon %A Alam,Khorshed %A Gyawali,Prajwal %A Mahumud,Rashidul Alam %+ Graduate Research Studies, University of Southern Queensland, West Street, Darling Heights, Toowoomba, 4350, Australia, 61 468835689, letlet.aranas@gmail.com %K drug-resistant tuberculosis %K health workers %K stigma %K tuberculosis stigma %K TB stigma %K DRTB stigma %D 2023 %7 13.1.2023 %9 Protocol %J JMIR Res Protoc %G English %X Background: Drug-resistant tuberculosis (DRTB) is an increasing threat to human health and economic security worldwide. Exacerbating the severity of DRTB is the low rate of service delivery, leading to increased community transmission of the disease, further amplified by stigma. Health workers are on the front line of service delivery; their efforts in all areas of disease control are suspected of having resulted in stigmatization, impacting patient-centered care. As a growing concern, attention to addressing the DRTB stigma confronting health workers is required. However, little is known about stigma among health workers delivering services to patients with DRTB. This scoping review will provide an overview that could help inform appropriate responses toward stigma-reduction interventions for these health workers. Objective: This scoping review protocol articulates a methodology that will examine the facets of DRTB-related stigma confronting health workers in high TB- and DRTB-burdened countries. This scoping review will (1) summarize stigma barriers and facilitators contributing to stigmatization among health workers delivering services to patients with DRTB, (2) identify the most common stigma barrier and facilitator, and (3) summarize the stigma-reduction intervention recommendations in the studies. Methods: Guided by Arksey and O’Malley’s framework and the recommendations of Munn et al, we will conduct a scoping review of relevant literature providing evidence of DRTB-related stigma among health workers from countries with a high burden of tuberculosis (TB) and DRTB. We will search published articles written in English from 2010 onward in electronic databases using Medical Subject Headings and keywords. Our search will apply a 3-step search strategy and use software tools to manage references and facilitate the entire scoping review process. The findings of our review will be presented following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Scoping Reviews checklist. Our study is registered with Open Science Framework Registries. Results: This scoping review is part of a bigger project that will critically investigate stigma among health workers delivering services to patients resistant to TB medications. This study began in November 2021 and is expected to finish in 2023. The study has retrieved 593 abstracts out of 12,138 articles searched since February 2022 from the identified databases. The findings of this study will be published in a peer-reviewed journal. Conclusions: This review will provide an outline of the aspects of DRTB-related stigma confronting health workers. The findings of this review could help inform appropriate responses toward stigma-reduction interventions for these health workers. This is significant because interventions addressing related TB (and DRTB) stigma in the workplace are lacking. International Registered Report Identifier (IRRID): DERR1-10.2196/43084 %M 36637899 %R 10.2196/43084 %U https://www.researchprotocols.org/2023/1/e43084 %U https://doi.org/10.2196/43084 %U http://www.ncbi.nlm.nih.gov/pubmed/36637899 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e42530 %T Influenza-Associated Excess Mortality by Age, Sex, and Subtype/Lineage: Population-Based Time-Series Study With a Distributed-Lag Nonlinear Model %A Li,Li %A Yan,Ze-Lin %A Luo,Lei %A Liu,Wenhui %A Yang,Zhou %A Shi,Chen %A Ming,Bo-Wen %A Yang,Jun %A Cao,Peihua %A Ou,Chun-Quan %+ State Key Laboratory of Organ Failure Research, Department of Biostatistics, School of Public Health, Southern Medical University, No1023, South Shatai Road, Baiyun District, Guangzhou, 510515, China, 86 20 61649461, ouchunquan@hotmail.com %K influenza %K disease burden %K distributed-lag nonlinear model %K excess mortality %K harvesting effects %D 2023 %7 11.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Accurate estimation of the influenza death burden is of great significance for influenza prevention and control. However, few studies have considered the short-term harvesting effects of influenza on mortality when estimating influenza-associated excess deaths by cause of death, age, sex, and subtype/lineage. Objective: This study aimed to estimate the cause-, age-, and sex-specific excess mortality associated with influenza and its subtypes and lineages in Guangzhou from 2015 to 2018. Methods: Distributed-lag nonlinear models were fitted to estimate the excess mortality related to influenza subtypes or lineages for different causes of death, age groups, and sex based on daily time-series data for mortality, influenza, and meteorological factors. Results: A total of 199,777 death certificates were included in the study. The average annual influenza-associated excess mortality rate (EMR) was 25.06 (95% empirical CI [eCI] 19.85-30.16) per 100,000 persons; 7142 of 8791 (81.2%) deaths were due to respiratory or cardiovascular mortality (EMR 20.36, 95% eCI 16.75-23.74). Excess respiratory and cardiovascular deaths in people aged 60 to 79 years and those aged ≥80 years accounted for 32.9% (2346/7142) and 63.7% (4549/7142) of deaths, respectively. The male to female ratio (MFR) of excess death from respiratory diseases was 1.34 (95% CI 1.17-1.54), while the MFR for excess death from cardiovascular disease was 0.72 (95% CI 0.63-0.82). The average annual excess respiratory and cardiovascular mortality rates attributed to influenza A (H3N2), B/Yamagata, B/Victoria, and A (H1N1) were 8.47 (95% eCI 6.60-10.30), 5.81 (95% eCI 3.35-8.25), 3.68 (95% eCI 0.81-6.49), and 2.83 (95% eCI –1.26 to 6.71), respectively. Among these influenza subtypes/lineages, A (H3N2) had the highest excess respiratory and cardiovascular mortality rates for people aged 60 to 79 years (20.22, 95% eCI 14.56-25.63) and ≥80 years (180.15, 95% eCI 130.75-227.38), while younger people were more affected by A (H1N1), with an EMR of 1.29 (95% eCI 0.07-2.32). The mortality displacement of influenza A (H1N1), A (H3N2), and B/Yamagata was 2 to 5 days, but 5 to 13 days for B/Victoria. Conclusions: Influenza was associated with substantial mortality in Guangzhou, occurring predominantly in the elderly, even after considering mortality displacement. The mortality burden of influenza B, particularly B/Yamagata, cannot be ignored. Contrasting sex differences were found in influenza-associated excess mortality from respiratory diseases and from cardiovascular diseases; the underlying mechanisms need to be investigated in future studies. Our findings can help us better understand the magnitude and time-course of the effect of influenza on mortality and inform targeted interventions for mitigating the influenza mortality burden, such as immunizations with quadrivalent vaccines (especially for older people), behavioral campaigns, and treatment strategies. %M 36630176 %R 10.2196/42530 %U https://publichealth.jmir.org/2023/1/e42530 %U https://doi.org/10.2196/42530 %U http://www.ncbi.nlm.nih.gov/pubmed/36630176 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 4 %N %P e42700 %T SARS-CoV-2 Omicron Variant Genomic Sequences and Their Epidemiological Correlates Regarding the End of the Pandemic: In Silico Analysis %A Kumar,Ashutosh %A Asghar,Adil %A Singh,Himanshu N %A Faiq,Muneeb A %A Kumar,Sujeet %A Narayan,Ravi K %A Kumar,Gopichand %A Dwivedi,Prakhar %A Sahni,Chetan %A Jha,Rakesh K %A Kulandhasamy,Maheswari %A Prasoon,Pranav %A Sesham,Kishore %A Kant,Kamla %A Pandey,Sada N %+ Department of Anatomy, All India Institute of Medical Sciences-Patna, Phulwari Sharif, Patna, 801507, India, 91 0612245 ext 1335, drashutoshkumar@aiimspatna.org %K COVID-19 %K pandemic %K variants %K immune escape %K transmissibility %K virulence %K policy %K mutations %K epidemiology %K data %K Omicron %K virus %K transmission %K genomic %D 2023 %7 10.1.2023 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: Emergence of the new SARS-CoV-2 variant B.1.1.529 worried health policy makers worldwide due to a large number of mutations in its genomic sequence, especially in the spike protein region. The World Health Organization (WHO) designated this variant as a global variant of concern (VOC), which was named “Omicron.” Following Omicron’s emergence, a surge of new COVID-19 cases was reported globally, primarily in South Africa. Objective: The aim of this study was to understand whether Omicron had an epidemiological advantage over existing variants. Methods: We performed an in silico analysis of the complete genomic sequences of Omicron available on the Global Initiative on Sharing Avian Influenza Data (GISAID) database to analyze the functional impact of the mutations present in this variant on virus-host interactions in terms of viral transmissibility, virulence/lethality, and immune escape. In addition, we performed a correlation analysis of the relative proportion of the genomic sequences of specific SARS-CoV-2 variants (in the period from October 1 to November 29, 2021) with matched epidemiological data (new COVID-19 cases and deaths) from South Africa. Results: Compared with the current list of global VOCs/variants of interest (VOIs), as per the WHO, Omicron bears more sequence variation, specifically in the spike protein and host receptor-binding motif (RBM). Omicron showed the closest nucleotide and protein sequence homology with the Alpha variant for the complete sequence and the RBM. The mutations were found to be primarily condensed in the spike region (n=28-48) of the virus. Further mutational analysis showed enrichment for the mutations decreasing binding affinity to angiotensin-converting enzyme 2 receptor and receptor-binding domain protein expression, and for increasing the propensity of immune escape. An inverse correlation of Omicron with the Delta variant was noted (r=–0.99, P<.001; 95% CI –0.99 to –0.97) in the sequences reported from South Africa postemergence of the new variant, subsequently showing a decrease. There was a steep rise in new COVID-19 cases in parallel with the increase in the proportion of Omicron isolates since the report of the first case (74%-100%). By contrast, the incidence of new deaths did not increase (r=–0.04, P>.05; 95% CI –0.52 to 0.58). Conclusions: In silico analysis of viral genomic sequences suggests that the Omicron variant has more remarkable immune-escape ability than existing VOCs/VOIs, including Delta, but reduced virulence/lethality than other reported variants. The higher power for immune escape for Omicron was a likely reason for the resurgence in COVID-19 cases and its rapid rise as the globally dominant strain. Being more infectious but less lethal than the existing variants, Omicron could have plausibly led to widespread unnoticed new, repeated, and vaccine breakthrough infections, raising the population-level immunity barrier against the emergence of new lethal variants. The Omicron variant could have thus paved the way for the end of the pandemic. %M 36688013 %R 10.2196/42700 %U https://bioinform.jmir.org/2023/1/e42700 %U https://doi.org/10.2196/42700 %U http://www.ncbi.nlm.nih.gov/pubmed/36688013 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 9 %N %P e36538 %T A Spatiotemporal Solution to Control COVID-19 Transmission at the Community Scale for Returning to Normalcy: COVID-19 Symptom Onset Risk Spatiotemporal Analysis %A Tong,Chengzhuo %A Shi,Wenzhong %A Zhang,Anshu %A Shi,Zhicheng %+ Research Institute for Smart Cities, School of Architecture and Urban Planning, Shenzhen University, 3688 Nanhai Avenue, Nanshan District, Shenzhen, 518060, China, 86 0755 26531244, shizhic@hotmail.com %K return to normalcy %K precise prevention and control %K risk prediction %K COVID-19 symptom onset %K symptom %K COVID-19 %D 2023 %7 6.1.2023 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 36508488 %R 10.2196/36538 %U https://publichealth.jmir.org/2023/1/e36538 %U https://doi.org/10.2196/36538 %U http://www.ncbi.nlm.nih.gov/pubmed/36508488 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e38533 %T A Smartphone-Based Platform Assisted by Artificial Intelligence for Reading and Reporting Rapid Diagnostic Tests: Evaluation Study in SARS-CoV-2 Lateral Flow Immunoassays %A Bermejo-Peláez,David %A Marcos-Mencía,Daniel %A Álamo,Elisa %A Pérez-Panizo,Nuria %A Mousa,Adriana %A Dacal,Elena %A Lin,Lin %A Vladimirov,Alexander %A Cuadrado,Daniel %A Mateos-Nozal,Jesús %A Galán,Juan Carlos %A Romero-Hernandez,Beatriz %A Cantón,Rafael %A Luengo-Oroz,Miguel %A Rodriguez-Dominguez,Mario %+ Spotlab, P.º de Juan XXIII, 36B, Madrid, 28040, Spain, 34 916256927, miguel@spotlab.ai %K rapid diagnostic test %K artificial intelligence %K AI %K telemedicine platform %K COVID-19 %K rapid test %K diagnostics %K epidemiology %K surveillance %K automatic %K automated %K tracking %D 2022 %7 30.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Rapid diagnostic tests (RDTs) are being widely used to manage COVID-19 pandemic. However, many results remain unreported or unconfirmed, altering a correct epidemiological surveillance. Objective: Our aim was to evaluate an artificial intelligence–based smartphone app, connected to a cloud web platform, to automatically and objectively read RDT results and assess its impact on COVID-19 pandemic management. Methods: Overall, 252 human sera were used to inoculate a total of 1165 RDTs for training and validation purposes. We then conducted two field studies to assess the performance on real-world scenarios by testing 172 antibody RDTs at two nursing homes and 96 antigen RDTs at one hospital emergency department. Results: Field studies demonstrated high levels of sensitivity (100%) and specificity (94.4%, CI 92.8%-96.1%) for reading IgG band of COVID-19 antibody RDTs compared to visual readings from health workers. Sensitivity of detecting IgM test bands was 100%, and specificity was 95.8% (CI 94.3%-97.3%). All COVID-19 antigen RDTs were correctly read by the app. Conclusions: The proposed reading system is automatic, reducing variability and uncertainty associated with RDTs interpretation and can be used to read different RDT brands. The web platform serves as a real-time epidemiological tracking tool and facilitates reporting of positive RDTs to relevant health authorities. %M 36265136 %R 10.2196/38533 %U https://publichealth.jmir.org/2022/12/e38533 %U https://doi.org/10.2196/38533 %U http://www.ncbi.nlm.nih.gov/pubmed/36265136 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e38196 %T The Importance of Incorporating At-Home Testing Into SARS-CoV-2 Point Prevalence Estimates: Findings From a US National Cohort, February 2022 %A Qasmieh,Saba A %A Robertson,McKaylee M %A Rane,Madhura S %A Shen,Yanhan %A Zimba,Rebecca %A Picchio,Camila A %A Parcesepe,Angela M %A Chang,Mindy %A Kulkarni,Sarah G %A Grov,Christian %A Nash,Denis %+ Institute for Implementation Science in Population Health, City University of New York, 6th Floor, 55 W 125th St, New York, NY, 10027, United States, 1 646 364 9618, saba.qasmieh@sph.cuny.edu %K COVID-19 prevalence %K at-home rapid SARS-CoV-2 tests %K population-based surveys %K COVID-19 %K surveillance %K public health %K rapid test %K Omicron variant %K point prevalence %D 2022 %7 27.12.2022 %9 Short Paper %J JMIR Public Health Surveill %G English %X 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. %M 36240020 %R 10.2196/38196 %U https://publichealth.jmir.org/2022/12/e38196 %U https://doi.org/10.2196/38196 %U http://www.ncbi.nlm.nih.gov/pubmed/36240020 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e37122 %T The Role of Heterogenous Real-world Data for Dengue Surveillance in Martinique: Observational Retrospective Study %A Sylvestre,Emmanuelle %A Cécilia-Joseph,Elsa %A Bouzillé,Guillaume %A Najioullah,Fatiha %A Etienne,Manuel %A Malouines,Fabrice %A Rosine,Jacques %A Julié,Sandrine %A Cabié,André %A Cuggia,Marc %+ Centre de Données Cliniques, Centre Hospitalier Universitaire Martinique, CS 90632, Fort-de-France, 97261, Martinique, 596 596553507, emmanuelle.sylvestre@chu-martinique.fr %K dengue %K surveillance %K real-word data %K Big Data %K Caribbean %K dengue-endemic region %D 2022 %7 22.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Traditionally, dengue prevention and control rely on vector control programs and reporting of symptomatic cases to a central health agency. However, case reporting is often delayed, and the true burden of dengue disease is often underestimated. Moreover, some countries do not have routine control measures for vector control. Therefore, researchers are constantly assessing novel data sources to improve traditional surveillance systems. These studies are mostly carried out in big territories and rarely in smaller endemic regions, such as Martinique and the Lesser Antilles. Objective: The aim of this study was to determine whether heterogeneous real-world data sources could help reduce reporting delays and improve dengue monitoring in Martinique island, a small endemic region. Methods: Heterogenous data sources (hospitalization data, entomological data, and Google Trends) and dengue surveillance reports for the last 14 years (January 2007 to February 2021) were analyzed to identify associations with dengue outbreaks and their time lags. Results: The dengue hospitalization rate was the variable most strongly correlated with the increase in dengue positivity rate by real-time reverse transcription polymerase chain reaction (Pearson correlation coefficient=0.70) with a time lag of −3 weeks. Weekly entomological interventions were also correlated with the increase in dengue positivity rate by real-time reverse transcription polymerase chain reaction (Pearson correlation coefficient=0.59) with a time lag of −2 weeks. The most correlated query from Google Trends was the “Dengue” topic restricted to the Martinique region (Pearson correlation coefficient=0.637) with a time lag of −3 weeks. Conclusions: Real-word data are valuable data sources for dengue surveillance in smaller territories. Many of these sources precede the increase in dengue cases by several weeks, and therefore can help to improve the ability of traditional surveillance systems to provide an early response in dengue outbreaks. All these sources should be better integrated to improve the early response to dengue outbreaks and vector-borne diseases in smaller endemic territories. %M 36548023 %R 10.2196/37122 %U https://publichealth.jmir.org/2022/12/e37122 %U https://doi.org/10.2196/37122 %U http://www.ncbi.nlm.nih.gov/pubmed/36548023 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 12 %P e37591 %T Synchronous Teleconsultation and Monitoring Service Targeting COVID-19: Leveraging Insights for Postpandemic Health Care %A Marcolino,Milena Soriano %A Diniz,Clara Sousa %A Chagas,Bruno Azevedo %A Mendes,Mayara Santos %A Prates,Raquel %A Pagano,Adriana %A Ferreira,Thiago Castro %A Alkmim,Maria Beatriz Moreira %A Oliveira,Clara Rodrigues Alves %A Borges,Isabela Nascimento %A Raposo,Magda César %A Reis,Zilma Silveira Nogueira %A Paixão,Maria Cristina %A Ribeiro,Leonardo Bonisson %A Rocha,Gustavo Machado %A Cardoso,Clareci Silva %A Ribeiro,Antonio Luiz Pinho %+ Telehealth Center, University Hospital and Telehealth Network of Minas Gerais, Universidade Federal de Minas Gerais, Avenida Professor Alfredo Balena, 110 Room 107 Ala Sul, Santa Efigênia, Belo Horizonte, 30130-100, Brazil, 55 31 33079201, milenamarc@gmail.com %K COVID-19 %K telemonitoring %K remote consultation %K telemedicine %K primary health care %K delivery of health care %K telehealth %K text message %K mobile health %K public health %K remote care %K digital health %K usability %D 2022 %7 22.12.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Although a great number of teleconsultation services have been developed during the COVID-19 pandemic, studies assessing usability and health care provider satisfaction are still incipient. Objective: This study aimed to describe the development, implementation, and expansion of a synchronous teleconsultation service targeting patients with symptoms of COVID-19 in Brazil, as well as to assess its usability and health care professionals’ satisfaction. Methods: This mixed methods study was developed in 5 phases: (1) the identification of components, technical and functional requirements, and system architecture; (2) system and user interface development and validation; (3) pilot-testing in the city of Divinópolis; (4) expansion in the cities of Divinópolis, Teófilo Otoni, and Belo Horizonte for Universidade Federal de Minas Gerais faculty and students; and (5) usability and satisfaction assessment, using Likert-scale and open-ended questions. Results: During pilot development, problems contacting users were solved by introducing standardized SMS text messages, which were sent to users to obtain their feedback and keep track of them. Until April 2022, the expanded system served 31,966 patients in 146,158 teleconsultations. Teleconsultations were initiated through chatbot in 27.7% (40,486/146,158) of cases. Teleconsultation efficiency per city was 93.7% (13,317/14,212) in Teófilo Otoni, 92.4% (11,747/12,713) in Divinópolis, and 98.8% (4981/5041) in Belo Horizonte (university campus), thus avoiding in-person assistance for a great majority of patients. In total, 50 (83%) out of 60 health care professionals assessed the system’s usability as satisfactory, despite a few system instability problems. Conclusions: The system provided updated information about COVID-19 and enabled remote care for thousands of patients, which evidenced the critical role of telemedicine in expanding emergency services capacity during the pandemic. The dynamic nature of the current pandemic required fast planning, implementation, development, and updates in the system. Usability and satisfaction assessment was key to identifying areas for improvement. The experience reported here is expected to inform telemedicine strategies to be implemented in a postpandemic scenario. %M 36191175 %R 10.2196/37591 %U https://medinform.jmir.org/2022/12/e37591 %U https://doi.org/10.2196/37591 %U http://www.ncbi.nlm.nih.gov/pubmed/36191175 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 3 %N 1 %P e42243 %T Mutational Patterns Observed in SARS-CoV-2 Genomes Sampled From Successive Epochs Delimited by Major Public Health Events in Ontario, Canada: Genomic Surveillance Study %A Chen,David %A Randhawa,Gurjit S %A Soltysiak,Maximillian PM %A de Souza,Camila PE %A Kari,Lila %A Singh,Shiva M %A Hill,Kathleen A %+ Department of Biology, Western University, 1151 Richmond Street, London, ON, N6A 5B7, Canada, 1 519 661 2111 ext 81337, khill22@uwo.ca %K SARS-CoV-2 %K COVID-19 %K Ontario %K virus %K genetics %K evolution %K selection %K mutation %K epidemiology %K variant %D 2022 %7 22.12.2022 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: The emergence of SARS-CoV-2 variants with mutations associated with increased transmissibility and virulence is a public health concern in Ontario, Canada. Characterizing how the mutational patterns of the SARS-CoV-2 genome have changed over time can shed light on the driving factors, including selection for increased fitness and host immune response, that may contribute to the emergence of novel variants. Moreover, the study of SARS-CoV-2 in the microcosm of Ontario, Canada can reveal how different province-specific public health policies over time may be associated with observed mutational patterns as a model system. Objective: This study aimed to perform a comprehensive analysis of single base substitution (SBS) types, counts, and genomic locations observed in SARS-CoV-2 genomic sequences sampled in Ontario, Canada. Comparisons of mutational patterns were conducted between sequences sampled during 4 different epochs delimited by major public health events to track the evolution of the SARS-CoV-2 mutational landscape over 2 years. Methods: In total, 24,244 SARS-CoV-2 genomic sequences and associated metadata sampled in Ontario, Canada from January 1, 2020, to December 31, 2021, were retrieved from the Global Initiative on Sharing All Influenza Data database. Sequences were assigned to 4 epochs delimited by major public health events based on the sampling date. SBSs from each SARS-CoV-2 sequence were identified relative to the MN996528.1 reference genome. Catalogues of SBS types and counts were generated to estimate the impact of selection in each open reading frame, and identify mutation clusters. The estimation of mutational fitness over time was performed using the Augur pipeline. Results: The biases in SBS types and proportions observed support previous reports of host antiviral defense activity involving the SARS-CoV-2 genome. There was an increase in U>C substitutions associated with adenosine deaminase acting on RNA (ADAR) activity uniquely observed during Epoch 4. The burden of novel SBSs observed in SARS-CoV-2 genomic sequences was the greatest in Epoch 2 (median 5), followed by Epoch 3 (median 4). Clusters of SBSs were observed in the spike protein open reading frame, ORF1a, and ORF3a. The high proportion of nonsynonymous SBSs and increasing dN/dS metric (ratio of nonsynonymous to synonymous mutations in a given open reading frame) to above 1 in Epoch 4 indicate positive selection of the spike protein open reading frame. Conclusions: Quantitative analysis of the mutational patterns of the SARS-CoV-2 genome in the microcosm of Ontario, Canada within early consecutive epochs of the pandemic tracked the mutational dynamics in the context of public health events that instigate significant shifts in selection and mutagenesis. Continued genomic surveillance of emergent variants will be useful for the design of public health policies in response to the evolving COVID-19 pandemic. %R 10.2196/42243 %U https://bioinform.jmir.org/2022/1/e42243 %U https://doi.org/10.2196/42243 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e39141 %T Representativeness, Vaccination Uptake, and COVID-19 Clinical Outcomes 2020-2021 in the UK Oxford-Royal College of General Practitioners Research and Surveillance Network: Cohort Profile Summary %A Leston,Meredith %A Elson,William H %A Watson,Conall %A Lakhani,Anissa %A Aspden,Carole %A Bankhead,Clare R %A Borrow,Ray %A Button,Elizabeth %A Byford,Rachel %A Elliot,Alex J %A Fan,Xuejuan %A Hoang,Uy %A Linley,Ezra %A Macartney,Jack %A Nicholson,Brian D %A Okusi,Cecilia %A Ramsay,Mary %A Smith,Gillian %A Smith,Sue %A Thomas,Mark %A Todkill,Dan %A Tsang,Ruby SM %A Victor,William %A Williams,Alice J %A Williams,John %A Zambon,Maria %A Howsam,Gary %A Amirthalingam,Gayatri %A Lopez-Bernal,Jamie %A Hobbs,F D Richard %A de Lusignan,Simon %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, United Kingdom, 44 01865 617855, simon.delusignan@phc.ox.ac.uk %K cohort profile %K computerized medical record systems %K general practice %K influenza %K COVID-19 %K sentinel surveillance %K syndromic surveillance %K serology %K virology %K public health %K digital surveillance %K vaccination %K primary care data %K health data %K cohort %K virus %K immunology %K surveillance %K representation %K uptake %K outcome %K hospital %K sampling %K monitoring %D 2022 %7 19.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) is one of Europe’s oldest sentinel systems, working with the UK Health Security Agency (UKHSA) and its predecessor bodies for 55 years. Its surveillance report now runs twice weekly, supplemented by online observatories. In addition to conducting sentinel surveillance from a nationally representative group of practices, the RSC is now also providing data for syndromic surveillance. Objective: The aim of this study was to describe the cohort profile at the start of the 2021-2022 surveillance season and recent changes to our surveillance practice. Methods: The RSC’s pseudonymized primary care data, linked to hospital and other data, are held in the Oxford-RCGP Clinical Informatics Digital Hub, a Trusted Research Environment. We describe the RSC’s cohort profile as of September 2021, divided into a Primary Care Sentinel Cohort (PCSC)—collecting virological and serological specimens—and a larger group of syndromic surveillance general practices (SSGPs). We report changes to our sampling strategy that brings the RSC into alignment with European Centre for Disease Control guidance and then compare our cohort’s sociodemographic characteristics with Office for National Statistics data. We further describe influenza and COVID-19 vaccine coverage for the 2020-2021 season (week 40 of 2020 to week 39 of 2021), with the latter differentiated by vaccine brand. Finally, we report COVID-19–related outcomes in terms of hospitalization, intensive care unit (ICU) admission, and death. Results: As a response to COVID-19, the RSC grew from just over 500 PCSC practices in 2019 to 1879 practices in 2021 (PCSC, n=938; SSGP, n=1203). This represents 28.6% of English general practices and 30.59% (17,299,780/56,550,136) of the population. In the reporting period, the PCSC collected >8000 virology and >23,000 serology samples. The RSC population was broadly representative of the national population in terms of age, gender, ethnicity, National Health Service Region, socioeconomic status, obesity, and smoking habit. The RSC captured vaccine coverage data for influenza (n=5.4 million) and COVID-19, reporting dose one (n=11.9 million), two (n=11 million), and three (n=0.4 million) for the latter as well as brand-specific uptake data (AstraZeneca vaccine, n=11.6 million; Pfizer, n=10.8 million; and Moderna, n=0.7 million). The median (IQR) number of COVID-19 hospitalizations and ICU admissions was 1181 (559-1559) and 115 (50-174) per week, respectively. Conclusions: The RSC is broadly representative of the national population; its PCSC is geographically representative and its SSGPs are newly supporting UKHSA syndromic surveillance efforts. The network captures vaccine coverage and has expanded from reporting primary care attendances to providing data on onward hospital outcomes and deaths. The challenge remains to increase virological and serological sampling to monitor the effectiveness and waning of all vaccines available in a timely manner. %M 36534462 %R 10.2196/39141 %U https://publichealth.jmir.org/2022/12/e39141 %U https://doi.org/10.2196/39141 %U http://www.ncbi.nlm.nih.gov/pubmed/36534462 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e40185 %T The Prognostic and Predictive Effects of Human Papillomavirus Status in Hypopharyngeal Carcinoma: Population-Based Study %A Yang,Shi-Ping %A Lin,Xiang-Ying %A Hu,Min %A Cai,Cheng-Fu %+ Department of Otorhinolaryngology Head and Neck Surgery, Zhongshan Hospital, School of Medicine, Xiamen University, 201-209, South Hubin Road, Xiamen, 361004, China, 86 5922292201, caichengfuxmu@126.com %K hypopharyngeal carcinoma %K human papillomavirus %K HPV %K chemotherapy %K radiotherapy %K prognosis %K cancer %K carcinoma %D 2022 %7 16.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The role of the Human Papillomavirus (HPV) status in patients with hypopharyngeal squamous cell carcinoma (HSCC) remains controversial. Objective: Our aim was to determine the prognostic and predictive effects of HPV status in patients with locally advanced HSCC (stage III-IVB) receiving primary radiotherapy. Methods: Patients diagnosed with stage III-IVB HSCC between 2010 and 2016 were identified. HPV status, demographics, clinicopathological characteristics, treatment, and survival data were captured. Kaplan-Meier analysis, multivariable Cox regression analysis, and propensity score matching analysis were performed. Results: We identified 531 patients in this study and 142 (26.7%) patients with HPV-positive diseases. No significant differences were observed between those with HPV-negative and HPV-positive diseases with regard to demographics, clinicopathological characteristics, and chemotherapy use. HPV-positive HSCC had better head and neck cancer-specific survival (HNCSS; P=.001) and overall survival (OS; P<.001) compared to those with HPV-negative tumors. Similar results were found using the multivariable Cox regression analysis. Sensitivity analyses showed that the receipt of chemotherapy was associated with significantly improving HNCSS (P<.001) and OS (P<.001) compared to not receiving chemotherapy in HPV-negative HSCC, whereas comparable HNCSS (P=.59) and OS (P=.12) were found between both treatment arms in HPV-positive HSCC. Similar results were found after propensity score matching. Conclusions: Approximately one-quarter of HSCC may be HPV-related, and HPV-positive HSCC is associated with improved survival outcomes. Furthermore, additional chemotherapy appears to be not related to a survival benefit in patients with HPV-positive tumors who received primary radiotherapy. %M 36525304 %R 10.2196/40185 %U https://publichealth.jmir.org/2022/12/e40185 %U https://doi.org/10.2196/40185 %U http://www.ncbi.nlm.nih.gov/pubmed/36525304 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e36827 %T Perceptions of, and Obstacles to, SARS-CoV-2 Vaccination Among Adults in Lebanon: Cross-sectional Online Survey %A Abou-Arraj,Nadeem Elias %A Maddah,Diana %A Buhamdan,Vanessa %A Abbas,Roua %A Jawad,Nadine Kamel %A Karaki,Fatima %A Alami,Nael H %A Geldsetzer,Pascal %+ School of Public Health, University of California, Berkeley, 2121 Berkeley Way, Berkeley, CA, 94704, United States, 1 510 643 0881, narraj@berkeley.edu %K Lebanon %K COVID-19 %K SARS-CoV-2 %K coronavirus %K vaccination %K vaccine hesitancy %K vaccine acceptance %K health care system %K misinformation %K public health %D 2022 %7 14.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is an additional burden on Lebanon’s fragmented health care system and adds to its ongoing political, economic, and refugee crises. Vaccination is an important means of reducing the impact of the pandemic. Objective: Our study’s aims were to (1) assess the prevalences of intention to vaccinate and vaccine hesitancy in Lebanon; (2) determine how vaccine hesitancy in Lebanon varies by sociodemographic, economic, and geographic characteristics; and (3) understand individuals’ motivations for vaccinating as well as concerns and obstacles to vaccination. Methods: We performed a cross-sectional study from January 29, 2021, to March 11, 2021, using an online questionnaire of open- and closed-ended questions in Arabic via convenience “snowball” sampling to assess the perceptions of adults residing in Lebanon. Results: Of the 1185 adults who participated in the survey, 46.1% (95% CI: 43.2%-49.0%) intended to receive the SARS-CoV-2 vaccine when available to them, 19.0% (95% CI 16.8%-21.4%) indicated they would not, and 34.0% (95% CI 31.3%-36.8%) were unsure (with an additional 0.9% skipping this question). The most common reasons for hesitancy were concerns about safety, limited testing, side effects, and efficacy. Top motivations for vaccinating were to protect oneself, protect one’s family and the public, and end the pandemic. Despite financial hardships in Lebanon, barriers to vaccine access were not frequently described as concerns. Established health care facilities, rather than new temporary vaccination centers, were most frequently selected as preferred vaccination sites. Conclusions: Vaccine hesitancy appears to be high in Lebanon. Disseminating clear, consistent, evidence-based safety and efficacy information on vaccines may help reduce vaccine hesitancy, especially among the large proportion of adults who appear to be unsure about (rather than opposed to) vaccination. %M 36383635 %R 10.2196/36827 %U https://formative.jmir.org/2022/12/e36827 %U https://doi.org/10.2196/36827 %U http://www.ncbi.nlm.nih.gov/pubmed/36383635 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e38158 %T Machine Learning Techniques to Explore Clinical Presentations of COVID-19 Severity and to Test the Association With Unhealthy Opioid Use: Retrospective Cross-sectional Cohort Study %A Thompson,Hale M %A Sharma,Brihat %A Smith,Dale L %A Bhalla,Sameer %A Erondu,Ihuoma %A Hazra,Aniruddha %A Ilyas,Yousaf %A Pachwicewicz,Paul %A Sheth,Neeral K %A Chhabra,Neeraj %A Karnik,Niranjan S %A Afshar,Majid %+ Section of Community Behavioral Health, Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Suite 302, 1645 W. Jackson Boulevard, Chicago, IL, 60612, United States, 1 4153108569, hale_thompson@rush.edu %K unhealthy opioid use %K substance misuse %K COVID-19 %K severity of illness %K overdose %K topic modeling %K machine learning %K opioid use %K pandemic %K health outcome %K public health %K disease severity %K electronic health record %K COVID-19 outcome %K risk factor %K patient data %D 2022 %7 8.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has exacerbated health inequities in the United States. People with unhealthy opioid use (UOU) may face disproportionate challenges with COVID-19 precautions, and the pandemic has disrupted access to opioids and UOU treatments. UOU impairs the immunological, cardiovascular, pulmonary, renal, and neurological systems and may increase severity of outcomes for COVID-19. Objective: We applied machine learning techniques to explore clinical presentations of hospitalized patients with UOU and COVID-19 and to test the association between UOU and COVID-19 disease severity. Methods: This retrospective, cross-sectional cohort study was conducted based on data from 4110 electronic health record patient encounters at an academic health center in Chicago between January 1, 2020, and December 31, 2020. The inclusion criterion was an unplanned admission of a patient aged ≥18 years; encounters were counted as COVID-19-positive if there was a positive test for COVID-19 or 2 COVID-19 International Classification of Disease, Tenth Revision codes. Using a predefined cutoff with optimal sensitivity and specificity to identify UOU, we ran a machine learning UOU classifier on the data for patients with COVID-19 to estimate the subcohort of patients with UOU. Topic modeling was used to explore and compare the clinical presentations documented for 2 subgroups: encounters with UOU and COVID-19 and those with no UOU and COVID-19. Mixed effects logistic regression accounted for multiple encounters for some patients and tested the association between UOU and COVID-19 outcome severity. Severity was measured with 3 utilization metrics: low-severity unplanned admission, medium-severity unplanned admission and receiving mechanical ventilation, and high-severity unplanned admission with in-hospital death. All models controlled for age, sex, race/ethnicity, insurance status, and BMI. Results: Topic modeling yielded 10 topics per subgroup and highlighted unique comorbidities associated with UOU and COVID-19 (eg, HIV) and no UOU and COVID-19 (eg, diabetes). In the regression analysis, each incremental increase in the classifier’s predicted probability of UOU was associated with 1.16 higher odds of COVID-19 outcome severity (odds ratio 1.16, 95% CI 1.04-1.29; P=.009). Conclusions: Among patients hospitalized with COVID-19, UOU is an independent risk factor associated with greater outcome severity, including in-hospital death. Social determinants of health and opioid-related overdose are unique comorbidities in the clinical presentation of the UOU patient subgroup. Additional research is needed on the role of COVID-19 therapeutics and inpatient management of acute COVID-19 pneumonia for patients with UOU. Further research is needed to test associations between expanded evidence-based harm reduction strategies for UOU and vaccination rates, hospitalizations, and risks for overdose and death among people with UOU and COVID-19. Machine learning techniques may offer more exhaustive means for cohort discovery and a novel mixed methods approach to population health. %M 36265163 %R 10.2196/38158 %U https://publichealth.jmir.org/2022/12/e38158 %U https://doi.org/10.2196/38158 %U http://www.ncbi.nlm.nih.gov/pubmed/36265163 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e37507 %T Assessing Associations Between COVID-19 Symptomology and Adverse Outcomes After Piloting Crowdsourced Data Collection: Cross-sectional Survey Study %A Flaks-Manov,Natalie %A Bai,Jiawei %A Zhang,Cindy %A Malpani,Anand %A Ray,Stuart C %A Taylor,Casey Overby %+ Johns Hopkins University School of Medicine, 3101 Wyman Park Dr., Baltimore, MD, 21218, United States, 1 443 287 6657, cot@jhu.edu %K COVID-19 %K coronavirus %K symptoms %K symptomology %K crowdsourcing %K adverse outcomes %K data quality %D 2022 %7 6.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Crowdsourcing is a useful way to rapidly collect information on COVID-19 symptoms. However, there are potential biases and data quality issues given the population that chooses to participate in crowdsourcing activities and the common strategies used to screen participants based on their previous experience. Objective: The study aimed to (1) build a pipeline to enable data quality and population representation checks in a pilot setting prior to deploying a final survey to a crowdsourcing platform, (2) assess COVID-19 symptomology among survey respondents who report a previous positive COVID-19 result, and (3) assess associations of symptomology groups and underlying chronic conditions with adverse outcomes due to COVID-19. Methods: We developed a web-based survey and hosted it on the Amazon Mechanical Turk (MTurk) crowdsourcing platform. We conducted a pilot study from August 5, 2020, to August 14, 2020, to refine the filtering criteria according to our needs before finalizing the pipeline. The final survey was posted from late August to December 31, 2020. Hierarchical cluster analyses were performed to identify COVID-19 symptomology groups, and logistic regression analyses were performed for hospitalization and mechanical ventilation outcomes. Finally, we performed a validation of study outcomes by comparing our findings to those reported in previous systematic reviews. Results: The crowdsourcing pipeline facilitated piloting our survey study and revising the filtering criteria to target specific MTurk experience levels and to include a second attention check. We collected data from 1254 COVID-19–positive survey participants and identified the following 6 symptomology groups: abdominal and bladder pain (Group 1); flu-like symptoms (loss of smell/taste/appetite; Group 2); hoarseness and sputum production (Group 3); joint aches and stomach cramps (Group 4); eye or skin dryness and vomiting (Group 5); and no symptoms (Group 6). The risk factors for adverse COVID-19 outcomes differed for different symptomology groups. The only risk factor that remained significant across 4 symptomology groups was influenza vaccine in the previous year (Group 1: odds ratio [OR] 6.22, 95% CI 2.32-17.92; Group 2: OR 2.35, 95% CI 1.74-3.18; Group 3: OR 3.7, 95% CI 1.32-10.98; Group 4: OR 4.44, 95% CI 1.53-14.49). Our findings regarding the symptoms of abdominal pain, cough, fever, fatigue, shortness of breath, and vomiting as risk factors for COVID-19 adverse outcomes were concordant with the findings of other researchers. Some high-risk symptoms found in our study, including bladder pain, dry eyes or skin, and loss of appetite, were reported less frequently by other researchers and were not considered previously in relation to COVID-19 adverse outcomes. Conclusions: We demonstrated that a crowdsourced approach was effective for collecting data to assess symptomology associated with COVID-19. Such a strategy may facilitate efficient assessments in a dynamic intersection between emerging infectious diseases, and societal and environmental changes. %M 36343205 %R 10.2196/37507 %U https://formative.jmir.org/2022/12/e37507 %U https://doi.org/10.2196/37507 %U http://www.ncbi.nlm.nih.gov/pubmed/36343205 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e37669 %T Digitalizing and Upgrading Severe Acute Respiratory Infections Surveillance in Malta: System Development %A Cauchi,John Paul %A Borg,Maria-Louise %A Džiugytė,Aušra %A Attard,Jessica %A Melillo,Tanya %A Zahra,Graziella %A Barbara,Christopher %A Spiteri,Michael %A Drago,Allan %A Zammit,Luke %A Debono,Joseph %A Souness,Jorgen %A Agius,Steve %A Young,Sharon %A Dimech,Alan %A Chetcuti,Ian %A Camenzuli,Mark %A Borg,Ivan %A Calleja,Neville %A Tabone,Lorraine %A Gauci,Charmaine %A Vassallo,Pauline %A Baruch,Joaquin %+ Health Promotion and Disease Prevention Directorate, 1, St. Luke's Square, Gwardamanġa, Msida, PTA 1010, Malta, 356 79899999, john-paul.cauchi@gov.mt %K surveillance %K public health %K epidemiology %K COVID-19 %K disease prevention %K disease surveillance %K digital health %K health system %K pandemic %K public hospital %K patient data %K health data %K electronic record %K monitoring %D 2022 %7 5.12.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In late 2020, the European Centre for Disease Prevention and Control and Epiconcept started implementing a surveillance system for severe acute respiratory infections (SARI) across Europe. Objective: We sought to describe the process of digitizing and upgrading SARI surveillance in Malta, an island country with a centralized health system, during the COVID-19 pandemic from February to November 2021. We described the characteristics of people included in the surveillance system and compared different SARI case definitions, including their advantages and disadvantages. This study also discusses the process, output, and future for SARI and other public health surveillance opportunities. Methods: Malta has one main public hospital where, on admission, patient data are entered into electronic records as free text. Symptoms and comorbidities are manually extracted from these records, whereas other data are collected from registers. Collected data are formatted to produce weekly and monthly reports to inform public health actions. From October 2020 to February 2021, we established an analogue incidence-based system for SARI surveillance. From February 2021 onward, we mapped key stakeholders and digitized most surveillance processes. Results: By November 30, 2021, 903 SARI cases were reported, with 380 (42.1%) positive for SARS-CoV-2. Of all SARI hospitalizations, 69 (7.6%) were admitted to the intensive care unit, 769 (85.2%) were discharged, 27 (3%) are still being treated, and 107 (11.8%) died. Among the 107 patients who died, 96 (89.7%) had more than one underlying condition, the most common of which were hypertension (n=57, 53.3%) and chronic heart disease (n=49, 45.8%). Conclusions: The implementation of enhanced SARI surveillance in Malta was completed by the end of May 2021, allowing the monitoring of SARI incidence and patient characteristics. A future shift to register-based surveillance should improve SARI detection through automated processes. %M 36227157 %R 10.2196/37669 %U https://publichealth.jmir.org/2022/12/e37669 %U https://doi.org/10.2196/37669 %U http://www.ncbi.nlm.nih.gov/pubmed/36227157 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 12 %P e40042 %T Risks, Epidemics, and Prevention Measures of Infectious Diseases in Major Sports Events: Scoping Review %A Yan,Xiangyu %A Fang,Yian %A Li,Yongjie %A Jia,Zhongwei %A Zhang,Bo %+ School of Public Health, Peking University, 38 Xueyuan Rd, Haidian District, Beijing, 100191, China, 86 18811186101, zhangbo0136@pku.edu.cn %K major sports event %K epidemic %K risk factor %K prevention %K surveillance %K scoping review %D 2022 %7 2.12.2022 %9 Review %J JMIR Public Health Surveill %G English %X 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. %M 36459401 %R 10.2196/40042 %U https://publichealth.jmir.org/2022/12/e40042 %U https://doi.org/10.2196/40042 %U http://www.ncbi.nlm.nih.gov/pubmed/36459401 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 4 %P e41739 %T Multiple Keratoacanthomas Following Moderna Messenger RNA-1273 COVID-19 Vaccination Resolved With 5-Fluorouracil Treatment: Case Report %A Ahmed,Fahad %A Memon,Nashwah %A Haque,Adel %+ Department of Dermatology, Perelman School of Medicine, University of Pennsylvania, 3400 Civic Center Blvd, 6th Floor, Philadelphia, PA, 19104, United States, 1 7729409756, fahad.ahmed@pennmedicine.upenn.edu %K keratoacanthoma %K COVID-19 vaccine %K COVID-19 %K vaccine %K treatment %K Moderna %K messenger RNA %K side effects %K vaccination %K case report %K oncology %K tumor %D 2022 %7 1.12.2022 %9 Case Report %J JMIR Dermatol %G English %X Cutaneous reactions have been commonly associated with the Moderna messenger RNA (mRNA) COVID-19 vaccine. Among the reported cutaneous side effects, there have not been any associations reported yet regarding keratoacanthoma development after COVID-19 mRNA vaccination. We report a novel case of an 86-year-old man who experienced an eruption of multiple keratoacanthomas 2 weeks after inoculation with the Moderna mRNA-1273 vaccine that resolved following treatment with intralesional 5-fluorouracil. %M 36504544 %R 10.2196/41739 %U https://derma.jmir.org/2022/4/e41739 %U https://doi.org/10.2196/41739 %U http://www.ncbi.nlm.nih.gov/pubmed/36504544 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 12 %P e39109 %T Influences, Barriers, and Facilitators to COVID-19 Vaccination: Cross-sectional Survey on Vaccine Hesitancy in 2 Rural States %A Nguyen,Elaine %A Wright,Melanie %A Holmes,John %A Cleveland,Kevin %A Oliphant,Catherine %A Nies,Mary %A Robinson,Renee %+ Department of Pharmacy Practice and Administration, College of Pharmacy, University of Alaska/Idaho State University, 2533 Providence Drive PSB111, Anchorage, AK, 99508, United States, 1 907 786 6233, robiren2@isu.edu %K COVID-19 %K COVID-19 vaccines %K vaccine hesitancy %K cross-sectional studies %K rural populations %D 2022 %7 1.12.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Vaccination remains one of the most effective ways to limit the spread of infectious diseases such as that caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus responsible for COVID-19. Unfortunately, vaccination hesitancy continues to be a threat to national and global health. Further research is necessary to determine the modifiable and nonmodifiable factors contributing to COVID-19 vaccine hesitancy in under-resourced, underserved, and at-risk rural and urban communities. Objective: This study aimed to identify, understand, and address modifiable barriers and factors contributing to COVID-19 vaccine hesitancy among vaccine-eligible individuals with access to the vaccine in Alaska and Idaho. Methods: An electronic survey based on the World Health Organization (WHO) Strategic Advisory Group on Experts (SAGE) on Immunization survey tool and investigators’ previous work was created and distributed in June 2021 and July 2021. To be eligible to participate in the survey, individuals had to be ≥18 years of age and reside in Alaska or Idaho. Responses were grouped into 4 mutually exclusive cohorts for data analysis and reporting based on intentions to be vaccinated. Respondent characteristics and vaccine influences between cohorts were compared using Chi-square tests and ANOVA. Descriptive statistics were also used. Results: There were data from 736 usable surveys with 40 respondents who did not intend to be vaccinated, 27 unsure of their intentions, 8 who intended to be fully vaccinated with no doses received, and 661 fully vaccinated or who intended to be vaccinated with 1 dose received. There were significant differences in characteristics and influences between those who were COVID-19 vaccine-hesitant and those who had been vaccinated. Concerns related to possible side effects, enough information on long-term side effects, and enough information that is specific to the respondent’s health conditions were seen in those who did not intend to be fully vaccinated and unsure about vaccination. In all cohorts except those who did not intend to be fully vaccinated, more information about how well the vaccine works was a likely facilitator to vaccination. Conclusions: These survey results from 2 rural states indicate that recognition of individual characteristics may influence vaccine choices. However, these individual characteristics represent only a starting point to delivering tailored messages that should come from trusted sources to address vaccination barriers. %M 36067411 %R 10.2196/39109 %U https://formative.jmir.org/2022/12/e39109 %U https://doi.org/10.2196/39109 %U http://www.ncbi.nlm.nih.gov/pubmed/36067411 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 12 %P e36549 %T Perceived Workload Using Separate (Filtering Facepiece Respirator and Face Shield) and Powered Air-Purifying Respirator and Integrated Lightweight Protective Air-Purifying Respirator: Protocol for an International Multisite Human Factors Randomized Crossover Feasibility Study %A Price,Amy %A Lin,Ying Ling %A Levin,Anna S %A Tumietto,Fabio %A Almeida,Rodrigo %A Almeida,Ana %A Ciofi-Silva,Caroline Lopes %A Fontana,Luca %A Oliveira,Naila %A Parisi,Nicola Francesco %A Mainardi,Giulia Marcelino %A Cordeiro,Luciana %A Roselli,Marco %A Shepherd,Paul %A Morelli,Luana %A Mehrabi,Najmeh %A Price,Kathleen %A Chan,Whitney %A Srinivas,Shrinidhy %A Harrison,T Kyle %A Chu,May %A Padoveze,Maria Clara %A Chu,Larry %+ Stanford Anesthesia Informatics and Media Lab, Stanford University School of Medicine, Suite 235, 2379 Watson Court, Palo Alto, CA, 94303, United States, 1 650 723 4671, lchu@stanford.edu %K N95 %K SARS-CoV-2 %K personal protective equipment %K human factors simulation %K human factors field study %K human factors %K health care workers %K health care %K safety %K patient care %D 2022 %7 1.12.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The design of personal protective equipment (PPE) may affect well-being and clinical work. PPE as an integrated item may improve usability and increase adherence by healthcare professionals. Human factors design and safety may reduce occupational-acquired diseases. As an integrated PPE, a lightweight protective air-purifying respirator (L-PAPR) could be used during health procedures where healthcare professionals are exposed to airborne pathogens. The human factors affecting the implementation of alternative PPE such as L-PAPR have not been thoroughly studied. The population of interest is health care professionals, the intervention is the performance by PPE during tasks across the three PPE types 1.) N95 respirators and face shields, 2.)traditional powered air-purifying respirator(PAPR), and 3.) L-PAPR. The outcomes are user error, communications, safety, and end-user preferences. Objective: This study will assess whether the L-PAPR improves health care professionals’ comfort in terms of perceived workload and physical and psychological burden during direct patient care when compared with the traditional PAPR or N95 and face shield. This study also aims to evaluate human factors during the comparison of the use of L-PAPR with a combination of N95 respirators plus face shields or the traditional PAPRs. Methods: This is an interventional randomized crossover quality improvement feasibility study consisting of a 3-site simulation phase with 10 participants per site and subsequent field testing in 2 sites with 30 participants at each site. The 3 types of respiratory PPE will be compared across medical tasks and while donning and doffing. We will evaluate the user’s perceived workload, usability, usage errors, and heart rate. We will conduct semistructured interviews to identify barriers and enablers to implementation across each PPE type over a single continuous wear episode and observe interpersonal communications across conditions and PPE types. Results: We expect the research may highlight communication challenges and differences in usability and convenience across PPE types along with error frequency during PPE use across PPE types, tasks, and time. Conclusions: The design of PPE may affect overall well-being and hinder or facilitate clinical work. Combining 2 pieces of PPE into a single integrated item may improve usability and reduce occupational-acquired diseases. The human factors affecting the implementation of an alternative PPE such as L-PAPR or PAPR have not been thoroughly studied. International Registered Report Identifier (IRRID): PRR1-10.2196/36549 %M 36454625 %R 10.2196/36549 %U https://www.researchprotocols.org/2022/12/e36549 %U https://doi.org/10.2196/36549 %U http://www.ncbi.nlm.nih.gov/pubmed/36454625 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e40866 %T New Surveillance Metrics for Alerting Community-Acquired Outbreaks of Emerging SARS-CoV-2 Variants Using Imported Case Data: Bayesian Markov Chain Monte Carlo Approach %A Yen,Amy Ming-Fang %A Chen,Tony Hsiu-Hsi %A Chang,Wei-Jung %A Lin,Ting-Yu %A Jen,Grace Hsiao-Hsuan %A Hsu,Chen-Yang %A Wang,Sen-Te %A Dang,Huong %A Chen,Sam Li-Sheng %+ School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, No 250, Wuxing St, Taipei, 110, Taiwan, 886 27361661 ext 5211, samchen@tmu.edu.tw %K COVID-19 %K imported case %K surveillance metric %K early detection %K community-acquired outbreak %D 2022 %7 25.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Global transmission from imported cases to domestic cluster infections is often the origin of local community-acquired outbreaks when facing emerging SARS-CoV-2 variants. Objective: We aimed to develop new surveillance metrics for alerting emerging community-acquired outbreaks arising from new strains by monitoring the risk of small domestic cluster infections originating from few imported cases of emerging variants. Methods: We used Taiwanese COVID-19 weekly data on imported cases, domestic cluster infections, and community-acquired outbreaks. The study period included the D614G strain in February 2020, the Alpha and Delta variants of concern (VOCs) in 2021, and the Omicron BA.1 and BA.2 VOCs in April 2022. The number of cases arising from domestic cluster infection caused by imported cases (Dci/Imc) per week was used as the SARS-CoV-2 strain-dependent surveillance metric for alerting local community-acquired outbreaks. Its upper 95% credible interval was used as the alert threshold for guiding the rapid preparedness of containment measures, including nonpharmaceutical interventions (NPIs), testing, and vaccination. The 2 metrics were estimated by using the Bayesian Monte Carlo Markov Chain method underpinning the directed acyclic graphic diagram constructed by the extra-Poisson (random-effect) regression model. The proposed model was also used to assess the most likely week lag of imported cases prior to the current week of domestic cluster infections. Results: A 1-week lag of imported cases prior to the current week of domestic cluster infections was considered optimal. Both metrics of Dci/Imc and the alert threshold varied with SARS-CoV-2 variants and available containment measures. The estimates were 9.54% and 12.59%, respectively, for D614G and increased to 14.14% and 25.10%, respectively, for the Alpha VOC when only NPIs and testing were available. The corresponding figures were 10.01% and 13.32% for the Delta VOC, but reduced to 4.29% and 5.19% for the Omicron VOC when NPIs, testing, and vaccination were available. The rapid preparedness of containment measures guided by the estimated metrics accounted for the lack of community-acquired outbreaks during the D614G period, the early Alpha VOC period, the Delta VOC period, and the Omicron VOC period between BA.1 and BA.2. In contrast, community-acquired outbreaks of the Alpha VOC in mid-May 2021, Omicron BA.1 VOC in January 2022, and Omicron BA.2 VOC from April 2022 onwards, were indicative of the failure to prepare containment measures guided by the alert threshold. Conclusions: We developed new surveillance metrics for estimating the risk of domestic cluster infections with increasing imported cases and its alert threshold for community-acquired infections varying with emerging SARS-CoV-2 strains and the availability of containment measures. The use of new surveillance metrics is important in the rapid preparedness of containment measures for averting large-scale community-acquired outbreaks arising from emerging imported SARS-CoV-2 variants. %M 36265134 %R 10.2196/40866 %U https://publichealth.jmir.org/2022/11/e40866 %U https://doi.org/10.2196/40866 %U http://www.ncbi.nlm.nih.gov/pubmed/36265134 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e40110 %T International Collaboration to Develop a Remote Monitoring Web App for COVID-19 Patients in Armenia: Design and Development With Agile Methodology %A Sikder,Abu %A Dickhoner,James %A Kysh,Lynn %A Musheghyan,Lusine %A Shekherdimian,Shant %A Levine,Barry %A Espinoza,Juan %+ Department of Pediatrics, Keck School of Medicine, University of Southern California, 4650 Sunset Blvd, Los Angeles, CA, 90027, United States, 1 323 660 2450, jespinoza@chla.usc.edu %K COVID-19 %K global health %K software %K mHealth %K Armenia %K web app %K home monitoring %K software development %K human-centered design %K remote monitoring %K patient care %D 2022 %7 25.11.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: COVID-19 has led to over 500 million cases and 6.2 million deaths around the world. Low- and middle-income countries (LMICs) like Armenia face unique infrastructure, financial, and capacity challenges that in many cases result in worse outcomes. Health care facilities across Armenia experienced a shortage of resources, including hospital beds and oxygen, which was further exacerbated by the war with neighboring Azerbaijan. Without a framework for home-based care, health care facilities were severely strained by COVID-19 patients who had prolonged oxygen requirements but were otherwise clinically stable. Objective: This paper describes our approach to establishing an international collaboration to develop a web app to support home monitoring of patients with COVID-19 with persistent oxygen requirements. Methods: The app was developed using a rapid, coordinated, and collaborative approach involving an international group of clinicians, developers, and collaborators. Health screening, monitoring, and discharge forms were developed into a lightweight OpenMRS web app and customized for the local Armenian context. Results: The software was designed and developed over 2 months using human-centered design and agile sprints. Once live, 5087 patient records were created for 439 unique patients. Conclusions: This project suggests a promising framework for designing and implementing remote monitoring programs in LMICs, despite pandemic and geopolitical challenges. %M 36350739 %R 10.2196/40110 %U https://humanfactors.jmir.org/2022/4/e40110 %U https://doi.org/10.2196/40110 %U http://www.ncbi.nlm.nih.gov/pubmed/36350739 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e40289 %T Association of Continuously Measured Vital Signs With Respiratory Insufficiency in Hospitalized COVID-19 Patients: Retrospective Cohort Study %A van Goor,Harriet M R %A Vernooij,Lisette M %A Breteler,Martine J M %A Kalkman,Cor J %A Kaasjager,Karin A H %A van Loon,Kim %+ Department of Anesthesiology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, Netherlands, 31 887567967, h.m.r.vangoor-3@umcutrecht.nl %K continuous monitoring %K vital sign monitoring %K COVID-19 %K general ward %K vital sign %K monitoring %K respiration %K data %K respiratory insufficiency %K cohort study %K respiratory rate %K heart rate %K oxygen %K clinical %D 2022 %7 23.11.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Continuous monitoring of vital signs has the potential to assist in the recognition of deterioration of patients admitted to the general ward. However, methods to efficiently process and use continuously measured vital sign data remain unclear. Objective: The aim of this study was to explore methods to summarize continuously measured vital sign data and evaluate their association with respiratory insufficiency in COVID-19 patients at the general ward. Methods: In this retrospective cohort study, we included patients admitted to a designated COVID-19 cohort ward equipped with continuous vital sign monitoring. We collected continuously measured data of respiratory rate, heart rate, and oxygen saturation. For each patient, 7 metrics to summarize vital sign data were calculated: mean, slope, variance, occurrence of a threshold breach, number of episodes, total duration, and area above/under a threshold. These summary measures were calculated over timeframes of either 4 or 8 hours, with a pause between the last data point and the endpoint (the “lead”) of 4, 2, 1, or 0 hours, and with 3 predefined thresholds per vital sign. The association between each of the summary measures and the occurrence of respiratory insufficiency was calculated using logistic regression analysis. Results: Of the 429 patients that were monitored, 334 were included for analysis. Of these, 66 (19.8%) patients developed respiratory insufficiency. Summarized continuously measured vital sign data in timeframes close to the endpoint showed stronger associations than data measured further in the past (ie, lead 0 vs 1, 2, or 4 hours), and summarized estimates over 4 hours of data had stronger associations than estimates taken over 8 hours of data. The mean was consistently strongly associated with respiratory insufficiency for the three vital signs: in a 4-hour timeframe without a lead, the standardized odds ratio for heart rate, respiratory rate, and oxygen saturation was 2.59 (99% CI 1.74-4.04), 5.05 (99% CI 2.87-10.03), and 3.16 (99% CI 1.78-6.26), respectively. The strength of associations of summary measures varied per vital sign, timeframe, and lead. Conclusions: The mean of a vital sign showed a relatively strong association with respiratory insufficiency for the majority of vital signs and timeframes. The type of vital sign, length of the timeframe, and length of the lead influenced the strength of associations. Highly associated summary measures and their combinations could be used in a clinical prediction score or algorithm for an automatic alarm system. %M 36256803 %R 10.2196/40289 %U https://www.i-jmr.org/2022/2/e40289 %U https://doi.org/10.2196/40289 %U http://www.ncbi.nlm.nih.gov/pubmed/36256803 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e40089 %T The Use of a Health Compliance Monitoring System During the COVID-19 Pandemic in Indonesia: Evaluation Study %A Aisyah,Dewi Nur %A Manikam,Logan %A Kiasatina,Thifal %A Naman,Maryan %A Adisasmito,Wiku %A Kozlakidis,Zisis %+ Department of Epidemiology and Public Health, Institute of Epidemiology and Health Care, University College London, 1-19 Torrington Place, London, WC1E 7HB, United Kingdom, 44 207 679 2000, logan.manikam.10@ucl.ac.uk %K COVID-19, public health informatics %K behavioral change %K digital health %K public health policy %K monitoring %K Asia %K mask %K social distance %K mobile app %K app %K transmission %K policy %K health compliance %D 2022 %7 22.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 cases are soaring in Asia. Indonesia, Southeast Asia’s most populous country, is now ranked second in the number of cases and deaths in Asia, after India. The compliance toward mask wearing, social distancing, and hand washing needs to be monitored to assess public behavioral changes that can reduce transmission. Objective: This study aimed to evaluate this compliance in Indonesia between October 2020 and May 2021 and demonstrate the use of the Bersatu Lawan COVID-19 (BLC) mobile app in monitoring this compliance. Methods: Data were collected in real time by the BLC app from reports submitted by personnel of military services, police officers, and behavioral change ambassadors. Subsequently, the data were analyzed automatically by the system managed by the Indonesia National Task Force for the Acceleration of COVID-19 Mitigation. Results: Between October 1, 2020, and May 2, 2021, the BLC app generated more than 165 million reports, with 469 million people monitored and 124,315,568 locations under observation in 514 districts/cities in 34 provinces in Indonesia. This paper grouped them into 4 colored zones, based on the degree of compliance, and analyzed variations among regions and locations. Conclusions: Compliance rates vary among the 34 provinces and among the districts and cities of those provinces. However, compliance to mask wearing seems slightly higher than social distancing. This finding suggests that policy makers need to promote higher compliance in other measures, including social distancing and hand washing, whose efficacies have been proven to break the chain of transmission when combined with masks wearing. %M 36219836 %R 10.2196/40089 %U https://publichealth.jmir.org/2022/11/e40089 %U https://doi.org/10.2196/40089 %U http://www.ncbi.nlm.nih.gov/pubmed/36219836 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e39312 %T Reinterpretation of Health Information in the Context of an Emerging Infectious Disease: A Digital Focus Group Study %A Tan,Rayner Kay Jin %A Lim,Jane Mingjie %A Neo,Pearlyn Hui Min %A Ong,Suan Ee %+ University of North Carolina Project-China, 2 Lujing Road, Guangzhou, 510095, China, 65 91878576, rayner.tan@nus.edu.sg %K health communication %K infodemic %K SARS-CoV-2 %K coronavirus %K Singapore %K WhatsApp %K COVID-19 %K health information %K misinformation %K mobile health %K smartphone %K information quality %K online health information %D 2022 %7 22.11.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Misinformation related to the COVID-19 pandemic has accelerated global public concern and panic. The glut of information, or “infodemic,” has caused concern for authorities due to its negative impacts on COVID-19 prevention and control, spurring calls for a greater scholarly focus on health literacy during the pandemic. Nevertheless, few studies have sought to qualitatively examine how individuals interpreted and assimilated health information at the initial wave of COVID-19 restrictions. Objective: We developed this qualitative study adopting chat-based focus group discussions to investigate how individuals interpreted COVID-19 health information during the first wave of COVID-19 restrictions. Methods: We conducted a qualitative study in Singapore to investigate how individuals perceive and interpret information that they receive on COVID-19. Data were generated through online focus group discussions conducted on the mobile messaging smartphone app WhatsApp. From March 28 to April 13, 2020, we held eight WhatsApp-based focus groups (N=60) with participants stratified by age groups, namely 21-30 years, 31-40 years, 41-50 years, and 51 years and above. Data were thematically analyzed. Results: A total of four types of COVID-19 health information were generated from the thematic analysis, labeled as formal health information, informal health information, suspicious health information, and fake health information, respectively. How participants interpreted these categories of information depended largely on the perceived trustworthiness of the information source as well as the perceived veracity of information. Both factors were instrumental in determining individuals’ perceptions, and their subsequent treatment and assimilation of COVID-19–related information. Conclusions: Both perceived trustworthiness of the information source and perceived veracity of information were instrumental concepts in determining one’s perception, and thus subsequent treatment and assimilation of such information for one’s knowledge of COVID-19 or the onward propagation to their social networks. These findings have implications for how policymakers and health authorities communicate with the public and deal with fake health information in the context of COVID-19. %M 36099011 %R 10.2196/39312 %U https://humanfactors.jmir.org/2022/4/e39312 %U https://doi.org/10.2196/39312 %U http://www.ncbi.nlm.nih.gov/pubmed/36099011 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e40751 %T The Association Between Clinical Severity and Incubation Period of SARS-CoV-2 Delta Variants: Retrospective Observational Study %A Wang,Kai %A Luan,Zemin %A Guo,Zihao %A Ran,Jinjun %A Tian,Maozai %A Zhao,Shi %+ JC School of Public Health and Primary Care, Chinese University of Hong Kong, Rm 417, Public Health Building, Prince of Wales Hospital, 30-32 Ngan Shing St, Hong Kong, China (Hong Kong), 852 22528865, zhaoshi.cmsa@gmail.com %K COVID-19 %K Delta variant %K incubation period %K clinical severity %K China %D 2022 %7 18.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As of August 25, 2021, Jiangsu province experienced the largest COVID-19 outbreak in eastern China that was seeded by SARS-CoV-2 Delta variants. As one of the key epidemiological parameters characterizing the transmission dynamics of COVID-19, the incubation period plays an essential role in informing public health measures for epidemic control. The incubation period of COVID-19 could vary by different age, sex, disease severity, and study settings. However, the impacts of these factors on the incubation period of Delta variants remains uninvestigated. Objective: The objective of this study is to characterize the incubation period of the Delta variant using detailed contact tracing data. The effects of age, sex, and disease severity on the incubation period were investigated by multivariate regression analysis and subgroup analysis. Methods: We extracted contact tracing data of 353 laboratory-confirmed cases of SARS-CoV-2 Delta variants’ infection in Jiangsu province, China, from July to August 2021. The distribution of incubation period of Delta variants was estimated by using likelihood-based approach with adjustment for interval-censored observations. The effects of age, sex, and disease severity on the incubation period were expiated by using multivariate logistic regression model with interval censoring. Results: The mean incubation period of the Delta variant was estimated at 6.64 days (95% credible interval: 6.27-7.00). We found that female cases and cases with severe symptoms had relatively longer mean incubation periods than male cases and those with nonsevere symptoms, respectively. One-day increase in the incubation period of Delta variants was associated with a weak decrease in the probability of having severe illness with an adjusted odds ratio of 0.88 (95% credible interval: 0.71-1.07). Conclusions: In this study, the incubation period was found to vary across different levels of sex, age, and disease severity of COVID-19. These findings provide additional information on the incubation period of Delta variants and highlight the importance of continuing surveillance and monitoring of the epidemiological characteristics of emerging SARS-CoV-2 variants as they evolve. %M 36346940 %R 10.2196/40751 %U https://publichealth.jmir.org/2022/11/e40751 %U https://doi.org/10.2196/40751 %U http://www.ncbi.nlm.nih.gov/pubmed/36346940 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e35025 %T Effect of Comorbidities on the Infection Rate and Severity of COVID-19: Nationwide Cohort Study With Propensity Score Matching %A Kim,Jiyong %A Park,Seong Hun %A Kim,Jong Moon %+ Department of Rehabilitation Medicine, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam, 13496, Republic of Korea, 82 31 780 5456, jmkim1013@gmail.com %K COVID-19 %K comorbidity %K infection rate %K severity of illness index %K hyperlipidemia %D 2022 %7 18.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: A vaccine against COVID-19 has been developed; however, COVID-19 transmission continues. Although there have been many studies of comorbidities that have important roles in COVID-19, some studies have reported contradictory results. Objective: This study was conducted using real-world data from COVID-19 patients in South Korea and aimed to investigate the impact of patient demographics and comorbidities on the infection rate and severity of COVID-19. Methods: Data were derived from a nationwide South Korean COVID-19 cohort study with propensity score (PS) matching. We included infected individuals who were COVID-19–positive between January 1, 2020, and May 30, 2020, and PS-matched uninfected controls. PS matching was performed to balance the baseline characteristics of each comorbidity and to adjust for potential confounders, such as age, sex, Charlson Comorbidity Index, medication, and other comorbidities, that were matched with binary variables. The outcomes were the confirmed comorbidities affecting the infection rate and severity of COVID-19. The endpoints were COVID-19 positivity and severe clinical outcomes of COVID-19 (such as tracheostomy, continuous renal replacement therapy, intensive care unit admission, ventilator use, cardiopulmonary resuscitation, and death). Results: The COVID-19 cohort with PS matching included 8070 individuals with positive COVID-19 test results and 8070 matched controls. The proportions of patients in the severe group were higher for individuals 60 years or older (severe clinical outcomes for those 60 years or older, 16.52%; severe clinical outcomes for those of other ages, 2.12%), those insured with Medicaid (Medicaid, 10.81%; other insurance, 5.61%), and those with disabilities (with disabilities, 18.26%; without disabilities, 5.07%). The COVID-19 infection rate was high for patients with pulmonary disease (odds ratio [OR] 1.88; 95% CI 1.70-2.03), dementia (OR 1.75; 95% CI 1.40-2.20), gastrointestinal disease (OR 1.74; 95% CI 1.62-1.88), stroke (OR 1.67; 95% CI 1.23-2.27), hepatobiliary disease (OR 1.31; 95% CI 1.19-1.44), diabetes mellitus (OR 1.28; 95% CI 1.16-1.43), and cardiovascular disease (OR 1.20; 95% CI 1.07-1.35). In contrast, it was lower for individuals with hyperlipidemia (OR 0.73; 95% CI 0.67-0.80), autoimmune disease (OR 0.73; 95% CI 0.60-0.89), and cancer (OR 0.73; 95% CI 0.62-0.86). The severity of COVID-19 was high for individuals with kidney disease (OR 5.59; 95% CI 2.48-12.63), hypertension (OR 2.92; 95% CI 1.91-4.47), dementia (OR 2.92; 95% CI 1.91-4.47), cancer (OR 1.84; 95% CI 1.15-2.94), pulmonary disease (OR 1.72; 95% CI 1.35-2.19), cardiovascular disease (OR 1.54; 95% CI 1.17-2.04), diabetes mellitus (OR 1.43; 95% CI 1.09-1.87), and psychotic disorders (OR 1.29; 95% CI 1.01-6.52). However, it was low for those with hyperlipidemia (OR 0.78; 95% CI 0.60-1.00). Conclusions: Upon PS matching considering the use of statins, it was concluded that people with hyperlipidemia could have lower infection rates and disease severity of COVID-19. %M 36265125 %R 10.2196/35025 %U https://publichealth.jmir.org/2022/11/e35025 %U https://doi.org/10.2196/35025 %U http://www.ncbi.nlm.nih.gov/pubmed/36265125 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e37426 %T Efficacy and Safety of Direct Hemoperfusion Using Polymyxin B-Immobilized Polystyrene Column for Patients With COVID-19: Protocol for an Exploratory Study %A Terada-Hirashima,Junko %A Izumi,Shinyu %A Katagiri,Daisuke %A Uemura,Yukari %A Mikami,Ayako %A Sugiura,Wataru %A Abe,Shinji %A Azuma,Arata %A Sugiyama,Haruhito %+ Center for Clinical Sciences, National Center for Global Health and Medicine, 1-21-1 Toyama Shinjuku-ku, Tokyo, 162-8655, Japan, 81 813 3202 7181, jterada@hosp.ncgm.go.jp %K polymyxin B-immobilized fiber column %K PMX %K diffuse alveolar damage %K DAD %K COVID-19 %K pneumonia %K fibrinogenolysis %K systemic inflammatory response syndrome %K lung disease %K lung damage %K pulmonary %K treatment %K prospective intervention %K health information %K treatment information %K therapy %K COVID-19 therapy %D 2022 %7 16.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Polymyxin B-immobilized fiber column (PMX; Toraymyxin column) was approved for the relief of systemic inflammatory response syndrome caused by bacterial infection or endotoxemia. PMX reduces lung damage by removing leukocytes and cytokines in addition to endotoxin removal in the setting of idiopathic pulmonary fibrosis. Acute exacerbation of interstitial pneumonia pathologically presents with diffuse alveolar damage (DAD). PMX direct hemoperfusion (PMX-DHP) demonstrated efficacy, improving oxygenation. The SARS-CoV-2 virus causes COVID-19, which emerged in December 2019. The condition may become severe about 1 week after onset, and respiratory failure rapidly develops, requiring intensive care management. A characteristic of COVID-19–related severe pneumonia is ground-glass opacities rapidly progressing in both lungs, which subsequently turn into infiltrative shadows. This condition could be classified as DAD. As for the congealing fibrinogenolysis system, D-dimer, fibrin/fibrinogen degradation product quantity, and prolonged prothrombin time were significant factors in nonsurviving COVID-19 cases, associated with aggravated pneumonia. Clinical trials are being conducted, but except for remdesivir and dexamethasone, no treatments have yet been approved. COVID-19 aggravates with the deterioration of oxygen saturation, decrease in lymphocytes, and the occurrence of an abnormal congealing fibrinogenolysis system, leading to diffuse lung damage. Once the condition transitions from moderate to severe, it is necessary to prevent further exacerbation by providing treatment that will suppress the aforementioned symptoms as soon as possible. Objective: This study aims to access treatment options to prevent the transition from acute exacerbation of interstitial pneumonia to DAD. The mechanism of action envisioned for PMX-DHP is to reduce congealing fibrinogenolysis system abnormalities and increase oxygenation by removing activated leukocytes and cytokines, which are risk factors for the aggravation of COVID-19–related pneumonia. Methods: We will conduct a multicenter, prospective, intervention, single-group study to evaluate the efficacy and safety of direct hemoperfusion using PMX-DHP for patients with COVID-19. Efficacy will be evaluated by the primary end point, which is the rate of Ordinal Scale for Clinical Improvement after PMX-DHP of at least 1 point from a status of 4, 5, or 6 on day 15. The effect of PMX-DHP will be estimated by setting a control group with background factors from non–PMX-DHP patients enrolled in the COVID-19 registry. This study will be carried out as a single-group open-label study and will be compared with a historical control. The historical control will be selected from the COVID-19 registry according to age, gender, and severity of pneumonia. Results: The study period is scheduled from September 28, 2020, through April 30, 2023. Patient enrollment was scheduled from the Japan Registry of Clinical Trials publication for March 31, 2022. Data fixation is scheduled for October 2022, with the publication of the results by March 2023. Conclusions: From a clinical perspective, PMX-DHP is expected to become an adjunctive therapy to address unmet medical needs and prevent the exacerbation from moderate to severe acute respiratory distress syndrome in COVID-19 cases. International Registered Report Identifier (IRRID): DERR1-10.2196/37426 %M 36126219 %R 10.2196/37426 %U https://www.researchprotocols.org/2022/11/e37426 %U https://doi.org/10.2196/37426 %U http://www.ncbi.nlm.nih.gov/pubmed/36126219 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e37203 %T Factors Associated With the Intention to Receive the COVID-19 Vaccine: Cross-sectional National Study %A Kasting,Monica L %A Macy,Jonathan T %A Grannis,Shaun J %A Wiensch,Ashley J %A Lavista Ferres,Juan M %A Dixon,Brian E %+ Department of Public Health, Purdue University, 812 W. State Street, Room 216, West Lafayette, IN, 47907, United States, 1 765 496 9483, mlkastin@purdue.edu %K SARS-CoV-2 %K COVID-19 vaccines %K vaccination intention %K vaccine hesitancy %K Health Belief Model %K reasoned action approach %K COVID-19 %K vaccination %K public health %K online survey %K health intervention %K logistic regression %K demographic %D 2022 %7 14.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic is an unprecedented public health crisis, and vaccines are the most effective means of preventing severe consequences of this disease. Hesitancy regarding vaccines persists among adults in the United States, despite overwhelming scientific evidence of safety and efficacy. Objective: The purpose of this study was to use the Health Belief Model (HBM) and reasoned action approach (RAA) to examine COVID-19 vaccine hesitancy by comparing those who had already received 1 vaccine to those who had received none. Methods: This study examined demographic and theory-based factors associated with vaccine uptake and intention among 1643 adults in the United States who completed an online survey during February and March 2021. Survey items included demographic variables (eg, age, sex, political ideology), attitudes, and health belief variables (eg, perceived self-efficacy, perceived susceptibility). Hierarchical logistic regression analyses were used for vaccine uptake/intent. The first model included demographic variables. The second model added theory-based factors to examine the association of health beliefs and vaccine uptake above and beyond the associations explained by demographic characteristics alone. Results: The majority of participants were male (n=974, 59.3%), White (n=1347, 82.0%), and non-Hispanic (n=1518, 92.4%) and reported they had already received a COVID-19 vaccine or definitely would when it was available to them (n=1306, 79.5%). Demographic variables significantly associated with vaccine uptake/intent included age (adjusted odds ratio [AOR] 1.05, 95% CI 1.04-1.06), other race (AOR 0.47, 95% CI 0.27-0.83 vs White), and political ideology (AOR 15.77, 95% CI 7.03-35.35 very liberal vs very conservative). The theory-based factors most strongly associated with uptake/intention were attitudes (AOR 3.72, 95% CI 2.42-5.73), self-efficacy (AOR 1.75, 95% CI 1.34-2.29), and concerns about side effects (AOR 0.59, 95% CI 0.46-0.76). Although race and political ideology were significant in the model of demographic characteristics, they were not significant when controlling for attitudes and beliefs. Conclusions: Vaccination represents one of the best tools to combat the COVID-19 pandemic, as well as other possible pandemics in the future. This study showed that older age, attitudes, injunctive norms, descriptive norms, and self-efficacy are positively associated with vaccine uptake and intent, whereas perceived side effects and lack of trust in the vaccine are associated with lower uptake and intent. Race and political ideology were not significant predictors when attitudes and beliefs were considered. Before vaccine hesitancy can be addressed, researchers and clinicians must understand the basis of vaccine hesitancy and which populations may show higher hesitancy to the vaccination so that interventions can be adequately targeted. %M 36219842 %R 10.2196/37203 %U https://publichealth.jmir.org/2022/11/e37203 %U https://doi.org/10.2196/37203 %U http://www.ncbi.nlm.nih.gov/pubmed/36219842 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e36712 %T Outcomes of COVID-19 Infection in People Previously Vaccinated Against Influenza: Population-Based Cohort Study Using Primary Health Care Electronic Records %A Giner-Soriano,Maria %A de Dios,Vanessa %A Ouchi,Dan %A Vilaplana-Carnerero,Carles %A Monteagudo,Mònica %A Morros,Rosa %+ Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Gran Via de les Corts Catalanes 587, àtic, Barcelona, 08007, Spain, 34 934824110, mginer@idiapjgol.info %K SARS-CoV-2 %K COVID-19 %K influenza vaccines %K pneumonia %K electronic health records %K primary health care %K vaccination %K public health %K cohort study %K epidemiology %K eHeatlh %K health outcome %K mortality %D 2022 %7 11.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: A possible link between influenza immunization and susceptibility to the complications of COVID-19 infection has been previously suggested owing to a boost in the immunity against SARS-CoV-2. Objective: This study aimed to investigate whether individuals with COVID-19 could have benefited from vaccination against influenza. We hypothesized that the immunity resulting from the previous influenza vaccination would boost part of the immunity against SARS-CoV-2. Methods: We performed a population-based cohort study including all patients with COVID-19 with registered entries in the primary health care (PHC) electronic records during the first wave of the COVID-19 pandemic (March 1 to June 30, 2020) in Catalonia, Spain. We compared individuals who took an influenza vaccine before being infected with COVID-19, with those who had not taken one. Data were obtained from Information System for Research in Primary Care, capturing PHC information of 5.8 million people from Catalonia. The main outcomes assessed during follow-up were a diagnosis of pneumonia, hospital admission, and mortality. Results: We included 309,039 individuals with COVID-19 and compared them on the basis of their influenza immunization status, with 114,181 (36.9%) having been vaccinated at least once and 194,858 (63.1%) having never been vaccinated. In total, 21,721 (19%) vaccinated individuals and 11,000 (5.7%) unvaccinated individuals had at least one of their outcomes assessed. Those vaccinated against influenza at any time (odds ratio [OR] 1.14, 95% CI 1.10-1.19), recently (OR 1.13, 95% CI 1.10-1.18), or recurrently (OR 1.10, 95% CI 1.05-1.15) before being infected with COVID-19 had a higher risk of presenting at least one of the outcomes than did unvaccinated individuals. When we excluded people living in long-term care facilities, the results were similar. Conclusions: We could not establish a protective role of the immunity conferred by the influenza vaccine on the outcomes of COVID-19 infection, as the risk of COVID-19 complications was higher in vaccinated than in unvaccinated individuals. Our results correspond to the first wave of the COVID-19 pandemic, where more complications and mortalities due to COVID-19 had occurred. Despite that, our study adds more evidence for the analysis of a possible link between the quality of immunity and COVID-19 outcomes, particularly in the PHC setting. %M 36265160 %R 10.2196/36712 %U https://publichealth.jmir.org/2022/11/e36712 %U https://doi.org/10.2196/36712 %U http://www.ncbi.nlm.nih.gov/pubmed/36265160 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e41004 %T Performance of the Swiss Digital Contact-Tracing App Over Various SARS-CoV-2 Pandemic Waves: Repeated Cross-sectional Analyses %A Daniore,Paola %A Nittas,Vasileios %A Ballouz,Tala %A Menges,Dominik %A Moser,André %A Höglinger,Marc %A Villiger,Petra %A Schmitz-Grosz,Krisztina %A Von Wyl,Viktor %+ Institute for Implementation Science in Healthcare, University of Zurich, Universitatstrasse 84, Zurich, 8006, Switzerland, 41 044 634 37 62, viktor.vonwyl@uzh.ch %K digital contact tracing %K exposure notification %K COVID-19 %K SARS-CoV-2 %K public health %K surveillance %K digital proximity %K contact-tracing app %K mobile app %K Switzerland %K variant of concern %K SwissCovid app %K digital tool %D 2022 %7 11.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Digital proximity-tracing apps have been deployed in multiple countries to assist with SARS-CoV-2 pandemic mitigation efforts. However, it is unclear how their performance and effectiveness were affected by changing pandemic contexts and new viral variants of concern. Objective: The aim of this study is to bridge these knowledge gaps through a countrywide digital proximity-tracing app effectiveness assessment, as guided by the World Health Organization/European Center for Prevention and Disease Control (WHO/ECDC) indicator framework to evaluate the public health effectiveness of digital proximity-tracing solutions. Methods: We performed a descriptive analysis of the digital proximity-tracing app SwissCovid in Switzerland for 3 different periods where different SARS-CoV-2 variants of concern (ie, Alpha, Delta, and Omicron, respectively) were most prevalent. In our study, we refer to the indicator framework for the evaluation of public health effectiveness of digital proximity-tracing apps of the WHO/ECDC. We applied this framework to compare the performance and effectiveness indicators of the SwissCovid app. Results: Average daily registered SARS-CoV-2 case rates during our assessment period from January 25, 2021, to March 19, 2022, were 20 (Alpha), 54 (Delta), and 350 (Omicron) per 100,000 inhabitants. The percentages of overall entered authentication codes from positive tests into the SwissCovid app were 9.9% (20,273/204,741), 3.9% (14,372/365,846), and 4.6% (72,324/1,581,506) during the Alpha, Delta, and Omicron variant phases, respectively. Following receipt of an exposure notification from the SwissCovid app, 58% (37/64, Alpha), 44% (7/16, Delta), and 73% (27/37, Omicron) of app users sought testing or performed self-tests. Test positivity among these exposure-notified individuals was 19% (7/37) in the Alpha variant phase, 29% (2/7) in the Delta variant phase, and 41% (11/27) in the Omicron variant phase compared to 6.1% (228,103/3,755,205), 12% (413,685/3,443,364), and 41.7% (1,784,951/4,285,549) in the general population, respectively. In addition, 31% (20/64, Alpha), 19% (3/16, Delta), and 30% (11/37, Omicron) of exposure-notified app users reported receiving mandatory quarantine orders by manual contact tracing or through a recommendation by a health care professional. Conclusions: In constantly evolving pandemic contexts, the effectiveness of digital proximity-tracing apps in contributing to mitigating pandemic spread should be reviewed regularly and adapted based on changing requirements. The WHO/ECDC framework allowed us to assess relevant domains of digital proximity tracing in a holistic and systematic approach. Although the Swisscovid app mostly worked, as reasonably expected, our analysis revealed room for optimizations and further performance improvements. Future implementation of digital proximity-tracing apps should place more emphasis on social, psychological, and organizational aspects to reduce bottlenecks and facilitate their use in pandemic contexts. %M 36219833 %R 10.2196/41004 %U https://publichealth.jmir.org/2022/11/e41004 %U https://doi.org/10.2196/41004 %U http://www.ncbi.nlm.nih.gov/pubmed/36219833 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 11 %P e37945 %T The Real-World Experiences of Persons With Multiple Sclerosis During the First COVID-19 Lockdown: Application of Natural Language Processing %A Chiavi,Deborah %A Haag,Christina %A Chan,Andrew %A Kamm,Christian Philipp %A Sieber,Chloé %A Stanikić,Mina %A Rodgers,Stephanie %A Pot,Caroline %A Kesselring,Jürg %A Salmen,Anke %A Rapold,Irene %A Calabrese,Pasquale %A Manjaly,Zina-Mary %A Gobbi,Claudio %A Zecca,Chiara %A Walther,Sebastian %A Stegmayer,Katharina %A Hoepner,Robert %A Puhan,Milo %A von Wyl,Viktor %+ Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, Zurich, 8001, Switzerland, 41 44 63 46380, viktor.vonwyl@uzh.ch %K natural language processing %K multiple sclerosis %K COVID-19 %K nervous system disease %K nervous system disorder %K textual data %K health data %K patient data %K topic modeling %K sentiment analysis %K linguistic inquiry %K medical informatics %K clinical informatics %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: The increasing availability of “real-world” data in the form of written text holds promise for deepening our understanding of societal and health-related challenges. Textual data constitute a rich source of information, allowing the capture of lived experiences through a broad range of different sources of information (eg, content and emotional tone). Interviews are the “gold standard” for gaining qualitative insights into individual experiences and perspectives. However, conducting interviews on a large scale is not always feasible, and standardized quantitative assessment suitable for large-scale application may miss important information. Surveys that include open-text assessments can combine the advantages of both methods and are well suited for the application of natural language processing (NLP) methods. While innovations in NLP have made large-scale text analysis more accessible, the analysis of real-world textual data is still complex and requires several consecutive steps. Objective: We developed and subsequently examined the utility and scientific value of an NLP pipeline for extracting real-world experiences from textual data to provide guidance for applied researchers. Methods: We applied the NLP pipeline to large-scale textual data collected by the Swiss Multiple Sclerosis (MS) registry. Such textual data constitute an ideal use case for the study of real-world text data. Specifically, we examined 639 text reports on the experienced impact of the first COVID-19 lockdown from the perspectives of persons with MS. The pipeline has been implemented in Python and complemented by analyses of the “Linguistic Inquiry and Word Count” software. It consists of the following 5 interconnected analysis steps: (1) text preprocessing; (2) sentiment analysis; (3) descriptive text analysis; (4) unsupervised learning–topic modeling; and (5) results interpretation and validation. Results: A topic modeling analysis identified the following 4 distinct groups based on the topics participants were mainly concerned with: “contacts/communication;” “social environment;” “work;” and “errands/daily routines.” Notably, the sentiment analysis revealed that the “contacts/communication” group was characterized by a pronounced negative emotional tone underlying the text reports. This observed heterogeneity in emotional tonality underlying the reported experiences of the first COVID-19–related lockdown is likely to reflect differences in emotional burden, individual circumstances, and ways of coping with the pandemic, which is in line with previous research on this matter. Conclusions: This study illustrates the timely and efficient applicability of an NLP pipeline and thereby serves as a precedent for applied researchers. Our study thereby contributes to both the dissemination of NLP techniques in applied health sciences and the identification of previously unknown experiences and burdens of persons with MS during the pandemic, which may be relevant for future treatment. %M 36252126 %R 10.2196/37945 %U https://medinform.jmir.org/2022/11/e37945 %U https://doi.org/10.2196/37945 %U http://www.ncbi.nlm.nih.gov/pubmed/36252126 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 4 %P e39670 %T Understanding Human Factors Challenges on the Front Lines of Mass COVID-19 Vaccination Clinics: Human Systems Modeling Study %A Tennant,Ryan %A Tetui,Moses %A Grindrod,Kelly %A Burns,Catherine M %+ Department of Systems Design Engineering, Faculty of Engineering, University of Waterloo, 200 University Ave W, Waterloo, ON, N2L 3G1, Canada, 1 519 888 4567, drtennan@uwaterloo.ca %K cognitive work analysis %K contextual design %K COVID-19 %K decision making %K health care system %K pandemic %K vaccination clinics %K workplace stress %D 2022 %7 10.11.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Implementing mass vaccination clinics for COVID-19 immunization has been a successful public health activity worldwide. However, this tightly coupled system has many logistical challenges, leading to increased workplace stress, as evidenced throughout the pandemic. The complexities of mass vaccination clinics that combine multidisciplinary teams working within nonclinical environments are yet to be understood through a human systems perspective. Objective: This study aimed to holistically model mass COVID-19 vaccination clinics in the Region of Waterloo, Ontario, Canada, to understand the challenges centered around frontline workers and to inform clinic design and technological recommendations that can minimize the systemic inefficiencies that contribute to workplace stress. Methods: An ethnographic approach was guided by contextual inquiry to gather data on work as done in these ad-hoc immunization settings. Observation data were clarified by speaking with clinic staff, and the research team discussed the observation data regularly throughout the data collection period. Data were analyzed by combining aspects of the contextual design framework and cognitive work analysis, and building workplace models that can identify the stress points and interconnections within mass vaccination clinic flow, developed artifacts, culture, physical layouts, and decision-making. Results: Observations were conducted at 6 mass COVID-19 vaccination clinics over 4 weeks in 2021. The workflow model depicted challenges with maintaining situational awareness about client intake and vaccine preparation among decision-makers. The artifacts model visualized how separately developed tools for the vaccine lead and clinic lead may support cognitive tasks through data synthesis. However, their effectiveness depends on sharing accurate and timely data. The cultural model indicated that perspectives on how to effectively achieve mass immunization might impact workplace stress with changes to responsibilities. This depends on the aggressive or relaxed approach toward minimizing vaccine waste while adapting to changing policies, regulations, and vaccine scarcity. The physical model suggested that the co-location of workstations may influence decision-making coordination. Finally, the decision ladder described the decision-making steps for managing end-of-day doses, highlighting challenges with data uncertainty and ways to support expertise. Conclusions: Modeling mass COVID-19 vaccination clinics from a human systems perspective identified 2 high-level opportunities for improving the inefficiencies within this health care delivery system. First, clinics may become more resilient to unexpected changes in client intake or vaccine preparation using strategies and artifacts that standardize data gathering and synthesis, thereby reducing uncertainties for end-of-day dose decision-making. Second, improving data sharing among staff by co-locating their workstations and implementing collaborative artifacts that support a collective understanding of the state of the clinic may reduce system complexity by improving shared situational awareness. Future research should examine how the developed models apply to immunization settings beyond the Region of Waterloo and evaluate the impact of the recommendations on workflow coordination, stress, and decision-making. %M 36219839 %R 10.2196/39670 %U https://humanfactors.jmir.org/2022/4/e39670 %U https://doi.org/10.2196/39670 %U http://www.ncbi.nlm.nih.gov/pubmed/36219839 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 11 %P e34075 %T The COVID-19 Schools Infection Survey in England: Protocol and Participation Profile for a Prospective Observational Cohort Study %A Halliday,Katherine E %A Nguipdop-Djomo,Patrick %A Oswald,William E %A Sturgess,Joanna %A Allen,Elizabeth %A Sundaram,Neisha %A Ireland,Georgina %A Poh,John %A Ijaz,Samreen %A Shute,Justin %A Diamond,Ian %A Rourke,Emma %A Dawe,Fiona %A Judd,Alison %A Clark,Taane %A Edmunds,W John %A Bonell,Chris %A Mangtani,Punam %A Ladhani,Shamez N %A Langan,Sinéad M %A Hargreaves,James %A , %+ Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 0207 927 2614, katherine.halliday@lshtm.ac.uk %K COVID-19 %K SARS-CoV-2 %K school-based %K epidemiology %K infection control %D 2022 %7 10.11.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: One of the most debated questions in the COVID-19 pandemic has been the role of schools in SARS-CoV-2 transmission. The COVID-19 Schools Infection Survey (SIS) aims to provide much-needed evidence addressing this issue. Objective: We present the study protocol and participation profile for the SIS study, aimed at assessing the role of schools in SARS-CoV-2 infection and transmission within school settings, and investigating how transmission within and from schools could be mitigated through the implementation of school COVID-19 control measures. Methods: SIS was a multisite, prospective, observational cohort study conducted in a stratified random sample of primary and secondary schools in selected local authorities in England. A total of 6 biobehavioral surveys were planned among participating students and staff during the 2020-2021 academic year, between November 2020 and July 2021. Key measurements were SARS-CoV-2 virus prevalence, assessed by nasal swab polymerase chain reaction; anti-SARS-CoV-2 (nucleocapsid protein) antibody prevalence and conversion, assessed in finger-prick blood for staff and oral fluid for students; student and staff school attendance rates; feasibility and acceptability of school-level implementation of SARS-CoV-2 control measures; and investigation of selected school outbreaks. The study was approved by the United Kingdom Health Security Agency Research Support and Governance Office (NR0237) and London School of Hygiene & Tropical Medicine Ethics Review Committee (reference 22657). Results: Data collection and laboratory analyses were completed by September 2021. A total of 22,585 individuals—1891 staff and 4654 students from 59 primary schools and 5852 staff and 10,188 students from 97 secondary schools—participated in at least one survey. Across all survey rounds, staff and student participation rates were 45.2% and 16.4%, respectively, in primary schools and 30% and 15.2%, respectively, in secondary schools. Although primary student participation increased over time, and secondary student participation remained reasonably consistent, staff participation declined across rounds, especially for secondary school staff (3165/7583, 41.7% in round 1 and 2290/10,374, 22.1% in round 6). Although staff participation overall was generally reflective of the eligible staff population, student participation was higher in schools with low absenteeism, a lower proportion of students eligible for free school meals, and from schools in the least deprived locations (in primary schools, 446/4654, 9.6% of participating students were from schools in the least deprived quintile compared with 1262/22,225, 5.7% of eligible students). Conclusions: We outline the study design, methods, and participation, and reflect on the strengths of the SIS study as well as the practical challenges encountered and the strategies implemented to address these challenges. The SIS study, by measuring current and incident infection over time, alongside the implementation of control measures in schools across a range of settings in England, aims to inform national guidance and public health policy for educational settings. International Registered Report Identifier (IRRID): RR1-10.2196/34075 %M 35635843 %R 10.2196/34075 %U https://www.researchprotocols.org/2022/11/e34075 %U https://doi.org/10.2196/34075 %U http://www.ncbi.nlm.nih.gov/pubmed/35635843 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e40175 %T Mass Screening of SARS-CoV-2 With Rapid Antigen Tests in a Receding Omicron Wave: Population-Based Survey for Epidemiologic Evaluation %A Kwan,Tsz Ho %A Wong,Ngai Sze %A Chan,Chin Pok %A Yeoh,Eng Kiong %A Wong,Samuel Yeung-shan %A Lee,Shui Shan %+ Stanley Ho Centre for Emerging Infectious Diseases, The Chinese University of Hong Kong, Room 207, Postgraduate Education Centre, Prince of Wales Hospital, Shatin, Hong Kong, 852 22528862, sslee@cuhk.edu.hk %K COVID-19 %K SARS-CoV-2 antigen testing %K COVID-19 vaccine %K mass screening %K antigen test %K epidemiology %K Omicron %K Hong Kong %K public health %K outbreak %K epidemic %K screening %K transmission %K online %K vaccination %K vaccines %K surveillance %D 2022 %7 9.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 36240027 %R 10.2196/40175 %U https://publichealth.jmir.org/2022/11/e40175 %U https://doi.org/10.2196/40175 %U http://www.ncbi.nlm.nih.gov/pubmed/36240027 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e38898 %T The Risk of Hospitalization and Mortality After Breakthrough SARS-CoV-2 Infection by Vaccine Type: Observational Study of Medical Claims Data %A Kshirsagar,Meghana %A Nasir,Md %A Mukherjee,Sumit %A Becker,Nicholas %A Dodhia,Rahul %A Weeks,William B %A Ferres,Juan Lavista %A Richardson,Barbra %+ Microsoft, 1 Microsoft Way, Redmond, WA, 98052, United States, 1 425 638 7777, meghana.ksagar@gmail.com %K breakthroughs %K vaccines %K Pfizer %K Moderna %K Janssen %K SARS-CoV-2 %K COVID-19 %K coronavirus %K infectious disease %K viral infection %K vaccination %K breakthrough infection %K public health %K health policy %K decision making %K booster vaccine %K mortality %K hospitalization %K healthcare system %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 36265135 %R 10.2196/38898 %U https://publichealth.jmir.org/2022/11/e38898 %U https://doi.org/10.2196/38898 %U http://www.ncbi.nlm.nih.gov/pubmed/36265135 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 11 %P e36424 %T The Relationship Between Population-Level SARS-CoV-2 Cycle Threshold Values and Trend of COVID-19 Infection: Longitudinal Study %A Dehesh,Paria %A Baradaran,Hamid Reza %A Eshrati,Babak %A Motevalian,Seyed Abbas %A Salehi,Masoud %A Donyavi,Tahereh %+ Department of Epidemiology, School of Public Health, Iran University of Medical Sciences, Hemmat Highway, Tehran, 1449614535, Iran, 98 9183616737, babak.eshrati@gmail.com %K cycle threshold value %K COVID-19 %K trend %K surveillance %K epidemiology %K disease surveillance %K surveillance %K digital surveillance %K prediction model %K epidemic modeling %K health system %K infectious disease %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The distribution of population-level real-time reverse transcription-polymerase chain reaction (RT-PCR) cycle threshold (Ct) values as a proxy of viral load may be a useful indicator for predicting COVID-19 dynamics. Objective: The aim of this study was to determine the relationship between the daily trend of average Ct values and COVID-19 dynamics, calculated as the daily number of hospitalized patients with COVID-19, daily number of new positive tests, daily number of COVID-19 deaths, and number of hospitalized patients with COVID-19 by age. We further sought to determine the lag between these data series. Methods: The samples included in this study were collected from March 21, 2021, to December 1, 2021. Daily Ct values of all patients who were referred to the Molecular Diagnostic Laboratory of Iran University of Medical Sciences in Tehran, Iran, for RT-PCR tests were recorded. The daily number of positive tests and the number of hospitalized patients by age group were extracted from the COVID-19 patient information registration system in Tehran province, Iran. An autoregressive integrated moving average (ARIMA) model was constructed for the time series of variables. Cross-correlation analysis was then performed to determine the best lag and correlations between the average daily Ct value and other COVID-19 dynamics–related variables. Finally, the best-selected lag of Ct identified through cross-correlation was incorporated as a covariate into the autoregressive integrated moving average with exogenous variables (ARIMAX) model to calculate the coefficients. Results: Daily average Ct values showed a significant negative correlation (23-day time delay) with the daily number of newly hospitalized patients (P=.02), 30-day time delay with the daily number of new positive tests (P=.02), and daily number of COVID-19 deaths (P=.02). The daily average Ct value with a 30-day delay could impact the daily number of positive tests for COVID-19 (β=–16.87, P<.001) and the daily number of deaths from COVID-19 (β=–1.52, P=.03). There was a significant association between Ct lag (23 days) and the number of COVID-19 hospitalizations (β=–24.12, P=.005). Cross-correlation analysis showed significant time delays in the average Ct values and daily hospitalized patients between 18-59 years (23-day time delay, P=.02) and in patients over 60 years old (23-day time delay, P<.001). No statistically significant relation was detected in the number of daily hospitalized patients under 5 years old (9-day time delay, P=.27) and aged 5-17 years (13-day time delay, P=.39). Conclusions: It is important for surveillance of COVID-19 to find a good indicator that can predict epidemic surges in the community. Our results suggest that the average daily Ct value with a 30-day delay can predict increases in the number of positive confirmed COVID-19 cases, which may be a useful indicator for the health system. %M 36240022 %R 10.2196/36424 %U https://publichealth.jmir.org/2022/11/e36424 %U https://doi.org/10.2196/36424 %U http://www.ncbi.nlm.nih.gov/pubmed/36240022 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 4 %P e38694 %T Patient Factors Associated With Teledermatology Visit Type and Submission of Photographs During the COVID-19 Pandemic: Cross-sectional Analysis %A Lamb,Jordan E %A Fitzsimmons,Robert %A Sevagamoorthy,Anjana %A Kovarik,Carrie L %A Shin,Daniel B %A Takeshita,Junko %+ Department of Dermatology, Perelman School of Medicine at the University of Pennsylvania, Office 728, 7th Floor, South Tower, 3400 Civic Center Blvd, Philadelphia, PA, 19104, United States, 1 215 349 5551, Junko.Takeshita@pennmedicine.upenn.edu %K teledermatology %K telemedicine %K COVID-19 pandemic %K healthcare disparities %K photographs %K virtual %K skin examination %K dermatology %D 2022 %7 8.11.2022 %9 Original Paper %J JMIR Dermatol %G English %X Background: The COVID-19 pandemic necessitated the widespread adoption of teledermatology, and this continues to account for a significant proportion of dermatology visits after clinics have reopened for in-person care. Delivery of high-quality teledermatology care requires adequate visualization of the patient’s skin, with photographs being preferred over live video for remote skin examination. It remains unknown which patients face the greatest barriers to participating in a teledermatology visit with photographs. Objective: The aim of this study was to identify patient characteristics associated with type of telemedicine visit and the factors associated with participating in teledermatology visits with digital photographs versus those without photographs. Methods: We performed a cross-sectional analysis of the University of Pennsylvania Health System electronic health record data for adult patients who participated in at least 1 teledermatology appointment between March 1, 2020, and June 30, 2020. The primary outcomes were participation in a live-interactive video visit versus a telephone visit and participation in any teledermatology visit with photographs versus one without photographs. Multivariable logistic regression was performed to evaluate the associations between patient characteristics and the primary outcomes. Results: In total, 5717 unique patients completed at least 1 teledermatology visit during the study period; 68.25% (n=3902) of patients participated in a video visit, and 31.75% (n=1815) participated in a telephone visit. A minority of patients (n=1815, 31.75%) submitted photographs for their video or telephone appointment. Patients who submitted photographs for their teledermatology visit were more likely to be White, have commercial insurance, and live in areas with higher income, better education, and greater access to a computer and high-speed internet (P<.001 for all). In adjusted analysis, older age (age group >75 years: odds ratio [OR] 0.60, 95% CI 0.44-0.82), male sex (OR 0.85, 95% CI 0.75-0.97), Black race (OR 0.79, 95% CI 0.65-0.96), and Medicaid insurance (OR 0.81, 95% CI 0.66-0.99) were each associated with lower odds of a patient submitting photographs for their video or telephone visit. Older age (age group >75 years: OR 0.37, 95% CI 0.27-0.50) and Black race (OR 0.82, 95% CI 0.68-0.98) were also associated with lower odds of a patient participating in a video visit versus telephone visit. Conclusions: Patients who were older, male, or Black, or who had Medicaid insurance were less likely to participate in teledermatology visits with photographs and may be particularly vulnerable to disparities in teledermatology care. Further research is necessary to identify the barriers to patients providing photographs for remote dermatology visits and to develop targeted interventions to facilitate equitable participation in teledermatology care. %M 37632882 %R 10.2196/38694 %U https://derma.jmir.org/2022/4/e38694 %U https://doi.org/10.2196/38694 %U http://www.ncbi.nlm.nih.gov/pubmed/37632882 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 11 %P e41914 %T The Incidence and Effect of Adverse Events Due to COVID-19 Vaccines on Breakthrough Infections: Decentralized Observational Study With Underrepresented Groups %A Gabashvili,Irene S %+ Aurametrix, MEBO Research, 13220 SW 35th Terrace, Miami, FL, 33175, United States, 1 4083419355, irene@aurametrix.com %K COVID-19 %K COVID-19 vaccines %K vaccine adverse events %K breakthrough infections %K decentralized participatory study %K elderly %K older individuals %K medically underserved populations %K aging %K elderly population %K vaccination %K genetic disparity %K microbiome disparity %K impaired immunity %D 2022 %7 4.11.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite continuing efforts to improve the inclusion of underserved groups in clinical research, gaps in diversity remain. Participation of special populations is especially important when facing problems of unprecedented complexity such as the COVID-19 pandemic. A better understanding of factors associated with the immune response in diverse populations would advance future preventive and curative approaches. Objective: The objective of this study was to investigate the factors potentially responsible for adverse events following COVID-19 immunization. The study population included adults from rural areas, transitional countries, and those with medically understudied conditions, across a broad age range. Methods: The study evolved from peer support networks developed during the COVID-19 pandemic. Participants were recruited digitally through online neighborhood and health communities. Some of the participants volunteered as study investigators assisting with offline recruitment and safety monitoring. Individuals who consented to participate were asked to share their vaccination experiences either using constantly evolving web-based surveys or via one-on-one communication. Inferential statistical analysis to estimate differences between study groups was performed using parametric and nonparametric tests. Results: Of 1430 participants who shared their vaccination experiences, 648 had outcome measures at their 1.5-year follow-up. Significant differences were found between age groups, types of vaccine adverse events (VAEs), incidences of breakthrough infections, and health conditions linked to the microbiome. Pairwise comparisons showed that VAEs interfering with daily activities were significantly higher in both younger (18-59 years) and older age groups (80-100 years, P<.001) than in the 60-79–year age group. Short-term VAEs were associated with lower incidence of breakthrough COVID-19 infections relative to those who reported either minimal or long-term adverse events (P<.001). A genetic origin was suggested for some adverse reactions. Conclusions: The findings of this study demonstrate that vaccine adverse reactions in older individuals are being overlooked, and the incidence of VAEs impairing immunity may be higher than previously perceived. Better preventive measures are needed for all those at risk for life-threatening and long-term adverse events due to vaccination. Supportive community-based studies focusing on these populations could add important data to the current body of knowledge. Further and more comprehensive studies should follow. Trial Registration: ClinicalTrials.gov NCT04832932; https://clinicaltrials.gov/ct2/show/NCT04832932 International Registered Report Identifier (IRRID): RR2-10.1101/2021.06.28.21256779 %M 36309347 %R 10.2196/41914 %U https://formative.jmir.org/2022/11/e41914 %U https://doi.org/10.2196/41914 %U http://www.ncbi.nlm.nih.gov/pubmed/36309347 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e38647 %T Entomological Surveillance of the Invasive Aedes Species at Higher-Priority Entry Points in Northern Iran: Exploratory Report on a Field Study %A Nikookar,Seyed Hassan %A Maleki,Alireza %A Fazeli-Dinan,Mahmoud %A Shabani Kordshouli,Razieh %A Enayati,Ahmadali %+ Department of Medical Entomology and Vector Control, School of Public Health and Health Sciences Research Center, Mazandaran University of Medical Sciences, Khazar Abad Road (Km-17th), Sari, P.O. Box 48175-1553, Iran, 98 9111522209, aenayati1372@gmail.com %K mosquito surveillance %K Aedes %K biodiversity %K Guilan %K Northern Iran %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Arboviral diseases such as dengue, Zika, and chikungunya are transmitted by Aedes aegypti and Ae albopictus and are emerging global public health concerns. Objective: This study aimed to provide up-to-date data on the occurrence of the invasive Aedes species in a given area as this is essential for planning and implementing timely control strategies. Methods: Entomological surveillance was planned and carried out monthly from May 2018 to December 2019 at higher-priority entry points in Guilan Province, Northern Iran, using ovitraps, larval collection, and human-baited traps. Species richness (R), Simpson (D), evenness (E), and Shannon-Wiener indexes (H̕) were measured to better understand the diversity of the Aedes species. The Spearman correlation coefficient and regression models were used for data analysis. Results: We collected a total of 3964 mosquito samples including 17.20% (682/3964) belonging to the Aedes species, from 3 genera and 13 species, and morphologically identified them from May 2018 to December 2019. Ae vexans and Ae geniculatus, which showed a peak in activity levels and population in October (226/564, 40.07% and 26/103, 25.2%), were the eudominant species (D=75.7%; D=21.2%) with constant (C=100) and frequent (C=66.7%) distributions, respectively. The population of Ae vexans had a significant positive correlation with precipitation (r=0.521; P=.009) and relative humidity (r=0.510; P=.01), whereas it was inversely associated with temperature (r=−0.432; P=.04). The Shannon-Wiener Index was up to 0.84 and 1.04 in the city of Rasht and in July, respectively. The rarefaction curve showed sufficiency in sampling efforts by reaching the asymptotic line at all spatial and temporal scales, except in Rasht and in October. Conclusions: Although no specimens of the Ae aegypti and Ae albopictus species were collected, this surveillance provides a better understanding of the native Aedes species in the northern regions of Iran. These data will assist the health system in future arbovirus research, and in the implementation of effective vector control and prevention strategies, should Ae aegypti and Ae albopictus be found in the province. %M 36315230 %R 10.2196/38647 %U https://publichealth.jmir.org/2022/10/e38647 %U https://doi.org/10.2196/38647 %U http://www.ncbi.nlm.nih.gov/pubmed/36315230 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e36211 %T Global Variations in Event-Based Surveillance for Disease Outbreak Detection: Time Series Analysis %A Ganser,Iris %A Thiébaut,Rodolphe %A Buckeridge,David L %+ McGill Clinical and Health Informatics, School of Population and Global Health, McGill University, 2001 McGill College Avenue, Suite 1200, Montreal, QC, H3A 1G1, Canada, 1 514 934 1934 ext 32991, david.buckeridge@mcgill.ca %K event-based surveillance %K digital disease detection %K public health surveillance %K influenza %K infectious disease outbreak %K surveillance %K disease %K outbreak %K analysis %K public health %K data %K detection %K detect %K epidemic %D 2022 %7 31.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Robust and flexible infectious disease surveillance is crucial for public health. Event-based surveillance (EBS) was developed to allow timely detection of infectious disease outbreaks by using mostly web-based data. Despite its widespread use, EBS has not been evaluated systematically on a global scale in terms of outbreak detection performance. Objective: The aim of this study was to assess the variation in the timing and frequency of EBS reports compared to true outbreaks and to identify the determinants of variability by using the example of seasonal influenza epidemic in 24 countries. Methods: We obtained influenza-related reports between January 2013 and December 2019 from 2 EBS systems, that is, HealthMap and the World Health Organization Epidemic Intelligence from Open Sources (EIOS), and weekly virological influenza counts for the same period from FluNet as the gold standard. Influenza epidemic periods were detected based on report frequency by using Bayesian change point analysis. Timely sensitivity, that is, outbreak detection within the first 2 weeks before or after an outbreak onset was calculated along with sensitivity, specificity, positive predictive value, and timeliness of detection. Linear regressions were performed to assess the influence of country-specific factors on EBS performance. Results: Overall, while monitoring the frequency of EBS reports over 7 years in 24 countries, we detected 175 out of 238 outbreaks (73.5%) but only 22 out of 238 (9.2%) within 2 weeks before or after an outbreak onset; in the best case, while monitoring the frequency of health-related reports, we identified 2 out of 6 outbreaks (33%) within 2 weeks of onset. The positive predictive value varied between 9% and 100% for HealthMap and from 0 to 100% for EIOS, and timeliness of detection ranged from 13% to 94% for HealthMap and from 0% to 92% for EIOS, whereas system specificity was generally high (59%-100%). The number of EBS reports available within a country, the human development index, and the country’s geographical location partially explained the high variability in system performance across countries. Conclusions: We documented the global variation of EBS performance and demonstrated that monitoring the report frequency alone in EBS may be insufficient for the timely detection of outbreaks. In particular, in low- and middle-income countries, low data quality and report frequency impair the sensitivity and timeliness of disease surveillance through EBS. Therefore, advances in the development and evaluation and EBS are needed, particularly in low-resource settings. %M 36315218 %R 10.2196/36211 %U https://publichealth.jmir.org/2022/10/e36211 %U https://doi.org/10.2196/36211 %U http://www.ncbi.nlm.nih.gov/pubmed/36315218 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e38153 %T The #VaccinesWork Hashtag on Twitter in the Context of the COVID-19 Pandemic: Network Analysis %A Fuster-Casanovas,Aïna %A Das,Ronnie %A Vidal-Alaball,Josep %A Lopez Segui,Francesc %A Ahmed,Wasim %+ Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Pica d'Estats 13-15, Sant Fruitós de Bages, 08272, Spain, 34 93 693 0040, jvidal.cc.ics@gencat.cat %K Twitter %K social media %K COVID-19 %K misinformation %K vaccination %K public health %K vaccine hesitancy %K infodemiology %K health campaign %K content analysis %K social network %K layout algorithm %D 2022 %7 28.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Vaccination is one of the most successful public health interventions for the prevention of COVID-19. Toward the end of April 2021, UNICEF (United Nations International Children’s Emergency Fund), alongside other organizations, were promoting the hashtag #VaccinesWork. Objective: The aim of this paper is to analyze the #VaccinesWork hashtag on Twitter in the context of the COVID-19 pandemic, analyzing the main messages shared and the organizations involved. Methods: The data set used in this study consists of 11,085 tweets containing the #VaccinesWork hashtag from the 29th to the 30th of April 2021. The data set includes tweets that may not have the hashtag but were replies or mentions in those tweets. The data were retrieved using NodeXL, and the network graph was laid out using the Harel-Koren fast multiscale layout algorithm. Results: The study found that organizations such as the World Health Organization, UNICEF, and Gavi were the key opinion leaders and had a big influence on the spread of information among users. Furthermore, the most shared URLs belonged to academic journals with a high impact factor. Provaccination users had other vaccination-promoting hashtags in common, not only in the COVID-19 scenario. Conclusions: This study investigated the discussions surrounding the #VaccinesWork hashtag. Social media networks containing conspiracy theories tend to contain dubious accounts leading the discussions and are often linked to unverified information. This kind of analysis can be useful to detect the optimal moment for launching health campaigns on Twitter. %M 36219832 %R 10.2196/38153 %U https://publichealth.jmir.org/2022/10/e38153 %U https://doi.org/10.2196/38153 %U http://www.ncbi.nlm.nih.gov/pubmed/36219832 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e40233 %T Effectiveness, Policy, and User Acceptance of COVID-19 Contact-Tracing Apps in the Post–COVID-19 Pandemic Era: Experience and Comparative Study %A Liu,MingXin %A Zhou,SiYu %A Jin,Qun %A Nishimura,Shoji %A Ogihara,Atsushi %+ Graduate School of Human Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, 3591192, Japan, 81 04 2949 8111, liumingxin98@akane.waseda.jp %K COVID-19 %K contact-tracing app %K digital contact tracing %K mobile phone %D 2022 %7 27.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 36190741 %R 10.2196/40233 %U https://publichealth.jmir.org/2022/10/e40233 %U https://doi.org/10.2196/40233 %U http://www.ncbi.nlm.nih.gov/pubmed/36190741 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e38718 %T Long-term Consequences of COVID-19 and the Pandemic: Protocol for a Web-Based, Longitudinal Observational Study (DEFEAT) %A Mikuteit,Marie %A Heinemann,Stephanie %A Roder,Sascha %A Niewolik,Jacqueline %A Schröder,Dominik %A Vahldiek,Kai %A Klawitter,Sandra %A Cossmann,Anne %A Bergemann,Torsten %A Degen,Chantal %A Klawonn,Frank %A Behrens,Georg Martin Norbert %A Müller,Frank %A Dopfer-Jablonka,Alexandra %A Steffens,Sandra %+ Department for Rheumatology and Immunology, Hannover Medical School, Carl-Neuberg-Straße 1, Hannover, 30625, Germany, 49 5115320, steffens.sandra@mh-hannover.de %K SARS-CoV-2 %K COVID-19 %K long COVID %K post–COVID-19 %K long haulers %K pandemic %K long-term effects %K symptoms %K long-term %K risk factors %K Germany %K population study %K quality of life %K social participation %K engagement %D 2022 %7 26.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: With population-wide vaccination availability, the global COVID-19 pandemic entered a new phase. Despite vaccination status, some people who were infected with SARS-CoV-2 experience long-term symptoms. Objective: In this study, we aim to characterize the long-term effects of SARS-CoV-2 infection and the pandemic. We also aim to build symptom clusters and determine risk factors for developing long COVID symptoms. Furthermore, we assess social participation and health-related quality of life in patients with long COVID and in the general population during a global pandemic. Methods: With a mixed-methods, web-based approach, we aim to recruit 2000 people in Germany who are older than 18 years and can provide informed consent. In the quantitative arm of the study, we identify symptoms of and predictive factors for long COVID manifestations with cluster analysis and assess social participation during the pandemic with standardized questionnaires. The qualitative arm of the study uses individual interviews and focus group discussions to better understand the illness experience of persons who experience long COVID. Results: Recruitment started in September 2021. Up until July 2022, we recruited approximately 4500 participants via our web-based database. Conclusions: This study aims to build an innovative, patient-centered, web-based research platform appropriate for the pandemic by minimizing physical contact between study personnel and participants. All study activities are designed to better understand the long COVID syndrome, social participation during the pandemic, and the illness experiences of persons affected by long COVID. Trial Registration: German Clinical Trial Registry DRKS00026007; https://tinyurl.com/yh282fkt International Registered Report Identifier (IRRID): DERR1-10.2196/38718 %M 36108134 %R 10.2196/38718 %U https://www.researchprotocols.org/2022/10/e38718 %U https://doi.org/10.2196/38718 %U http://www.ncbi.nlm.nih.gov/pubmed/36108134 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 10 %P e38604 %T Patient and Provider Experiences With Virtual Care in a Large, Ambulatory Care Hospital in Ontario, Canada During the COVID-19 Pandemic: Observational Study %A Chu,Cherry %A Nayyar,Dhruv %A Bhattacharyya,Onil %A Martin,Danielle %A Agarwal,Payal %A Mukerji,Geetha %+ Women's College Hospital Institute for Health System Solutions and Virtual Care, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400, geetha.mukerji@wchospital.ca %K virtual care %K telehealth %K COVID-19 pandemic %K patient experience %K provider experience %K virtual %K telemedicine %K COVID-19 %K ethnicity %K social factors %K experience %D 2022 %7 25.10.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Virtual care use increased during the COVID-19 pandemic. The impact of that shift on patient and provider experiences is unclear. Objective: We evaluated patient and provider experiences with virtual visits across an academic, ambulatory hospital in Toronto, Canada and assessed predictors of positive experience with virtual care. Methods: Survey data were analyzed from consenting patients who attended at least one virtual visit (video or telephone) and from consenting providers who delivered at least one virtual visit. Distributions for demographic variables and responses to survey questions are reported, with statistical significance assessed using chi-square tests and t tests. Ordinal logistic regression analysis was used to identify any patient predictors of responses. Results: During the study period, 253 patients (mean age 45.1, SD 15.6 years) completed 517 video visit surveys, and 147 patients (mean age 41.6, SD 16.4 years) completed 209 telephone visit surveys. A total of 75 and 94 providers completed the survey in June 2020 and June 2021, respectively. On a scale from 1 to 10 regarding likelihood to recommend virtual care to others, fewer providers rated a score of 8 or above compared with patients (providers: 62/94, 66% for video and 49/94, 52% for telephone; patients: 415/517, 80% for video and 150/209, 72% for telephone). Patients of non-White ethnicity had lower odds of rating a high score of 9 or 10 compared with White patients (odds ratio 0.52, 95% CI 0.28-0.99). Conclusions: Patient experiences with virtual care were generally positive, but provider experiences were less so. Findings suggest potential differences in patient experience by ethnicity, warranting further investigation into equity concerns with virtual care. %M 36194862 %R 10.2196/38604 %U https://www.jmir.org/2022/10/e38604 %U https://doi.org/10.2196/38604 %U http://www.ncbi.nlm.nih.gov/pubmed/36194862 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 4 %P e35000 %T Virtual Reality Applications in Medicine During the COVID-19 Pandemic: Systematic Review %A Pallavicini,Federica %A Pepe,Alessandro %A Clerici,Massimo %A Mantovani,Fabrizia %+ Department of Human Sciences for Education, Università degli Studi di Milano-Bicocca, Piazza dell'Ateneo Nuovo 1, Milano, 20126, Italy, 39 0264484931, federica.pallavicini@unimib.it %K virtual reality %K medicine %K mental health %K physical health %K education %K training %K COVID-19 %D 2022 %7 25.10.2022 %9 Review %J JMIR Serious Games %G English %X Background: Virtual reality can play an important role during the COVID-19 pandemic in the health care sector. This technology has the potential to supplement the traditional in-hospital medical training and treatment, and may increase access to training and therapies in various health care settings. Objective: This systematic review aimed to describe the literature on health care–targeted virtual reality applications during the COVID-19 crisis. Methods: We conducted a systematic search of the literature on the PsycINFO, Web of Science, and MEDLINE databases, according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. The search string was as follows: “[(virtual reality)] AND [(COVID-19) OR (coronavirus) OR (SARS-CoV-2) OR (healthcare)].” Papers published in English after December 2019 in peer-reviewed journals were selected and subjected to the inclusion and exclusion criteria. We used the Mixed Methods Appraisal Tool to assess the quality of studies and the risk of bias. Results: Thirty-nine studies met the inclusion criteria. Seventeen studies showed the usefulness of virtual reality during the COVID-19 crisis for reducing stress, anxiety, depression, and pain, and promoting physical activity. Twenty-two studies revealed that virtual reality was a helpful learning and training tool during the COVID-19 crisis in several areas, including emergency medicine, nursing, and pediatrics. This technology was also used as an educational tool for increasing public understanding of the COVID-19 pandemic. Different levels of immersion (ie, immersive and desktop virtual reality), types of head-mounted displays (ie, PC-based, mobile, and standalone), and content (ie, 360° videos and photos, virtual environments, virtual reality video games, and embodied virtual agents) have been successfully used. Virtual reality was helpful in both face-to-face and remote trials. Conclusions: Virtual reality has been applied frequently in medicine during the COVID-19 pandemic, with positive effects for treating several health conditions and for medical education and training. Some barriers need to be overcome for the broader adoption of virtual reality in the health care panorama. Trial Registration: International Platform of Registered Systematic Review and Meta-analysis Protocols (INPLASY) INPLASY202190108; https://inplasy.com/inplasy-2021-9-0108/ %M 36282554 %R 10.2196/35000 %U https://games.jmir.org/2022/4/e35000 %U https://doi.org/10.2196/35000 %U http://www.ncbi.nlm.nih.gov/pubmed/36282554 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 10 %P e31251 %T Factors Influencing Increased Use of Technology to Communicate With Others During the COVID-19 Pandemic: Cross-sectional Web-Based Survey Study %A Dawe-Lane,Erin %A Mutepua,Magano %A Morris,Daniel %A Odoi,Clarissa M %A Wilson,Emma %A Evans,Joanne %A Pinfold,Vanessa %A Wykes,Til %A Jilka,Sagar %A Simblett,Sara %+ Department of Psychology, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, Henry Wellcome Building, London, SE5 8AF, United Kingdom, 44 2078480762, sara.simblett@kcl.ac.uk %K COVID-19 %K technology use %K communication %K demographics %K digital health %K mental health %K pandemic %K depression %K health technology %K psychosocial %K lockdown %K United Kingdom %K cross-sectional %K survey %K social interaction %K mental health %K social connection %K social connectivity %D 2022 %7 25.10.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Communication via technology is regarded as an effective way of maintaining social connection and helping individuals to cope with the psychological impact of social distancing measures during a pandemic. However, there is little information about which factors have influenced increased use of technology to communicate with others during lockdowns and whether this has changed over time. Objective: The aim of this study is to explore which psychosocial factors (eg, mental health and employment) and pandemic-related factors (eg, shielding and time) influenced an increase in communication via technology during the first lockdown in the United Kingdom. Methods: A cross-sectional, web-based survey was conducted between April and July 2020, examining thoughts, feelings, and behaviors associated with the pandemic, including communicating more using technology (eg, via messaging, phone, or video). We collected sociodemographic information, employment status, mental health service user status, and depression symptoms. We used hierarchical logistic regression to test which factors were associated with communicating more using technology during the lockdown. Results: Participants (N=1464) were on average 41.07 (SD 14.61) years old, and mostly women (n=1141; 77.9%), White (n=1265; 86.4%), and employed (n=1030; 70.4%). Participants reported a mild level of depression (mean 9.43, SD 7.02), and were communicating more using technology (n=1164; 79.5%). The hierarchical regression indicated that people who were employed and experiencing lower levels of depression were more likely to report increased communication using technology during a lockdown period of the COVID-19 pandemic, and over time, men communicated more using technology. Increased use of technology to communicate was related to greater communication and the inability to see others due to the social distancing measures enacted during the lockdown. It was not related to a general increase in technology use during the lockdown. Conclusions: Although most participants reported increased use of technology to communicate during a lockdown period of the COVID-19 pandemic, this was more apparent in the employed and those experiencing low levels of depression. Moving forward, we should continue to monitor groups who may have been excluded from the benefits of support and communication using technology. %M 35435852 %R 10.2196/31251 %U https://mental.jmir.org/2022/10/e31251 %U https://doi.org/10.2196/31251 %U http://www.ncbi.nlm.nih.gov/pubmed/35435852 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 2 %P e39366 %T How Face Masks Affect the Use of Echolocation by Individuals With Visual Impairments During COVID-19: International Cross-sectional Online Survey %A Kreidy,Chantal %A Martiniello,Natalina %A Nemargut,Joseph Paul %A Wittich,Walter %+ School of Optometry, University of Montreal, 3744, rue Jean-Brillant Bureau 260-7, Montréal, QC, H3T 1P1, Canada, 1 514 343 7962, chantal.kreidy@umontreal.ca %K visual impairment %K echolocation %K COVID-19 %K orientation and mobility %K vision rehabilitation %K online survey %K rehabilitation %K face mask %K visual disability %K vision disorder %K quality of life %K health intervention %D 2022 %7 25.10.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: Although a critical safety measure, preliminary studies have suggested that the use of a face mask may pose a problem for some users with disabilities. To date, little is known about how the wearing of a traditional face mask may pose a barrier to individuals with visual impairments who draw on auditory cues and echolocation techniques during independent travel. Objective: The goal of this study was to document the difficulties, if any, encountered during orientation and mobility due to the use of a face mask during the COVID-19 pandemic and the strategies used to address these barriers. Methods: In total, 135 individuals aged 18 years and older who self-identified as being blind, being deafblind, or having low vision and who could communicate in either English or French completed an anonymous cross-sectional online survey between March 29 and August 23, 2021. Results: In total, 135 respondents (n=52, 38.5%, men; n=83, 61.5%, women) between the ages of 18 and 79 (mean 48.22, SD 14.48) years participated. Overall, 78 (57.7%) self-identified as blind and 57 (42.3%) as having low vision. In addition, 13 (9.6%) identified as having a combined vision and hearing loss and 3 (2.2%) as deafblind. The most common face coverings used were cloth (n=119, 88.1%) and surgical masks (n=74, 54.8%). Among the barriers raised, participants highlighted that face masks made it more difficult to locate people (n=86, 63.7%), communicate with others (n=101, 74.8%), and locate landmarks (n=82, 60.7%). Although the percentage of those who used a white cane before the pandemic did not substantially change, 6 (14.6%) of the 41 participants who were guide dog users prior to the pandemic reported no longer working with a guide dog at the time of the survey. Moreover, although guide dog users reported the highest level of confidence with independent travel before the pandemic, they indicated the lowest level of confidence a year after the pandemic began. Conclusions: These results suggest that participants were less able to draw on nonvisual cues during independent travel and social interactions due to the use of a facemask, contributing to a reduction in perceived self-confidence and independence. Findings inform the development of evidence-based recommendations to address identified barriers. %M 36223434 %R 10.2196/39366 %U https://www.i-jmr.org/2022/2/e39366 %U https://doi.org/10.2196/39366 %U http://www.ncbi.nlm.nih.gov/pubmed/36223434 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e37441 %T Exponential Growth Bias of Infectious Diseases: Protocol for a Systematic Review %A Berg,Siv Hilde %A Lungu,Daniel Adrian %A Brønnick,Kolbjørn %A Harthug,Stig %A Røislien,Jo %+ Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, SHARE – Centre for Resilience in Healthcare, Kjell Arholmsgate 43, Stavanger, 4021, Norway, 47 90022463, siv.h.berg@uis.no %K exponential growth bias %K pandemic %K infectious diseases %K COVID-19 %K health communication %K risk communication %D 2022 %7 24.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Humans struggle to grasp the extent of exponential growth, which is essential to comprehend the spread of an infectious disease. Exponential growth bias is the tendency to linearize exponential functions when assessing them intuitively. Effective public health communication about the nonlinear nature of infectious diseases has strong implications for the public’s compliance with strict restrictions. However, there is a lack of synthesized knowledge on the communication of the exponential growth of infectious diseases and on the outcomes of exponential growth bias. Objective: This systematic review identifies, evaluates, and synthesizes the findings of empirical studies on exponential growth bias of infectious diseases. Methods: A systematic review will be conducted using the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols) 2015 statement. Eligibility criteria include empirical studies of exponential growth bias of infectious diseases regardless of methodology. We include studies both with and without interventions/strategies. For information sources, we include the following five bibliographic databases: MEDLINE, Embase, Cochrane Library, PsychINFO, and Web of Science Core Collection. The risk of bias will be assessed using RoB 2 (Risk of Bias 2) and STROBE (Strengthening the Reporting of Observational Studies in Epidemiology). Data synthesis will be achieved through a narrative synthesis. Results: By February 2022, we included 11 experimental studies and 1 cross-sectional survey study. Preliminary themes identified are the presence of exponential growth bias, the effect of exponential growth bias, and communication strategies to mitigate exponential growth bias. Data extraction, narrative synthesis, and the risk of bias assessment are to be completed by February 2023. Conclusions: We anticipate that this systematic review will draw some lines related to how people comprehend and misperceive exponential growth and its consequences for infectious disease mitigation and communication. Furthermore, the study will conclude with the limitations of the research and suggestions for future research. International Registered Report Identifier (IRRID): DERR1-10.2196/37441 %M 36279166 %R 10.2196/37441 %U https://www.researchprotocols.org/2022/10/e37441 %U https://doi.org/10.2196/37441 %U http://www.ncbi.nlm.nih.gov/pubmed/36279166 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e38450 %T Prediction of COVID-19 Infections for Municipalities in the Netherlands: Algorithm Development and Interpretation %A van der Ploeg,Tjeerd %A Gobbens,Robbert J J %+ Faculty of Health, Sports and Social Work, Inholland University of Applied Sciences, De Boelelaan 1109, Amsterdam, 1081 HV, Netherlands, 31 653519264, tvdploeg@quicknet.nl %K municipality properties %K data merging %K modeling technique %K variable selection %K prediction model %K public health %K COVID-19 %K surveillance %K static data %K Dutch public domain %K pandemic %K Wuhan %K virus %K public %K infections %K fever %K cough %K congestion %K fatigue %K symptoms %K pneumonia %K dyspnea %K death %D 2022 %7 20.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 was first identified in December 2019 in the city of Wuhan, China. The virus quickly spread and was declared a pandemic on March 11, 2020. After infection, symptoms such as fever, a (dry) cough, nasal congestion, and fatigue can develop. In some cases, the virus causes severe complications such as pneumonia and dyspnea and could result in death. The virus also spread rapidly in the Netherlands, a small and densely populated country with an aging population. Health care in the Netherlands is of a high standard, but there were nevertheless problems with hospital capacity, such as the number of available beds and staff. There were also regions and municipalities that were hit harder than others. In the Netherlands, there are important data sources available for daily COVID-19 numbers and information about municipalities. Objective: We aimed to predict the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands, using a data set with the properties of 355 municipalities in the Netherlands and advanced modeling techniques. Methods: We collected relevant static data per municipality from data sources that were available in the Dutch public domain and merged these data with the dynamic daily number of infections from January 1, 2020, to May 9, 2021, resulting in a data set with 355 municipalities in the Netherlands and variables grouped into 20 topics. The modeling techniques random forest and multiple fractional polynomials were used to construct a prediction model for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants per municipality in the Netherlands. Results: The final prediction model had an R2 of 0.63. Important properties for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality in the Netherlands were exposure to particulate matter with diameters <10 μm (PM10) in the air, the percentage of Labour party voters, and the number of children in a household. Conclusions: Data about municipality properties in relation to the cumulative number of confirmed infections in a municipality in the Netherlands can give insight into the most important properties of a municipality for predicting the cumulative number of confirmed COVID-19 infections per 10,000 inhabitants in a municipality. This insight can provide policy makers with tools to cope with COVID-19 and may also be of value in the event of a future pandemic, so that municipalities are better prepared. %M 36219835 %R 10.2196/38450 %U https://publichealth.jmir.org/2022/10/e38450 %U https://doi.org/10.2196/38450 %U http://www.ncbi.nlm.nih.gov/pubmed/36219835 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 4 %P e39952 %T The Evolution of Live Patient Viewing in the Era of COVID-19: Survey Study %A Sally,Rachel %A Shaw,Katharina %A Ho,Roger %+ Ronald O Perelman Department of Dermatology, New York University Grossman School of Medicine, 240 East 38th Street, 12th Floor, New York, NY, 10016, United States, 1 212 263 5253, Roger.Ho@nyulangone.org %K COVID-19 pandemic %K live patient viewing %K dermatology education %K dermatology %K COVID-19 %K residency program %K residency %K dermatology residency %K medical education %K virtual education %K didactic %D 2022 %7 18.10.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 36937784 %R 10.2196/39952 %U https://derma.jmir.org/2022/4/e39952 %U https://doi.org/10.2196/39952 %U http://www.ncbi.nlm.nih.gov/pubmed/36937784 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e37177 %T Pilot Influenza Syndromic Surveillance System Based on Absenteeism and Temperature in China: Development and Usability Study %A Yang,Zhen %A Jiang,Chenghua %+ Dongfang Hospital, Tongji University, No 1239 Siping Road, Yangpu District, Shanghai, 200092, China, 86 18917266778, jchtongji@163.com %K influenza %K syndromic surveillance system %K face recognition %K infrared thermometer %K absenteeism %K temperature %D 2022 %7 14.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Shortcomings of the current school-based infectious disease syndromic surveillance system (SSS) in China include relying on school physicians to collect data manually and ignoring the health information of students in attendance. Objective: This study aimed to design and implement an influenza SSS based on the absenteeism (collected by face recognition) and temperature of attending students (measured by thermal imaging). Methods: An SSS was implemented by extending the functionality of an existing application. The system was implemented in 2 primary schools and 1 junior high school in the Yangtze River Delta, with a total of 3535 students. The examination period was from March 1, 2021, to January 14, 2022, with 174 effective days. The daily and weekly absenteeism and fever rates reported by the system (DAR1 and DFR; WAR1 and WFR) were calculated. The daily and weekly absenteeism rates reported by school physicians (DAR2 and WAR2) and the weekly positive rate of influenza virus (WPRIV, released by the Chinese National Influenza Center) were used as standards to evaluate the quality of the data reported by the system. Results: Absenteeism reported by school physicians (completeness 86.7%) was 36.5% of that reported by this system (completeness 100%), and a significant positive correlation between them was detected (r=0.372, P=.002). When the influenza activity level was moderate, DAR1s were significantly positively correlated among schools (rab=0.508, P=.004; rbc=0.427, P=.02; rac=0.447, P=.01). During the influenza breakout, the gap of DAR1s widened. WAR1 peaked 2 weeks earlier in schools A and B than in school C. Variables significantly positively correlated with the WPRIV were the WAR1 and WAR2 of school A, WAR1 of school C, and WFR of school B. The correlation between the WAR1 and WPRIV was greater than that between the WAR2 and WPRIV in school A. Addition of the WFR to the WAR1 of school B increased the correlation between the WAR1 and WPRIV. Conclusions: Data demonstrated that absenteeism calculation based on face recognition was reliable, but the accuracy of the temperature recorded by the infrared thermometer should be enhanced. Compared with similar SSSs, this system has superior simplicity, cost-effectiveness, data quality, sensitivity, and timeliness. %M 36239991 %R 10.2196/37177 %U https://publichealth.jmir.org/2022/10/e37177 %U https://doi.org/10.2196/37177 %U http://www.ncbi.nlm.nih.gov/pubmed/36239991 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 4 %P e35310 %T COVID-19 Diagnosis and Risk of Death Among Adults With Cancer in Indiana: Retrospective Cohort Study %A Valvi,Nimish %A Patel,Hetvee %A Bakoyannis,Giorgos %A Haggstrom,David A %A Mohanty,Sanjay %A Dixon,Brian E %+ Richard M. Fairbanks School of Public Health, Indiana University, 1050 Wishard Boulevard, Floors 5 and 6, Indianapolis, IN, 46202-2872, United States, 1 3172783072, bedixon@regenstrief.org %K COVID-19 %K SARS-CoV-2 %K coronavirus %K cancer %K survival %K mortality %K death %K oncology %K cancer experience %K outcome %K electronic health record %K EHR %K patient with cancer %K cancer population %K Kaplan-Meier %K Cox proportional hazards model %K hazard ratio %K risk %D 2022 %7 6.10.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: Prior studies, generally conducted at single centers with small sample sizes, found that individuals with cancer experience more severe outcomes due to COVID-19, caused by SARS-CoV-2 infection. Although early examinations revealed greater risk of severe outcomes for patients with cancer, the magnitude of the increased risk remains unclear. Furthermore, prior studies were not typically performed using population-level data, especially those in the United States. Given robust prevention measures (eg, vaccines) are available for populations, examining the increased risk of patients with cancer due to SARS-CoV-2 infection using robust population-level analyses of electronic medical records is warranted. Objective: The aim of this paper is to evaluate the association between SARS-CoV-2 infection and all-cause mortality among recently diagnosed adults with cancer. Methods: We conducted a retrospective cohort study of newly diagnosed adults with cancer between January 1, 2019, and December 31, 2020, using electronic health records linked to a statewide SARS-CoV-2 testing database. The primary outcome was all-cause mortality. We used the Kaplan-Meier estimator to estimate survival during the COVID-19 period (January 15, 2020, to December 31, 2020). We further modeled SARS-CoV-2 infection as a time-dependent exposure (immortal time bias) in a multivariable Cox proportional hazards model adjusting for clinical and demographic variables to estimate the hazard ratios (HRs) among newly diagnosed adults with cancer. Sensitivity analyses were conducted using the above methods among individuals with cancer-staging information. Results: During the study period, 41,924 adults were identified with newly diagnosed cancer, of which 2894 (6.9%) tested positive for SARS-CoV-2. The population consisted of White (n=32,867, 78.4%), Black (n=2671, 6.4%), Hispanic (n=832, 2.0%), and other (n=5554, 13.2%) racial backgrounds, with both male (n=21,354, 50.9%) and female (n=20,570, 49.1%) individuals. In the COVID-19 period analysis, after adjusting for age, sex, race or ethnicity, comorbidities, cancer type, and region, the risk of death increased by 91% (adjusted HR 1.91; 95% CI 1.76-2.09) compared to the pre–COVID-19 period (January 1, 2019, to January 14, 2020) after adjusting for other covariates. In the adjusted time-dependent analysis, SARS-CoV-2 infection was associated with an increase in all-cause mortality (adjusted HR 6.91; 95% CI 6.06-7.89). Mortality increased 2.5 times among adults aged 65 years and older (adjusted HR 2.74; 95% CI 2.26-3.31) compared to adults 18-44 years old, among male (adjusted HR 1.23; 95% CI 1.14-1.32) compared to female individuals, and those with ≥2 chronic conditions (adjusted HR 2.12; 95% CI 1.94-2.31) compared to those with no comorbidities. Risk of mortality was 9% higher in the rural population (adjusted HR 1.09; 95% CI 1.01-1.18) compared to adult urban residents. Conclusions: The findings highlight increased risk of death is associated with SARS-CoV-2 infection among patients with a recent diagnosis of cancer. Elevated risk underscores the importance of adhering to social distancing, mask adherence, vaccination, and regular testing among the adult cancer population. %M 36201388 %R 10.2196/35310 %U https://cancer.jmir.org/2022/4/e35310 %U https://doi.org/10.2196/35310 %U http://www.ncbi.nlm.nih.gov/pubmed/36201388 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e38914 %T Understanding Racial Disparities in COVID-19–Related Complications: Protocol for a Mixed Methods Study %A Harding,Jessica L %A Patel,Shivani A %A Davis,Teaniese %A Patzer,Rachel E %A McDonald,Bennett %A Walker-Williams,Doraina %A Jagannathan,Ram %A Teunis,Larissa %A Gander,Jennifer %+ Department of Surgery, Emory University, 101 Woodruff Circle Suite 1019, Atlanta, GA, 30322, United States, 1 404 824 1483, jessica.harding@emory.edu %K COVID-19 %K social determinants of health %K race %K mixed methods %K equity %K disparity %K health %K pandemic %K disease severity %K mortality %K racial %K ethnicity %K complications %D 2022 %7 6.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: In the United States, the COVID-19 pandemic has magnified the disproportionate and long-standing health disparities experienced by Black communities. Although it is acknowledged that social determinants of health (SDOH) rather than biological factors likely contribute to this disparity, few studies using rigorous analytic approaches in large, information-rich community-based data sets are dedicated to understanding the underlying drivers of these racial disparities. Objective: The overall aim of our study is to elucidate the mechanisms by which racial disparities in severe COVID-19 outcomes arise, using both quantitative and qualitative methods. Methods: In this protocol, we outline a convergent parallel mixed methods approach to identifying, quantifying, and contextualizing factors that contribute to the dramatic disparity in COVID-19 severity (ie, hospitalization, mortality) in Black versus white COVID-19 patients within the integrated health care system of Kaiser Permanente Georgia (KPGA). Toward this end, we will generate two quantitative cohorts of KPGA members with a confirmed COVID-19 diagnosis between January 1, 2020, and September 30, 2021: (1) an electronic medical record (EMR) cohort including routinely captured data on diagnoses, medications, and laboratory values, and a subset of patients hospitalized at Emory Healthcare to capture additional in-hospital data; and (2) a survey cohort, where participants will answer a range of questions related to demographics (eg, race, education), usual health behaviors (eg, physical activity, smoking), impact of COVID-19 (eg, job loss, caregiving responsibilities), and medical mistrust. Key outcomes of interest for these two cohorts include hospitalization, mortality, intensive care unit admission, hospital readmission, and long COVID-19. Finally, we will conduct qualitative semistructured interviews to capture perceptions of and experiences of being hospitalized with COVID-19 as well as related interactions with KPGA health care providers. We will analyze and interpret the quantitative and qualitative data separately, and then integrate the qualitative and quantitative findings using a triangulation design approach. Results: This study has been funded by a Woodruff Health Sciences grant from December 2020 to December 2022. As of August 31, 2022, 31,500 KPGA members diagnosed with COVID-19 have been included in the EMR cohort, including 3028 who were hospitalized at Emory Healthcare, and 482 KPGA members completed the survey. In addition, 20 KPGA members (10 Black and 10 white) have been interviewed about their experiences navigating care with COVID-19. Quantitative and qualitative data cleaning and coding have been completed. Data analysis is underway with results anticipated to be published in December 2022. Conclusions: Results from this mixed methods pilot study in a diverse integrated care setting in the southeastern United States will provide insights into the mechanisms underpinning racial disparities in COVID-19 complications. The quantitative and qualitative data will provide important context to generate hypotheses around the mechanisms for racial disparities in COVID-19, and may help to inform the development of multilevel strategies to reduce the burden of racial disparities in COVID-19 and its ongoing sequelae. Incorporating contextual information, elucidated from qualitative interviews, will increase the efficacy, adoption, and sustainability of such strategies. International Registered Report Identifier (IRRID): RR1-10.2196/38914 %M 36166652 %R 10.2196/38914 %U https://www.researchprotocols.org/2022/10/e38914 %U https://doi.org/10.2196/38914 %U http://www.ncbi.nlm.nih.gov/pubmed/36166652 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 10 %P e36077 %T Soil-Transmitted Helminth Infection in Malaysia: Protocol for a Scoping Review %A Mohd Hisham,Muhammad Faiz %A Ahmad,Fazila Haryati %A Mohamed Haris,Hasmah %A Lodz,Noor Aliza %A Yoep,Norzawati %A Muhammad,Eida Nurhadzira %A Ali,Rafidah %A Muhamad,Nor Asiah %+ Institute for Public Health, National Institute of Health, No 1, Jalan Setia Murni U13/52, Setia Alam, B6L6, Institute of Public Health, Shah Alam, 40170, Malaysia, 60 333628888 ext 8722, faizhisham86@gmail.com %K STH %K soil-transmitted helminth %K PRISMA-ScR %K Malaysia %K helminth %K tropical disease %D 2022 %7 5.10.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Soil-transmitted helminth (STH) infection is 1 of the 20 notable neglected tropical diseases according to the Centers for Disease Control and Prevention and World Health Organization. In 2010, it is estimated that 1.73 billion people are infected with STH globally, of which 70% of cases occur in Asia. To date, there is a dearth of published literature on the prevalence of STH infection throughout Malaysia. Objective: The objectives of this study are to review research activity on STH infection in Malaysia, to estimate the prevalence of STH infection among Malaysians, and to identify significant risk factors associated with the infection. This review aims to provide the current state of evidence pertaining to STH infections, focusing on the main areas, limitations, and biases of research and mapping out the morbidity distribution of the diseases and their causative agents, and to identify significant risk factors for preventive measures. Methods: We will conduct a scoping review based on the 6-stage structured framework developed by Arksey and O’Malley. A comprehensive search strategy focusing on STH infection will be executed using electronic databases (Scopus, PubMed, Web of Science, and Embase). A systematic approach for searching, screening, reviewing, and data extraction will be applied based on the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines. Mendeley software and Microsoft Excel will be used to manage the references and to remove duplicates. Relevant data from selected articles will be extracted using a standardized data extraction form. Results: A total of 164 potential manuscripts were retrieved. Data extraction is currently in progress and completion is expected by the end of 2022. Conclusions: Our scoping review will summarize the current state of research in this field and provide comprehensive information regarding STH infections in Malaysia for future reference. Trial Registration: National Medical Research Register NMRR-20-2889-54348; https://nmrr.gov.my/research-directory/e52ea778-d31c-4eb4-9163-a45bb3680bbf International Registered Report Identifier (IRRID): DERR1-10.2196/36077 %M 36197715 %R 10.2196/36077 %U https://www.researchprotocols.org/2022/10/e36077 %U https://doi.org/10.2196/36077 %U http://www.ncbi.nlm.nih.gov/pubmed/36197715 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 4 %P e31579 %T Association of Pregnancy With Coronavirus Cytokine Storm: Systematic Review and Meta-analysis %A Muthuka,John %A Kiptoo,Michael %A Oluoch,Kelly %A Nzioki,Japheth Mativo %A Nyamai,Everlyn Musangi %+ Head Quaters, Kenya Medical Training College, PO Box 30195-00100, Nairobi, Kenya, 254 724274843, johnmuthuka@gmail.com %K COVID-19 %K pandemic %K pregnancy %K maternal health %K cytokine %K cytokine storm %K immune response %K infectious disease %K coronavirus %K respiratory %K virus %K pregnant %D 2022 %7 4.10.2022 %9 Review %J JMIR Pediatr Parent %G English %X 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 (I²=98%, P<.001). Furthermore, the updated analysis showed substantially low heterogeneity (I²=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 (I²=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. %M 35319475 %R 10.2196/31579 %U https://pediatrics.jmir.org/2022/4/e31579 %U https://doi.org/10.2196/31579 %U http://www.ncbi.nlm.nih.gov/pubmed/35319475 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 10 %P e34927 %T COVID-19 Cases Among Congregate Care Facility Staff by Neighborhood of Residence and Social and Structural Determinants: Observational Study %A Ma,Huiting %A Yiu,Kristy C Y %A Baral,Stefan D %A Fahim,Christine %A Moloney,Gary %A Darvin,Dariya %A Landsman,David %A Chan,Adrienne K %A Straus,Sharon %A Mishra,Sharmistha %+ St Michael's Hospital, Unity Health Toronto, Room 315, 209 Victoria Street, Toronto, ON, M5B 1T8, Canada, 1 416 864 6060 ext 5568, sharmistha.mishra@utoronto.ca %K long-term care %K nursing home %K staff %K essential worker %K retirement home %K shelter %K congregate living %K COVID-19 %K observational %K risk %K transmission %K elderly %K older adults %K retirement %K nurse %K health care worker %K congregate %K trend %K geography %K Canada %K Toronto %D 2022 %7 4.10.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Disproportionate risks of COVID-19 in congregate care facilities including long-term care homes, retirement homes, and shelters both affect and are affected by SARS-CoV-2 infections among facility staff. In cities across Canada, there has been a consistent trend of geographic clustering of COVID-19 cases. However, there is limited information on how COVID-19 among facility staff reflects urban neighborhood disparities, particularly when stratified by the social and structural determinants of community-level transmission. Objective: This study aimed to compare the concentration of cumulative cases by geography and social and structural determinants across 3 mutually exclusive subgroups in the Greater Toronto Area (population: 7.1 million): community, facility staff, and health care workers (HCWs) in other settings. Methods: We conducted a retrospective, observational study using surveillance data on laboratory-confirmed COVID-19 cases (January 23 to December 13, 2020; prior to vaccination rollout). We derived neighborhood-level social and structural determinants from census data and generated Lorenz curves, Gini coefficients, and the Hoover index to visualize and quantify inequalities in cases. Results: The hardest-hit neighborhoods (comprising 20% of the population) accounted for 53.87% (44,937/83,419) of community cases, 48.59% (2356/4849) of facility staff cases, and 42.34% (1669/3942) of other HCW cases. Compared with other HCWs, cases among facility staff reflected the distribution of community cases more closely. Cases among facility staff reflected greater social and structural inequalities (larger Gini coefficients) than those of other HCWs across all determinants. Facility staff cases were also more likely than community cases to be concentrated in lower-income neighborhoods (Gini 0.24, 95% CI 0.15-0.38 vs 0.14, 95% CI 0.08-0.21) with a higher household density (Gini 0.23, 95% CI 0.17-0.29 vs 0.17, 95% CI 0.12-0.22) and with a greater proportion working in other essential services (Gini 0.29, 95% CI 0.21-0.40 vs 0.22, 95% CI 0.17-0.28). Conclusions: COVID-19 cases among facility staff largely reflect neighborhood-level heterogeneity and disparities, even more so than cases among other HCWs. The findings signal the importance of interventions prioritized and tailored to the home geographies of facility staff in addition to workplace measures, including prioritization and reach of vaccination at home (neighborhood level) and at work. %M 35867901 %R 10.2196/34927 %U https://publichealth.jmir.org/2022/10/e34927 %U https://doi.org/10.2196/34927 %U http://www.ncbi.nlm.nih.gov/pubmed/35867901 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 3 %N 1 %P e36860 %T A Bioinformatics Tool for Predicting Future COVID-19 Waves Based on a Retrospective Analysis of the Second Wave in India: Model Development Study %A Kumar,Ashutosh %A Asghar,Adil %A Dwivedi,Prakhar %A Kumar,Gopichand %A Narayan,Ravi K %A Jha,Rakesh K %A Parashar,Rakesh %A Sahni,Chetan %A Pandey,Sada N %+ Department of Anatomy, All India Institute of Medical Sciences - Patna, Phulwari Sharif, Patna, 801507, India, 91 612 245 ext 1335, drashutoshkumar@aiimspatna.org %K COVID-19 %K epidemiology %K genomic surveillance %K second wave %K SARS-CoV-2 %D 2022 %7 22.9.2022 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: Since the start of the COVID-19 pandemic, health policymakers globally have been attempting to predict an impending wave of COVID-19. India experienced a devastating second wave of COVID-19 in the late first week of May 2021. We retrospectively analyzed the viral genomic sequences and epidemiological data reflecting the emergence and spread of the second wave of COVID-19 in India to construct a prediction model. Objective: We aimed to develop a bioinformatics tool that can predict an impending COVID-19 wave. Methods: We analyzed the time series distribution of genomic sequence data for SARS-CoV-2 and correlated it with epidemiological data for new cases and deaths for the corresponding period of the second wave. In addition, we analyzed the phylodynamics of circulating SARS-CoV-2 variants in the Indian population during the study period. Results: Our prediction analysis showed that the first signs of the arrival of the second wave could be seen by the end of January 2021, about 2 months before its peak in May 2021. By the end of March 2021, it was distinct. B.1.617 lineage variants powered the wave, most notably B.1.617.2 (Delta variant). Conclusions: Based on the observations of this study, we propose that genomic surveillance of SARS-CoV-2 variants, complemented with epidemiological data, can be a promising tool to predict impending COVID-19 waves. %M 36193192 %R 10.2196/36860 %U https://bioinform.jmir.org/2022/1/e36860 %U https://doi.org/10.2196/36860 %U http://www.ncbi.nlm.nih.gov/pubmed/36193192 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 9 %P e29927 %T Business Process Model and Notation and openEHR Task Planning for Clinical Pathway Standards in Infections: Critical Analysis %A Iglesias,Natalia %A Juarez,Jose M %A Campos,Manuel %+ Instituto de Investigación de Tecnologías de la Información y las Comunicaciones Orientadas, University of Murcia, Faculty of Computer Science, Campus Espinardo, University of Murcia, Murcia, 30100, Spain, 34 868887864, natalia.iglesias@um.es %K openEHR task planning %K business process model and notation %K BPMN %K clinical pathways %K catheter-related bloodstream infection %K CR-BSI %K clinical guidelines %D 2022 %7 15.9.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 36107480 %R 10.2196/29927 %U https://www.jmir.org/2022/9/e29927 %U https://doi.org/10.2196/29927 %U http://www.ncbi.nlm.nih.gov/pubmed/36107480 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e35434 %T Modeling Adoption, Security, and Privacy of COVID-19 Apps: Findings and Recommendations From an Empirical Study Using the Unified Theory of Acceptance and Use of Technology %A Nunes,Nuno %A Adamo,Greta %A Ribeiro,Miguel %A R Gouveia,Bruna %A Rubio Gouveia,Elvio %A Teixeira,Pedro %A Nisi,Valentina %+ Instituto Superior Técnico, University of Lisbon, Campus Alameda, Av Rovisco Pais, Lisbon, 1049-001, Portugal, 351 917754700, jose.miguel.ribeiro@tecnico.ulisboa.pt %K COVID-19 %K SARS-CoV-2 %K UTAUT %K empirical study %K structural equation modeling %K confirmatory factor analysis %K security %K privacy %K global health %K technology solution %K research model %K technology acceptance %K digital health %K mobile health %D 2022 %7 14.9.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The global health crisis caused by COVID-19 has drastically changed human society in a relatively short time. However, this crisis has offered insights into the different roles that such a worldwide virus plays in the lives of people and how those have been affected, as well as eventually proposing new solutions. From the beginning of the pandemic, technology solutions have featured prominently in virus control and in the frame of reference for international travel, especially contact tracing and passenger locator applications. Objective: The objective of this paper is to study specific areas of technology acceptance and adoption following a unified theory of acceptance and use of technology (UTAUT) research model. Methods: We presented a research model based on UTAUT constructs to study the determinants for adoption of COVID-19–related apps using a questionnaire. We tested the model via confirmatory factor analysis (CFA) and structural equation modeling (SEM) using travelers’ data from an insular tourist region. Results: Our model explained 90.3% of the intention to use (N=9555) and showed an increased understanding of the vital role of safety, security, privacy, and trust in the usage intention of safety apps. Results also showed how the impact of COVID-19 is not a strong predictor of adoption, while age, education level, and social capital are essential moderators of behavioral intention. Conclusions: In terms of scientific impact, the results described here provide important insights and contributions not only for researchers but also for policy and decision makers by explaining the reasons behind the adoption and usage of apps designed for COVID-19. %M 35862671 %R 10.2196/35434 %U https://humanfactors.jmir.org/2022/3/e35434 %U https://doi.org/10.2196/35434 %U http://www.ncbi.nlm.nih.gov/pubmed/35862671 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e40064 %T Patient Experience and Feedback After Using an Electronic Health Record–Integrated COVID-19 Symptom Checker: Survey Study %A Liu,Andrew W %A Odisho,Anobel Y %A Brown III,William %A Gonzales,Ralph %A Neinstein,Aaron B %A Judson,Timothy J %+ Center for Digital Health Innovation, University of California, San Francisco, 1700 Owens St, Suite 541, San Francisco, CA, 94158, United States, 1 415 514 8755, timothy.judson@ucsf.edu %K COVID-19 %K patient portals %K digital health %K diagnostic self evaluation %K medical informatics %K internet %K telemedicine %K triage %K feedback %K medical records systems %K San Francisco %K user experience %K user satisfaction %K self-triage %K symptom checker %K health system %K workflow %K feedback %K integration %K electronic health record %D 2022 %7 13.9.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Symptom checkers have been widely used during the COVID-19 pandemic to alleviate strain on health systems and offer patients a 24-7 self-service triage option. Although studies suggest that users may positively perceive web-based symptom checkers, no studies have quantified user feedback after use of an electronic health record–integrated COVID-19 symptom checker with self-scheduling functionality. Objective: In this paper, we aimed to understand user experience, user satisfaction, and user-reported alternatives to the use of a COVID-19 symptom checker with self-triage and self-scheduling functionality. Methods: We launched a patient-portal–based self-triage and self-scheduling tool in March 2020 for patients with COVID-19 symptoms, exposures, or questions. We made an optional, anonymous Qualtrics survey available to patients immediately after they completed the symptom checker. Results: Between December 16, 2021, and March 28, 2022, there were 395 unique responses to the survey. Overall, the respondents reported high satisfaction across all demographics, with a median rating of 8 out of 10 and 288/395 (47.6%) of the respondents giving a rating of 9 or 10 out of 10. User satisfaction scores were not associated with any demographic factors. The most common user-reported alternatives had the web-based tool not been available were calling the COVID-19 telephone hotline and sending a patient-portal message to their physician for advice. The ability to schedule a test online was the most important symptom checker feature for the respondents. The most common categories of user feedback were regarding other COVID-19 services (eg, telephone hotline), policies, or procedures, and requesting additional features or functionality. Conclusions: This analysis suggests that COVID-19 symptom checkers with self-triage and self-scheduling functionality may have high overall user satisfaction, regardless of user demographics. By allowing users to self-triage and self-schedule tests and visits, tools such as this may prevent unnecessary calls and messages to clinicians. Individual feedback suggested that the user experience for this type of tool is highly dependent on the organization's operational workflows for COVID-19 testing and care. This study provides insight for the implementation and improvement of COVID-19 symptom checkers to ensure high user satisfaction. %M 35960593 %R 10.2196/40064 %U https://humanfactors.jmir.org/2022/3/e40064 %U https://doi.org/10.2196/40064 %U http://www.ncbi.nlm.nih.gov/pubmed/35960593 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 9 %P e34675 %T Psychometric Properties of the COVID-19 Pandemic Fatigue Scale: Cross-sectional Online Survey Study %A Rodriguez-Blazquez,Carmen %A Romay-Barja,Maria %A Falcon,Maria %A Ayala,Alba %A Forjaz,Maria João %+ School of Medicine, University of Murcia, Campus de Espinardo, Murcia, 31000, Spain, 34 868887583, falcon@um.es %K COVID-19 %K pandemic fatigue %K psychometric properties %K Rasch analysis %K validation %K online survey %K pandemic %K fatigue %K mental health %K information seeking %K health information %D 2022 %7 8.9.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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; χ25=8.06, P=.15). The CPFS showed good fit to the Rasch model (χ 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. %M 35785547 %R 10.2196/34675 %U https://publichealth.jmir.org/2022/9/e34675 %U https://doi.org/10.2196/34675 %U http://www.ncbi.nlm.nih.gov/pubmed/35785547 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e38386 %T The Pragmatic Return to Effective Dental Infection Control Through Triage and Testing (PREDICT) Study: Protocol for a Prospective Clinical Study in the National Dental Practice–Based Research Network %A Fredericks-Younger,Janine %A Fine,Daniel H %A Subramanian,Gayathri %A Coker,Modupe O %A Meyerowitz,Cyril %A Ragusa,Patricia %A Allareddy,Veerasathpurush %A McBurnie,Mary Ann %A Funkhouser,Ellen %A Gennaro,Maria Laura %A Feldman,Cecile A %+ School of Dental Medicine, Rutgers University, 110 Bergen Street, Newark, NJ, 07103, United States, 1 973 972 1679, frederja@sdm.rutgers.edu %K COVID-19 %K COVID-19 triage %K COVID-19 testing %K SARS-CoV-2 %K feasibility study %K National Dental Practice–Based Research Network %K PBRN %K dental practice %K dental health %K dentist %K dentistry %K safety %K healthcare professional safety %K health care %K patient safety %K dental healthcare staff %D 2022 %7 31.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Dental practice has been greatly affected by the COVID-19 pandemic. As SARS-CoV-2 infection is transmitted by respiratory fluids, dental practice techniques, which include aerosol-generating procedures, can increase the risk of transmission causing heightened safety concerns for both dental health care workers (DHCWs) and patients. These concerns have resulted in the reduction in patient volume and the available workforce within dental practices across the United States. Standardized methods for COVID-19 triage and testing may lead to increased safety and perceptions of safety for DHCWs and their patients and promote willingness to provide and access oral health care services. Objective: This study is designed to develop procedures that test the feasibility of enhanced COVID-19 triage and testing in dental offices. It will provide preliminary data to support a larger network-wide study grant application aimed at developing protocols to address safety concerns of patients and DHCWs in a peri–COVID-19 pandemic era. Methods: The feasibility study is being conducted in 4 private dental practices, each of which has a dentist member of the National Dental Practice–Based Research Network. Participants include the DHCWs and patients of the dental practice. Study procedures include completion of COVID-19 triage, completion of COVID-19 testing (point-of-care [POC] or laboratory-based [LAB] SARS-CoV-2 viral, antigen, and antibody tests based on office designation), and administration of perception and attitude surveys for participating DCHWs and patients of the dental practice over a defined study period. The office designation and the participant’s role in the practice determines which testing protocol is executed within the office. There are 4 study groups following 4 distinct protocols: (1) POC DHCWs, (2) POC patients, (3) LAB DHCWs, and (4) LAB patients. Results: Data collection began in December of 2021 and concluded in March 2022. Study results are expected to be published in fall 2022. Conclusions: The results of this feasibility study will help identify the viability and functionality of COVID-19 triage and testing in dental practices and inform a larger network-wide study grant application that develops protocols that address safety concerns of patients and DHCWs in a COVID-19 environment. Trial Registration: ClinicalTrials.gov NTC05123742; https://clinicaltrials.gov/ct2/show/NCT05123742?term=NCT05123742 International Registered Report Identifier (IRRID): DERR1-10.2196/38386 %M 35944181 %R 10.2196/38386 %U https://www.researchprotocols.org/2022/8/e38386 %U https://doi.org/10.2196/38386 %U http://www.ncbi.nlm.nih.gov/pubmed/35944181 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e34757 %T Impact of COVID-19 Social Distancing Mandates on Gastrointestinal Pathogen Positivity: Secondary Data Analysis %A Palmer,Tanner %A Benson,L Scott %A Porucznik,Christina %A Gren,Lisa H %+ bioMérieux, Inc, 515 Colorow Drive, Salt Lake City, UT, 84108, United States, 1 801 736 6354 ext 2398, tanner.palmer@biomerieux.com %K social distancing %K gastrointestinal %K COVID-19 %K gastroenteritis %K surveillance %K epidemiology %K pathogen transmission %K respiratory pathogen %K public health %K pathogen outbreak %K outbreak %K surveillance tool %K diagnostic database %D 2022 %7 24.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 35507923 %R 10.2196/34757 %U https://publichealth.jmir.org/2022/8/e34757 %U https://doi.org/10.2196/34757 %U http://www.ncbi.nlm.nih.gov/pubmed/35507923 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 3 %P e38172 %T Objectively Measured Physical Activity Levels and Associated Factors in Older US Women During the COVID-19 Pandemic: Cross-sectional Study %A Choudhury,Renoa %A Park,Joon-Hyuk %A Thiamwong,Ladda %A Xie,Rui %A Stout,Jeffrey R %+ Department of Mechanical and Aerospace Engineering, University of Central Florida, 4000 Central Florida Blvd, Orlando, FL, 32816, United States, 1 407 823 1227, Joonpark@ucf.edu %K physical activity %K older women %K COVID-19 %K sedentary behavior %K wrist-worn accelerometers %K ActiGraph %K aging %K elderly population %K women's health %K digital health %K frail %K healthy lifestyle %D 2022 %7 22.8.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Physical activity (PA) is vital for attenuating the aging-related physiological and functional declines in women aged 60 years or above. However, little is known about the objectively assessed PA behavior in older women during the COVID-19 pandemic and its association with sociodemographics, health and physical function, and COVID-19 related factors. Objective: This study aims to examine the objectively measured PA levels and associated factors among older US women who were living under the physical distancing guidelines during the second year of the pandemic. Methods: In this cross-sectional study, we collected free-living PA data from 94 community-dwelling older women aged between 60 and 96 years (mean age 75.1 years, SD 7.3) using wrist-worn ActiGraph GT9X accelerometers between February and August 2021. We examined whether their daily duration spent in sedentary behavior (SB), light-intensity physical activity (LPA), and moderate-to-vigorous-intensity physical activity (MVPA) varied by sociodemographic characteristics, health and physical function, and COVID-19 related factors. Results: On average, participants accumulated 12.4 (SD 1.9) hours/day in SB, 218.6 (SD 64.3) minutes/day in LPA, and 42.4 (SD 31.0) minutes/day in MVPA, exhibiting overall reduced PA levels than previously published pre–COVID-19 norms of older US women. Among participants aged ≥80 years, sedentary time was 7.5% (P=.003) higher and the time spent in LPA and MVPA was, respectively, 13.3% (P=.03) and 44.9% (P<.001) lower than those aged 60-79 years. More MVPA participation and a less sedentary lifestyle were observed in those who had a higher self-rated health score (MVPA: P=.001, SB: P=.04) and lower fear of falling (FOF; MVPA: P=.003, SB: P=.04). Poorer performance in the 30-second sit-to-stand (STS) test was independently associated with more SB (P=.01) and less LPA (P=.04) and MVPA (P=.001) time among participants. In addition, sedentary time was 5.0% higher (P=.03) in frail and prefrail participants than their healthy counterparts. Conclusions: During the pandemic, older women spent the majority of their waking time being sedentary, while LPA accounted for a larger portion of their daily PA. Therefore, replacing SB with LPA (rather than MVPA) might provide a more feasible PA target for older women, particularly those aged ≥80 years or who have reduced physical function. In addition, targeted interventions might be beneficial in promoting an active lifestyle for those who live alone, are prefrail or frail, and have a high FOF in older age. International Registered Report Identifier (IRRID): RR2-10.2196/27381 %M 35994346 %R 10.2196/38172 %U https://aging.jmir.org/2022/3/e38172 %U https://doi.org/10.2196/38172 %U http://www.ncbi.nlm.nih.gov/pubmed/35994346 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e37668 %T Differences in Clinical Presentation With Long COVID After Community and Hospital Infection and Associations With All-Cause Mortality: English Sentinel Network Database Study %A Meza-Torres,Bernardo %A Delanerolle,Gayathri %A Okusi,Cecilia %A Mayor,Nikhil %A Anand,Sneha %A Macartney,Jack %A Gatenby,Piers %A Glampson,Ben %A Chapman,Martin %A Curcin,Vasa %A Mayer,Erik %A Joy,Mark %A Greenhalgh,Trisha %A Delaney,Brendan %A de Lusignan,Simon %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, Walton Well Road, Oxford, OX2 6ED, United Kingdom, 44 01865 616600, simon.delusignan@phc.ox.ac.uk %K medical record systems %K computerized %K Systematized Nomenclature of Medicine %K post–acute COVID-19 syndrome %K phenotype %K COVID-19 %K post–COVID-19 syndrome %K long COVID %K ethnicity %K social class %K general practitioners %K data accuracy %K data extracts %K biomedical ontologies %K SARS-CoV-2 %K hospitalization %D 2022 %7 16.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 35605170 %R 10.2196/37668 %U https://publichealth.jmir.org/2022/8/e37668 %U https://doi.org/10.2196/37668 %U http://www.ncbi.nlm.nih.gov/pubmed/35605170 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e37422 %T Preferences for Attributes of Initial COVID-19 Diagnosis in the United States and China During the Pandemic: Discrete Choice Experiment With Propensity Score Matching %A Zhang,Yimin %A Liu,Taoran %A He,Zonglin %A Chan,Sze Ngai %A Akinwunmi,Babatunde %A Huang,Jian %A Wong,Tak-Hap %A Zhang,Casper J P %A Ming,Wai-Kit %+ Department of Infectious Diseases and Public Health, City University of Hong Kong, Room 1A-503, 5/F, Block 1, To Yuen Building, 31 To Yuen Street, Hong Kong, China, 852 3442 6956, wkming2@cityu.edu.hk %K COVID-19 %K public health %K discrete choice experiment %K patient preference %K propensity score matching %K patients with fever %D 2022 %7 16.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: China and the United States play critical leading roles in the global effort to contain the COVID-19 virus. Therefore, their population’s preferences for initial diagnosis were compared to provide policy and clinical insights. Objective: We aim to quantify and compare the public’s preferences for medical management of fever and the attributes of initial diagnosis in the case of presenting symptoms during the COVID-19 pandemic in China and the United States. Methods: We conducted a cross-sectional study from January to March 2021 in China and the United States using an online discrete choice experiment (DCE) questionnaire distributed through Amazon Mechanical Turk (MTurk; in the United States) and recruited volunteers (in China). Propensity score matching (PSM) was used to match the 2 groups of respondents from China and the United States to minimize confounding effects. In addition, the respondents’ preferences for different diagnosis options were evaluated using a mixed logit model (MXL) and latent class models (LCMs). Moreover, demographic data were collected and compared using the chi-square test, Fisher test, and Mann-Whitney U test. Results: A total of 9112 respondents (5411, 59.4%, from China and 3701, 40.6%, from the United States) who completed our survey were included in our analysis. After PSM, 1240 (22.9%) respondents from China and 1240 (33.5%) from the United States were matched for sex, age, educational level, occupation, and annual salary levels. The segmented sizes of 3 classes of respondents from China were 870 (70.2%), 270 (21.8%), and 100 (8.0%), respectively. Meanwhile, the US respondents’ segmented sizes were 269 (21.7%), 139 (11.2%), and 832 (67.1%), respectively. Respondents from China attached the greatest importance to the type of medical institution (weighted importance=40.0%), while those from the United States valued the waiting time (weighted importance=31.5%) the most. Respondents from China preferred the emergency department (coefficient=0.973, reference level: online consultation) and fever clinic (a special clinic for the treatment of fever patients for the prevention and control of acute infectious diseases in China; coefficient=0.974, reference level: online consultation), while those from the United States preferred private clinics (general practices; coefficient=0.543, reference level: online consultation). Additionally, shorter waiting times, COVID-19 nucleic acid testing arrangements, higher reimbursement rates, and lower costs were always preferred. Conclusions: Improvements in the availability of COVID-19 testing and medical professional skills and increased designated health care facilities may help boost potential health care seeking during COVID-19 and prevent unrecognized community spreading of SARS-CoV-2 in China and the United States. Moreover, to better prevent future waves of pandemics, identify undiagnosed patients, and encourage those undiagnosed to seek health care services to curb the pandemic, the hierarchical diagnosis and treatment system needs improvement in China, and the United States should focus on reducing diagnosis costs and raising the reimbursement rate of medical insurance. %M 35759683 %R 10.2196/37422 %U https://publichealth.jmir.org/2022/8/e37422 %U https://doi.org/10.2196/37422 %U http://www.ncbi.nlm.nih.gov/pubmed/35759683 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e36989 %T Developing a Long COVID Phenotype for Postacute COVID-19 in a National Primary Care Sentinel Cohort: Observational Retrospective Database Analysis %A Mayor,Nikhil %A Meza-Torres,Bernardo %A Okusi,Cecilia %A Delanerolle,Gayathri %A Chapman,Martin %A Wang,Wenjuan %A Anand,Sneha %A Feher,Michael %A Macartney,Jack %A Byford,Rachel %A Joy,Mark %A Gatenby,Piers %A Curcin,Vasa %A Greenhalgh,Trisha %A Delaney,Brendan %A de Lusignan,Simon %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, 7 Walton Well Road, Oxford, OX2 6ED, United Kingdom, 44 01865 616600, simon.delusignan@phc.ox.ac.uk %K medical record systems %K computerized %K Systematized Nomenclature of Medicine %K postacute COVID-19 syndrome %K phenotype %K COVID-19 %K long COVID %K ethnicity %K social class %K general practitioners %K data accuracy %K data extracts %K biomedical ontologies %K SARS-CoV-2 %K hospitalization %K epidemiology %K surveillance %K public health %K BioPortal %K electronic health record %K disease management %K digital tool %D 2022 %7 11.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Following COVID-19, up to 40% of people have ongoing health problems, referred to as postacute COVID-19 or long COVID (LC). LC varies from a single persisting symptom to a complex multisystem disease. Research has flagged that this condition is underrecorded in primary care records, and seeks to better define its clinical characteristics and management. Phenotypes provide a standard method for case definition and identification from routine data and are usually machine-processable. An LC phenotype can underpin research into this condition. Objective: This study aims to develop a phenotype for LC to inform the epidemiology and future research into this condition. We compared clinical symptoms in people with LC before and after their index infection, recorded from March 1, 2020, to April 1, 2021. We also compared people recorded as having acute infection with those with LC who were hospitalized and those who were not. Methods: We used data from the Primary Care Sentinel Cohort (PCSC) of the Oxford Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) database. This network was recruited to be nationally representative of the English population. We developed an LC phenotype using our established 3-step ontological method: (1) ontological step (defining the reasoning process underpinning the phenotype, (2) coding step (exploring what clinical terms are available, and (3) logical extract model (testing performance). We created a version of this phenotype using Protégé in the ontology web language for BioPortal and using PhenoFlow. Next, we used the phenotype to compare people with LC (1) with regard to their symptoms in the year prior to acquiring COVID-19 and (2) with people with acute COVID-19. We also compared hospitalized people with LC with those not hospitalized. We compared sociodemographic details, comorbidities, and Office of National Statistics–defined LC symptoms between groups. We used descriptive statistics and logistic regression. Results: The long-COVID phenotype differentiated people hospitalized with LC from people who were not and where no index infection was identified. The PCSC (N=7.4 million) includes 428,479 patients with acute COVID-19 diagnosis confirmed by a laboratory test and 10,772 patients with clinically diagnosed COVID-19. A total of 7471 (1.74%, 95% CI 1.70-1.78) people were coded as having LC, 1009 (13.5%, 95% CI 12.7-14.3) had a hospital admission related to acute COVID-19, and 6462 (86.5%, 95% CI 85.7-87.3) were not hospitalized, of whom 2728 (42.2%) had no COVID-19 index date recorded. In addition, 1009 (13.5%, 95% CI 12.73-14.28) people with LC were hospitalized compared to 17,993 (4.5%, 95% CI 4.48-4.61; P<.001) with uncomplicated COVID-19. Conclusions: Our LC phenotype enables the identification of individuals with the condition in routine data sets, facilitating their comparison with unaffected people through retrospective research. This phenotype and study protocol to explore its face validity contributes to a better understanding of LC. %M 35861678 %R 10.2196/36989 %U https://publichealth.jmir.org/2022/8/e36989 %U https://doi.org/10.2196/36989 %U http://www.ncbi.nlm.nih.gov/pubmed/35861678 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 8 %P e36798 %T The Facilitation of Clinical and Therapeutic Discoveries in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome and Related Diseases: Protocol for the You + ME Registry Research Platform %A Ramiller,Allison %A Mudie,Kathleen %A Seibert,Elle %A Whittaker,Sadie %+ Solve ME/CFS Initiative, Suite B #368 Glendale, 350 N Glendale Ave, Glendale, CA, 91206, United States, 1 704 364 0016, research@solvecfs.org %K myalgic encephalomyelitis/chronic fatigue syndrome %K long COVID %K data acquisition source %K postinfectious %K longitudinal cohort study %K patient powered %K COVID-19 %K chronic fatigue syndrome %K longitudinal health data %K symptom-tracking app %K health application %K mobile health %K digital health %D 2022 %7 10.8.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS) is a chronic, complex, heterogeneous disease that affects millions and lacks both diagnostics and treatments. Big data, or the collection of vast quantities of data that can be mined for information, have transformed the understanding of many complex illnesses, such as cancer and multiple sclerosis, by dissecting heterogeneity, identifying subtypes, and enabling the development of personalized treatments. It is possible that big data can reveal the same for ME/CFS. Objective: This study aims to describe the protocol for the You + ME Registry, present preliminary results related to participant enrollment and satisfaction, and discuss the limitations of the registry as well as next steps. Methods: We developed and launched the You + ME Registry to collect longitudinal health data from people with ME/CFS, people with long COVID (LC), and control volunteers using rigorous protocols designed to harmonize with other groups collecting data from similar groups of people. Results: As of September 30, 2021, the You + ME Registry had over 4200 geographically diverse participants (3033/4339, 69.9%, people with ME/CFS; 833/4339, 19.2%, post–COVID-19 people; and 473/4339, 10.9%, control volunteers), with an average of 72 new people registered every week. It has qualified as “great” using a net promotor score, indicating registrants are likely to recommend the registry to a friend. Analyses of collected data are currently underway, and preliminary findings are expected in the near future. Conclusions: The You + ME Registry is an invaluable resource because it integrates with a symptom-tracking app, as well as a biorepository, to provide a robust and rich data set that is available to qualified researchers. Accordingly, it facilitates collaboration that may ultimately uncover causes and help accelerate the development of therapies. Trial Registration: ClinicalTrials.gov NCT04806620; https://clinicaltrials.gov/ct2/show/NCT04806620 International Registered Report Identifier (IRRID): DERR1-10.2196/36798 %M 35816681 %R 10.2196/36798 %U https://www.researchprotocols.org/2022/8/e36798 %U https://doi.org/10.2196/36798 %U http://www.ncbi.nlm.nih.gov/pubmed/35816681 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e35840 %T 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 %A Luo,Wei %A Liu,Zhaoyin %A Zhou,Yuxuan %A Zhao,Yumin %A Li,Yunyue Elita %A Masrur,Arif %A Yu,Manzhu %+ Department of Geography, National University of Singapore, 1 Arts Link, #04-32 Block AS2, Singapore, 117570, Singapore, 65 65163851, geowl@nus.edu.sg %K COVID-19 %K Delta variant %K space-time scan %K intervention %K Southeast Asia %D 2022 %7 9.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 35861674 %R 10.2196/35840 %U https://publichealth.jmir.org/2022/8/e35840 %U https://doi.org/10.2196/35840 %U http://www.ncbi.nlm.nih.gov/pubmed/35861674 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e38551 %T The Landscape of Participatory Surveillance Systems Across the One Health Spectrum: Systematic Review %A McNeil,Carrie %A Verlander,Sarah %A Divi,Nomita %A Smolinski,Mark %+ Ending Pandemics, 870 Market Street, Suite 528, San Francisco, CA, 94102, United States, 1 415 571 2175, carrie@endingpandemics.org %K participatory surveillance %K One Health %K citizen science %K community-based surveillance %K infectious disease %K digital disease detection %K community participation %K mobile phone %D 2022 %7 5.8.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Participatory surveillance systems augment traditional surveillance systems through bidirectional community engagement. The digital platform evolution has enabled the expansion of participatory surveillance systems, globally, for the detection of health events impacting people, animals, plants, and the environment, in other words, across the entire One Health spectrum. Objective: The aim of this landscape was to identify and provide descriptive information regarding system focus, geography, users, technology, information shared, and perceived impact of ongoing participatory surveillance systems across the One Health spectrum. Methods: This landscape began with a systematic literature review to identify potential ongoing participatory surveillance systems. A survey was sent to collect standardized data from the contacts of systems identified in the literature review and through direct outreach to stakeholders, experts, and professional organizations. Descriptive analyses of survey and literature review results were conducted across the programs. Results: The landscape identified 60 ongoing single-sector and multisector participatory surveillance systems spanning five continents. Of these, 29 (48%) include data on human health, 26 (43%) include data on environmental health, and 24 (40%) include data on animal health. In total, 16 (27%) systems are multisectoral; of these, 9 (56%) collect animal and environmental health data; 3 (19%) collect human, animal, and environmental health data; 2 (13%) collect human and environmental health data; and 2 (13%) collect human and animal health data. Out of 60 systems, 31 (52%) are designed to cover a national scale, compared to those with a subnational (n=19, 32%) or multinational (n=10, 17%) focus. All systems use some form of digital technology. Email communication or websites (n=40, 67%) and smartphones (n=29, 48%) are the most common technologies used, with some using both. Systems have capabilities to download geolocation data (n=31, 52%), photographs (n=29, 48%), and videos (n=6, 10%), and can incorporate lab data or sample collection (n=15, 25%). In sharing information back with users, most use visualization, such as maps (n=43, 72%); training and educational materials (n=37, 62%); newsletters, blogs, and emails (n=34, 57%); and disease prevention information (n=32, 53%). Out of the 46 systems responding to the survey regarding perceived impacts of their systems, 36 (78%) noted “improved community knowledge and understanding” and 31 (67%) noted “earlier detection.” Conclusions: The landscape demonstrated the breadth of applicability of participatory surveillance around the world to collect data from community members and trained volunteers in order to inform the detection of events, from invasive plant pests to weekly influenza symptoms. Acknowledging the importance of bidirectionality of information, these systems simultaneously share findings back with the users. Such directly engaged community detection systems capture events early and provide opportunities to stop outbreaks quickly. %M 35930345 %R 10.2196/38551 %U https://publichealth.jmir.org/2022/8/e38551 %U https://doi.org/10.2196/38551 %U http://www.ncbi.nlm.nih.gov/pubmed/35930345 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 8 %P e38247 %T Programmatic Adoption and Implementation of Video-Observed Therapy in Minnesota: Prospective Observational Cohort Study %A Bachina,Preetham %A Lippincott,Christopher Kirk %A Perry,Allison %A Munk,Elizabeth %A Maltas,Gina %A Bohr,Rebecca %A Rock,Robert Bryan %A Shah,Maunank %+ Division of Infectious Diseases, Johns Hopkins School of Medicine, CRB-II, 1M-10, 1550 Orleans St, Baltimore, MD, 21287, United States, 1 4432870401, mshah28@jhmi.edu %K video directly observed therapy %K vDOT %K mobile health %K mHealth %K tuberculosis %K medication adherence %K telemedicine %K treatment %K telehealth %K observed therapy %K COVID-19 %K primary outcome %K treatment adherence %K technology adoption %K virtual health %D 2022 %7 5.8.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In-person directly observed therapy (DOT) is standard of care for tuberculosis (TB) treatment adherence monitoring in the US, with increasing use of video-DOT (vDOT). In Minneapolis, vDOT became available in 2019. Objective: In this paper, we aimed to evaluate the use and effectiveness of vDOT in a program setting, including comparison of verified adherence among those receiving vDOT and in-person DOT. We also sought to understand the impact of COVID-19 on TB treatment adherence and technology adoption. Methods: We abstracted routinely collected data on individuals receiving therapy for TB in Minneapolis, MN, between September 2019 and June 2021. Our primary outcomes were to assess vDOT use and treatment adherence, defined as the proportion of prescribed doses (7 days per week) verified by observation (in person versus video-DOT), and to compare individuals receiving therapy in the pre–COVID-19 (before March 2020), and post–COVID-19 (after March 2020) periods; within the post–COVID-19 period, we evaluated early COVID-19 (March-August 2020), and intra–COVID-19 (after August 2020) periods. Results: Among 49 patients with TB (mean age 41, SD 19; n=27, 55% female and n=47, 96% non–US born), 18 (36.7%) received treatment during the post–COVID-19 period. Overall, verified adherence (proportion of observed doses) was significantly higher when using vDOT (mean 81%, SD 17.4) compared to in-person DOT (mean 54.5%, SD 10.9; P=.001). The adoption of vDOT increased significantly from 35% (11/31) of patients with TB in the pre–COVID-19 period to 67% (12/18) in the post–COVID-19 period (P=.04). Consequently, overall verified (ie, observed) adherence among all patients with TB in the clinic improved across the study periods (56%, 67%, and 79%, P=.001 for the pre–, early, and intra–COVID-19 periods, respectively). Conclusions: vDOT use increased after the COVID-19 period, was more effective than in-person DOT at verifying ingestion of prescribed treatment, and led to overall increased verified adherence in the clinic despite the onset of the COVID-19 pandemic. %M 35834671 %R 10.2196/38247 %U https://formative.jmir.org/2022/8/e38247 %U https://doi.org/10.2196/38247 %U http://www.ncbi.nlm.nih.gov/pubmed/35834671 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 8 %P e32347 %T Mental Health Presentations Across Health Care Settings During the First 9 Months of the COVID-19 Pandemic in England: Retrospective Observational Study %A Smith,Gillian E %A Harcourt,Sally E %A Hoang,Uy %A Lemanska,Agnieszka %A Elliot,Alex J %A Morbey,Roger A %A Hughes,Helen E %A Lake,Iain %A Edeghere,Obaghe %A Oliver,Isabel %A Sherlock,Julian %A Amlôt,Richard %A de Lusignan,Simon %+ Real-time Syndromic Surveillance Team, Field Service, UK Health Security Agency, 2nd Floor 23 Stephenson Street, Birmingham, B2 4BH, United Kingdom, 44 77407 40944, alex.elliot@ukhsa.gov.uk %K pandemic %K public health %K syndromic surveillance %K mental health %K anxiety %K sleep problems %K COVID-19 %K health care %K health surveillance %K health care service %D 2022 %7 3.8.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has resulted in an unprecedented impact on the day-to-day lives of people, with several features potentially adversely affecting mental health. There is growing evidence of the size of the impact of COVID-19 on mental health, but much of this is from ongoing population surveys using validated mental health scores. Objective: This study investigated the impact of the pandemic and control measures on mental health conditions presenting to a spectrum of national health care services monitored using real-time syndromic surveillance in England. Methods: We conducted a retrospective observational descriptive study of mental health presentations (those calling the national medical helpline, National Health Service [NHS] 111; consulting general practitioners [GPs] in and out-of-hours; calling ambulance services; and attending emergency departments) from January 1, 2019, to September 30, 2020. Estimates for the impact of lockdown measures were provided using an interrupted time series analysis. Results: Mental health presentations showed a marked decrease during the early stages of the pandemic. Postlockdown, attendances for mental health conditions reached higher than prepandemic levels across most systems—a rise of 10% compared to that expected for NHS 111 and 21% for GP out-of-hours service—while the number of consultations to GP in-hours service was 13% lower compared to the same time previous year. Increases were observed in calls to NHS 111 for sleep problems. Conclusions: These analyses showed marked changes in the health care attendances and prescribing for common mental health conditions across a spectrum of health care provision, with some of these changes persisting. The reasons for such changes are likely to be complex and multifactorial. The impact of the pandemic on mental health may not be fully understood for some time, and therefore, these syndromic indicators should continue to be monitored. %M 35486809 %R 10.2196/32347 %U https://publichealth.jmir.org/2022/8/e32347 %U https://doi.org/10.2196/32347 %U http://www.ncbi.nlm.nih.gov/pubmed/35486809 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e39142 %T Bridging the Gap in End Tuberculosis Targets in the Elderly Population in Eastern China: Observational Study From 2015 to 2020 %A Liu,Kui %A Xie,Zhenhua %A Xie,Bo %A Chen,Songhua %A Zhang,Yu %A Wang,Wei %A Wu,Qian %A Cai,Gaofeng %A Chen,Bin %+ Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Zhejiang Province, Hangzhou, 310000, China, 86 057187115020, gfcai@cdc.zj.cn %K pulmonary tuberculosis %K elderly population %K prediction %D 2022 %7 29.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With a progressive increase in the aging process, the challenges posed by pulmonary tuberculosis (PTB) are also increasing for the elderly population. Objective: This study aimed to identify the epidemiological distribution of PTB among the elderly, forecast the achievement of the World Health Organization’s 2025 goal in this specific group, and predict further advancement of PTB in the eastern area of China. Methods: All notified active PTB cases aged ≥65 years from Zhejiang Province were screened and analyzed. The general epidemiological characteristics were depicted and presented using the ArcGIS software. Further prediction of PTB was performed using R and SPSS software programs. Results: Altogether 41,431 cases aged ≥65 years were identified by the surveillance system from 2015 to 2020. After excluding extrapulmonary TB cases, we identified 39,832 PTB cases, including laboratory-confirmed (23,664, 59.41%) and clinically diagnosed (16,168, 40.59%) PTB. The notified PTB incidence indicated an evident downward trend with a reduction of 30%; however, the incidence of bacteriologically positive cases was steady at approximately 60/100,000. Based on the geographical distribution, Quzhou and Jinhua Cities had a higher PTB incidence among the elderly. The delay in PTB diagnosis was identified, and a significantly prolonged treatment course was observed in the elderly. Moreover, a 50% reduction of PTB incidence by the middle of 2024 was predicted using a linear regression model. It was found that using the exponential smoothing model would be better to predict the PTB trend in the elderly than a seasonal autoregressive integrated moving average model. Conclusions: More comprehensive and effective interventions such as active PTB screening combined with physical checkup and succinct health education should be implemented and strengthened in the elderly. A more systematic assessment of the PTB epidemic trend in the elderly population should be considered to incorporate more predictive factors. %M 35904857 %R 10.2196/39142 %U https://publichealth.jmir.org/2022/7/e39142 %U https://doi.org/10.2196/39142 %U http://www.ncbi.nlm.nih.gov/pubmed/35904857 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 7 %P e34168 %T Peer-Presented Versus Mental Health Service Provider–Presented Mental Health Outreach Programs for University Students: Randomized Controlled Trial %A Bastien,Laurianne %A Boke,Bilun Naz %A Mettler,Jessica %A Zito,Stephanie %A Di Genova,Lina %A Romano,Vera %A Lewis,Stephen P %A Whitley,Rob %A Iyer,Srividya N %A Heath,Nancy L %+ Department of Educational and Counselling Psychology, McGill University, 3700 McTavish, Montreal, QC, H3A 1Y9, Canada, 1 5143981232, laurianne.bastien@mail.mcgill.ca %K web-based mental health outreach %K resilience building %K university student %K peer-presented %K mental health service provider–presented %K mental health %K outreach %K resilience %K student %K service provider %K randomized controlled trial %D 2022 %7 22.7.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: University students are reporting concerning levels of mental health distress and challenges. University mental health service provider initiatives have been shown to be effective in supporting students’ mental health, but these services are often resource-intensive. Consequently, new approaches to service delivery, such as web-based and peer support initiatives, have emerged as cost-effective and efficient approaches to support university students. However, these approaches have not been sufficiently evaluated for effectiveness or acceptability in university student populations. Objective: Thus, the overarching goal of this study was to evaluate a mental health service provider–presented versus peer-presented web-based mental health resilience–building video outreach program against a wait-list comparison group. Methods: Participants were 217 undergraduate students (mean age 20.44, SD 1.98 years; 171/217, 78.8% women) who were randomly assigned to one of the intervention groups (mental health service provider–presented: 69/217, 31.8%; peer-presented: 73/217, 33.6%) or the wait-list comparison group (75/217, 34.6%). Participants in the intervention groups were asked to watch 3 brief skill-building videos addressing strategies for building mental health resilience, whereas the comparison group was wait-listed. The mental health service provider–presented and peer-presented video series were identical in content, with presenters using a script to ensure consistency across delivery methods, but the videos differed in that they were either presented by mental health service providers or university students (peers). All participants were asked to complete web-based self-report measures of stress, coping self-efficacy, social support, social connectedness, mindfulness, and quality of life at baseline (time 1), 6 weeks later (time 2, after the intervention), and 1-month follow-up (time 3). Results: Results from a series of 2-way ANOVAs found no significant differences in outcomes among any of the 3 groups. Surprisingly, a main effect of time revealed that all students improved on several well-being outcomes. In addition, results for program satisfaction revealed that both the mental health service provider–presented and peer-presented programs were rated very highly and at comparable levels. Conclusions: Thus, findings suggest that a web-based mental health resilience–building video outreach program may be acceptable for university students regardless of it being mental health service provider–presented or peer-presented. Furthermore, the overall increases in well-being across groups, which coincided with the onset and early weeks of the COVID-19 pandemic, suggest an unexpected pattern of response among university students to the early period of the pandemic. Limitations and barriers as well as research implications are discussed. Trial Registration: ClinicalTrials.gov NCT05454592; https://clinicaltrials.gov/ct2/show/NCT05454592 %M 35762935 %R 10.2196/34168 %U https://mental.jmir.org/2022/7/e34168 %U https://doi.org/10.2196/34168 %U http://www.ncbi.nlm.nih.gov/pubmed/35762935 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e31306 %T Causal Modeling to Mitigate Selection Bias and Unmeasured Confounding in Internet-Based Epidemiology of COVID-19: Model Development and Validation %A Stockham,Nathaniel %A Washington,Peter %A Chrisman,Brianna %A Paskov,Kelley %A Jung,Jae-Yoon %A Wall,Dennis Paul %+ Neurosciences Interdepartmental Program, Stanford University, 3145 Porter Dr, Palo Alto, CA, 94304, United States, 1 2056021832, stockham@stanford.edu %K selection bias %K COVID-19 %K epidemiology %K causality %K sensitivity analysis %K public health %K surveillance %K method %K epidemiologic research design %K model %K bias %K development %K validation %K utility %K implementation %K sensitivity %K design %K research %K epidemiology %D 2022 %7 21.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Selection bias and unmeasured confounding are fundamental problems in epidemiology that threaten study internal and external validity. These phenomena are particularly dangerous in internet-based public health surveillance, where traditional mitigation and adjustment methods are inapplicable, unavailable, or out of date. Recent theoretical advances in causal modeling can mitigate these threats, but these innovations have not been widely deployed in the epidemiological community. Objective: The purpose of our paper is to demonstrate the practical utility of causal modeling to both detect unmeasured confounding and selection bias and guide model selection to minimize bias. We implemented this approach in an applied epidemiological study of the COVID-19 cumulative infection rate in the New York City (NYC) spring 2020 epidemic. Methods: We collected primary data from Qualtrics surveys of Amazon Mechanical Turk (MTurk) crowd workers residing in New Jersey and New York State across 2 sampling periods: April 11-14 and May 8-11, 2020. The surveys queried the subjects on household health status and demographic characteristics. We constructed a set of possible causal models of household infection and survey selection mechanisms and ranked them by compatibility with the collected survey data. The most compatible causal model was then used to estimate the cumulative infection rate in each survey period. Results: There were 527 and 513 responses collected for the 2 periods, respectively. Response demographics were highly skewed toward a younger age in both survey periods. Despite the extremely strong relationship between age and COVID-19 symptoms, we recovered minimally biased estimates of the cumulative infection rate using only primary data and the most compatible causal model, with a relative bias of +3.8% and –1.9% from the reported cumulative infection rate for the first and second survey periods, respectively. Conclusions: We successfully recovered accurate estimates of the cumulative infection rate from an internet-based crowdsourced sample despite considerable selection bias and unmeasured confounding in the primary data. This implementation demonstrates how simple applications of structural causal modeling can be effectively used to determine falsifiable model conditions, detect selection bias and confounding factors, and minimize estimate bias through model selection in a novel epidemiological context. As the disease and social dynamics of COVID-19 continue to evolve, public health surveillance protocols must continue to adapt; the emergence of Omicron variants and shift to at-home testing as recent challenges. Rigorous and transparent methods to develop, deploy, and diagnosis adapted surveillance protocols will be critical to their success. %M 35605128 %R 10.2196/31306 %U https://publichealth.jmir.org/2022/7/e31306 %U https://doi.org/10.2196/31306 %U http://www.ncbi.nlm.nih.gov/pubmed/35605128 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e35276 %T Publication and Impact of Preprints Included in the First 100 Editions of the CDC COVID-19 Science Update: Content Analysis %A Otridge,Jeremy %A Ogden,Cynthia L %A Bernstein,Kyle T %A Knuth,Martha %A Fishman,Julie %A Brooks,John T %+ Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, United States, 1 2406874849, jeremy.otridge@gmail.com %K preprints %K preprint %K publishing %K publish %K bioRxiv %K medRxiv %K Centers for Disease Control and Prevention %K CDC %K preprint server %K public health %K health information %K COVID-19 %K pandemic %K publication %K Altmetric attention score %K Altmetric %K attention score %K citation count %K citation %K science update %K decision-making %D 2022 %7 15.7.2022 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: Preprints are publicly available manuscripts posted to various servers that have not been peer reviewed. Although preprints have existed since 1961, they have gained increased popularity during the COVID-19 pandemic due to the need for immediate, relevant information. Objective: The aim of this study is to evaluate the publication rate and impact of preprints included in the Centers for Disease Control and Prevention (CDC) COVID-19 Science Update and assess the performance of the COVID-19 Science Update team in selecting impactful preprints. Methods: All preprints in the first 100 editions (April 1, 2020, to July 30, 2021) of the Science Update were included in the study. Preprints that were not published were categorized as “unpublished preprints.” Preprints that were subsequently published exist in 2 versions (in a peer-reviewed journal and on the original preprint server), which were analyzed separately and referred to as “peer-reviewed preprint” and “original preprint,” respectively. Time to publish was the time interval between the date on which a preprint was first posted and the date on which it was first available as a peer-reviewed article. Impact was quantified by Altmetric Attention Score and citation count for all available manuscripts on August 6, 2021. Preprints were analyzed by publication status, publication rate, preprint server, and time to publication. Results: Of the 275 preprints included in the CDC COVID-19 Science Update during the study period, most came from three servers: medRxiv (n=201, 73.1%), bioRxiv (n=41, 14.9%), and SSRN (n=25, 9.1%), with 8 (2.9%) coming from other sources. Additionally, 152 (55.3%) were eventually published. The median time to publish was 2.3 (IQR 1.4-3.7). When preprints posted in the last 2.3 months were excluded (to account for the time to publish), the publication rate was 67.8%. Moreover, 76 journals published at least one preprint from the CDC COVID-19 Science Update, and 18 journals published at least three. The median Altmetric Attention Score for unpublished preprints (n=123, 44.7%) was 146 (IQR 22-552) with a median citation count of 2 (IQR 0-8); for original preprints (n=152, 55.2%), these values were 212 (IQR 22-1164) and 14 (IQR 2-40), respectively; for peer-review preprints, these values were 265 (IQR 29-1896) and 19 (IQR 3-101), respectively. Conclusions: Prior studies of COVID-19 preprints found publication rates between 5.4% and 21.1%. Preprints included in the CDC COVID-19 Science Update were published at a higher rate than overall COVID-19 preprints, and those that were ultimately published were published within months and received higher attention scores than unpublished preprints. These findings indicate that the Science Update process for selecting preprints had a high fidelity in terms of their likelihood to be published and their impact. The incorporation of high-quality preprints into the CDC COVID-19 Science Update improves this activity’s capacity to inform meaningful public health decision-making. %M 35544426 %R 10.2196/35276 %U https://publichealth.jmir.org/2022/7/e35276 %U https://doi.org/10.2196/35276 %U http://www.ncbi.nlm.nih.gov/pubmed/35544426 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e32969 %T Papers Please - Predictive Factors of National and International Attitudes Toward Immunity and Vaccination Passports: Online Representative Surveys %A Garrett,Paul M %A White,Joshua P %A Dennis,Simon %A Lewandowsky,Stephan %A Yang,Cheng-Ta %A Okan,Yasmina %A Perfors,Andrew %A Little,Daniel R %A Kozyreva,Anastasia %A Lorenz-Spreen,Philipp %A Kusumi,Takashi %A Kashima,Yoshihisa %+ Melbourne School of Psychological Sciences, The University of Melbourne, 12th Floor Redmond Barry Building, Parkville Campus, Melbourne, 3010, Australia, 61 8344 6377 ext 03, paul.garrett@unimelb.edu.au %K COVID-19 %K immunity passport %K vaccination passport %K cross-cultural %K health policy %K digital certificates %K SARS-CoV-2 %K vaccine %K policy %K international %D 2022 %7 15.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In response to the COVID-19 pandemic, countries are introducing digital passports that allow citizens to return to normal activities if they were previously infected with (immunity passport) or vaccinated against (vaccination passport) SARS-CoV-2. To be effective, policy decision-makers must know whether these passports will be widely accepted by the public and under what conditions. This study focuses attention on immunity passports, as these may prove useful in countries both with and without an existing COVID-19 vaccination program; however, our general findings also extend to vaccination passports. Objective: We aimed to assess attitudes toward the introduction of immunity passports in six countries, and determine what social, personal, and contextual factors predicted their support. Methods: We collected 13,678 participants through online representative sampling across six countries—Australia, Japan, Taiwan, Germany, Spain, and the United Kingdom—during April to May of the 2020 COVID-19 pandemic, and assessed attitudes and support for the introduction of immunity passports. Results: Immunity passport support was moderate to low, being the highest in Germany (775/1507 participants, 51.43%) and the United Kingdom (759/1484, 51.15%); followed by Taiwan (2841/5989, 47.44%), Australia (963/2086, 46.16%), and Spain (693/1491, 46.48%); and was the lowest in Japan (241/1081, 22.94%). Bayesian generalized linear mixed effects modeling was used to assess predictive factors for immunity passport support across countries. International results showed neoliberal worldviews (odds ratio [OR] 1.17, 95% CI 1.13-1.22), personal concern (OR 1.07, 95% CI 1.00-1.16), perceived virus severity (OR 1.07, 95% CI 1.01-1.14), the fairness of immunity passports (OR 2.51, 95% CI 2.36-2.66), liking immunity passports (OR 2.77, 95% CI 2.61-2.94), and a willingness to become infected to gain an immunity passport (OR 1.6, 95% CI 1.51-1.68) were all predictive factors of immunity passport support. By contrast, gender (woman; OR 0.9, 95% CI 0.82-0.98), immunity passport concern (OR 0.61, 95% CI 0.57-0.65), and risk of harm to society (OR 0.71, 95% CI 0.67-0.76) predicted a decrease in support for immunity passports. Minor differences in predictive factors were found between countries and results were modeled separately to provide national accounts of these data. Conclusions: Our research suggests that support for immunity passports is predicted by the personal benefits and societal risks they confer. These findings generalized across six countries and may also prove informative for the introduction of vaccination passports, helping policymakers to introduce effective COVID-19 passport policies in these six countries and around the world. %M 35377317 %R 10.2196/32969 %U https://publichealth.jmir.org/2022/7/e32969 %U https://doi.org/10.2196/32969 %U http://www.ncbi.nlm.nih.gov/pubmed/35377317 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e34277 %T Effects of an mHealth Intervention for Pulmonary Tuberculosis Self-management Based on the Integrated Theory of Health Behavior Change: Randomized Controlled Trial %A Bao,Yuhan %A Wang,Chunxiang %A Xu,Haiping %A Lai,Yongjie %A Yan,Yupei %A Ma,Yuanyuan %A Yu,Ting %A Wu,Yibo %+ School of Public Health, Peking University, 38 Xueyuan Road, Haidian District, Beijing, 100191, China, 86 18810169630, bjmuwuyibo@outlook.com %K ITHBC %K mHealth %K RCT %K pulmonary tuberculosis %D 2022 %7 14.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Improving the health self-management level of patients with tuberculosis (TB) is significant for reducing drug resistance, improving the cure rate, and controlling the prevalence of TB. Mobile health (mHealth) interventions based on behavioral science theories may be promising to achieve this goal. Objective: This study aims to explore and conduct an mHealth intervention based on the Integrated Theory of Health Behavior Change (ITHBC) in patients with pulmonary TB to increase their ability of self-care management. Methods: A prospective randomized controlled study was conducted from May to November 2020. A total of 114 patients who were admitted consecutively to the TB clinic of Harbin Chest Hospital, China from May 2020 to August 2020 were recruited by convenience sampling. Patients were divided into the control group and intervention group, and all received a 3-month intervention. Patients in the intervention group and the control group received routine medical and nursing care in the TB clinic, including the supervision of their medications. In addition, pharmacist-assisted mHealth (WeChat) intervention based on the ITHBC theory about TB management was provided to the intervention group. The primary outcome was self-management behavior, while the secondary outcomes were TB awareness, self-efficacy, social support, and degree of satisfaction with health education. The outcomes were measured using web-based self-designed and standard questionnaires administered at baseline and at the end point of the study. Intergroup data were assessed using the Mann-Whitney U test, whereas intragroup data were assessed with the Wilcoxon test (for paired samples). Results: A total of 112 patients (59 in intervention group and 53 in control group) completed the study. After the intervention, a statistically significant increase was noted in the scores of each item of self-care management behaviors compared with the scores at the baseline (P<.001) in the intervention group. The scores of all self-care management behaviors of the control group were lower than those of all self-care management behaviors in the intervention group (all P<.05), except for the item “cover your mouth and nose when coughing or sneezing” (P=.23) and item “wash hands properly” (P=.60), which had no statistically significant difference from those in the intervention group. Compared with those at baseline, TB knowledge awareness, self-efficacy, social support, and degree of satisfaction with health education in the intervention group increased significantly (P<.001), and the intervention group had significantly higher scores than the control group (P<.001). Conclusions: mHealth intervention for TB self-management based on ITHBC could deepen the understanding of patients with TB about their disease and improve their objective initiative and self-care management behaviors, which were beneficial for promoting compliance behavior and quality of prevention and control for pulmonary TB. Trial Registration: Chinese Clinical Trial Registry ChiCTR2200055557; https://tinyurl.com/4ray3xnw %M 35834302 %R 10.2196/34277 %U https://publichealth.jmir.org/2022/7/e34277 %U https://doi.org/10.2196/34277 %U http://www.ncbi.nlm.nih.gov/pubmed/35834302 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e34583 %T Linguistic Pattern–Infused Dual-Channel Bidirectional Long Short-term Memory With Attention for Dengue Case Summary Generation From the Program for Monitoring Emerging Diseases–Mail Database: Algorithm Development Study %A Chang,Yung-Chun %A Chiu,Yu-Wen %A Chuang,Ting-Wu %+ Department of Molecular Parasitology and Tropical Diseases, School of Medicine, College of Medicine, Taipei Medical University, No 250, Wu-Hsing Street, Taipei, 110, Taiwan, 886 27361661 ext 3123, chtingwu@tmu.edu.tw %K ProMED-mail %K natural language processing %K dengue %K dual channel %K bidirectional long short-term memory %D 2022 %7 13.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Globalization and environmental changes have intensified the emergence or re-emergence of infectious diseases worldwide, such as outbreaks of dengue fever in Southeast Asia. Collaboration on region-wide infectious disease surveillance systems is therefore critical but difficult to achieve because of the different transparency levels of health information systems in different countries. Although the Program for Monitoring Emerging Diseases (ProMED)–mail is the most comprehensive international expert–curated platform providing rich disease outbreak information on humans, animals, and plants, the unstructured text content of the reports makes analysis for further application difficult. Objective: To make monitoring the epidemic situation in Southeast Asia more efficient, this study aims to develop an automatic summary of the alert articles from ProMED-mail, a huge textual data source. In this paper, we proposed a text summarization method that uses natural language processing technology to automatically extract important sentences from alert articles in ProMED-mail emails to generate summaries. Using our method, we can quickly capture crucial information to help make important decisions regarding epidemic surveillance. Methods: Our data, which span a period from 1994 to 2019, come from the ProMED-mail website. We analyzed the collected data to establish a unique Taiwan dengue corpus that was validated with professionals’ annotations to achieve almost perfect agreement (Cohen κ=90%). To generate a ProMED-mail summary, we developed a dual-channel bidirectional long short-term memory with attention mechanism with infused latent syntactic features to identify key sentences from the alerting article. Results: Our method is superior to many well-known machine learning and neural network approaches in identifying important sentences, achieving a macroaverage F1 score of 93%. Moreover, it can successfully extract the relevant correct information on dengue fever from a ProMED-mail alerting article, which can help researchers or general users to quickly understand the essence of the alerting article at first glance. In addition to verifying the model, we also recruited 3 professional experts and 2 students from related fields to participate in a satisfaction survey on the generated summaries, and the results show that 84% (63/75) of the summaries received high satisfaction ratings. Conclusions: The proposed approach successfully fuses latent syntactic features into a deep neural network to analyze the syntactic, semantic, and contextual information in the text. It then exploits the derived information to identify crucial sentences in the ProMED-mail alerting article. The experiment results show that the proposed method is not only effective but also outperforms the compared methods. Our approach also demonstrates the potential for case summary generation from ProMED-mail alerting articles. In terms of practical application, when a new alerting article arrives, our method can quickly identify the relevant case information, which is the most critical part, to use as a reference or for further analysis. %M 35830225 %R 10.2196/34583 %U https://publichealth.jmir.org/2022/7/e34583 %U https://doi.org/10.2196/34583 %U http://www.ncbi.nlm.nih.gov/pubmed/35830225 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 3 %P e37454 %T Role of Trusted Sources and Behavioral Beliefs in Promoting Mitigation Behaviors During the COVID-19 Pandemic: Survey Study %A Hanson,Bridget L %A Finley,Kari %A Otto,Jay %A Ward,Nicholas J %+ Center for Health and Safety Culture, Montana State University, PO Box 170548, Bozeman, MT, 59717, United States, 1 406 994 7873, bridget.hanson@montana.edu %K behavioral beliefs %K health literacy %K vaccination %K trusted sources %K social media %K vaccine hesitancy %K health information %K masking %K healthcare %K public health %K health beliefs %D 2022 %7 13.7.2022 %9 Short Paper %J JMIR Hum Factors %G English %X 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. %M 35830238 %R 10.2196/37454 %U https://humanfactors.jmir.org/2022/3/e37454 %U https://doi.org/10.2196/37454 %U http://www.ncbi.nlm.nih.gov/pubmed/35830238 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 10 %N 3 %P e37026 %T Effect of the “Art Coloring” Online Coloring Game on Subjective Well-Being Increase and Anxiety Reduction During the COVID-19 Pandemic: Development and Evaluation %A Xi,JuZhe %A Gao,YuHan %A Lyu,Na %A She,Zhuang %A Wang,XinYue %A Zhang,Xin-An %A Yu,XiaoYu %A Ji,WeiDong %A Wei,MengSheng %A Dai,WeiHui %A Qian,Xuesheng %+ School of Management, Fudan University, Room 722, Siyuan Building, 670 Guoshun Road, Shanghai, 200433, China, 86 13916208229, qianxuesheng@fudan.edu.cn %K coloring game %K online intervention %K mental health %K COVID-19 pandemic %K gamification %K game-based intervention %K commercially released game %D 2022 %7 8.7.2022 %9 Original Paper %J JMIR Serious Games %G English %X Background: COVID-19 has spread worldwide and generated tremendous stress on human beings. Unfortunately, it is often hard for distressed individuals to access mental health services under conditions of restricted movement or even lockdown. Objective: The study first aims to develop an online digital intervention package based on a commercially released coloring game. The second aim is to test the effectiveness of difference intervention packages for players to increase subjective well-being (SWB) and reduce anxiety during the pandemic. Methods: An evidence-based coloring intervention package was developed and uploaded to an online coloring game covering almost 1.5 million players worldwide in January 2021. Players worldwide participated to color either 4 rounds of images characterized by awe, pink, nature, and blue or 4 rounds of irrelevant images. Participants' SWB and anxiety and the perceived effectiveness of the game in reducing anxiety (subjective effectiveness [SE]) were assessed 1 week before the intervention (T1), after the participants completed pictures in each round (T2-T5), and after the intervention (T6). Independent 2-tailed t tests were conducted to examine the general intervention (GI) effect and the intervention effect of each round. Univariate analysis was used to examine whether these outcome variables were influenced by the number of rounds completed. Results: In total, 1390 players worldwide responded and completed at least 1 assessment. Overall, the GI group showed a statistical significantly greater increase in SWB than the general control (GC) group (N=164, t162=3.59, Cohen d=0.59, 95% CI 0.36-1.24, P<.001). Compared to the control group, the best effectiveness of the intervention group was seen in the awe round, in which the increase in SWB was significant (N=171, t169=2.51, Cohen d=0.39, 95% CI 0.10-0.82, P=.01), and players who colored all 4 pictures had nearly significant improvements in SWB (N=171, F4,170=2.34, partial ŋ2=0.053, P=.06) and a significant decrease in anxiety (N=171, F4,170=3.39, partial ŋ2=0.075, P=.01). Conclusions: These data indicate the effectiveness of online psychological interventions, such as coloring games, for mental health in the specific period. They also show the feasibility of applying existing commercial games embedded with scientific psychological interventions that can fill the gap in mental crises and services for a wider group of people during the pandemic. The results would inspire innovations to prevent the psychological problems caused by public emergencies and encourage more games, especially the most popular ones, to take more positive action for the common crises of humankind. %M 35575761 %R 10.2196/37026 %U https://games.jmir.org/2022/3/e37026 %U https://doi.org/10.2196/37026 %U http://www.ncbi.nlm.nih.gov/pubmed/35575761 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e34605 %T Assessing the Implementation of Digital Innovations in Response to the COVID-19 Pandemic to Address Key Public Health Functions: Scoping Review of Academic and Nonacademic Literature %A Francombe,Joseph %A Ali,Gemma-Claire %A Gloinson,Emily Ryen %A Feijao,Carolina %A Morley,Katherine I %A Gunashekar,Salil %A de Carvalho Gomes,Helena %+ European Centre for Disease Prevention and Control, Gustav III:s Boulevard 40, Solna, Stockholm, 169 73, Sweden, 46 858601000, helena.gomes@ecdc.europa.eu %K digital technologies %K COVID-19 %K key public health functions %K scoping review %K digital health %K pandemic %K surveillance %K mobile phone %D 2022 %7 6.7.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: Digital technologies have been central to efforts to respond to the COVID-19 pandemic. In this context, a range of literature has reported on developments regarding the implementation of new digital technologies for COVID-19–related surveillance, prevention, and control. Objective: In this study, scoping reviews of academic and nonacademic literature were undertaken to obtain an overview of the evidence regarding digital innovations implemented to address key public health functions in the context of the COVID-19 pandemic. This study aimed to expand on the work of existing reviews by drawing on additional data sources (including nonacademic sources) by considering literature published over a longer time frame and analyzing data in terms of the number of unique digital innovations. Methods: We conducted a scoping review of the academic literature published between January 1, 2020, and September 15, 2020, supplemented by a further scoping review of selected nonacademic literature published between January 1, 2020, and October 13, 2020. Both reviews followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) approach. Results: A total of 226 academic articles and 406 nonacademic articles were included. The included articles provided evidence of 561 (academic literature) and 497 (nonacademic literature) unique digital innovations. The most common implementation settings for digital innovations were the United States, China, India, and the United Kingdom. Technologies most commonly used by digital innovations were those belonging to the high-level technology group of integrated and ubiquitous fixed and mobile networks. The key public health functions most commonly addressed by digital innovations were communication and collaboration and surveillance and monitoring. Conclusions: Digital innovations implemented in response to the COVID-19 pandemic have been wide ranging in terms of their implementation settings, the digital technologies used, and the public health functions addressed. However, evidence gathered through this study also points to a range of barriers that have affected the successful implementation of digital technologies for public health functions. It is also evident that many digital innovations implemented in response to the COVID-19 pandemic are yet to be formally evaluated or assessed. %M 35605152 %R 10.2196/34605 %U https://publichealth.jmir.org/2022/7/e34605 %U https://doi.org/10.2196/34605 %U http://www.ncbi.nlm.nih.gov/pubmed/35605152 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 7 %P e37920 %T Use of Random Domain Intercept Technology to Track COVID-19 Vaccination Rates in Real Time Across the United States: Survey Study %A Sargent,Rikki H %A Laurie,Shaelyn %A Weakland,Leo F %A Lavery,James V %A Salmon,Daniel A %A Orenstein,Walter A %A Breiman,Robert F %+ RIWI Corp, 180 Bloor Street West, Suite 1000, Toronto, ON, M5S2V6, Canada, 1 888 505 7494, rsargent@riwi.com %K COVID-19 %K vaccination rates %K Random Domain Intercept Technology %K health technology %K vaccination %K vaccine tracker %K web-based survey %K epidemiology %K health data %K digital tool %K online intercept sampling %K health service %D 2022 %7 1.7.2022 %9 Short Paper %J J Med Internet Res %G English %X Background: Accurate and timely COVID-19 vaccination coverage data are vital for informing targeted, effective messaging and outreach and identifying barriers to equitable health service access. However, gathering vaccination rate data is challenging, and efforts often result in information that is either limited in scope (eg, limited to administrative data) or delayed (impeding the ability to rapidly respond). The evaluation of innovative technologies and approaches that can assist in addressing these limitations globally are needed. Objective: The objective of this survey study was to assess the validity of Random Domain Intercept Technology (RDIT; RIWI Corp) for tracking self-reported vaccination rates in real time at the US national and state levels. RDIT—a form of online intercept sampling—has the potential to address the limitations of current vaccination tracking systems by allowing for the measurement of additional data (eg, attitudinal data) and real-time, rapid data collection anywhere there is web access. Methods: We used RDIT from June 30 to July 26, 2021, to reach a broad sample of US adult (aged ≥18 years) web users and asked questions related to COVID-19 vaccination. Self-reported vaccination status was used as the focus of this validation exercise. National- and state-level RDIT-based vaccination rates were compared to Centers for Disease Control and Prevention (CDC)–reported national and state vaccination rates. Johns Hopkins University’s and Emory University’s institutional review boards designated this project as public health practice to inform message development (not human subjects research). Results: By using RDIT, 63,853 adult web users reported their vaccination status (6.2% of the entire 1,026,850 American web-using population that was exposed to the survey). At the national level, the RDIT-based estimate of adult COVID-19 vaccine coverage was slightly higher (44,524/63,853, 69.7%; 95% CI 69.4%-70.1%) than the CDC-reported estimate (67.9%) on July 15, 2021 (ie, midway through data collection; t63,852=10.06; P<.001). The RDIT-based and CDC-reported state-level estimates were strongly and positively correlated (r=0.90; P<.001). RDIT-based estimates were within 5 percentage points of the CDC’s estimates for 29 states. Conclusions: This broad-reaching, real-time data stream may provide unique advantages for tracking the use of a range of vaccines and for the timely evaluation of vaccination interventions. Moreover, RDIT could be harnessed to rapidly assess demographic, attitudinal, and behavioral constructs that are not available in administrative data, which could allow for deeper insights into the real-time predictors of vaccine uptake–enabling targeted and timely interventions. %M 35709335 %R 10.2196/37920 %U https://www.jmir.org/2022/7/e37920 %U https://doi.org/10.2196/37920 %U http://www.ncbi.nlm.nih.gov/pubmed/35709335 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 7 %P e36242 %T Unbalanced Risk of Pulmonary Tuberculosis in China at the Subnational Scale: Spatiotemporal Analysis %A Hu,Maogui %A Feng,Yuqing %A Li,Tao %A Zhao,Yanlin %A Wang,Jinfeng %A Xu,Chengdong %A Chen,Wei %+ National Center for Tuberculosis Control and Prevention, Chinese Center for Disease Control and Prevention, No 155 Changbai Road, Changping District, Beijing, 102206, China, 86 010 58900537, chenwei@chinacdc.cn %K pulmonary tuberculosis %K infectious disease %K pattern %K notification rates %K Bayesian %K spatiotemporal pattern %K tuberculosis %K public health %K China %K disease burden %K spatial data %K regional inequality %K risk %K TB %K unbalanced %K notification data %K trend %K cases %K incidence %D 2022 %7 1.7.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: China has one of the highest tuberculosis (TB) burdens in the world. However, the unbalanced spatial and temporal trends of TB risk at a fine level remain unclear. Objective: We aimed to investigate the unbalanced risks of pulmonary tuberculosis (PTB) at different levels and how they evolved from both temporal and spatial aspects using PTB notification data from 2851 counties over a decade in China. Methods: County-level notified PTB case data were collected from 2009 to 2018 in mainland China. A Bayesian hierarchical model was constructed to analyze the unbalanced spatiotemporal patterns of PTB notification rates during this period at subnational scales. The Gini coefficient was calculated to assess the inequality of the relative risk (RR) of PTB across counties. Results: From 2009 to 2018, the number of notified PTB cases in mainland China decreased from 946,086 to 747,700. The average number of PTB cases in counties was 301 (SD 26) and the overall average notification rate was 60 (SD 6) per 100,000 people. There were obvious regional differences in the RRs for PTB (Gini coefficient 0.32, 95% CI 0.31-0.33). Xinjiang had the highest PTB notification rate, with a multiyear average of 155/100,000 (RR 2.3, 95% CI 1.6-2.8; P<.001), followed by Guizhou (117/100,000; RR 1.8, 95% CI 1.3-1.9; P<.001) and Tibet (108/100,000; RR 1.7, 95% CI 1.3-2.1; P<.001). The RR for PTB showed a steady downward trend. Gansu (local trend [LT] 0.95, 95% CI 0.93-0.96; P<.001) and Shanxi (LT 0.94, 95% CI 0.92-0.96; P<.001) experienced the fastest declines. However, the RRs for PTB in the western region (such as counties in Xinjiang, Guizhou, and Tibet) were significantly higher than those in the eastern and central regions (P<.001), and the decline rate of the RR for PTB was lower than the overall level (P<.001). Conclusions: PTB risk showed significant regional inequality among counties in China, and western China presented a high plateau of disease burden. Improvements in economic and medical service levels are required to boost PTB case detection and eventually reduce PTB risk in the whole country. %M 35776442 %R 10.2196/36242 %U https://publichealth.jmir.org/2022/7/e36242 %U https://doi.org/10.2196/36242 %U http://www.ncbi.nlm.nih.gov/pubmed/35776442 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e33995 %T Reasons for COVID-19 Vaccine Hesitancy Among Chinese People Living With HIV/AIDS: Structural Equation Modeling Analysis %A Yao,Yan %A Chai,Ruiyu %A Yang,Jianzhou %A Zhang,Xiangjun %A Huang,Xiaojie %A Yu,Maohe %A Fu,Geng-feng %A Lan,Guanghua %A Qiao,Ying %A Zhou,Qidi %A Li,Shuyue %A Xu,Junjie %+ Clinical Research Academy, Peking University Shenzhen Hospital, Peking University, 1120, Lianhua Road, Futian District, Shenzhen, 518036, China, 86 755 8392333, xjjcmu@163.com %K COVID-19 vaccine %K vaccine hesitancy %K PLWHA %K structural equation modeling %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 35486810 %R 10.2196/33995 %U https://publichealth.jmir.org/2022/6/e33995 %U https://doi.org/10.2196/33995 %U http://www.ncbi.nlm.nih.gov/pubmed/35486810 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 6 %P e34685 %T Health Consumer Engagement, Enablement, and Empowerment in Smartphone-Enabled Home-Based Diagnostic Testing for Viral Infections: Mixed Methods Study %A LeRouge,Cynthia %A Durneva,Polina %A Lyon,Victoria %A Thompson,Matthew %+ Department of Information Systems and Business Analytics, College of Business, Florida International University, 11200 S.W. 8th St., RB 206B, Miami, FL, 33199, United States, 1 305 348 4709, clerouge@fiu.edu %K smart HT %K mHealth %K patient engagement %K patient enablement %K patient empowerment %K diagnostic testing %K viral infection %K patient activation %K consumer health informatics %K influenza %K home testing %K mobile phone %D 2022 %7 30.6.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Health consumers are increasingly taking a more substantial role in decision-making and self-care regarding their health. A range of digital technologies is available for laypeople to find, share, and generate health-related information that supports their health care processes. There is also innovation and interest in home testing enabled by smartphone technology (smartphone-supported home testing [smart HT]). However, few studies have focused on the process from initial engagement to acting on the test results, which involves multiple decisions. Objective: This study aimed to identify and model the key factors leading to health consumers’ engagement and enablement associated with smart HT. We also explored multiple levels of health care choices resulting from health consumer empowerment and activation from smart HT use. Understanding the factors and choices associated with engagement, enablement, empowerment, and activation helps both research and practice to support the intended and optimal use of smart HT. Methods: This study reports the findings from 2 phases of a more extensive pilot study of smart HT for viral infection. In these 2 phases, we used mixed methods (semistructured interviews and surveys) to shed light on the situated complexities of health consumers making autonomous decisions to engage with, perform, and act on smart HT, supporting the diagnostic aspects of their health care. Interview (n=31) and survey (n=282) participants underwent smart HT testing for influenza in earlier pilot phases. The survey also extended the viral infection context to include questions related to potential smart HT use for SARS-CoV-2 diagnosis. Results: Our resulting model revealed the smart HT engagement and enablement factors, as well as choices resulting from empowerment and activation. The model included factors leading to engagement, specifically various intrinsic and extrinsic influences. Moreover, the model included various enablement factors, including the quality of smart HT and the personal capacity to perform smart HT. The model also explores various choices resulting from empowerment and activation from the perspectives of various stakeholders (public vs private) and concerning different levels of impact (personal vs distant). Conclusions: The findings provide insight into the nuanced and complex ways health consumers make decisions to engage with and perform smart HT and how they may react to positive results in terms of public-private and personal-distant dimensions. Moreover, the study illuminates the role that providers and smart HT sources can play to better support digitally engaged health consumers in the smart HT decision process. %M 35771605 %R 10.2196/34685 %U https://mhealth.jmir.org/2022/6/e34685 %U https://doi.org/10.2196/34685 %U http://www.ncbi.nlm.nih.gov/pubmed/35771605 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 6 %P e36050 %T Impact of a Long Lockdown on Mental Health and the Role of Media Use: Web-Based Survey Study %A Grygarová,Dominika %A Adámek,Petr %A Juríčková,Veronika %A Horáček,Jiří %A Bakštein,Eduard %A Fajnerová,Iveta %A Kesner,Ladislav %+ Center for Advanced Studies of Brain and Consciousness, National Institute of Mental Health, Topolová 748, Klecany, 250 67, Czech Republic, 420 283 088 264, dominika.grygarova@nudz.cz %K mental health %K COVID-19 %K lockdown %K media use %K anxiety %K depression %K nationally representative data %K survey %K longitudinal study %K pandemic %K social isolation %K social media %K psychological trauma %K mental stress %K media news %D 2022 %7 28.6.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: Due to the COVID-19 pandemic, the Czech population experienced a second lockdown lasting for about half a year, restricting free movement and imposing social isolation. However, it is not known whether the impact of this long lockdown resulted in habituation to the adverse situation or in the traumatization of the Czech population, and whether the media and specific media use contributed to these effects. Objective: The aim of this study was to elucidate the effect of the long lockdown on the mental health of the Czech population, and the role of exposure to COVID-19 news reports and specific forms of media news use in mental health. Methods: We conducted two consecutive surveys in the early (November 2020) and late (March/April 2021) phases of the nationwide lockdown on the same nationally representative group of Czech adults (N=1777) participating in a longitudinal panel study. Results: Our findings showed that the self-reported symptoms of anxiety and depression increased in the second observation period, confirming the negative effect of the pandemic lockdown as it unfolded, suggesting that restrictive measures and continuous exposure to a collective stressor did not result in the strengthening of resilience but rather in ongoing traumatization. The results also suggest a negative role of the media’s coverage of the COVID-19 pandemic in mental health during the early, and particularly late, phases of the lockdown. Furthermore, we found several risk and protective factors of specific media news use. The media practice in news consumption connected to social media use was the strongest predictor of exacerbated mental health symptoms, particularly in the late phase of the lockdown. Moreover, news media use characterized by internalization of information learned from the news, as well as negative attitudes toward media news, were associated with higher levels of anxiety and depression. Conversely, the use of infotainment, together with an in-depth and contextual style of reading news articles, were related to improvement of mental health. Conclusions: Our study showed that the long lockdown resulted in traumatization rather than habituation, and in more pronounced effects (both negative and positive) of media use in mental health. %M 35605112 %R 10.2196/36050 %U https://mental.jmir.org/2022/6/e36050 %U https://doi.org/10.2196/36050 %U http://www.ncbi.nlm.nih.gov/pubmed/35605112 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35091 %T Implementation and Evaluation of COVIDCare@Home, a Family Medicine–Led Remote Monitoring Program for Patients With COVID-19: Multimethod Cross-sectional Study %A Laur,Celia %A Agarwal,Payal %A Thai,Kelly %A Kishimoto,Vanessa %A Kelly,Shawna %A Liang,Kyle %A Bhatia,R Sacha %A Bhattacharyya,Onil %A Martin,Danielle %A Mukerji,Geetha %+ Women’s College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400, Geetha.Mukerji@wchospital.ca %K virtual care %K COVID-19 pandemic %K remote monitoring programs %K social determinants of health %K digital health %K COVID-19 %K pandemic %K health care %K remote monitoring %K clinical outcome %K patient %K health care cost %K patient experience %D 2022 %7 28.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: COVIDCare@Home (CC@H) is a multifaceted, interprofessional team-based remote monitoring program led by family medicine for patients diagnosed with COVID-19, based at Women’s College Hospital (WCH), an ambulatory academic center in Toronto, Canada. CC@H offers virtual visits (phone and video) to address the clinical needs and broader social determinants of the health of patients during the acute phase of COVID-19 infection, including finding a primary care provider (PCP) and support for food insecurity. Objective: The objective of this evaluation is to understand the implementation and quality outcomes of CC@H within the Quadruple Aim framework of patient experience, provider experience, cost, and population health. Methods: This multimethod cross-sectional evaluation follows the Quadruple Aim framework to focus on implementation and service quality outcomes, including feasibility, adoption, safety, effectiveness, equity, and patient centeredness. These measures were explored using clinical and service utilization data, patient experience data (an online survey and a postdischarge questionnaire), provider experience data (surveys, interviews, and focus groups), and stakeholder interviews. Descriptive analysis was conducted for surveys and utilization data. Deductive analysis was conducted for interviews and focus groups, mapping to implementation and quality domains. The Ontario Marginalization Index (ON-Marg) measured the proportion of underserved patients accessing CC@H. Results: In total, 3412 visits were conducted in the first 8 months of the program (April 8-December 8, 2020) for 616 discrete patients, including 2114 (62.0%) visits with family physician staff/residents and 149 (4.4%) visits with social workers/mental health professionals. There was a median of 5 (IQR 4) visits per patient, with a median follow-up of 7 days (IQR 27). The net promoter score was 77. In addition, 144 (23.3%) of the patients were in the most marginalized populations based on the residential postal code (as per ON-Marg). Interviews with providers and stakeholders indicated that the program continued to adapt to meet the needs of patients and the health care system. Conclusions: Future remote monitoring should integrate support for addressing the social determinants of health and ensure patient-centered care through comprehensive care teams. %M 35499974 %R 10.2196/35091 %U https://humanfactors.jmir.org/2022/2/e35091 %U https://doi.org/10.2196/35091 %U http://www.ncbi.nlm.nih.gov/pubmed/35499974 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e35343 %T Changes in Temporal Properties of Notifiable Infectious Disease Epidemics in China During the COVID-19 Pandemic: Population-Based Surveillance Study %A Zhao,Xixi %A Li,Meijia %A Haihambo,Naem %A Jin,Jianhua %A Zeng,Yimeng %A Qiu,Jinyi %A Guo,Mingrou %A Zhu,Yuyao %A Li,Zhirui %A Liu,Jiaxin %A Teng,Jiayi %A Li,Sixiao %A Zhao,Ya-nan %A Cao,Yanxiang %A Wang,Xuemei %A Li,Yaqiong %A Gao,Michel %A Feng,Xiaoyang %A Han,Chuanliang %+ Brain Cognition and Brain Disease Institute, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, 1068 Xueyuan Avenue, Shenzhen University Town, Nanshan District, Shenzhen, 518055, China, 86 18800129802, hanchuanliang2014@163.com %K class B infectious disease %K COVID-19 %K event-related trough %K infection selectivity %K oscillation %K public health interventions %K pandemic %K surveillance %K health policy %K epidemiology %K prevention policy %K public health %K risk prevention %D 2022 %7 23.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 35649394 %R 10.2196/35343 %U https://publichealth.jmir.org/2022/6/e35343 %U https://doi.org/10.2196/35343 %U http://www.ncbi.nlm.nih.gov/pubmed/35649394 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e38423 %T COVID-19 Vaccine Fact-Checking Posts on Facebook: Observational Study %A Xue,Haoning %A Gong,Xuanjun %A Stevens,Hannah %+ Department of Communication, University of California, Davis, One Shields Avenue, Davis, CA, 95616, United States, 1 5303048532, hnxue@ucdavis.edu %K COVID-19 vaccine %K fact checking %K misinformation correction %K sentiment analysis %K social media %K COVID-19 %K vaccination %K misinformation %K health information %K online information %K infodemic %K public sentiment %D 2022 %7 21.6.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective interventions aimed at correcting COVID-19 vaccine misinformation, known as fact-checking messages, are needed to combat the mounting antivaccine infodemic and alleviate vaccine hesitancy. Objective: This work investigates (1) the changes in the public's attitude toward COVID-19 vaccines over time, (2) the effectiveness of COVID-19 vaccine fact-checking information on social media engagement and attitude change, and (3) the emotional and linguistic features of the COVID-19 vaccine fact-checking information ecosystem. Methods: We collected a data set of 12,553 COVID-19 vaccine fact-checking Facebook posts and their associated comments (N=122,362) from January 2020 to March 2022 and conducted a series of natural language processing and statistical analyses to investigate trends in public attitude toward the vaccine in COVID-19 vaccine fact-checking posts and comments, and emotional and linguistic features of the COVID-19 fact-checking information ecosystem. Results: The percentage of fact-checking posts relative to all COVID-19 vaccine posts peaked in May 2020 and then steadily decreased as the pandemic progressed (r=–0.92, df=21, t=–10.94, 95% CI –0.97 to –0.82, P<.001). The salience of COVID-19 vaccine entities was significantly lower in comments (mean 0.03, SD 0.03, t=39.28, P<.001) than in posts (mean 0.09, SD 0.11). Third-party fact checkers have been playing a more important role in more fact-checking over time (r=0.63, df=25, t=4.06, 95% CI 0.33-0.82, P<.001). COVID-19 vaccine fact-checking posts continued to be more analytical (r=0.81, df=25, t=6.88, 95% CI 0.62-0.91, P<.001) and more confident (r=0.59, df=25, t=3.68, 95% CI 0.27-0.79, P=.001) over time. Although comments did not exhibit a significant increase in confidence over time, tentativeness in comments significantly decreased (r=–0.62, df=25, t=–3.94, 95% CI –0.81 to –0.31, P=.001). In addition, although hospitals receive less engagement than other information sources, the comments expressed more positive attitudinal valence in comments compared to other information sources (b=0.06, 95% CI 0.00-0.12, t=2.03, P=.04). Conclusions: The percentage of fact-checking posts relative to all posts about the vaccine steadily decreased after May 2020. As the pandemic progressed, third-party fact checkers played a larger role in posting fact-checking COVID-19 vaccine posts. COVID-19 vaccine fact-checking posts continued to be more analytical and more confident over time, reflecting increased confidence in posts. Similarly, tentativeness in comments decreased; this likewise suggests that public uncertainty diminished over time. COVID-19 fact-checking vaccine posts from hospitals yielded more positive attitudes toward vaccination than other information sources. At the same time, hospitals received less engagement than other information sources. This suggests that hospitals should invest more in generating engaging public health campaigns on social media. %M 35671409 %R 10.2196/38423 %U https://www.jmir.org/2022/6/e38423 %U https://doi.org/10.2196/38423 %U http://www.ncbi.nlm.nih.gov/pubmed/35671409 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35173 %T Self-care Behaviors and Technology Used During COVID-19: Systematic Review %A Sakur,Fareeya %A Ward,Kanesha %A Khatri,Neha Nafees %A Lau,Annie Y S %+ Australian Institute of Health Innovation, Macquarie University, 75 Talavera Rd, North Ryde, NSW 2113, Australia, 61 (02) 9850 2400, fareeya.sakur@hdr.mq.edu.au %K self-care %K self-management %K chronic conditions %K COVID-19 %K pandemic %K technology %K digital health %K telehealth %K health technology %D 2022 %7 21.6.2022 %9 Review %J JMIR Hum Factors %G English %X Background: Self-care behaviors are essential for people living with chronic conditions; however, the outbreak of the COVID-19 pandemic has imposed additional complications on their daily routines. Few studies have analyzed how self-care behaviors have changed during COVID-19 and the role of digital technology, especially among people with chronic conditions. Objective: This study aims to review how self-care behaviors have changed for people with chronic conditions during the COVID-19 pandemic, and what technology they have adopted to manage their conditions during that period. Methods: A systematic review was conducted using narrative synthesis. Data were extracted from PubMed, MEDLINE, EMBASE, PsycINFO, CINAHL, and Google Scholar, including articles from December 2019 onward. Eligible studies focused on adults diagnosed with chronic conditions undertaking any self-care tasks in line with the middle-range theory of self-care of chronic illness (ie, self-care maintenance, monitoring, and management). The methodological quality of the included articles was assessed with the McMaster Critical Review Forms for Quantitative or Qualitative Studies. Results: In total, 36 primary research articles were included. Changes to self-care behaviors during COVID-19 among people with chronic conditions were organized according to the middle-range theory of self-care of chronic illness focusing on self-care maintenance (ie, medication adherence, physical activity, and diet control), self-care monitoring (ie, monitoring signs and symptoms), and self-care management (ie, consultations with health care providers). Positive self-care behaviors observed include the following: individuals trying to maintain good glycemic control during COVID-19 increased their medication adherence in 27% (10/36) of studies; and diet control improved in 50% (18/36) of studies. Negative self-care behaviors observed include the following: decline in physical activities and increased sedentariness were observed in 65% (23/36) of studies; poor diet control was observed in 57% (21/36) of studies; and self-monitoring of health status dropped in 43% (15/36) of studies. The use of technology to support self-care of chronic conditions during COVID-19 was reported in 72% (26/36) of studies. The actual use of telehealth in place of physical consultations during COVID-19 was observed in 50% (18/36) of studies, and other digital technologies (eg, social media apps, smartphone apps, web-based platforms, and web browsing) were used in 50% (18/36) of studies. Telehealth was discussed and recommended as the default technology in delivering future health care services during COVID-19 and beyond in 77% (28/36) of studies. Conclusions: This review highlighted the necessity to rethink how models of self-care should continue to address the demands of chronic conditions while being responsive to the imminent threats of infectious diseases. Perhaps the silver lining of COVID-19 is that adoption of digital technology (especially telehealth) among a vast cross-section of people with chronic conditions is possible. Future research should investigate effective ways to incorporate evidence-based digital health tools into these new models of self-care that address the challenges of chronic and infectious conditions. %M 35442904 %R 10.2196/35173 %U https://humanfactors.jmir.org/2022/2/e35173 %U https://doi.org/10.2196/35173 %U http://www.ncbi.nlm.nih.gov/pubmed/35442904 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e34615 %T Testing the Efficacy of Attitudinal Inoculation Videos to Enhance COVID-19 Vaccine Acceptance: Quasi-Experimental Intervention Trial %A Piltch-Loeb,Rachael %A Su,Max %A Hughes,Brian %A Testa,Marcia %A Goldberg,Beth %A Braddock,Kurt %A Miller-Idriss,Cynthia %A Maturo,Vanessa %A Savoia,Elena %+ Department of Biostatistics, Harvard TH Chan School of Public Health, 90 Smith St, Boston, MA, 02120, United States, 1 3393649813, piltch-loeb@hsph.harvard.edu %K attitudinal inoculation %K intervention %K COVID-19 vaccine %K vaccine hesitancy %K COVID-19 %K vaccine %K vaccination %K public health %K health intervention %K misinformation %K infodemiology %K vaccine misinformation %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Over the course of the COVID-19 pandemic, a variety of COVID-19-related misinformation has spread and been amplified online. The spread of misinformation can influence COVID-19 beliefs and protective actions, including vaccine hesitancy. Belief in vaccine misinformation is associated with lower vaccination rates and higher vaccine resistance. Attitudinal inoculation is a preventative approach to combating misinformation and disinformation, which leverages the power of narrative, rhetoric, values, and emotion. Objective: This study seeks to test inoculation messages in the form of short video messages to promote resistance against persuasion by COVID-19 vaccine misinformation. Methods: We designed a series of 30-second inoculation videos and conducted a quasi-experimental study to test the use of attitudinal inoculation in a population of individuals who were unvaccinated (N=1991). The 3 intervention videos were distinguished by their script design, with intervention video 1 focusing on narrative/rhetorical (“Narrative”) presentation of information, intervention video 2 focusing on delivering a fact-based information (“Fact”), and intervention video 3 using a hybrid design (“Hybrid”). Analysis of covariance (ANCOVA) models were used to compare the main effect of the intervention on the 3 outcome variables: ability to recognize misinformation tactics (“Recognize”), willingness to share misinformation (“Share”), and willingness to take the COVID-19 vaccine (“Willingness”). Results: There were significant effects across all 3 outcome variables comparing inoculation intervention groups to controls. For the Recognize outcome, the ability to recognize rhetorical strategies, there was a significant intervention group effect (P<.001). For the Share outcome, support for sharing the mis- and disinformation, the intervention group main effect was statistically significant (P=.02). For the Willingness outcome, there was a significant intervention group effect; intervention groups were more willing to get the COVID-19 vaccine compared to controls (P=.01). Conclusions: Across all intervention groups, inoculated individuals showed greater resistance to misinformation than their noninoculated counterparts. Relative to those who were not inoculated, inoculated participants showed significantly greater ability to recognize and identify rhetorical strategies used in misinformation, were less likely to share false information, and had greater willingness to get the COVID-19 vaccine. Attitudinal inoculation delivered through short video messages should be tested in public health messaging campaigns to counter mis- and disinformation. %M 35483050 %R 10.2196/34615 %U https://publichealth.jmir.org/2022/6/e34615 %U https://doi.org/10.2196/34615 %U http://www.ncbi.nlm.nih.gov/pubmed/35483050 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e33637 %T Applying the Health Belief Model to Characterize Racial/Ethnic Differences in Digital Conversations Related to Depression Pre- and Mid-COVID-19: Descriptive Analysis %A Castilla-Puentes,Ruby %A Pesa,Jacqueline %A Brethenoux,Caroline %A Furey,Patrick %A Gil Valletta,Liliana %A Falcone,Tatiana %+ Center for Public Health Practice, Drexel University, 530 S 2nd st Suite 743, Philadelphia, PA, 19147, United States, 1 6108642528, rcastil4@its.jnj.com %K depression %K COVID-19 %K treatment %K race/ethnicity %K digital conversations %K health belief model %K artificial intelligence %K natural language processing %D 2022 %7 20.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prevalence of depression in the United States is >3 times higher mid-COVID-19 versus prepandemic. Racial/ethnic differences in mindsets around depression and the potential impact of the COVID-19 pandemic are not well characterized. Objective: This study aims to describe attitudes, mindsets, key drivers, and barriers related to depression pre- and mid-COVID-19 by race/ethnicity using digital conversations about depression mapped to health belief model (HBM) concepts. Methods: Advanced search, data extraction, and artificial intelligence–powered tools were used to harvest, mine, and structure open-source digital conversations of US adults who engaged in conversations about depression pre- (February 1, 2019-February 29, 2020) and mid-COVID-19 pandemic (March 1, 2020-November 1, 2020) across the internet. Natural language processing, text analytics, and social data mining were used to categorize conversations that included a self-identifier into racial/ethnic groups. Conversations were mapped to HBM concepts (ie, perceived susceptibility, perceived severity, perceived benefits, perceived barriers, cues to action, and self-efficacy). Results are descriptive in nature. Results: Of 2.9 and 1.3 million relevant digital conversations pre- and mid-COVID-19, race/ethnicity was determined among 1.8 million (62.2%) and 979,000 (75.3%) conversations, respectively. Pre-COVID-19, 1.3 million (72.1%) conversations about depression were analyzed among non-Hispanic Whites (NHW), 227,200 (12.6%) among Black Americans (BA), 189,200 (10.5%) among Hispanics, and 86,800 (4.8%) among Asian Americans (AS). Mid-COVID-19, a total of 736,100 (75.2%) conversations about depression were analyzed among NHW, 131,800 (13.5%) among BA, 78,300 (8.0%) among Hispanics, and 32,800 (3.3%) among AS. Conversations among all racial/ethnic groups had a negative tone, which increased pre- to mid-COVID-19; finding support from others was seen as a benefit among most groups. Hispanics had the highest rate of any racial/ethnic group of conversations showing an avoiding mindset toward their depression. Conversations related to external barriers to seeking treatment (eg, stigma, lack of support, and lack of resources) were generally more prevalent among Hispanics, BA, and AS than among NHW. Being able to benefit others and building a support system were key drivers to seeking help or treatment for all racial/ethnic groups. Conclusions: There were considerable racial/ethnic differences in drivers and barriers to seeking help and treatment for depression pre- and mid-COVID-19. As expected, COVID-19 has made conversations about depression more negative and with frequent discussions of barriers to seeking care. Applying concepts of the HBM to data on digital conversation about depression allowed organization of the most frequent themes by race/ethnicity. Individuals of all groups came online to discuss their depression. These data highlight opportunities for culturally competent and targeted approaches to addressing areas amenable to change that might impact the ability of people to ask for or receive mental health help, such as the constructs that comprise the HBM. %M 35275834 %R 10.2196/33637 %U https://formative.jmir.org/2022/6/e33637 %U https://doi.org/10.2196/33637 %U http://www.ncbi.nlm.nih.gov/pubmed/35275834 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e38269 %T Navigating the Credibility of Web-Based Information During the COVID-19 Pandemic: Using Mnemonics to Empower the Public to Spot Red Flags in Health Information on the Internet %A Stokes-Parish,Jessica %+ Faculty of Health Sciences and Medicine, Bond University, 14 University Drive, Robina, 4227, Australia, 61 755951468, jstokesp@bond.edu.au %K science communication %K critical appraisal %K social media %K health literacy %K digital literacy %K misinformation %K COVID-19 %K online health %K infodemic %K infodemiology %D 2022 %7 17.6.2022 %9 Viewpoint %J J Med Internet Res %G English %X Misinformation creates challenges for the general public in differentiating truth from fiction in web-based content. During the COVID-19 pandemic, this issue has been amplified due to high volumes of news and changing information. Evidence on misinformation largely focuses on understanding the psychology of misinformation and debunking strategies but neglects to explore critical thinking education for the general public. This viewpoint outlines the science of misinformation and the current resources available to the public. This paper describes the development and theoretical underpinnings of a mnemonic (Conflict of Interest, References, Author, Buzzwords, Scope of Practice [CRABS]) for identifying misinformation in web-based health content. Leveraging evidence-based educational strategies may be a promising approach for empowering the public with the confidence needed to differentiate truth from fiction in an infodemic. %M 35649183 %R 10.2196/38269 %U https://www.jmir.org/2022/6/e38269 %U https://doi.org/10.2196/38269 %U http://www.ncbi.nlm.nih.gov/pubmed/35649183 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 6 %P e36882 %T Nursing Workflow Change in a COVID-19 Inpatient Unit Following the Deployment of Inpatient Telehealth: Observational Study Using a Real-Time Locating System %A Vilendrer,Stacie %A Lough,Mary E %A Garvert,Donn W %A Lambert,Monique H %A Lu,Jonathan Hsijing %A Patel,Birju %A Shah,Nigam H %A Williams,Michelle Y %A Kling,Samantha M R %+ Evaluation Sciences Unit, Division of Primary Care and Population Health, Department of Medicine, Stanford University School of Medicine, 1265 Welch Road, Stanford, CA, 94305, United States, 1 587 206 4043, staciev@stanford.edu %K telemedicine %K telehealth %K informatics %K real-time locating system %K COVID-19 %K pandemic %K nursing %K patient safety %K PPE %K virtual care %K nurses %K patient outcomes %K pathogen exposure %K health risk %K health care staff %K health care professional %D 2022 %7 17.6.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 35635840 %R 10.2196/36882 %U https://www.jmir.org/2022/6/e36882 %U https://doi.org/10.2196/36882 %U http://www.ncbi.nlm.nih.gov/pubmed/35635840 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e33099 %T Characterizing Anchoring Bias in Vaccine Comparator Selection Due to Health Care Utilization With COVID-19 and Influenza: Observational Cohort Study %A Ostropolets,Anna %A Ryan,Patrick B %A Schuemie,Martijn J %A Hripcsak,George %+ Department of Biomedical Informatics, Columbia University Irving Medical Center, 622 West 168th Street, PH20, New York, NY, 10032, United States, 1 2123055334, gh13@cumc.columbia.edu %K COVID-19 %K vaccine %K anchoring %K comparator selection %K time-at-risk %K vaccination %K bias %K observational %K utilization %K flu %K influenza %K index %K cohort %D 2022 %7 17.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Observational data enables large-scale vaccine safety surveillance but requires careful evaluation of the potential sources of bias. One potential source of bias is the index date selection procedure for the unvaccinated cohort or unvaccinated comparison time (“anchoring”). Objective: Here, we evaluated the different index date selection procedures for 2 vaccinations: COVID-19 and influenza. Methods: For each vaccine, we extracted patient baseline characteristics on the index date and up to 450 days prior and then compared them to the characteristics of the unvaccinated patients indexed on (1) an arbitrary date or (2) a date of a visit. Additionally, we compared vaccinated patients indexed on the date of vaccination and the same patients indexed on a prior date or visit. Results: COVID-19 vaccination and influenza vaccination differ drastically from each other in terms of the populations vaccinated and their status on the day of vaccination. When compared to indexing on a visit in the unvaccinated population, influenza vaccination had markedly higher covariate proportions, and COVID-19 vaccination had lower proportions of most covariates on the index date. In contrast, COVID-19 vaccination had similar covariate proportions when compared to an arbitrary date. These effects attenuated, but were still present, with a longer lookback period. The effect of day 0 was present even when the patients served as their own controls. Conclusions: Patient baseline characteristics are sensitive to the choice of the index date. In vaccine safety studies, unexposed index event should represent vaccination settings. Study designs previously used to assess influenza vaccination must be reassessed for COVID-19 to account for a potentially healthier population and lack of medical activity on the day of vaccination. %M 35482996 %R 10.2196/33099 %U https://publichealth.jmir.org/2022/6/e33099 %U https://doi.org/10.2196/33099 %U http://www.ncbi.nlm.nih.gov/pubmed/35482996 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e35266 %T Enhancing COVID-19 Epidemic Forecasting Accuracy by Combining Real-time and Historical Data From Multiple Internet-Based Sources: Analysis of Social Media Data, Online News Articles, and Search Queries %A Li,Jingwei %A Huang,Wei %A Sia,Choon Ling %A Chen,Zhuo %A Wu,Tailai %A Wang,Qingnan %+ National Center for Applied Mathematics Shenzhen, No. 1088, Xueyuan Avenue, Nanshan District, Shenzhen, 518055, China, 86 15129077179, waynehuangwei@163.com %K SARS-CoV-2 %K COVID 19 %K epidemic forecasting %K disease surveillance %K infectious disease epidemiology %K social medial %K online news %K search query %K autoregression model %D 2022 %7 16.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The SARS-COV-2 virus and its variants pose extraordinary challenges for public health worldwide. Timely and accurate forecasting of the COVID-19 epidemic is key to sustaining interventions and policies and efficient resource allocation. Internet-based data sources have shown great potential to supplement traditional infectious disease surveillance, and the combination of different Internet-based data sources has shown greater power to enhance epidemic forecasting accuracy than using a single Internet-based data source. However, existing methods incorporating multiple Internet-based data sources only used real-time data from these sources as exogenous inputs but did not take all the historical data into account. Moreover, the predictive power of different Internet-based data sources in providing early warning for COVID-19 outbreaks has not been fully explored. Objective: The main aim of our study is to explore whether combining real-time and historical data from multiple Internet-based sources could improve the COVID-19 forecasting accuracy over the existing baseline models. A secondary aim is to explore the COVID-19 forecasting timeliness based on different Internet-based data sources. Methods: We first used core terms and symptom-related keyword-based methods to extract COVID-19–related Internet-based data from December 21, 2019, to February 29, 2020. The Internet-based data we explored included 90,493,912 online news articles, 37,401,900 microblogs, and all the Baidu search query data during that period. We then proposed an autoregressive model with exogenous inputs, incorporating real-time and historical data from multiple Internet-based sources. Our proposed model was compared with baseline models, and all the models were tested during the first wave of COVID-19 epidemics in Hubei province and the rest of mainland China separately. We also used lagged Pearson correlations for COVID-19 forecasting timeliness analysis. Results: Our proposed model achieved the highest accuracy in all 5 accuracy measures, compared with all the baseline models of both Hubei province and the rest of mainland China. In mainland China, except for Hubei, the COVID-19 epidemic forecasting accuracy differences between our proposed model (model i) and all the other baseline models were statistically significant (model 1, t198=–8.722, P<.001; model 2, t198=–5.000, P<.001, model 3, t198=–1.882, P=.06; model 4, t198=–4.644, P<.001; model 5, t198=–4.488, P<.001). In Hubei province, our proposed model's forecasting accuracy improved significantly compared with the baseline model using historical new confirmed COVID-19 case counts only (model 1, t198=–1.732, P=.09). Our results also showed that Internet-based sources could provide a 2- to 6-day earlier warning for COVID-19 outbreaks. Conclusions: Our approach incorporating real-time and historical data from multiple Internet-based sources could improve forecasting accuracy for epidemics of COVID-19 and its variants, which may help improve public health agencies' interventions and resource allocation in mitigating and controlling new waves of COVID-19 or other relevant epidemics. %M 35507921 %R 10.2196/35266 %U https://publichealth.jmir.org/2022/6/e35266 %U https://doi.org/10.2196/35266 %U http://www.ncbi.nlm.nih.gov/pubmed/35507921 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 2 %P e34115 %T Experience of Pediatricians and Pediatric Surgeons With Virtual Care During the COVID-19 Pandemic: Descriptive Study %A McCrady,Emma %A Strychowsky,Julie E %A Woolfson,Jessica P %+ Department of Pediatrics, London Health Sciences Centre Children's Hospital, Office B3-444, London, ON, N6A 5W9, Canada, 1 5198789608, emccrad@uwo.ca %K virtual care %K web-based care %K COVID-19 %K pediatrics %K pandemic %K physicians %K digital health %K pediatricians %K telehealth %D 2022 %7 15.6.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Prior to the COVID-19 pandemic, in-clinic visits were the standard of care for pediatric physicians and surgeons at our center. At the pandemic onset, web-based care was adopted at an unprecedented scale and pace. Objective: This descriptive study explores the web-based care experience of pediatric physicians and surgeons during the pandemic by determining factors that supported and challenged web-based care adoption. Methods: This study took place at the Children’s Hospital at London Health Sciences Centre, a children’s hospital in London, Ontario, Canada, which provides pediatric care for patients from the London metropolitan area and the rest of Southwestern Ontario. The Donabedian model was used to structure a web-based survey evaluating web-based care experience, which was distributed to 121 department-affiliated pediatric physicians (including generalists and subspecialists in surgery and medicine). Recruitment occurred via department listserv email. Qualitative data were collected through discrete and free-text survey responses. Results: Survey response rate was 52.1% (63/121). Before the pandemic, few physicians within the Department of Paediatrics used web-based care, and physicians saw <10% of patients digitally. During March-May 2020, the majority transitioned to web-based care, seeing >50% of patients digitally. Web-based care use in our sample fell from June to September 2020, with the majority seeing <50% of patients digitally. Telephone and Ontario Telemedicine Network were the platforms most used from March to September 2020. Web-based care was rated to be convenient for most providers and their patients, despite the presence of technical difficulties. Challenges included lack of physical exam, lower patient volumes, and poor patient digital care etiquette. Regardless of demographics, 96.4% (116/121) would continue web-based care, ideally for patients who live far away and for follow-ups or established diagnoses. Conclusions: Transition to web-based care during COVID-19 was associated with challenges but also positive experiences. Willingness among pediatricians and pediatric surgeons to continue web-based care was high. Web-based care experiences at our center could be improved with patient education and targeting select populations. Future research is needed to improve practice efficiency and to inform regulatory guidelines for web-based care. %M 35666938 %R 10.2196/34115 %U https://pediatrics.jmir.org/2022/2/e34115 %U https://doi.org/10.2196/34115 %U http://www.ncbi.nlm.nih.gov/pubmed/35666938 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e36289 %T General Practitioners’ Experiences of Professional Uncertainties Emerging from the Introduction of Video Consultations in General Practice: Qualitative Study %A Nordtug,Maja %A Assing Hvidt,Elisabeth %A Lüchau,Elle Christine %A Grønning,Anette %+ Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Stensberggata 26, Oslo, 0170, Norway, 47 67236935, majanord@oslomet.no %K video consultation technology %K general practice, COVID-19, doctor-patient communication %K uncertainties %K general practitioners %K video consultation %K virtual health %K physician %K digital health %K pandemic %D 2022 %7 14.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Uncertainties are omnipresent in health care, but little is known about general practitioners’ (GPs) professional uncertainties concerning digital consultations. This is problematic, as many countries have undergone an extensive digital transformation. Objective: The aim of this study was to explore the professional uncertainties that emerged among Danish GPs with the introduction of video consultations. Methods: We conducted qualitative interviews with 15 Danish GPs during the beginning of the COVID-19 pandemic in 2020. The interviews were analyzed using an abductive approach. Results: We identified 3 categories of uncertainty: integrity, setting, and interaction. Respectively, these 3 categories of uncertainty refer to (1) uncertainties related to how technology may impede the provision of health care; (2) uncertainties related to the potentials of video technology; and (3) uncertainties related to how the video consultation technology affects interactions with patients. Conclusions: The uncertainties experienced by Danish GPs appear to be a typical reaction to the introduction of new technology. Embedding video consultation technology into GPs’ working routines will take time, and GPs do not necessarily feel intuitively capable of transferring their abilities, such as being good and socially present for video-mediated consultations. The heterogeneity of professional uncertainties experienced among the GPs suggests that they are the product of individual GP-technology relationships—not of the technology in itself. Consequently, we cannot expect that uncertainties can be remedied by changing or precluding new technology. %M 35653607 %R 10.2196/36289 %U https://formative.jmir.org/2022/6/e36289 %U https://doi.org/10.2196/36289 %U http://www.ncbi.nlm.nih.gov/pubmed/35653607 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e37327 %T COVID-19 Surveillance in the Biobank at the Colorado Center for Personalized Medicine: Observational Study %A Johnson,Randi K %A Marker,Katie M %A Mayer,David %A Shortt,Jonathan %A Kao,David %A Barnes,Kathleen C %A Lowery,Jan T %A Gignoux,Christopher R %+ Division of Biomedical Informatics and Personalized Medicine, Department of Medicine, University of Colorado School of Medicine, 13001 E 17th Place, Mail Stop 563, Aurora, CO, 80045, United States, 1 3037245375, randi.johnson@cuanschutz.edu %K COVID-19 %K surveillance %K pandemic %K biobank %K EHR %K public health %K integrated data %K population health %K health monitoring %K electronic health record %K eHealth %K health record %K emergency response %K vaccination status %K vaccination %K testing %K symptom %K disease impact %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 35486493 %R 10.2196/37327 %U https://publichealth.jmir.org/2022/6/e37327 %U https://doi.org/10.2196/37327 %U http://www.ncbi.nlm.nih.gov/pubmed/35486493 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e33951 %T Modeling Trust in COVID-19 Contact-Tracing Apps Using the Human-Computer Trust Scale: Online Survey Study %A Sousa,Sonia %A Kalju,Tiina %+ School of Digital Technologies, Tallinn University, Narva mnt, 29, Tallinn, 10120, Estonia, 372 53921116, scs@tlu.ee %K human-computer interaction %K COVID-19 %K human factors %K trustworthy AI %K contact-tracing %K app %K safety %K trust %K artificial intelligence %K Estonia %K case study %K monitoring %K surveillance %K perspective %K awareness %K design %K covid %K mobile app %K mHealth %K mobile health %D 2022 %7 13.6.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic has caused changes in technology use worldwide, both socially and economically. This pandemic crisis has brought additional measures such as contact-tracing apps (CTAs) to help fight against spread of the virus. Unfortunately, the low adoption rate of these apps affected their success. There could be many reasons for the low adoption, including concerns of security and privacy, along with reported issues of trust in CTAs. Some concerns are related with how CTAs could be used as surveillance tools or their potential threats to privacy as they involve health data. For example, in Estonia, the CTA named HOIA had approximately 250,000 downloads in the middle of January 2021. However, in 2021, only 4.7% of the population used HOIA as a COVID-19 CTA. The reasons for the low adoption include lack of competency, and privacy and security concerns. This lower adoption and the lack of trustworthiness persist despite efforts of the European Union in building ethics and trustworthy artificial intelligence (AI)-based apps. Objective: The aim of this study was to understand how to measure trust in health technologies. Specifically, we assessed the usefulness of the Human-Computer Trust Scale (HCTS) to measure Estonians’ trust in the HOIA app and the causes for this lack of trust. Methods: The main research question was: Can the HCTS be used to assess citizens’ perception of trust in health technologies? We established four hypotheses that were tested with a survey. We used a convenience sample for data collection, including sharing the questionnaire on social network sites and using the snowball method to reach all potential HOIA users in the Estonian population. Results: Among the 78 respondents, 61 had downloaded the HOIA app with data on usage patterns. However, 20 of those who downloaded the app admitted that it was never opened despite most claiming to regularly use mobile apps. The main reasons included not understanding how it works, and privacy and security concerns. Significant correlations were found between participants’ trust in CTAs in general and their perceived trust in the HOIA app regarding three attributes: competency (P<.001), risk perception (P<.001), and reciprocity (P=.01). Conclusions: This study shows that trust in the HOIA app among Estonian residents did affect their predisposition to use the app. Participants did not generally believe that HOIA could help to control the spread of the virus. The result of this work is limited to HOIA and health apps that use similar contact-tracing methods. However, the findings can contribute to gaining a broader understanding and awareness of the need for designing trustworthy technologies. Moreover, this work can help to provide design recommendations that ensure trustworthiness in CTAs, and the ability of AI to use highly sensitive data and serve society. %M 35699973 %R 10.2196/33951 %U https://humanfactors.jmir.org/2022/2/e33951 %U https://doi.org/10.2196/33951 %U http://www.ncbi.nlm.nih.gov/pubmed/35699973 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e37479 %T Public Health Implications of Adapting HIV Pre-exposure Prophylaxis Programs for Virtual Service Delivery in the Context of the COVID-19 Pandemic: Systematic Review %A Patel,Pragna %A Kerzner,Michael %A Reed,Jason B %A Sullivan,Patrick Sean %A El-Sadr,Wafaa M %+ COVID-19 Response Team, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, United States, 1 4046396132, plp3@cdc.gov %K HIV %K pre-exposure prophylaxis %K COVID-19 %K virtual service delivery %K HIV prevention %K public health %K systematic review %K virtual service %K health intervention %K digital intervention %K health technology %K social media platform %K telehealth %K public health message %D 2022 %7 7.6.2022 %9 Review %J JMIR Public Health Surveill %G English %X Background: The novel coronavirus disease COVID-19 caused by SARS-CoV-2 threatens to disrupt global progress toward HIV epidemic control. Opportunities exist to leverage ongoing public health responses to mitigate the impacts of COVID-19 on HIV services, and novel approaches to care provision might help address both epidemics. Objective: As the COVID-19 pandemic continues, novel approaches to maintain comprehensive HIV prevention service delivery are needed. The aim of this study was to summarize the related literature to highlight adaptations that could address potential COVID-19–related service interruptions. Methods: We performed a systematic review and searched six databases, OVID/Medline, Scopus, Cochrane Library, CINAHL, PsycINFO, and Embase, for studies published between January 1, 2010, and October 26, 2021, related to recent technology-based interventions for virtual service delivery. Search terms included “telemedicine,” “telehealth,” “mobile health,” “eHealth,” “mHealth,” “telecommunication,” “social media,” “mobile device,” and “internet,” among others. Of the 6685 abstracts identified, 1259 focused on HIV virtual service delivery, 120 of which were relevant for HIV prevention efforts; 48 pertained to pre-exposure prophylaxis (PrEP) and 19 of these focused on evaluations of interventions for the virtual service delivery of PrEP. Of the 16 systematic reviews identified, three were specific to PrEP. All 35 papers were reviewed for outcomes of efficacy, feasibility, and/or acceptability. Limitations included heterogeneity of the studies’ methodological approaches and outcomes; thus, a meta-analysis was not performed. We considered the evidence-based interventions found in our review and developed a virtual service delivery model for HIV prevention interventions. We also considered how this platform could be leveraged for COVID-19 prevention and care. Results: We summarize 19 studies of virtual service delivery of PrEP and 16 relevant reviews. Examples of technology-based interventions that were effective, feasible, and/or acceptable for PrEP service delivery include: use of SMS, internet, and smartphone apps such as iText (50% [95% CI 16%-71%] reduction in discontinuation of PrEP) and PrEPmate (OR 2.62, 95% CI 1.24-5.5.4); telehealth and eHealth platforms for virtual visits such as PrEPTECH and IowaTelePrEP; and platforms for training of health care workers such as Extension for Community Healthcare Outcomes (ECHO). We suggest a virtual service delivery model for PrEP that can be leveraged for COVID-19 using the internet and social media for demand creation, community-based self-testing, telehealth platforms for risk assessment and follow-up, applications for support groups and adherence/appointment reminders, and applications for monitoring. Conclusions: Innovations in the virtual service provision of PrEP occurred before COVID-19 but have new relevance during the COVID-19 pandemic. The innovations we describe might strengthen HIV prevention service delivery during the COVID-19 pandemic and in the long run by engaging traditionally hard-to-reach populations, reducing stigma, and creating a more accessible health care platform. These virtual service delivery platforms can mitigate the impacts of the COVID-19 pandemic on HIV services, which can be leveraged to facilitate COVID-19 pandemic control now and for future responses. %M 35486813 %R 10.2196/37479 %U https://publichealth.jmir.org/2022/6/e37479 %U https://doi.org/10.2196/37479 %U http://www.ncbi.nlm.nih.gov/pubmed/35486813 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e33484 %T Attitudes Toward the Global Allocation of Chinese COVID-19 Vaccines: Cross-sectional Online Survey of Adults Living in China %A Yu,Hanzhi %A Du,Runming %A Wang,Minmin %A Yu,Fengyun %A Yang,Juntao %A Jiao,Lirui %A Wang,Zhuoran %A Liu,Haitao %A Wu,Peixin %A Bärnighausen,Till %A Xue,Lan %A Wang,Chen %A McMahon,Shannon %A Geldsetzer,Pascal %A Chen,Simiao %+ Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Postfach 10 57 60 69047, Heidelberg, 69047, Germany, 49 6221 54 0, simiao.chen@uni-heidelberg.de %K COVID-19 vaccines %K China %K global allocation %K public attitudes %K cross-sectional %K survey %K vaccines %K COVID-19 %K pandemic %K public health %K health policy %K epidemiology %D 2022 %7 7.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 35483084 %R 10.2196/33484 %U https://publichealth.jmir.org/2022/6/e33484 %U https://doi.org/10.2196/33484 %U http://www.ncbi.nlm.nih.gov/pubmed/35483084 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 6 %P e37779 %T Mobile Health App for Tuberculosis Screening and Compliance to Undergo Chest X-ray Examination Among Presumptive Cases Detected by the App in Myanmar: Usability Study %A Htet,Kyaw Ko Ko %A Phyu,Aye Nyein %A Thwin,Thandar %A Chongsuvivatwong,Virasakdi %+ Department of Epidemiology, Faculty of Medicine, Prince of Songkla University, 15 Kanjanavanich Road, Hat Yai, 90110, Thailand, 66 74451165, cvirasak@medicine.psu.ac.th %K usability %K mobile app %K TB screening %K chest X-ray compliance %K mobile health %K health application %K risk score %K tuberculosis %K COVID-19 %D 2022 %7 7.6.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In Myanmar, the use of a mobile app for tuberculosis (TB) screening and its operational effect on seeking TB health care have not been evaluated yet. Objective: This study aims to report the usability of a simple mobile app to screen TB and comply with chest X-ray (CXR) examination of presumptive cases detected by the app. Methods: A new “TB-screen” app was developed from a Google Sheet based on a previously published algorithm. The app calculates a TB risk propensity score from an individual’s sociodemographic characteristics and TB clinical history and suggests whether the individual should undergo a CXR. The screening program was launched in urban slum areas soon after the COVID-19 outbreak subsided. A standard questionnaire was used to assess the app’s usability rated by presumptive cases. Compliance to undergo CXR was confirmed by scanning the referral quick response (QR) code via the app. Results: Raters were 453 presumptive cases detected by the app. The mean usability rating score was 4.1 out of 5. Compliance to undergo CXR examination was 71.1% (n=322). Active TB case detection among CXR compliances was 7.5% (n=24). One standard deviation (SD) increase in the app usability score was significantly associated with a 59% increase in the odds to comply with CXR (β=.464) after adjusting for other variables (P<.001). Conclusions: This simple mobile app got a high usability score rated by 453 users. The mobile app usability score successfully predicted compliance to undergo CXR examination. Eventually, 24 (7.5%) of 322 users who were suspected of having TB by the mobile app were detected as active TB cases by CXR. The system should be upscaled for a large trial. %M 35623000 %R 10.2196/37779 %U https://formative.jmir.org/2022/6/e37779 %U https://doi.org/10.2196/37779 %U http://www.ncbi.nlm.nih.gov/pubmed/35623000 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 5 %N 2 %P e34793 %T The Factors Associated With Nonuse of Social Media or Video Communications to Connect With Friends and Family During the COVID-19 Pandemic in Older Adults: Web-Based Survey Study %A Savage,Rachel D %A Di Nicolo,Sophia %A Wu,Wei %A Li,Joyce %A Lawson,Andrea %A Grieve,Jim %A Goel,Vivek %A Rochon,Paula A %+ Women's Age Lab, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 416 351 3732 ext 3822, rachel.savage@wchospital.ca %K digital technology %K loneliness %K older adults %K COVID-19 %K elderly %K lonely %K mental health %K factor %K usage %K social media %K video %K communication %K connection %K connect %K family %K friend %K age %K support %D 2022 %7 6.6.2022 %9 Original Paper %J JMIR Aging %G English %X Background: Digital technologies have enabled social connection during prolonged periods of physical distancing and travel restrictions throughout the COVID-19 pandemic. These solutions may exclude older adults, who are at higher risk for social isolation, loneliness, and severe outcomes if infected with SARS-CoV-2. Objective: This study investigated factors associated with nonuse of social media or video communications to connect with friends and family among older adults during the pandemic’s first wave. Methods: A web-based, cross-sectional survey was administered to members of a national retired educators’ organization based in Ontario, Canada, between May 6 and 19, 2020. Respondents (N=4879) were asked about their use of social networking websites or apps to communicate with friends and family, their internet connection and smartphone access, loneliness, and sociodemographic characteristics. Factors associated with nonuse were evaluated using multivariable logistic regression. A thematic analysis was performed on open-ended survey responses that described experiences with technology and virtual connection. Results: Overall, 15.4% (751/4868) of respondents did not use social networking websites or apps. After adjustment, male gender (odds ratio [OR] 1.60, 95% CI 1.33-1.92), advanced age (OR 1.88, 95% CI 1.38-2.55), living alone (OR 1.68, 95% CI 1.39-2.02), poorer health (OR 1.33, 95% CI 1.04-1.71), and lower social support (OR 1.44, 95% CI 1.20-1.71) increased the odds of nonuse. The reliability of internet connection and access to a smartphone also predicted nonuse. Many respondents viewed these technologies as beneficial, especially for maintaining pre–COVID-19 social contacts and routines, despite preferences for in-person connection. Conclusions: Several factors including advanced age, living alone, and low social support increased the odds of nonuse of social media in older adults to communicate with friends and family during COVID-19’s first wave. Our findings identified socially vulnerable subgroups who may benefit from intervention (eg, improved access, digital literacy, and telephone outreach) to improve social connection. %M 35344502 %R 10.2196/34793 %U https://aging.jmir.org/2022/2/e34793 %U https://doi.org/10.2196/34793 %U http://www.ncbi.nlm.nih.gov/pubmed/35344502 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e37377 %T Overlapping Delta and Omicron Outbreaks During the COVID-19 Pandemic: Dynamic Panel Data Estimates %A Lundberg,Alexander L %A Lorenzo-Redondo,Ramon %A Hultquist,Judd F %A Hawkins,Claudia A %A Ozer,Egon A %A Welch,Sarah B %A Prasad,P V Vara %A Achenbach,Chad J %A White,Janine I %A Oehmke,James F %A Murphy,Robert L %A Havey,Robert J %A Post,Lori A %+ Buehler Center for Health Policy and Economics, Robert J Havey, MD Institute for Global Health, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States, 1 3125031706, lori.post@northwestern.edu %K Omicron variant of concern %K Delta %K COVID-19 %K SARS-CoV-2 %K B.1.1.529 %K outbreak %K Arellano-Bond estimator %K dynamic panel data %K stringency index %K surveillance %K disease transmission metrics %D 2022 %7 3.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Omicron variant of SARS-CoV-2 is more transmissible than prior variants of concern (VOCs). It has caused the largest outbreaks in the pandemic, with increases in mortality and hospitalizations. Early data on the spread of Omicron were captured in countries with relatively low case counts, so it was unclear how the arrival of Omicron would impact the trajectory of the pandemic in countries already experiencing high levels of community transmission of Delta. Objective: The objective of this study is to quantify and explain the impact of Omicron on pandemic trajectories and how they differ between countries that were or were not in a Delta outbreak at the time Omicron occurred. Methods: We used SARS-CoV-2 surveillance and genetic sequence data to classify countries into 2 groups: those that were in a Delta outbreak (defined by at least 10 novel daily transmissions per 100,000 population) when Omicron was first sequenced in the country and those that were not. We used trend analysis, survival curves, and dynamic panel regression models to compare outbreaks in the 2 groups over the period from November 1, 2021, to February 11, 2022. We summarized the outbreaks in terms of their peak rate of SARS-CoV-2 infections and the duration of time the outbreaks took to reach the peak rate. Results: Countries that were already in an outbreak with predominantly Delta lineages when Omicron arrived took longer to reach their peak rate and saw greater than a twofold increase (2.04) in the average apex of the Omicron outbreak compared to countries that were not yet in an outbreak. Conclusions: These results suggest that high community transmission of Delta at the time of the first detection of Omicron was not protective, but rather preluded larger outbreaks in those countries. Outbreak status may reflect a generally susceptible population, due to overlapping factors, including climate, policy, and individual behavior. In the absence of strong mitigation measures, arrival of a new, more transmissible variant in these countries is therefore more likely to lead to larger outbreaks. Alternately, countries with enhanced surveillance programs and incentives may be more likely to both exist in an outbreak status and detect more cases during an outbreak, resulting in a spurious relationship. Either way, these data argue against herd immunity mitigating future outbreaks with variants that have undergone significant antigenic shifts. %M 35500140 %R 10.2196/37377 %U https://publichealth.jmir.org/2022/6/e37377 %U https://doi.org/10.2196/37377 %U http://www.ncbi.nlm.nih.gov/pubmed/35500140 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 6 %P e34296 %T Estimating COVID-19 Hospitalizations in the United States With Surveillance Data Using a Bayesian Hierarchical Model: Modeling Study %A Couture,Alexia %A Iuliano,A Danielle %A Chang,Howard H %A Patel,Neha N %A Gilmer,Matthew %A Steele,Molly %A Havers,Fiona P %A Whitaker,Michael %A Reed,Carrie %+ Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, 30329, United States, 1 4044985984, njh6@cdc.gov %K COVID-19 %K SARS-CoV-2 %K hospitalization %K Bayesian %K COVID-NET %K extrapolation %K hospital %K estimation %K prediction %K United States %K surveillance %K data %K model %K modeling %K hierarchical %K rate %K novel %K framework %K monitoring %D 2022 %7 2.6.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In the United States, COVID-19 is a nationally notifiable disease, meaning cases and hospitalizations are reported by states to the Centers for Disease Control and Prevention (CDC). Identifying and reporting every case from every facility in the United States may not be feasible in the long term. Creating sustainable methods for estimating the burden of COVID-19 from established sentinel surveillance systems is becoming more important. Objective: We aimed to provide a method leveraging surveillance data to create a long-term solution to estimate monthly rates of hospitalizations for COVID-19. Methods: We estimated monthly hospitalization rates for COVID-19 from May 2020 through April 2021 for the 50 states using surveillance data from the COVID-19-Associated Hospitalization Surveillance Network (COVID-NET) and a Bayesian hierarchical model for extrapolation. Hospitalization rates were calculated from patients hospitalized with a lab-confirmed SARS-CoV-2 test during or within 14 days before admission. We created a model for 6 age groups (0-17, 18-49, 50-64, 65-74, 75-84, and ≥85 years) separately. We identified covariates from multiple data sources that varied by age, state, and month and performed covariate selection for each age group based on 2 methods, Least Absolute Shrinkage and Selection Operator (LASSO) and spike and slab selection methods. We validated our method by checking the sensitivity of model estimates to covariate selection and model extrapolation as well as comparing our results to external data. Results: We estimated 3,583,100 (90% credible interval [CrI] 3,250,500-3,945,400) hospitalizations for a cumulative incidence of 1093.9 (992.4-1204.6) hospitalizations per 100,000 population with COVID-19 in the United States from May 2020 through April 2021. Cumulative incidence varied from 359 to 1856 per 100,000 between states. The age group with the highest cumulative incidence was those aged ≥85 years (5575.6; 90% CrI 5066.4-6133.7). The monthly hospitalization rate was highest in December (183.7; 90% CrI 154.3-217.4). Our monthly estimates by state showed variations in magnitudes of peak rates, number of peaks, and timing of peaks between states. Conclusions: Our novel approach to estimate hospitalizations for COVID-19 has potential to provide sustainable estimates for monitoring COVID-19 burden as well as a flexible framework leveraging surveillance data. %M 35452402 %R 10.2196/34296 %U https://publichealth.jmir.org/2022/6/e34296 %U https://doi.org/10.2196/34296 %U http://www.ncbi.nlm.nih.gov/pubmed/35452402 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35380 %T Digital Health Opportunities to Improve Primary Health Care in the Context of COVID-19: Scoping Review %A Silva,Cícera Renata Diniz Vieira %A Lopes,Rayssa Horácio %A de Goes Bay Jr,Osvaldo %A Martiniano,Claudia Santos %A Fuentealba-Torres,Miguel %A Arcêncio,Ricardo Alexandre %A Lapão,Luís Velez %A Dias,Sonia %A Uchoa,Severina Alice da Costa %+ Faculty of Health Sciences, Federal University of Rio Grande do Norte, 601 General Gustavo Cordeiro de Faria Street, Natal, 59012-570, Brazil, 55 84 3221 0862, renatadiniz_enf@yahoo.com.br %K digital health %K telehealth %K telemedicine %K primary health care %K quality of care %K COVID-19 %K pandemic %K science database %K gray literature %D 2022 %7 31.5.2022 %9 Review %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic brought social, economic, and health impacts, requiring fast adaptation of health systems. Although information and communication technologies were essential for achieving this objective, the extent to which health systems incorporated this technology is unknown. Objective: The aim of this study was to map the use of digital health strategies in primary health care worldwide and their impact on quality of care during the COVID-19 pandemic. Methods: We performed a scoping review based on the Joanna Briggs Institute manual and guided by the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. A systematic and comprehensive three-step search was performed in June and July 2021 in multidisciplinary health science databases and the gray literature. Data extraction and eligibility were performed by two authors independently and interpreted using thematic analysis. Results: A total of 44 studies were included and six thematic groups were identified: characterization and geographic distribution of studies; nomenclatures of digital strategies adopted; types of information and communication technologies; characteristics of digital strategies in primary health care; impacts on quality of care; and benefits, limitations, and challenges of digital strategies in primary health care. The impacts on organization of quality of care were investigated by the majority of studies, demonstrating the strengthening of (1) continuity of care; (2) economic, social, geographical, time, and cultural accessibility; (3) coordination of care; (4) access; (5) integrality of care; (6) optimization of appointment time; (7) and efficiency. Negative impacts were also observed in the same dimensions, such as reduced access to services and increased inequity and unequal use of services offered, digital exclusion of part of the population, lack of planning for defining the role of professionals, disarticulation of actions with real needs of the population, fragile articulation between remote and face-to-face modalities, and unpreparedness of professionals to meet demands using digital technologies. Conclusions: The results showed the positive and negative impacts of remote strategies on quality of care in primary care and the inability to take advantage of the potential of technologies. This may demonstrate differences in the organization of fast and urgent implementation of digital strategies in primary health care worldwide. Primary health care must strengthen its response capacity, expand the use of information and communication technologies, and manage challenges using scientific evidence since digital health is important and must be integrated into public service. %M 35319466 %R 10.2196/35380 %U https://humanfactors.jmir.org/2022/2/e35380 %U https://doi.org/10.2196/35380 %U http://www.ncbi.nlm.nih.gov/pubmed/35319466 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e34438 %T A Novel Tool for Real-time Estimation of Epidemiological Parameters of Communicable Diseases Using Contact-Tracing Data: Development and Deployment %A Silenou,Bernard C %A Verset,Carolin %A Kaburi,Basil B %A Leuci,Olivier %A Ghozzi,Stéphane %A Duboudin,Cédric %A Krause,Gérard %+ Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, Braunschweig, 38124, Germany, 49 5316181 3100, Gerard.Krause@helmholtz-hzi.de %K COVID-19 %K disease outbreak %K contact tracing %K serial interval %K basic reproduction number %K infectious disease incubation period %K superspreading events %K telemedicine %K public health %K epidemiology %K surveillance tool %K outbreak response %K pandemic %K digital health application %K response strategy %D 2022 %7 31.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Surveillance Outbreak Response Management and Analysis System (SORMAS) contains a management module to support countries in their epidemic response. It consists of the documentation, linkage, and follow-up of cases, contacts, and events. To allow SORMAS users to visualize data, compute essential surveillance indicators, and estimate epidemiological parameters from such network data in real-time, we developed the SORMAS Statistics (SORMAS-Stats) application. Objective: This study aims to describe the essential visualizations, surveillance indicators, and epidemiological parameters implemented in the SORMAS-Stats application and illustrate the application of SORMAS-Stats in response to the COVID-19 outbreak. Methods: Based on findings from a rapid review and SORMAS user requests, we included the following visualization and estimation of parameters in SORMAS-Stats: transmission network diagram, serial interval (SI), time-varying reproduction number R(t), dispersion parameter k, and additional surveillance indicators presented in graphs and tables. We estimated SI by fitting lognormal, gamma, and Weibull distributions to the observed distribution of the number of days between symptom onset dates of infector-infectee pairs. We estimated k by fitting a negative binomial distribution to the observed number of infectees per infector. Furthermore, we applied the Markov Chain Monte Carlo approach and estimated R(t) using the incidence data and the observed SI computed from the transmission network data. Results: Using COVID-19 contact-tracing data of confirmed cases reported between July 31 and October 29, 2021, in the Bourgogne-Franche-Comté region of France, we constructed a network diagram containing 63,570 nodes. The network comprises 1.75% (1115/63,570) events, 19.59% (12,452/63,570) case persons, and 78.66% (50,003/63,570) exposed persons, including 1238 infector-infectee pairs and 3860 transmission chains with 24.69% (953/3860) having events as the index infector. The distribution with the best fit to the observed SI data was a lognormal distribution with a mean of 4.30 (95% CI 4.09-4.51) days. We estimated a dispersion parameter k of 21.11 (95% CI 7.57-34.66) and an effective reproduction number R of 0.9 (95% CI 0.58-0.60). The weekly estimated R(t) values ranged from 0.80 to 1.61. Conclusions: We provide an application for real-time estimation of epidemiological parameters, which is essential for informing outbreak response strategies. The estimates are commensurate with findings from previous studies. The SORMAS-Stats application could greatly assist public health authorities in the regions using SORMAS or similar tools by providing extensive visualizations and computation of surveillance indicators. %M 35486812 %R 10.2196/34438 %U https://publichealth.jmir.org/2022/5/e34438 %U https://doi.org/10.2196/34438 %U http://www.ncbi.nlm.nih.gov/pubmed/35486812 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e34279 %T Application of Spatial Risk Assessment Integrated With a Mobile App in Fighting Against the Introduction of African Swine Fever in Pig Farms in Thailand: Development Study %A Thanapongtharm,Weerapong %A Wongphruksasoong,Vilaiporn %A Sangrat,Waratida %A Thongsrimoung,Kittin %A Ratanavanichrojn,Nattavut %A Kasemsuwan,Suwicha %A Khamsiriwatchara,Amnat %A Kaewkungwal,Jaranit %A Leelahapongsathon,Kansuda %+ Faculty of Veterinary Medicine, Kasetsart University, Malaiman Rd, Kamphaeng Saen, Nakhon Pathom, 73140, Thailand, 66 34351901, fvetkul@ku.ac.th %K African swine fever %K multi-criteria decision analysis %K risk-based surveillance %K risk assessment %K spatial analysis %D 2022 %7 31.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: African swine fever (ASF), a highly contagious disease affecting both domestic and wild pigs, has been having a serious impact on the swine industry worldwide. This important transboundary animal disease can be spread by animals and ticks via direct transmission and by contaminated feed and fomites via indirect transmission because of the high environmental resistance of the ASF virus. Thus, the prevention of the introduction of ASF to areas free of ASF is essential. After an outbreak was reported in China, intensive import policies and biosecurity measures were implemented to prevent the introduction of ASF to pig farms in Thailand. Objective: Enhancing prevention and control, this study aims to identify the potential areas for ASF introduction and transmission in Thailand, develop a tool for farm assessment of ASF risk introduction focusing on smallholders, and develop a spatial analysis tool that is easily used by local officers for disease prevention and control planning. Methods: We applied a multi-criteria decision analysis approach with spatial and farm assessment and integrated the outputs with the necessary spatial layers to develop a spatial analysis on a web-based platform. Results: The map that referred to potential areas for ASF introduction and transmission was derived from 6 spatial risk factors; namely, the distance to the port, which had the highest relative importance, followed by the distance to the border, the number of pig farms using swill feeding, the density of small pig farms (<50 heads), the number of pigs moving in the area, and the distance to the slaughterhouse. The possible transmission areas were divided into 5 levels (very low, low, medium, high, and very high) at the subdistrict level, with 27 subdistricts in 10 provinces having very high suitability and 560 subdistricts in 34 provinces having high suitability. At the farm level, 17 biosecurity practices considered as useful and practical for smallholders were selected and developed on a mobile app platform. The outputs from the previous steps integrated with necessary geographic information system layers were added to a spatial analysis web-based platform. Conclusions: The tools developed in this study have been complemented with other strategies to fight against the introduction of ASF to pig farms in the country. The areas showing high and very high risk for disease introduction and transmission were applied for spatial information planning, for example, intensive surveillance, strict animal movement, and public awareness. In addition, farms with low biosecurity were improved in these areas, and the risk assessment developed on a mobile app in this study helped enhance this matter. The spatial analysis on a web-based platform helped facilitate disease prevention planning for the authorities. %M 35639455 %R 10.2196/34279 %U https://formative.jmir.org/2022/5/e34279/ %U https://doi.org/10.2196/34279 %U http://www.ncbi.nlm.nih.gov/pubmed/35639455 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e34710 %T COVID-19 News and Its Association With the Mental Health of Sexual and Gender Minority Adults: Cross-sectional Study %A Clark,Kristen D %A Lunn,Mitchell R %A Sherman,Athena D F %A Bosley,Hannah G %A Lubensky,Micah E %A Obedin-Maliver,Juno %A Dastur,Zubin %A Flentje,Annesa %+ Department of Nursing, University of New Hampshire, 4 Library Way, Durham, NH, 03824, United States, 1 603 862 2271, kristen.clark@unh.edu %K PTSD %K posttraumatic stress disorder %K anxiety %K minority populations %K vicarious trauma %K tertiary trauma %K COVID-19 %K pandemic %K public health %K sexual orientation %K gender identity %K mental health %D 2022 %7 30.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Sexual and gender minority (SGM; people whose sexual orientation is not heterosexual or whose gender identity varies from what is traditionally associated with the sex assigned to them at birth) people experience high rates of trauma and substantial disparities in anxiety and posttraumatic stress disorder (PTSD). Exposure to traumatic stressors such as news related to COVID-19 may be associated with symptoms of anxiety and PTSD. Objective: This study aims to evaluate the relationship of COVID-19 news exposure with anxiety and PTSD symptoms in a sample of SGM adults in the United States. Methods: Data were collected between March 23 and August 2, 2020, from The PRIDE Study, a national longitudinal cohort study of SGM people. Regression analyses were used to analyze the relationship between self-reported news exposure and symptoms of anxiety using the Generalized Anxiety Disorder-7 and symptoms of COVID-19–related PTSD using the Impact of Events Scale-Revised. Results: Our sample included a total of 3079 SGM participants. Each unit increase in COVID-19–related news exposure was associated with greater anxiety symptoms (odds ratio 1.77, 95% CI 1.63-1.93; P<.001) and 1.93 greater odds of PTSD (95% CI 1.74-2.14; P<.001). Conclusions: Our study found that COVID-19 news exposure was positively associated with greater symptoms of anxiety and PTSD among SGM people. This supports previous literature in other populations where greater news exposure was associated with poorer mental health. Further research is needed to determine the direction of this relationship and to evaluate for differences among SGM subgroups with multiple marginalized identities. %M 35486805 %R 10.2196/34710 %U https://publichealth.jmir.org/2022/5/e34710 %U https://doi.org/10.2196/34710 %U http://www.ncbi.nlm.nih.gov/pubmed/35486805 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e37328 %T The Efficacy of a Brief, Altruism-Eliciting Video Intervention in Enhancing COVID-19 Vaccination Intentions Among a Population-Based Sample of Younger Adults: Randomized Controlled Trial %A Zhu,Patricia %A Tatar,Ovidiu %A Griffin-Mathieu,Gabrielle %A Perez,Samara %A Haward,Ben %A Zimet,Gregory %A Tunis,Matthew %A Dubé,Ève %A Rosberger,Zeev %+ Lady Davis Institute for Medical Research, Jewish General Hospital, 4333 Cote Ste-Catherine Road, Montreal, QC, H3T1E4, Canada, 1 514 340 8222 ext 23978, ovidiu.tatar@mail.mcgill.ca %K COVID-19 %K vaccination %K altruism %K prosocial motives %K video intervention %K randomized controlled trial %K younger adults %K vaccine hesitancy %K public health %K youth %K digital intervention %K health intervention %K health promotion %K web survey %K digital health %K online health %K health information %D 2022 %7 30.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: High COVID-19 vaccine uptake is crucial to containing the pandemic and reducing hospitalizations and deaths. Younger adults (aged 20-39 years) have demonstrated lower levels of vaccine uptake compared to older adults, while being more likely to transmit the virus due to a higher number of social contacts. Consequently, this age group has been identified by public health authorities as a key target for vaccine uptake. Previous research has demonstrated that altruistic messaging and motivation is associated with vaccine acceptance. Objective: This study had 2 objectives: (1) to evaluate the within-group efficacy of an altruism-eliciting short, animated video intervention in increasing COVID-19 vaccination intentions amongst unvaccinated Canadian younger adults and (2) to examine the video’s efficacy compared to a text-based intervention focused exclusively on non-vaccine-related COVID-19 preventive health measures. Methods: Using a web-based survey in a pre-post randomized control trial (RCT) design, we recruited Canadians aged 20-39 years who were not yet vaccinated against COVID-19 and randomized them in a 1:1 ratio to receive either the video intervention or an active text control. The video intervention was developed by our team in collaboration with a digital media company. The measurement of COVID-19 vaccination intentions before and after completing their assigned intervention was informed by the multistage Precaution Adoption Process Model (PAPM). The McNemar chi-square test was performed to evaluate within-group changes of vaccine intentions. Exact tests of symmetry using pairwise McNemar tests were applied to evaluate changes in multistaged intentions. Between-group vaccine intentions were assessed using the Pearson chi-square test postintervention. Results: Analyses were performed on 1373 participants (n=686, 50%, in the video arm, n=687, 50%, in the text arm). Within-group results for the video intervention arm showed that there was a significant change in the intention to receive the vaccine (χ21=20.55, P<.001). The between-group difference in postintervention intentions (χ23=1.70, P=.64) was not significant. When administered the video intervention, we found that participants who had not thought about or were undecided about receiving a COVID-19 vaccine were more amenable to change than participants who had already decided not to vaccinate. Conclusions: Although the video intervention was limited in its effect on those who had firmly decided not to vaccinate, our study demonstrates that prosocial and altruistic messages could increase COVID-19 vaccine uptake, especially when targeted to younger adults who are undecided or unengaged regarding vaccination. This might indicate that altruistic messaging provides a “push” for those who are tentative toward, or removed from, the decision to receive the vaccine. The results of our study could also be applied to more current COVID-19 vaccination recommendations (eg, booster shots) and for other vaccine-preventable diseases. Trial Registration: ClinicalTrials.gov NCT04960228; https://clinicaltrials.gov/ct2/show/NCT04960228 %M 35544437 %R 10.2196/37328 %U https://publichealth.jmir.org/2022/5/e37328 %U https://doi.org/10.2196/37328 %U http://www.ncbi.nlm.nih.gov/pubmed/35544437 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 3 %N 1 %P e37391 %T In Silico Comparative Analysis of the Functional, Structural, and Evolutionary Properties of SARS-CoV-2 Variant Spike Proteins %A Math,Renukaradhya K %A Mudennavar,Nayana %A Javaregowda,Palaksha Kanive %A Savanur,Ambuja %+ SDM Research Institute for Biomedical Sciences, Shri Dharmasthala Manjunatheshwara University, 5th floor, Manjushree building, SDM College of Medical Sciences & Hospital Campus, Dharwad, 580009, India, 91 7019982929, aradhya.swamy@gmail.com %K spike protein variants %K NCBI %K bioinformatics tools %K pI %K isoelectric point %K 2D map %K phylogenetic tree %K COVID-19 %K COVID therapy %K SARS-CoV-2 treatment %K therapeutic %K spike protein %K protein %K prophylactic %K sequence analysis %K genomic %K bioinformatics %K viral protein %D 2022 %7 30.5.2022 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: A recent global outbreak of COVID-19 caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) created a pandemic and emerged as a potential threat to humanity. The analysis of virus genetic composition has revealed that the spike protein, one of the major structural proteins, facilitates the entry of the virus to host cells. Objective: The spike protein has become the main target for prophylactics and therapeutics studies. Here, we compared the spike proteins of SARS-CoV-2 variants using bioinformatics tools. Methods: The spike protein sequences of wild-type SARS-CoV-2 and its 6 variants—D614G, alpha (B.1.1.7), beta (B.1.351), delta (B.1.617.2), gamma (P.1), and omicron (B.1.1.529)—were retrieved from the NCBI database. The ClustalX program was used to sequence multiple alignment and perform mutational analysis. Several online bioinformatics tools were used to predict the physiological, immunological, and structural features of the spike proteins of SARS-CoV-2 variants. A phylogenetic tree was constructed using CLC software. Statistical analysis of the data was done using jamovi 2 software. Results: Multiple sequence analysis revealed that the P681R mutation in the delta variant, which changed an amino acid from histidine (H) to arginine (R), made the protein more alkaline due to arginine’s high pKa value (12.5) compared to histidine’s (6.0). Physicochemical properties revealed the relatively higher isoelectric point (7.34) and aliphatic index (84.65) of the delta variant compared to other variants. Statistical analysis of the isoelectric point, antigenicity, and immunogenicity of all the variants revealed significant correlation, with P values ranging from <.007 to .04. The generation of a 2D gel map showed the separation of the delta spike protein from a grouping of the other variants. The phylogenetic tree of the spike proteins showed that the delta variant was close to and a mix of the Rousettus bat coronavirus and MERS-CoV. Conclusions: The comparative analysis of SARS-CoV-2 variants revealed that the delta variant is more aliphatic in nature, which provides more stability to it and subsequently influences virus behavior. %M 35669291 %R 10.2196/37391 %U https://bioinform.jmir.org/2022/1/e37391 %U https://doi.org/10.2196/37391 %U http://www.ncbi.nlm.nih.gov/pubmed/35669291 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 5 %P e30371 %T The Associations Between Racially/Ethnically Stratified COVID-19 Tweets and COVID-19 Cases and Deaths: Cross-sectional Study %A Liu,Xiaohui %A Kar,Bandana %A Montiel Ishino,Francisco Alejandro %A Onega,Tracy %A Williams,Faustine %+ National Institute on Minority Health and Health Disparities, National Institutes of Health, 6707 Democracy Boulevard, Suite 800, Bethesda, MD, 20892, United States, 1 8016464179, xiaohuiliugis@gmail.com %K racial/ethnic stratification %K geo-tagged COVID-19 tweets %K racial/ethnic disparity %K surveillance %D 2022 %7 30.5.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic exacerbated existing racial/ethnic health disparities in the United States. Monitoring nationwide Twitter conversations about COVID-19 and race/ethnicity could shed light on the impact of the pandemic on racial/ethnic minorities and help address health disparities. Objective: This paper aims to examine the association between COVID-19 tweet volume and COVID-19 cases and deaths, stratified by race/ethnicity, in the early onset of the pandemic. Methods: This cross-sectional study used geotagged COVID-19 tweets from within the United States posted in April 2020 on Twitter to examine the association between tweet volume, COVID-19 surveillance data (total cases and deaths in April), and population size. The studied time frame was limited to April 2020 because April was the earliest month when COVID-19 surveillance data on racial/ethnic groups were collected. Racially/ethnically stratified tweets were extracted using racial/ethnic group–related keywords (Asian, Black, Latino, and White) from COVID-19 tweets. Racially/ethnically stratified tweets, COVID-19 cases, and COVID-19 deaths were mapped to reveal their spatial distribution patterns. An ordinary least squares (OLS) regression model was applied to each stratified dataset. Results: The racially/ethnically stratified tweet volume was associated with surveillance data. Specifically, an increase of 1 Asian tweet was correlated with 288 Asian cases (P<.001) and 93.4 Asian deaths (P<.001); an increase of 1 Black tweet was linked to 47.6 Black deaths (P<.001); an increase of 1 Latino tweet was linked to 719 Latino deaths (P<.001); and an increase of 1 White tweet was linked to 60.2 White deaths (P<.001). Conclusions: Using racially/ethnically stratified Twitter data as a surveillance indicator could inform epidemiologic trends to help estimate future surges of COVID-19 cases and potential future outbreaks of a pandemic among racial/ethnic groups. %M 35537056 %R 10.2196/30371 %U https://formative.jmir.org/2022/5/e30371 %U https://doi.org/10.2196/30371 %U http://www.ncbi.nlm.nih.gov/pubmed/35537056 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e38034 %T A Web-Based Public Health Intervention for Addressing Vaccine Misinformation: Protocol for Analyzing Learner Engagement and Impacts on the Hesitancy to Vaccinate %A Powell,Leigh %A Nour,Radwa %A Zidoun,Youness %A Kaladhara,Sreelekshmi %A Al Suwaidi,Hanan %A Zary,Nabil %+ Institute for Excellence in Health Professions Education, Mohammed Bin Rashid University of Medicine and Health Sciences, Building 14, Dubai Healthcare City, PO Box 505055, Dubai, United Arab Emirates, 971 585960762, nabil.zary@icloud.com %K public health %K population health %K education %K gamification %K COVID-19 %K vaccination %K misinformation %K infodemic %K vaccine hesitancy %K web-based health %K web-based intervention %K learning design %K dissemination %D 2022 %7 30.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: A barrier to successful COVID-19 vaccine campaigns is the ongoing misinformation pandemic, or infodemic, which is contributing to vaccine hesitancy. Web-based population health interventions have been shown to impact health behaviors positively. For web-based interventions to be successful, they must use effective learning design strategies that seek to address known issues with learner engagement and retention. To know if an intervention successfully addresses vaccine hesitancy, there must be some embedded measure for comparing learners preintervention and postintervention. Objective: This protocol aims to describe a study on the effectiveness of a web-based population health intervention that is designed to address vaccine misinformation and hesitancy. The study will examine learner analytics to understand what aspects of the learning design for the intervention were effective and implement a validated instrument—the Adult Vaccine Hesitancy Scale—to measure if any changes in vaccine hesitancy were observed preintervention and postintervention. Methods: We developed a fully web-based population health intervention to help learners identify misinformation concerning COVID-19 and share the science behind vaccinations. Intervention development involves using a design-based research approach to output more effective interventions in which data can be analyzed to improve future health interventions. The study will use a quasi-experimental design in which a pre-post survey will be provided and compared statistically. Learning analytics will also be generated based on the engagement and retention data collected through the intervention to understand what aspects of our learning design are effective. Results: The web-based intervention was released to the public in September 2021, and data collection is ongoing. No external marketing or advertising has been done to market the course, making our current population of 486 participants our pilot study population. An analysis of this initial population will enable the revision of the intervention, which will then be marketed to a broader audience. Study outcomes are expected to be published by August 2022. We anticipate the release of the revised intervention by May 2022. Conclusions: Disseminating accurate information to the public during pandemic situations is vital to contributing to positive health outcomes, such as those among people getting vaccinated. Web-based interventions are valuable, as they can reach people anytime and anywhere. However, web-based interventions must use sound learning design to help incentivize engagement and motivate learners to learn and must provide a means of evaluating the intervention to determine its impact. Our study will examine both the learning design and the effectiveness of the intervention by using the analytics collected within the intervention and a statistical analysis of a validated instrument to determine if learners had a change in vaccine hesitancy as a result of what they learned. International Registered Report Identifier (IRRID): DERR1-10.2196/38034 %M 35451967 %R 10.2196/38034 %U https://www.researchprotocols.org/2022/5/e38034 %U https://doi.org/10.2196/38034 %U http://www.ncbi.nlm.nih.gov/pubmed/35451967 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e32543 %T Artificial Intelligence–Enabled Social Media Analysis for Pharmacovigilance of COVID-19 Vaccinations in the United Kingdom: Observational Study %A Hussain,Zain %A Sheikh,Zakariya %A Tahir,Ahsen %A Dashtipour,Kia %A Gogate,Mandar %A Sheikh,Aziz %A Hussain,Amir %+ Edinburgh Medical School, College of Medicine and Veterinary Medicine, University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, United Kingdom, 44 131 242 9100, zhuss95@gmail.com %K COVID-19 %K artificial intelligence %K deep learning %K Facebook %K health informatics %K natural language processing %K public health %K sentiment analysis %K social media %K Twitter %K infodemiology %K vaccination %D 2022 %7 27.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background:  The rollout of vaccines for COVID-19 in the United Kingdom started in December 2020. Uptake has been high, and there has been a subsequent reduction in infections, hospitalizations, and deaths among vaccinated individuals. However, vaccine hesitancy remains a concern, in particular relating to adverse effects following immunization (AEFIs). Social media analysis has the potential to inform policy makers about AEFIs being discussed by the public as well as public attitudes toward the national immunization campaign. Objective:  We sought to assess the frequency and nature of AEFI-related mentions on social media in the United Kingdom and to provide insights on public sentiments toward COVID-19 vaccines. Methods:  We extracted and analyzed over 121,406 relevant Twitter and Facebook posts, from December 8, 2020, to April 30, 2021. These were thematically filtered using a 2-step approach, initially using COVID-19–related keywords and then using vaccine- and manufacturer-related keywords. We identified AEFI-related keywords and modeled their word frequency to monitor their trends over 2-week periods. We also adapted and utilized our recently developed hybrid ensemble model, which combines state-of-the-art lexicon rule–based and deep learning–based approaches, to analyze sentiment trends relating to the main vaccines available in the United Kingdom. Results:  Our COVID-19 AEFI search strategy identified 46,762 unique Facebook posts by 14,346 users and 74,644 tweets (excluding retweets) by 36,446 users over the 4-month period. We identified an increasing trend in the number of mentions for each AEFI on social media over the study period. The most frequent AEFI mentions were found to be symptoms related to appetite (n=79,132, 14%), allergy (n=53,924, 9%), injection site (n=56,152, 10%), and clots (n=43,907, 8%). We also found some rarely reported AEFIs such as Bell palsy (n=11,909, 2%) and Guillain-Barre syndrome (n=9576, 2%) being discussed as frequently as more well-known side effects like headache (n=10,641, 2%), fever (n=12,707, 2%), and diarrhea (n=16,559, 3%). Overall, we found public sentiment toward vaccines and their manufacturers to be largely positive (58%), with a near equal split between negative (22%) and neutral (19%) sentiments. The sentiment trend was relatively steady over time and had minor variations, likely based on political and regulatory announcements and debates. Conclusions:  The most frequently discussed COVID-19 AEFIs on social media were found to be broadly consistent with those reported in the literature and by government pharmacovigilance. We also detected potential safety signals from our analysis that have been detected elsewhere and are currently being investigated. As such, we believe our findings support the use of social media analysis to provide a complementary data source to conventional knowledge sources being used for pharmacovigilance purposes. %M 35144240 %R 10.2196/32543 %U https://publichealth.jmir.org/2022/5/e32543 %U https://doi.org/10.2196/32543 %U http://www.ncbi.nlm.nih.gov/pubmed/35144240 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e31955 %T Mask Use to Curtail Influenza in a Post–COVID-19 World: Modeling Study %A Froese,Henri %A A Prempeh,Angel G %+ Saginaw Valley State University, 7400 Bay Road, University Center, MI, 48604, United States, 1 9893555177, prempehresearch@gmail.com %K mask %K protection %K COVID-19 %K influenza %K transmission %K intervention %K infectious disease %K respiratory %K simulation %K model %K prevalence %K efficacy %D 2022 %7 27.5.2022 %9 Original Paper %J JMIRx Med %G English %X 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. %M 35666696 %R 10.2196/31955 %U https://med.jmirx.org/2022/2/e31955 %U https://doi.org/10.2196/31955 %U http://www.ncbi.nlm.nih.gov/pubmed/35666696 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e32278 %T Factors Associated With Protective Mask-Wearing Behavior to Avoid COVID-19 Infection in China: Internet-Based Cross-sectional Study %A Xu,Yue %A Wu,Qingqing %A Xu,Shuiyang %A Zhao,Yusui %A Zhang,Xuehai %+ Department of Health Education, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Hangzhou, 310051, China, 86 87115248, xhzhang@cdc.zj.cn %K COVID-19 %K internet-based %K disease prevention %K mask %K knowledge %K behavior %D 2022 %7 26.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 35486491 %R 10.2196/32278 %U https://publichealth.jmir.org/2022/5/e32278 %U https://doi.org/10.2196/32278 %U http://www.ncbi.nlm.nih.gov/pubmed/35486491 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e30070 %T The Impacts of the COVID-19 Pandemic on HIV Testing Utilization Among Men Who Have Sex With Men in China: Cross-sectional Online Survey %A Zhang,Ke Chun %A Fang,Yuan %A Cao,He %A Chen,Hongbiao %A Hu,Tian %A Chen,Ya Qi %A Zhou,Xiaofeng %A Wang,Zixin %+ JC School of Public Health and Primary Care, Faculty of Medicine, Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong, 666888, Hong Kong, 852 22528740, wangzx@cuhk.edu.hk %K COVID-19 %K HIV testing %K sexual risk behaviors %K structural barriers %K perception %K men who have sex with men %K China %K MSM %K HIV %K testing %K impact %K utilization %K cross-sectional %K online survey %K barrier %K access %D 2022 %7 25.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has created disruptions in HIV prevention and sexual health services for men who have sex with men (MSM). Objective: This study compared HIV testing utilization in 3 different reference periods (period 1: before the COVID-19 outbreak, November 2019-January 2020; period 2: after the outbreak, February-April 2020; and period 3: after the pandemic was under initial control, May-July 2020). Factors associated with HIV testing utilization after the COVID-19 outbreak (combined periods 2 and 3) were also investigated. Methods: Participants were MSM aged ≥18 years living in Shenzhen, China. Those self-reporting as HIV positive were excluded. A total of 595 participants recruited through multiple sources completed a self-administered online survey during August-September 2020. HIV testing utilization after the COVID-19 outbreak was the dependent variable, and multivariate logistic regression models were fitted. Results: HIV testing utilization was significantly lower in period 2 than in period 1 (n=262 vs 363, 44.0% vs 61.0%, P<.001). However, HIV testing utilization was not significantly higher in period 3 than in period 2 (n=277 vs 262, 46.6% vs 44.0%, P=.21). The prevalence of HIV testing utilization after the COVID-19 outbreak was seen in 331 (55.6%) participants. After adjusting for significant background characteristics, condomless anal intercourse (CAI) with regular male sex partners (RPs; adjusted odds ratio [AOR] 2.15, 95% CI 1.29-3.57) and sexualized drug use (SDU; AOR 2.94, 95% CI 1.41-6.06) both before and after the COVID-19 outbreak, CAI with RPs (AOR 2.07, 95% CI 1.06-4.07) and nonregular male sex partners (NRPs; AOR 3.57, 95%CI: 1.43-8.89) only after the COVID-19 outbreak was positively associated with the dependent variable. Regarding HIV prevention service utilization, HIV testing utilization before the COVID-19 outbreak (AOR 10.75, 95% CI 7.22-16.02) and the use of sexually transmitted infection (STI) testing (AOR 7.02, 95% CI 4.10-12.02), other HIV/STI prevention (AOR 3.15, 95% CI 2.16-4.60), and preexposure prophylaxis (PrEP; AOR 3.58, 95% CI 1.54-8.34) after the COVID-19 outbreak were associated with higher HIV testing utilization. The current perceived risk of HIV infection was higher than that before the COVID-19 outbreak (AOR 1.15, 95% CI 1.01-1.30), and perceived COVID-19 preventive measures taken by HIV testing service providers to be effective (AOR 1.52, 95% CI 1.29-1.78) and perceived higher behavioral control to undergo HIV testing (AOR 1.18, 95% CI 1.00-1.40) were positively associated with HIV testing utilization. Concerns about COVID-19 infection during HIV testing (AOR 0.78, 95% CI 0.68-0.89), avoiding crowded places (AOR 0.68, 95% CI 0.48-0.98), and HIV testing service providers reducing their working hours (AOR 0.59, 95% CI 0.48-0.98) were negatively associated with the dependent variable. Conclusions: HIV testing utilization among Chinese MSM declined after the COVID-19 outbreak and did not increase after the pandemic was under initial control. Removing structural barriers to accessing HIV testing caused by COVID-19, modifying perceptions related to HIV testing, and making use of HIV self-testing (HIVST) might be useful strategies to improve HIV testing among MSM during the pandemic. %M 35486811 %R 10.2196/30070 %U https://publichealth.jmir.org/2022/5/e30070 %U https://doi.org/10.2196/30070 %U http://www.ncbi.nlm.nih.gov/pubmed/35486811 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e35311 %T Risk Factors Associated With SARS-CoV-2 Breakthrough Infections in Fully mRNA-Vaccinated Individuals: Retrospective Analysis %A Liu,Cong %A Lee,Junghwan %A Ta,Casey %A Soroush,Ali %A Rogers,James R %A Kim,Jae Hyun %A Natarajan,Karthik %A Zucker,Jason %A Perl,Yehoshua %A Weng,Chunhua %+ Department of Biomedical Informatics, Columbia University Irving Medical Center, PH-20, 622 W 168 Street, New York, NY, 10032, United States, 1 212 304 7907, cw2384@cumc.columbia.edu %K COVID-19 %K medical informatics %K real-word evidence %K vaccination %K electronic health records %D 2022 %7 24.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 35486806 %R 10.2196/35311 %U https://publichealth.jmir.org/2022/5/e35311 %U https://doi.org/10.2196/35311 %U http://www.ncbi.nlm.nih.gov/pubmed/35486806 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e35958 %T Korea's Response to COVID-19 According to Set Time Frames, With a Focus on the Network Between the Government and Responding Agencies: Social Network Analysis %A Cho,Jungyun %A Kang,Wook %A Lee,Julak %+ Department of Industrial Security, Chung-Ang University, 84 Heukseok-ro, Seoul, 06974, Republic of Korea, 82 1096231289, julaklee71@cau.ac.kr %K COVID-19 %K government departments’ networks %K network structure %K contagious disease response %K social network analysis %D 2022 %7 23.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In December 2019, COVID-19 was first confirmed in Wuhan, China, and as the respiratory disease spread around the globe, there was a spike in interest worldwide in combating such contagious diseases. When such disasters occur, the central government of South Korea and its affiliated local governments—together with nongovernmental organizations—play a crucial role in crisis management systems. Objective: The purpose of this paper is to corroborate the characteristics government ministries and domestic and foreign institutions exhibit through their interconnection when the parties are undergoing a disease-related catastrophe such as the COVID-19 pandemic. Methods: Using the social network analysis technique, the span of the COVID-19 pandemic was segmented into 3 time frames, and the relational characteristics of the COVID-19 contagious disease response department and related agencies at home and abroad were analyzed based on 3 centralities. Results: Evidence from the second and third time frames indicates that the agents reacting to contagious diseases do not necessarily hold the central position in the network. From this, it can be inferred that it is not only the primary host that plays a pivotal role but the key to a successful response to various disasters also lies in cooperation with the relevant parties. Conclusions: The incongruency between the findings of this paper and the existing disaster response system gives rise to the corollary that both the essential parties and the adjoining ones need to collaborate for a coordinated crisis response in disaster situations. Furthermore, much significance lies in the fact that this paper explores the various aspects that could surface among the host and relevant parties in a real-life pandemic. %M 35486100 %R 10.2196/35958 %U https://publichealth.jmir.org/2022/5/e35958 %U https://doi.org/10.2196/35958 %U http://www.ncbi.nlm.nih.gov/pubmed/35486100 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37674 %T Exploring Online Peer Support Groups for Adults Experiencing Long COVID in the United Kingdom: Qualitative Interview Study %A Day,Hannah L S %+ Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 2079272700, hannah.day1@alumni.lshtm.ac.uk %K COVID-19 %K long COVID %K post-COVID-19 syndrome %K peer support %K online health communities %K self-help groups %K internet %K qualitative %K interview %K patient experience %K digital health %K digital peer support %K online health %D 2022 %7 20.5.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Long COVID is an emerging public health concern. A growing number of individuals are experiencing prolonged, multifaceted health challenges and accompanying social impacts after COVID-19 infections. Support services in the United Kingdom remain insufficient and fraught with complexity. Responding to persistent gaps in care, patients joined forces in online peer support groups. However, little is known about how these groups impact patients with long COVID and their lived experiences of the condition. Objective: The aim of this study is to explore the roles that online peer support groups take on and the impact they have on patients experiencing and recovering from long COVID in the United Kingdom. In doing so, this study aims to identify ways to inform future long COVID care, including online peer support and broader long COVID care structures. Methods: I conducted 11 semistructured interviews virtually on Zoom in July 2021. Participants had long COVID, were UK-based, and used long COVID online peer support groups. Topics discussed in interviews included what led participants to these groups, experiences within them, and feelings about the roles that the groups took on. I analyzed the results by manually conducting thematic analysis. Results: Long COVID online peer support groups had numerous roles, significantly impacting users. I identified 5 themes and 13 subthemes through thematic analysis. The identified themes were as follows: (1) filling professional care gaps, (2) societal awareness, (3) engagement behavior, (4) diversity, and (5) social connections. Given the void of professional support, those experiencing long COVID gained some benefit from these groups. However, participants emphasized notable concerns about the all-encompassing roles these groups embody and speculated over potential improvements. Conclusions: If used appropriately, online peer support groups could be immensely beneficial for patient well-being, beyond simply filling gaps in long COVID care. However, it appears many groups take on more than they can manage and become potentially harmful. Through prioritizing patient voices, long COVID care could be restructured to maximize peer support’s benefits within broader care structures. %M 35468083 %R 10.2196/37674 %U https://www.jmir.org/2022/5/e37674 %U https://doi.org/10.2196/37674 %U http://www.ncbi.nlm.nih.gov/pubmed/35468083 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e35054 %T The Effectiveness of Pfizer-BioNTech and Oxford-AstraZeneca Vaccines to Prevent Severe COVID-19 in Costa Rica: Nationwide, Ecological Study of Hospitalization Prevalence %A Rosero-Bixby,Luis %+ Centro Centroamericano de Población, Universidad de Costa Rica, Ciudad Universitaria Rodrigo Facio, San Pedro, 11501, Costa Rica, 506 25111452, roserobixby@gmail.com %K COVID-19 %K vaccine %K effectiveness %K hospitalization %K epidemiology %K prevention %K severity %K Costa Rica %K observational %K prevalence %K real-world %K virus %K variant %K policy %K monitoring %K surveillance %D 2022 %7 20.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Costa Rican COVID-19 vaccination program has used Pfizer-BioNTech and Oxford-AstraZeneca vaccines. Real-world estimates of the effectiveness of these vaccines to prevent hospitalizations range from 90%-98% for two doses and from 70%-91% for a single dose. Almost all of these estimates predate the Delta variant. Objective: The aim of this study is to estimate the dose-dependent effectiveness of COVID-19 vaccines to prevent severe illness in real-world conditions in Costa Rica, after the Delta variant became dominant. Methods: This observational study is a secondary analysis of hospitalization prevalence. The sample is all 3.67 million adult residents living in Costa Rica by mid-2021. The study is based on public aggregated data of 5978 COVID-19–related hospital records from September 14, 2021, to October 20, 2021, and 6.1 million vaccination doses administered to determine hospitalization prevalence by dose-specific vaccination status. The intervention retrospectively evaluated is vaccination with Pfizer-BioNTech (78%) and Oxford-AstraZeneca (22%). The main outcome studied is being hospitalized. Results: Vaccine effectiveness against hospitalization (VEH) was estimated as 93.4% (95% CI 93.0-93.9) for complete vaccination and 76.7% (95% CI 75.0-78.3) for single-dose vaccination among adults of all ages. VEH was lower and more uncertain among older adults aged ≥58 years: 92% (95% CI 91%-93%) for those who had received full vaccination and 64% (95% CI 58%-69%) for those who had received partial vaccination. Single-dose VEH declined over time during the study period, especially in the older age group. Estimates were sensitive to possible errors in the population count used to determine the residual number of unvaccinated people when vaccine coverage is high. Conclusions: The Costa Rican COVID-19 vaccination program that administered Pfizer-BioNTech and Oxford-AstraZeneca vaccines seems to be highly effective at preventing COVID-19–related hospitalization after the Delta variant became dominant. Even a single dose seems to provide some degree of protection, which is good news for people whose second dose of the Pfizer-BioNTech vaccine was postponed several weeks to more rapidly increase the number of people vaccinated with a first dose. Timely monitoring of vaccine effectiveness is important to detect eventual failures and motivate the public to get vaccinated by providing information regarding the effectiveness of the vaccines. %M 35483079 %R 10.2196/35054 %U https://publichealth.jmir.org/2022/5/e35054 %U https://doi.org/10.2196/35054 %U http://www.ncbi.nlm.nih.gov/pubmed/35483079 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e33235 %T Changes in Parental Attitudes Toward COVID-19 Vaccination and Routine Childhood Vaccination During the COVID-19 Pandemic: Repeated Cross-sectional Survey Study %A Wang,Qiang %A Xiu,Shixin %A Yang,Liuqing %A Han,Ying %A Cui,Tingting %A Shi,Naiyang %A Liu,Minqi %A Yi,Youqin %A Liu,Chang %A Wang,Xuwen %A Yang,Guoping %A Ji,Lili %A Zhou,Weijie %A Jin,Hui %A Zhen,Shiqi %A Lin,Leesa %+ Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, 87# Dingjiaqiao, Nanjing, 210009, China, 86 02583272572, jinhui_hld@163.com %K childhood vaccination %K COVID-19 vaccine %K vaccine hesitancy %K repeated cross-section survey %D 2022 %7 13.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: It was reported that one in four parents were hesitant about vaccinating their children in China. Previous studies have revealed a declining trend in the vaccine willingness rate in China. There is a need to monitor the level of parental vaccine hesitancy toward routine childhood vaccination and hesitancy toward the COVID-19 vaccine during the ongoing COVID-19 pandemic. Objective: This study aims to assess changes in trends of parental attitudes toward routine childhood vaccines and COVID-19 vaccinations across different time periods in China. Methods: Three waves of cross-sectional surveys were conducted on parents residing in Wuxi City in Jiangsu Province, China from September to October 2020, February to March 2021, and May to June 2021. Participants were recruited from immunization clinics. Chi-square tests were used to compare the results of the three surveys, controlling for sociodemographic factors. Binary and multivariable logistic regression analysis was used to examine factors related to parental vaccine hesitancy and COVID-19 vaccine willingness. Results: Overall, 2881, 1038, and 1183 participants were included in the survey’s three waves. Using the Vaccine Hesitancy Scale, 7.8% (225/2881), 15.1% (157/1038), and 5.5% (65/1183) of parents showed hesitancy to childhood vaccination (P<.001), and 59.3% (1709/2881), 64.6% (671/1038), and 92% (1088/1183) of parents agreed to receive a COVID-19 vaccine themselves in the first, second, and third surveys, respectively (P<.001). In all three surveys, “concerns about vaccine safety and side effects” was the most common reason for refusal. Conclusions: There has been an increasing acceptance of COVID-19 vaccination in Wuxi City, China. Effective interventions are needed to mitigate public concerns about vaccine safety. %M 35486516 %R 10.2196/33235 %U https://publichealth.jmir.org/2022/5/e33235 %U https://doi.org/10.2196/33235 %U http://www.ncbi.nlm.nih.gov/pubmed/35486516 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e32859 %T Cognitive Factors Associated With Public Acceptance of COVID-19 Nonpharmaceutical Prevention Measures: Cross-sectional Study %A Constant,Aymery %A Conserve,Donaldson %A Gallopel-Morvan,Karine %A Raude,Jocelyn %+ Ecole des Hautes Etudes en Santé Publique, 15 Avenue du Prof Leon Bernard, Rennes, 35043, France, 33 2 99 02 25 93, Aymery.constant@ehesp.Fr %K Extended Parallel Process Model %K COVID-19 %K lockdown %K public acceptance %K nonpharmaceutical measures %K Likert scale %K France %D 2022 %7 13.5.2022 %9 Original Paper %J JMIRx Med %G English %X 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. %M 35648730 %R 10.2196/32859 %U https://med.jmirx.org/2022/2/e32859 %U https://doi.org/10.2196/32859 %U http://www.ncbi.nlm.nih.gov/pubmed/35648730 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e34480 %T Implementing Infection Control and Quality of Life Best Practices in Nursing Homes With Project ECHO: Protocol for a Patient-Centered Randomized Controlled Trial %A Calo,William A %A Francis,Erica %A Kong,Lan %A Hogentogler,Ruth %A Heilbrunn,Emily %A Fisher,Abbey %A Hood,Nancy %A Kraschnewski,Jennifer %+ Department of Medicine, College of Medicine, Penn State University, 90 Hope Dr, Hershey, PA, 17033, United States, 1 202 329 1973, efrancis@pennstatehealth.psu.edu %K infection control %K COVID-19 %K nursing home %K telementoring %K Project ECHO %K case-based learning %K patient-centered outcome %K RE-AIM %K randomized controlled trial %K implementation %K quality of life %K best practice %K guideline %K comparison %K effectiveness %K intervention %D 2022 %7 13.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 35476823 %R 10.2196/34480 %U https://www.researchprotocols.org/2022/5/e34480 %U https://doi.org/10.2196/34480 %U http://www.ncbi.nlm.nih.gov/pubmed/35476823 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 5 %P e29343 %T Factors Associated With COVID-19 Death in the United States: Cohort Study %A Chen,Uan-I %A Xu,Hua %A Krause,Trudy Millard %A Greenberg,Raymond %A Dong,Xiao %A Jiang,Xiaoqian %+ School of Biomedical Informatics, The University of Texas Health Science Center at Houston, 7000 Fannin St., Houston, TX, 77030, United States, 1 713 500 3930, xiaoqian.jiang@uth.tmc.edu %K COVID-19 %K risk factors %K survival analysis %K cohort studies %K EHR data %D 2022 %7 12.5.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the initial COVID-19 cases were identified in the United States in February 2020, the United States has experienced a high incidence of the disease. Understanding the risk factors for severe outcomes identifies the most vulnerable populations and helps in decision-making. Objective: This study aims to assess the factors associated with COVID-19–related deaths from a large, national, individual-level data set. Methods: A cohort study was conducted using data from the Optum de-identified COVID-19 electronic health record (EHR) data set; 1,271,033 adult participants were observed from February 1, 2020, to August 31, 2020, until their deaths due to COVID-19, deaths due to other reasons, or the end of the study. Cox proportional hazards models were constructed to evaluate the risks for each patient characteristic. Results: A total of 1,271,033 participants (age: mean 52.6, SD 17.9 years; male: 507,574/1,271,033, 39.93%) were included in the study, and 3315 (0.26%) deaths were attributed to COVID-19. Factors associated with COVID-19–related death included older age (≥80 vs 50-59 years old: hazard ratio [HR] 13.28, 95% CI 11.46-15.39), male sex (HR 1.68, 95% CI 1.57-1.80), obesity (BMI ≥40 vs <30 kg/m2: HR 1.71, 95% CI 1.50-1.96), race (Hispanic White, African American, Asian vs non-Hispanic White: HR 2.46, 95% CI 2.01-3.02; HR 2.27, 95% CI 2.06-2.50; HR 2.06, 95% CI 1.65-2.57), region (South, Northeast, Midwest vs West: HR 1.62, 95% CI 1.33-1.98; HR 2.50, 95% CI 2.06-3.03; HR 1.35, 95% CI 1.11-1.64), chronic respiratory disease (HR 1.21, 95% CI 1.12-1.32), cardiac disease (HR 1.10, 95% CI 1.01-1.19), diabetes (HR 1.92, 95% CI 1.75-2.10), recent diagnosis of lung cancer (HR 1.70, 95% CI 1.14-2.55), severely reduced kidney function (HR 1.92, 95% CI 1.69-2.19), stroke or dementia (HR 1.25, 95% CI 1.15-1.36), other neurological diseases (HR 1.77, 95% CI 1.59-1.98), organ transplant (HR 1.35, 95% CI 1.09-1.67), and other immunosuppressive conditions (HR 1.21, 95% CI 1.01-1.46). Conclusions: This is one of the largest national cohort studies in the United States; we identified several patient characteristics associated with COVID-19–related deaths, and the results can serve as the basis for policy making. The study also offered directions for future studies, including the effect of other socioeconomic factors on the increased risk for minority groups. %M 35377319 %R 10.2196/29343 %U https://publichealth.jmir.org/2022/5/e29343 %U https://doi.org/10.2196/29343 %U http://www.ncbi.nlm.nih.gov/pubmed/35377319 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e36673 %T Long COVID Optimal Health Program (LC-OHP) to Enhance Psychological and Physical Health: Protocol for a Feasibility Randomized Controlled Trial %A Al-Jabr,Hiyam %A Windle,Karen %A Thompson,David R %A Jenkins,Zoe M %A Castle,David J %A Ski,Chantal F %+ Integrated Care Academy, University of Suffolk, Waterfront Building, 19 Neptune Quay, Ipswich, IP4 1QJ, United Kingdom, 44 01473 338845, h.al-jabr@uos.ac.uk %K long COVID %K COVID-19 %K optimal health program %K telemedicine %K integrated care %K telehealth %K patient care %K health intervention %K mental health %K physical health %K psychological health %K pandemic %K patient support %D 2022 %7 12.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Long COVID is a collection of symptoms that develop during or following a confirmed or suspected case of COVID-19, which continue for more than 12 weeks. Despite the negative impact of long COVID on people’s lives and functioning, there is no validated treatment or even rehabilitation guidance. What has been recommended thus far is the adoption of holistic management approaches. The Optimal Health Program (OHP) is a brief 5-session, plus booster, psychosocial program designed to support mental and physical well-being that has been used effectively for a range of chronic conditions. Objective: This study examines the feasibility and acceptability of employing an especially customized version of OHP (long COVID OHP [LC-OHP]) to improve psychological and physical health of people with long COVID. Methods: This is a feasibility randomized controlled trial that will be running from November 2021 to February 2023. Eligible participants aged 18 years or older who are experiencing symptoms of long COVID will be identified through their secondary practitioners with recruitment to be undertaken by the research team. A total of 60 participants will be randomized into a control (usual care) or an intervention (LC-OHP) group. Outcomes will be feasibility and acceptability of the program (primary); and efficacy of the LC-OHP in improving anxiety, depression, fatigue, self-efficacy, and quality of life (secondary). Up to 20 participants will be interviewed at the end of the trial to explore their experience with the program. Quantitative data will be analyzed using SPSS, and differences between groups will be compared using inferential tests where appropriate. Qualitative data will be transcribed and thematically analyzed to identify common emerging themes. Results: This is an ongoing study, which began in November 2021. Conclusions: Long COVID has a significant impact on an individual’s mental and physical functioning. The LC-OHP has a potential to provide people living with long COVID with additional support and to improve self-efficacy. The findings of this study would identify the feasibility of delivering this program to this population and will provide an indication for the program’s effectiveness. Trial Registration: ISRCTN Registry ISRCTN38746119; https://www.isrctn.com/ISRCTN38746119 International Registered Report Identifier (IRRID): DERR1-10.2196/36673 %M 35468586 %R 10.2196/36673 %U https://www.researchprotocols.org/2022/5/e36673 %U https://doi.org/10.2196/36673 %U http://www.ncbi.nlm.nih.gov/pubmed/35468586 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e35187 %T Patient Portal Messaging for Asynchronous Virtual Care During the COVID-19 Pandemic: Retrospective Analysis %A Huang,Ming %A Khurana,Aditya %A Mastorakos,George %A Wen,Andrew %A He,Huan %A Wang,Liwei %A Liu,Sijia %A Wang,Yanshan %A Zong,Nansu %A Prigge,Julie %A Costello,Brian %A Shah,Nilay %A Ting,Henry %A Fan,Jungwei %A Patten,Christi %A Liu,Hongfang %+ Department of Artificial Intelligence and Informatics, Mayo Clinic, 200 1st Street SW, Rochester, MN, 55905, United States, 1 507 293 0057, Liu.Hongfang@mayo.edu %K patient portal %K patient portal message %K asynchronous communication %K COVID-19 %K utilization %K digital health %K healthcare %K health care %K remote healthcare %K virtual care %K pandemic %D 2022 %7 5.5.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: During the COVID-19 pandemic, patient portals and their message platforms allowed remote access to health care. Utilization patterns in patient messaging during the COVID-19 crisis have not been studied thoroughly. In this work, we propose characterizing patients and their use of asynchronous virtual care for COVID-19 via a retrospective analysis of patient portal messages. Objective: This study aimed to perform a retrospective analysis of portal messages to probe asynchronous patient responses to the COVID-19 crisis. Methods: We collected over 2 million patient-generated messages (PGMs) at Mayo Clinic during February 1 to August 31, 2020. We analyzed descriptive statistics on PGMs related to COVID-19 and incorporated patients’ sociodemographic factors into the analysis. We analyzed the PGMs on COVID-19 in terms of COVID-19–related care (eg, COVID-19 symptom self-assessment and COVID-19 tests and results) and other health issues (eg, appointment cancellation, anxiety, and depression). Results: The majority of PGMs on COVID-19 pertained to COVID-19 symptom self-assessment (42.50%) and COVID-19 tests and results (30.84%). The PGMs related to COVID-19 symptom self-assessment and COVID-19 test results had dynamic patterns and peaks similar to the newly confirmed cases in the United States and in Minnesota. The trend of PGMs related to COVID-19 care plans paralleled trends in newly hospitalized cases and deaths. After an initial peak in March, the PGMs on issues such as appointment cancellations and anxiety regarding COVID-19 displayed a declining trend. The majority of message senders were 30-64 years old, married, female, White, or urban residents. This majority was an even higher proportion among patients who sent portal messages on COVID-19. Conclusions: During the COVID-19 pandemic, patients increased portal messaging utilization to address health care issues about COVID-19 (in particular, symptom self-assessment and tests and results). Trends in message usage closely followed national trends in new cases and hospitalizations. There is a wide disparity for minority and rural populations in the use of PGMs for addressing the COVID-19 crisis. %M 35171108 %R 10.2196/35187 %U https://humanfactors.jmir.org/2022/2/e35187 %U https://doi.org/10.2196/35187 %U http://www.ncbi.nlm.nih.gov/pubmed/35171108 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 5 %P e35706 %T An Agreement of Antigen Tests on Oral Pharyngeal Swabs or Less Invasive Testing With Reverse Transcription Polymerase Chain Reaction for Detecting SARS-CoV-2 in Adults: Protocol for a Prospective Nationwide Observational Study %A Schneider,Uffe Vest %A Knudsen,Jenny Dahl %A Koch,Anders %A Kirkby,Nikolai Søren %A Lisby,Jan Gorm %+ Department of Clinical Microbiology, Copenhagen University Hospital Hvidovre, Kettegaard Alle 30, Hvidovre, 2650, Denmark, 45 38623189, uffe.vest.schneider@regionh.dk %K SARS-CoV-2 %K COVID-19 %K point of care %K PoC %K antigen test %K anatomic sampling location %K Reverse Transcription Polymerase Chain Reaction %K RT-PCR %K rapid antigen test %K RAT %K testing %K antigen %K sampling %K PCR %K rapid %K protocol %K prospective %K observational %K agreement %K oral %K adult %K sensitivity %K specificity %K test location %K anatomy %K saliva %K swab %K nasopharyngeal %K nasal %D 2022 %7 4.5.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The SARS-CoV-2 pandemic has resulted in an unprecedented level of worldwide testing for epidemiologic and diagnostic purposes, and due to the extreme need for tests, the gold-standard Reverse Transcription Polymerase Chain Reaction (RT-PCR) testing capacity has been unable to meet the overall worldwide testing demand. Consequently, although the current literature has shown the sensitivity of rapid antigen tests (RATs) to be inferior to RT-PCR, RATs have been implemented on a large scale without solid data on performance. Objective: This study will compare analytical and clinical sensitivities and specificities of 50 lateral flow– or laboratory-based RATs and 3 strand invasion–based amplification (SIBA)-RT-PCR tests from 30 manufacturers to RT-PCR testing of samples obtained from the deep oropharynx. In addition, the study will compare sensitivities and specificities of the included RATs as well as RT-PCR on clinical samples obtained from the deep oropharynx, the anterior nasal cavity, saliva, the deep nasopharynx, and expired air to RT-PCR on deep oropharyngeal samples. Methods: In the prospective part of the study, 200 individuals found SARS-CoV-2 positive and 200 individuals found SARS-CoV-2 negative by routine RT-PCR testing will be retested with each RAT, applying RT-PCR as the reference method. In the retrospective part of the study, 304 deep oropharyngeal cavity swabs divided into 4 groups based on RT-PCR quantification cycle (Cq) levels will be tested with each RAT. Results: The results will be reported in several papers with different aims. The first paper will report retrospective (analytical sensitivity, overall and stratified into different Cq range groups) and prospective (clinical sensitivity) data for RATs, with RT-PCR as the reference method. The second paper will report results for RAT based on anatomical sampling location. The third paper will compare different anatomical sampling locations by RT-PCR testing. The fourth paper will focus on RATs that rely on central laboratory testing. Tests from 4 different manufacturers will be compared for analytical performance data on retrospective deep oropharyngeal swab samples. The fifth paper will report the results of 4 RATs applied both as professional use and as self-tests. The last paper will report the results from 2 breath tests in the study. A comparison of sensitivity and specificity between RATs will be conducted using the McNemar test for paired samples and the chi-squared test for unpaired samples. Comparison of the positive predictive value (PPV) and negative predictive value (NPV) between RATs will be performed by the bootstrap test, and 95% CIs for sensitivity, specificity, PPV, and NPV will be calculated as bootstrap CIs. Conclusions: The study will compare the sensitivities of a large number of RATs for SARS-CoV-2 to with those of RT-PCR and will address whether lateral flow–based RATs differ significantly from laboratory-based RATs. The anatomical test locations for both RATs and RT-PCR will also be compared. Trial Registration: ClinicalTrials.gov NCT04913116; https://clinicaltrials.gov/ct2/show/NCT04913116 International Registered Report Identifier (IRRID): DERR1-10.2196/35706 %M 35394449 %R 10.2196/35706 %U https://www.researchprotocols.org/2022/5/e35706 %U https://doi.org/10.2196/35706 %U http://www.ncbi.nlm.nih.gov/pubmed/35394449 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e37413 %T Authors Reply to: Research Using Social Media to Recruit Research Participants Should Proceed With Caution. Comment on “Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial” %A Adly,Aya Sedky %A Adly,Mahmoud Sedky %A Adly,Afnan Sedky %+ Faculty of Engineering and Technology, Badr University in Cairo (BUC), Cairo Suez Road, Badr City, Cairo, 11511, Egypt, 20 1145559778, aya.sedky@gmail.com %K telemedicine %K oxygen therapy %K noninvasive positive airway pressure %K BiPAP %K osteopathic medicine %K physical therapy %K SARS-CoV-2 %K COVID-19 %K teletherapy %K telemanagement %D 2022 %7 2.5.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 35476751 %R 10.2196/37413 %U https://www.jmir.org/2022/5/e37413 %U https://doi.org/10.2196/37413 %U http://www.ncbi.nlm.nih.gov/pubmed/35476751 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 5 %P e34437 %T Research Using Social Media to Recruit Research Participants Should Proceed With Caution. Comment on “Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial” %A Chen,Chih-Wei %A Wei,James Cheng-Chung %+ Institute of Medicine, Chung Shan Medical University, No 110, Sec 1, Jianguo N Rd, South District, Taichung, 40201, Taiwan, 886 4 24739595, jccwei@gmail.com %K telemedicine %K oxygen therapy %K noninvasive positive airway pressure %K BiPAP %K osteopathic medicine %K physical therapy %K SARS-CoV-2 %K COVID-19 %K teletherapy %K telemanagement %D 2022 %7 2.5.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 35476637 %R 10.2196/34437 %U https://www.jmir.org/2022/5/e34437 %U https://doi.org/10.2196/34437 %U http://www.ncbi.nlm.nih.gov/pubmed/35476637 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e34321 %T The Mutual Influence of the World Health Organization (WHO) and Twitter Users During COVID-19: Network Agenda-Setting Analysis %A Tahamtan,Iman %A Potnis,Devendra %A Mohammadi,Ehsan %A Singh,Vandana %A Miller,Laura E %+ School of Information Sciences, The University of Tennessee, 1345 Circle Park Drive, 451 Communications Building, Knoxville, TN, 37996-0332, United States, 1 865 974 1000, iman.tahamtan@gmail.com %K COVID-19 %K agenda setting %K network agenda setting %K Twitter %K social media %K public opinion %K content analysis %K public health %K WHO %D 2022 %7 26.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Little is known about the role of the World Health Organization (WHO) in communicating with the public on social media during a global health emergency. More specifically, there is no study about the relationship between the agendas of the WHO and Twitter users during the COVID-19 pandemic. Objective: This study utilizes the network agenda-setting model to investigate the mutual relationship between the agenda of the WHO’s official Twitter account and the agenda of 7.5 million of its Twitter followers regarding COVID-19. Methods: Content analysis was applied to 7090 tweets posted by the WHO on Twitter from January 1, 2020, to July 31, 2020, to identify the topics of tweets. The quadratic assignment procedure (QAP) was used to investigate the relationship between the WHO agenda network and the agenda network of the 6 Twitter user categories, including “health care professionals,” “academics,” “politicians,” “print and electronic media,” “legal professionals,” and the “private sector.” Additionally, 98 Granger causality statistical tests were performed to determine which topic in the WHO agenda had an effect on the corresponding topic in each Twitter user category and vice versa. Results: Content analysis revealed 7 topics that reflect the WHO agenda related to the COVID-19 pandemic, including “prevention,” “solidarity,” “charity,” “teamwork,” “ill-effect,” “surveillance,” and “credibility.” Results of the QAP showed significant and strong correlations between the WHO agenda network and the agenda network of each Twitter user category. These results provide evidence that WHO had an overall effect on different types of Twitter users on the identified topics. For instance, the Granger causality tests indicated that the WHO tweets influenced politicians and print and electronic media about “surveillance.” The WHO tweets also influenced academics and the private sector about “credibility” and print and electronic media about “ill-effect.” Additionally, Twitter users affected some topics in the WHO. For instance, WHO followers affected “charity” and “prevention” in the WHO. Conclusions: This paper extends theorizing on agenda setting by providing empirical evidence that agenda-setting effects vary by topic and types of Twitter users. Although prior studies showed that network agenda setting is a “one-way” model, the novel findings of this research confirm a “2-way” or “multiway” effect of agenda setting on social media due to the interactions between the content creators and audiences. The WHO can determine which topics should be promoted on social media during different phases of a pandemic and collaborate with other public health gatekeepers to collectively make them salient in the public. %M 35275836 %R 10.2196/34321 %U https://www.jmir.org/2022/4/e34321 %U https://doi.org/10.2196/34321 %U http://www.ncbi.nlm.nih.gov/pubmed/35275836 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e36830 %T The Prevalence and Impact of Fake News on COVID-19 Vaccination in Taiwan: Retrospective Study of Digital Media %A Chen,Yen-Pin %A Chen,Yi-Ying %A Yang,Kai-Chou %A Lai,Feipei %A Huang,Chien-Hua %A Chen,Yun-Nung %A Tu,Yi-Chin %+ Department of Computer Science and Information Engineering, National Taiwan University, No 1, Sec 4, Roosevelt Rd, Taipei, 106, Taiwan, 886 2 3366 3366, yvchen@csie.ntu.edu.tw %K misinformation %K vaccine hesitancy %K vaccination %K infodemic %K infodemiology %K COVID-19 %K public immunity %K social media %K fake news %D 2022 %7 26.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaccination is an important intervention to prevent the incidence and spread of serious diseases. Many factors including information obtained from the internet influence individuals’ decisions to vaccinate. Misinformation is a critical issue and can be hard to detect, although it can change people's minds, opinions, and decisions. The impact of misinformation on public health and vaccination hesitancy is well documented, but little research has been conducted on the relationship between the size of the population reached by misinformation and the vaccination decisions made by that population. A number of fact-checking services are available on the web, including the Islander news analysis system, a free web service that provides individuals with real-time judgment on web news. In this study, we used such services to estimate the amount of fake news available and used Google Trends levels to model the spread of fake news. We quantified this relationship using official public data on COVID-19 vaccination in Taiwan. Objective: In this study, we aimed to quantify the impact of the magnitude of the propagation of fake news on vaccination decisions. Methods: We collected public data about COVID-19 infections and vaccination from Taiwan's official website and estimated the popularity of searches using Google Trends. We indirectly collected news from 26 digital media sources, using the news database of the Islander system. This system crawls the internet in real time, analyzes the news, and stores it. The incitement and suspicion scores of the Islander system were used to objectively judge news, and a fake news percentage variable was produced. We used multivariable linear regression, chi-square tests, and the Johnson-Neyman procedure to analyze this relationship, using weekly data. Results: A total of 791,183 news items were obtained over 43 weeks in 2021. There was a significant increase in the proportion of fake news in 11 of the 26 media sources during the public vaccination stage. The regression model revealed a positive adjusted coefficient (β=0.98, P=.002) of vaccine availability on the following week's vaccination doses, and a negative adjusted coefficient (β=–3.21, P=.04) of the interaction term on the fake news percentage with the Google Trends level. The Johnson-Neiman plot of the adjusted effect for the interaction term showed that the Google Trends level had a significant negative adjustment effect on vaccination doses for the following week when the proportion of fake news exceeded 39.3%. Conclusions: There was a significant relationship between the amount of fake news to which the population was exposed and the number of vaccination doses administered. Reducing the amount of fake news and increasing public immunity to misinformation will be critical to maintain public health in the internet age. %M 35380546 %R 10.2196/36830 %U https://www.jmir.org/2022/4/e36830 %U https://doi.org/10.2196/36830 %U http://www.ncbi.nlm.nih.gov/pubmed/35380546 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e32411 %T Design of a Vaccine Passport Validation System Using Blockchain-based Architecture: Development Study %A Lee,Hsiu An %A Wu,Wei-Chen %A Kung,Hsin-Hua %A Udayasankaran,Jai Ganesh %A Wei,Yu-Chih %A Kijsanayotin,Boonchai %A Marcelo,Alvin B %A Hsu,Chien-Yeh %+ Department of Information Management, National Taipei University of Nursing and Health Sciences, No.365, Ming-te Road, Peitou District, Taipei, 112, Taiwan, 886 0939193212, cyhsu@ntunhs.edu.tw %K COVID-19 %K vaccine passport %K global border control %K health policy %K international infectious disease strategy %K vaccine %K policy %K strategy %K blockchain %K privacy %K security %K testing %K verification %K certification %K Fast Healthcare Interoperability Resource %D 2022 %7 26.4.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 is an ongoing global pandemic caused by SARS-CoV-2. As of June 2021, 5 emergency vaccines were available for COVID-19 prevention, and with the improvement of vaccination rates and the resumption of activities in each country, verification of vaccination has become an important issue. Currently, in most areas, vaccination and reverse transcription polymerase chain reaction (RT-PCR) test results are certified and validated on paper. This leads to the problem of counterfeit documents. Therefore, a global vaccination record is needed. Objective: The main objective of this study is to design a vaccine passport (VP) validation system based on a general blockchain architecture for international use in a simulated environment. With decentralized characteristics, the system is expected to have the advantages of low cost, high interoperability, effectiveness, security, and verifiability through blockchain architecture. Methods: The blockchain decentralized mechanism was used to build an open and anticounterfeiting information platform for VPs. The contents of a vaccination card are recorded according to international Fast Healthcare Interoperability Resource (FHIR) standards, and blockchain smart contracts (SCs) are used for authorization and authentication to achieve hierarchical management of various international hospitals and people receiving injections. The blockchain stores an encrypted vaccination path managed by the user who manages the private key. The blockchain uses the proof-of-authority (PoA) public chain and can access all information through the specified chain. This will achieve the goal of keeping development costs low and streamlining vaccine transit management so that countries in different economies can use them. Results: The openness of the blockchain helps to create transparency and data accuracy. This blockchain architecture contains a total of 3 entities. All approvals are published on Open Ledger. Smart certificates enable authorization and authentication, and encryption and decryption mechanisms guarantee data protection. This proof of concept demonstrates the design of blockchain architecture, which can achieve accurate global VP verification at an affordable price. In this study, an actual VP case was established and demonstrated. An open blockchain, an individually approved certification mechanism, and an international standard vaccination record were introduced. Conclusions: Blockchain architecture can be used to build a viable international VP authentication process with the advantages of low cost, high interoperability, effectiveness, security, and verifiability. %M 35377316 %R 10.2196/32411 %U https://publichealth.jmir.org/2022/4/e32411 %U https://doi.org/10.2196/32411 %U http://www.ncbi.nlm.nih.gov/pubmed/35377316 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 3 %N 1 %P e32401 %T Identification of Potential Vaccine Candidates Against SARS-CoV-2 to Fight COVID-19: Reverse Vaccinology Approach %A Gupta,Ekta %A Mishra,Rupesh Kumar %A Kumar Niraj,Ravi Ranjan %+ Amity University Rajasthan, SP-1, Kant Kalwar, RIICO Industrial Area, Jaipur, 303002, India, 91 9729559580, rrkniraj@gmail.com %K COVID-19 %K SARS-CoV-2 %K reverse vaccinology %K molecular docking %K molecular dynamics simulation %K vaccine candidates %K vaccine %K simulation %K virus %K peptide %K antigen %K immunology %K biochemistry %K genetics %D 2022 %7 26.4.2022 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: The recent emergence of COVID-19 has caused an immense global public health crisis. The etiological agent of COVID-19 is the novel coronavirus SARS-CoV-2. More research in the field of developing effective vaccines against this emergent viral disease is indeed a need of the hour. Objective: The aim of this study was to identify effective vaccine candidates that can offer a new milestone in the battle against COVID-19. Methods: We used a reverse vaccinology approach to explore the SARS-CoV-2 genome among strains prominent in India. Epitopes were predicted and then molecular docking and simulation were used to verify the molecular interaction of the candidate antigenic peptide with corresponding amino acid residues of the host protein. Results: A promising antigenic peptide, GVYFASTEK, from the surface glycoprotein of SARS-CoV-2 (protein accession number QIA98583.1) was predicted to interact with the human major histocompatibility complex (MHC) class I human leukocyte antigen (HLA)-A*11-01 allele, showing up to 90% conservancy and a high antigenicity value. After vigorous analysis, this peptide was predicted to be a suitable epitope capable of inducing a strong cell-mediated immune response against SARS-CoV-2. Conclusions: These results could facilitate selecting SARS-CoV-2 epitopes for vaccine production pipelines in the immediate future. This novel research will certainly pave the way for a fast, reliable, and effective platform to provide a timely countermeasure against this dangerous virus responsible for the COVID-19 pandemic. %M 35506029 %R 10.2196/32401 %U https://bioinform.jmir.org/2022/1/e32401 %U https://doi.org/10.2196/32401 %U http://www.ncbi.nlm.nih.gov/pubmed/35506029 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e30885 %T US Black Maternal Health Advocacy Topics and Trends on Twitter: Temporal Infoveillance Study %A Grigsby-Toussaint,Diana %A Champagne,Ashley %A Uhr,Justin %A Silva,Elizabeth %A Noh,Madeline %A Bradley,Adam %A Rashleigh,Patrick %+ Department of Epidemiology, School of Public Health, Brown University, 121 S Main Street, Providence, RI, 02903, United States, 1 401 863 6164, diana_grigsby-toussaint@brown.edu %K Black maternal health %K disparity %K COVID-19 %K Twitter %K topic modeling %K digital humanities %K infoveillance %K maternal health %K minority %K women %K advocacy %K social media %K model %K trend %K feasibility %D 2022 %7 20.4.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Black women in the United States disproportionately suffer adverse pregnancy and birth outcomes compared to White women. Economic adversity and implicit bias during clinical encounters may lead to physiological responses that place Black women at higher risk for adverse birth outcomes. The novel coronavirus disease of 2019 (COVID-19) further exacerbated this risk, as safety protocols increased social isolation in clinical settings, thereby limiting opportunities to advocate for unbiased care. Twitter, 1 of the most popular social networking sites, has been used to study a variety of issues of public interest, including health care. This study considers whether posts on Twitter accurately reflect public discourse during the COVID-19 pandemic and are being used in infodemiology studies by public health experts. Objective: This study aims to assess the feasibility of Twitter for identifying public discourse related to social determinants of health and advocacy that influence maternal health among Black women across the United States and to examine trends in sentiment between 2019 and 2020 in the context of the COVID-19 pandemic. Methods: Tweets were collected from March 1 to July 13, 2020, from 21 organizations and influencers and from 4 hashtags that focused on Black maternal health. Additionally, tweets from the same organizations and hashtags were collected from the year prior, from March 1 to July 13, 2019. Twint, a Python programming library, was used for data collection and analysis. We gathered the text of approximately 17,000 tweets, as well as all publicly available metadata. Topic modeling and k-means clustering were used to analyze the tweets. Results: A variety of trends were observed when comparing the 2020 data set to the 2019 data set from the same period. The percentages listed for each topic are probabilities of that topic occurring in our corpus. In our topic models, tweets on reproductive justice, maternal mortality crises, and patient care increased by 67.46% in 2020 versus 2019. Topics on community, advocacy, and health equity increased by over 30% in 2020 versus 2019. In contrast, tweet topics that decreased in 2020 versus 2019 were as follows: tweets on Medicaid and medical coverage decreased by 27.73%, and discussions about creating space for Black women decreased by just under 30%. Conclusions: The results indicate that the COVID-19 pandemic may have spurred an increased focus on advocating for improved reproductive health and maternal health outcomes among Black women in the United States. Further analyses are needed to capture a longer time frame that encompasses more of the pandemic, as well as more diverse voices to confirm the robustness of the findings. We also concluded that Twitter is an effective source for providing a snapshot of relevant topics to guide Black maternal health advocacy efforts. %M 35578642 %R 10.2196/30885 %U https://infodemiology.jmir.org/2022/1/e30885 %U https://doi.org/10.2196/30885 %U http://www.ncbi.nlm.nih.gov/pubmed/35578642 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e33733 %T Interactive Versus Static Decision Support Tools for COVID-19: Randomized Controlled Trial %A Röbbelen,Alice %A Schmieding,Malte L %A Kopka,Marvin %A Balzer,Felix %A Feufel,Markus A %+ Institute of Medical Informatics, Charité – Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Charitéplatz 1, Berlin, 10117, Germany, 49 30 450 570 425, malte.schmieding@charite.de %K clinical decision support %K usability %K COVID-19 %K consumer health %K medical informatic %K symptom checker %K decision support %K symptom %K support %K decision making %K algorithm %K flowchart %K agent %D 2022 %7 15.4.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the COVID-19 pandemic, medical laypersons with symptoms indicative of a COVID-19 infection commonly sought guidance on whether and where to find medical care. Numerous web-based decision support tools (DSTs) have been developed, both by public and commercial stakeholders, to assist their decision making. Though most of the DSTs’ underlying algorithms are similar and simple decision trees, their mode of presentation differs: some DSTs present a static flowchart, while others are designed as a conversational agent, guiding the user through the decision tree’s nodes step-by-step in an interactive manner. Objective: This study aims to investigate whether interactive DSTs provide greater decision support than noninteractive (ie, static) flowcharts. Methods: We developed mock interfaces for 2 DSTs (1 static, 1 interactive), mimicking patient-facing, freely available DSTs for COVID-19-related self-assessment. Their underlying algorithm was identical and based on the Centers for Disease Control and Prevention’s guidelines. We recruited adult US residents online in November 2020. Participants appraised the appropriate social and care-seeking behavior for 7 fictitious descriptions of patients (case vignettes). Participants in the experimental groups received either the static or the interactive mock DST as support, while the control group appraised the case vignettes unsupported. We determined participants’ accuracy, decision certainty (after deciding), and mental effort to measure the quality of decision support. Participants’ ratings of the DSTs’ usefulness, ease of use, trust, and future intention to use the tools served as measures to analyze differences in participants’ perception of the tools. We used ANOVAs and t tests to assess statistical significance. Results: Our survey yielded 196 responses. The mean number of correct assessments was higher in the intervention groups (interactive DST group: mean 11.71, SD 2.37; static DST group: mean 11.45, SD 2.48) than in the control group (mean 10.17, SD 2.00). Decisional certainty was significantly higher in the experimental groups (interactive DST group: mean 80.7%, SD 14.1%; static DST group: mean 80.5%, SD 15.8%) compared to the control group (mean 65.8%, SD 20.8%). The differences in these measures proved statistically significant in t tests comparing each intervention group with the control group (P<.001 for all 4 t tests). ANOVA detected no significant differences regarding mental effort between the 3 study groups. Differences between the 2 intervention groups were of small effect sizes and nonsignificant for all 3 measures of the quality of decision support and most measures of participants’ perception of the DSTs. Conclusions: When the decision space is limited, as is the case in common COVID-19 self-assessment DSTs, static flowcharts might prove as beneficial in enhancing decision quality as interactive tools. Given that static flowcharts reveal the underlying decision algorithm more transparently and require less effort to develop, they might prove more efficient in providing guidance to the public. Further research should validate our findings on different use cases, elaborate on the trade-off between transparency and convenience in DSTs, and investigate whether subgroups of users benefit more with 1 type of user interface than the other. Trial Registration: Deutsches Register Klinischer Studien DRKS00028136; https://tinyurl.com/4bcfausx (retrospectively registered) %M 34882571 %R 10.2196/33733 %U https://publichealth.jmir.org/2022/4/e33733 %U https://doi.org/10.2196/33733 %U http://www.ncbi.nlm.nih.gov/pubmed/34882571 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e30523 %T Requirements for a Bespoke Intensive Care Unit Dashboard in Response to the COVID-19 Pandemic: Semistructured Interview Study %A Davidson,Brittany %A Ferrer Portillo,Katiuska Mara %A Wac,Marceli %A McWilliams,Chris %A Bourdeaux,Christopher %A Craddock,Ian %+ Department of Electrical & Electronic Engineering, University of Bristol, 1 Cathedral Square, Bristol, BS1 5DD, United Kingdom, 44 07774286342, m.wac@bristol.ac.uk %K intensive care %K critical care %K COVID-19 %K human-centered design %K dashboard %K eHealth %K disease monitoring %K monitoring %K ICU %K design %K development %K interview %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Intensive care units (ICUs) around the world are in high demand due to patients with COVID-19 requiring hospitalization. As researchers at the University of Bristol, we were approached to develop a bespoke data visualization dashboard to assist two local ICUs during the pandemic that will centralize disparate data sources in the ICU to help reduce the cognitive load on busy ICU staff in the ever-evolving pandemic. Objective: The aim of this study was to conduct interviews with ICU staff in University Hospitals Bristol and Weston National Health Service Foundation Trust to elicit requirements for a bespoke dashboard to monitor the high volume of patients, particularly during the COVID-19 pandemic. Methods: We conducted six semistructured interviews with clinical staff to obtain an overview of their requirements for the dashboard and to ensure its ultimate suitability for end users. Interview questions aimed to understand the job roles undertaken in the ICU, potential uses of the dashboard, specific issues associated with managing COVID-19 patients, key data of interest, and any concerns about the introduction of a dashboard into the ICU. Results: From our interviews, we found the following design requirements: (1) a flexible dashboard, where the functionality can be updated quickly and effectively to respond to emerging information about the management of this new disease; (2) a mobile dashboard, which allows staff to move around on wards with a dashboard, thus potentially replacing paper forms to enable detailed and consistent data entry; (3) a customizable and intuitive dashboard, where individual users would be able to customize the appearance of the dashboard to suit their role; (4) real-time data and trend analysis via informative data visualizations that help busy ICU staff to understand a patient’s clinical trajectory; and (5) the ability to manage tasks and staff, tracking both staff and patient movements, handovers, and task monitoring to ensure the highest quality of care. Conclusions: The findings of this study confirm that digital solutions for ICU use would potentially reduce the cognitive load of ICU staff and reduce clinical errors at a time of notably high demand of intensive health care. %M 35038301 %R 10.2196/30523 %U https://humanfactors.jmir.org/2022/2/e30523 %U https://doi.org/10.2196/30523 %U http://www.ncbi.nlm.nih.gov/pubmed/35038301 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e33827 %T Identifying Frames of the COVID-19 Infodemic: Thematic Analysis of Misinformation Stories Across Media %A Mohammadi,Ehsan %A Tahamtan,Iman %A Mansourian,Yazdan %A Overton,Holly %+ School of Information Sciences, University of South Carolina, Davis College, Room 207, 1501 Greene Street, Columbia, SC, 29208, United States, 1 803 777 2324, ehsan2@sc.edu %K COVID-19 %K pandemic %K misinformation %K fake news %K framing theory %K social media %K infodemic %K thematic analysis %K theme %K social media %K pattern %K prevalence %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The word “infodemic” refers to the deluge of false information about an event, and it is a global challenge for today’s society. The sheer volume of misinformation circulating during the COVID-19 pandemic has been harmful to people around the world. Therefore, it is important to study different aspects of misinformation related to the pandemic. Objective: This paper aimed to identify the main subthemes related to COVID-19 misinformation on various platforms, from traditional outlets to social media. This paper aimed to place these subthemes into categories, track the changes, and explore patterns in prevalence, over time, across different platforms and contexts. Methods: From a theoretical perspective, this research was rooted in framing theory; it also employed thematic analysis to identify the main themes and subthemes related to COVID-19 misinformation. The data were collected from 8 fact-checking websites that formed a sample of 127 pieces of false COVID-19 news published from January 1, 2020 to March 30, 2020. Results: The findings revealed 4 main themes (attribution, impact, protection and solutions, and politics) and 19 unique subthemes within those themes related to COVID-19 misinformation. Governmental and political organizations (institutional level) and administrators and politicians (individual level) were the 2 most frequent subthemes, followed by origination and source, home remedies, fake statistics, treatments, drugs, and pseudoscience, among others. Results indicate that the prevalence of misinformation subthemes had altered over time between January 2020 and March 2020. For instance, false stories about the origin and source of the virus were frequent initially (January). Misinformation regarding home remedies became a prominent subtheme in the middle (February), while false information related to government organizations and politicians became popular later (March). Although conspiracy theory web pages and social media outlets were the primary sources of misinformation, surprisingly, results revealed trusted platforms such as official government outlets and news organizations were also avenues for creating COVID-19 misinformation. Conclusions: The identified themes in this study reflect some of the information attitudes and behaviors, such as denial, uncertainty, consequences, and solution-seeking, that provided rich information grounds to create different types of misinformation during the COVID-19 pandemic. Some themes also indicate that the application of effective communication strategies and the creation of timely content were used to persuade human minds with false stories in different phases of the crisis. The findings of this study can be beneficial for communication officers, information professionals, and policy makers to combat misinformation in future global health crises or related events. %M 37113806 %R 10.2196/33827 %U https://infodemiology.jmir.org/2022/1/e33827 %U https://doi.org/10.2196/33827 %U http://www.ncbi.nlm.nih.gov/pubmed/37113806 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e26335 %T Discussions and Misinformation About Electronic Nicotine Delivery Systems and COVID-19: Qualitative Analysis of Twitter Content %A Sidani,Jaime E %A Hoffman,Beth %A Colditz,Jason B %A Wolynn,Riley %A Hsiao,Lily %A Chu,Kar-Hai %A Rose,Jason J %A Shensa,Ariel %A Davis,Esa %A Primack,Brian %+ Center for Social Dynamics and Community Health, Department of Behavioral and Community Health Sciences, University of Pittsburgh School of Public Health, 130 DeSoto Street, Pittsburgh, PA, 15261, United States, 1 412 383 0733, jaime.sidani@pitt.edu %K COVID-19 %K coronavirus %K e-cigarette %K electronic nicotine delivery systems %K Twitter %K social media %K misinformation %K discussion %K public health %K communication %K concern %K severity %K conspiracy %D 2022 %7 13.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Misinformation and conspiracy theories related to COVID-19 and electronic nicotine delivery systems (ENDS) are increasing. Some of this may stem from early reports suggesting a lower risk of severe COVID-19 in nicotine users. Additionally, a common conspiracy is that the e-cigarette or vaping product use–associated lung injury (EVALI) outbreak of 2019 was actually an early presentation of COVID-19. This may have important public health ramifications for both COVID-19 control and ENDS use. Objective: Twitter is an ideal tool for analyzing real-time public discussions related to both ENDS and COVID-19. This study seeks to collect and classify Twitter messages (“tweets”) related to ENDS and COVID-19 to inform public health messaging. Methods: Approximately 2.1 million tweets matching ENDS-related keywords were collected from March 1, 2020, through June 30, 2020, and were then filtered for COVID-19–related keywords, resulting in 67,321 original tweets. A 5% (n=3366) subsample was obtained for human coding using a systematically developed codebook. Tweets were coded for relevance to the topic and four overarching categories. Results: A total of 1930 (57.3%) tweets were coded as relevant to the research topic. Half (n=1008, 52.2%) of these discussed a perceived association between ENDS use and COVID-19 susceptibility or severity, with 42.4% (n=818) suggesting that ENDS use is associated with worse COVID-19 symptoms. One-quarter (n=479, 24.8%) of tweets discussed the perceived similarity/dissimilarity of COVID-19 and EVALI, and 13.8% (n=266) discussed ENDS use behavior. Misinformation and conspiracy theories were present throughout all coding categories. Conclusions: Discussions about ENDS use and COVID-19 on Twitter frequently highlight concerns about the susceptibility and severity of COVID-19 for ENDS users; however, many contain misinformation and conspiracy theories. Public health messaging should capitalize on these concerns and amplify accurate Twitter messaging. %M 35311684 %R 10.2196/26335 %U https://formative.jmir.org/2022/4/e26335 %U https://doi.org/10.2196/26335 %U http://www.ncbi.nlm.nih.gov/pubmed/35311684 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e30144 %T Modeling Years of Life Lost Due to COVID-19, Socioeconomic Status, and Nonpharmaceutical Interventions: Development of a Prediction Model %A John,Jari %+ Institute of Political Science, University of Heidelberg, Bergheimer Str. 58, Heidelberg, 69115, Germany, 49 1636057958, jari.john@uni-heidelberg.de %K COVID-19 %K pandemic %K socioeconomic status %K mortality %K nonpharmaceutical interventions %K prediction model %K low-income status %K life expectancy %K public health %K income groups %D 2022 %7 12.4.2022 %9 Original Paper %J JMIRx Med %G English %X Background: Research in the COVID-19 pandemic focused on the health burden, thereby largely neglecting the potential harm to life from welfare losses. Objective: This paper develops a model that compares the years of life lost (YLL) due to COVID-19 and the potential YLL due to the socioeconomic consequences of its containment. Methods: It improves on existing estimates by conceptually disentangling YLL due to COVID-19 and socioeconomic status. By reconciling the normative life table approach with socioeconomic differences in life expectancy, it accounts for the fact that people with low socioeconomic status are hit particularly hard by the pandemic. The model also draws on estimates of socioeconomic differences in life expectancy to ascertain potential YLL due to income loss, school closures, and extreme poverty. Results: Tentative results suggest that if only one-tenth of the current socioeconomic damage becomes permanent in the future, it may carry a higher YLL burden than COVID-19 in the more likely pandemic scenarios. The model further suggests that the socioeconomic harm outweighs the disease burden due to COVID-19 more quickly in poorer and more unequal societies. Most urgently, the substantial increase in extreme poverty needs immediate attention. Avoiding a relatively minor number of 4 million unemployed, 1 million extremely poor, and 2 million students with a higher learning loss may save a similar amount of life years as saving 1 million people from dying from COVID-19. Conclusions: Primarily, the results illustrate the urgent need for redistributive policy interventions and global solidarity. In addition, the potentially high YLL burden from income and learning losses raises the burden of proof for the efficacy and necessity of school and business closures in the containment of the pandemic, especially where social safety nets are underdeveloped. %M 35438949 %R 10.2196/30144 %U https://med.jmirx.org/2022/2/e30144 %U https://doi.org/10.2196/30144 %U http://www.ncbi.nlm.nih.gov/pubmed/35438949 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e33680 %T The Impact and Applications of Social Media Platforms for Public Health Responses Before and During the COVID-19 Pandemic: Systematic Literature Review %A Gunasekeran,Dinesh Visva %A Chew,Alton %A Chandrasekar,Eeshwar K %A Rajendram,Priyanka %A Kandarpa,Vasundhara %A Rajendram,Mallika %A Chia,Audrey %A Smith,Helen %A Leong,Choon Kit %+ National University of Singapore, 10 Medical Drive, Singapore, 117597, Singapore, 65 67723737, dineshvg@hotmail.sg %K digital health %K social media %K big data %K population health %K blockchain %K COVID-19 %K review %K benefit %K challenge %K public health %D 2022 %7 11.4.2022 %9 Review %J J Med Internet Res %G English %X Background:  Social media platforms have numerous potential benefits and drawbacks on public health, which have been described in the literature. The COVID-19 pandemic has exposed our limited knowledge regarding the potential health impact of these platforms, which have been detrimental to public health responses in many regions. Objective: This review aims to highlight a brief history of social media in health care and report its potential negative and positive public health impacts, which have been characterized in the literature. Methods:  We searched electronic bibliographic databases including PubMed, including Medline and Institute of Electrical and Electronics Engineers Xplore, from December 10, 2015, to December 10, 2020. We screened the title and abstracts and selected relevant reports for review of full text and reference lists. These were analyzed thematically and consolidated into applications of social media platforms for public health. Results:  The positive and negative impact of social media platforms on public health are catalogued on the basis of recent research in this report. These findings are discussed in the context of improving future public health responses and incorporating other emerging digital technology domains such as artificial intelligence. However, there is a need for more research with pragmatic methodology that evaluates the impact of specific digital interventions to inform future health policy. Conclusions:  Recent research has highlighted the potential negative impact of social media platforms on population health, as well as potentially useful applications for public health communication, monitoring, and predictions. More research is needed to objectively investigate measures to mitigate against its negative impact while harnessing effective applications for the benefit of public health. %M 35129456 %R 10.2196/33680 %U https://www.jmir.org/2022/4/e33680 %U https://doi.org/10.2196/33680 %U http://www.ncbi.nlm.nih.gov/pubmed/35129456 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e32325 %T The Impact of COVID-19 on the Delivery of Educational Programs in Native American Communities: Qualitative Study %A Sacca,Lea %A Markham,Christine %A Hernandez,Belinda %A Shegog,Ross %A Peskin,Melissa %A Craig Rushing,Stephanie %A Warren,Hannah %A Tsosie,Monique %+ Center for Health Promotion and Disease Prevention, University of Texas Health Science Center Houston, 7000 Fannin Street, Houston, TX, 77030, United States, 1 (713) 500 9050, lea.sacca@uth.tmc.edu %K online sexual health programs %K COVID-19 %K COVID-19 pandemic %K AI/AN youth %K sexual health educators %K culturally responsive adaptation %K program implementation %K sexual health %K implementation %K Native communities %K American Indian youth %K Alaskan youth %K education %K tribal communities %K online %K virtual %D 2022 %7 11.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite the availability of culturally responsive sexual health educational programs for American Indian and Alaska Native (AI/AN) youth, barriers to their uptake and utilization persist in tribal communities. These challenges were exacerbated by the COVID-19 pandemic, which required flexible program delivery using both in-person and virtual classrooms. Objective: This exploratory study provides a preliminary understanding of the extent to which pre-existing challenges impact the delivery of culturally responsive sexual health education programs in Native communities and to what extent they were exacerbated by the COVID-19 pandemic. It also highlights the challenges faced by adolescent health advocates when adapting culturally responsive health curricula to online platforms. Finally, this study discloses major socioeconomic, health, and mental challenges experienced by AI/AN youth during the pandemic. Methods: An exploratory, descriptive, qualitative design approach was adopted to carry out 5 individual and 1 collective in-depth key informant interviews. A total of 8 Native and non-Native sexual health educators served as key informants and shared their personal experiences with the delivery of sexual health education programs for youth during the COVID-19 pandemic. The interviews were conducted virtually from October to November 2020 using Zoom to reach participants dispersed across different regions of the United States. We followed the consolidated criteria for reporting qualitative research (COREQ) as a reference for the study methodology. We also used the Braun and Clarke framework (2006) to conduct a thematic analysis. Results: Experts’ opinions were structured according to 5 main themes: (1) competing community priorities during COVID-19; (2) moving to web-based programming: skills, training, support; (3) recruiting youth; and (4) challenges for implementation in a household environment; and (5) recommendations to overcome implementation challenges. These themes are complementary, connected, and should be considered holistically for the development, dissemination, and implementation of online sexual health programs for AI/AN youth, specifically during the COVID-19 pandemic. The results raised the following points for discussion: (1) Building partnerships with schools and community organizations facilitates program adaptation and implementation, (2) there is a need to adopt a holistic approach when addressing youth sexual health in AI/AN communities, (3) a systematic and culturally responsive adaptation approach ensures effective virtual program delivery, and (4) community and youth engagement is essential for the success of virtual sexual health programs. Conclusions: Findings can provide recommendations on actions to be taken by sexual health educators and guidelines to follow to ensure cultural sensitivity, effective adaptation, and successful implementation when setting out to advocate for online sexual health programs for AI/AN youth. %M 35348464 %R 10.2196/32325 %U https://formative.jmir.org/2022/4/e32325 %U https://doi.org/10.2196/32325 %U http://www.ncbi.nlm.nih.gov/pubmed/35348464 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e30055 %T The Strategies for Quantitative and Qualitative Remote Data Collection: Lessons From the COVID-19 Pandemic %A Tiersma,Keenae %A Reichman,Mira %A Popok,Paula J %A Nelson,Zoe %A Barry,Maura %A Elwy,A Rani %A Flores,Efrén J %A Irwin,Kelly E %A Vranceanu,Ana-Maria %+ Integrated Brain Health Clinical and Research Program, Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, Suite 100, Boston, MA, 02114, United States, 1 6177244977, avranceanu@mgh.harvard.edu %K web-based research %K remote research %K remote data collection %K blended design %K electronic data collection %K mobile phone %D 2022 %7 8.4.2022 %9 Viewpoint %J JMIR Form Res %G English %X The COVID-19 pandemic has necessitated a rapid shift to web-based or blended design models for both ongoing and future clinical research activities. Research conducted virtually not only has the potential to increase the patient-centeredness of clinical research but may also further widen existing disparities in research participation among underrepresented individuals. In this viewpoint, we discuss practical strategies for quantitative and qualitative remote research data collection based on previous literature and our own ongoing clinical research to overcome challenges presented by the shift to remote data collection. We aim to contribute to and catalyze the dissemination of best practices related to remote data collection methodologies to address the opportunities presented by this shift and develop strategies for inclusive research. %M 35394441 %R 10.2196/30055 %U https://formative.jmir.org/2022/4/e30055 %U https://doi.org/10.2196/30055 %U http://www.ncbi.nlm.nih.gov/pubmed/35394441 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 4 %P e33982 %T Developing a Clinic-Based, Vaccine-Promoting Intervention for African American Youth in Rural Alabama: Protocol for a Pilot Cluster-Randomized Controlled Implementation Science Trial %A Budhwani,Henna %A Sharma,Vinita %A Long,Dustin %A Simpson,Tina %+ Department of Health Policy and Organization, School of Public Health, University of Alabama at Birmingham, 1720 University Blvd, Birmingham, AL, 35294, United States, 1 2059757613, budhwani@uab.edu %K human papillomavirus %K COVID-19 %K vaccine %K adolescents %K rural %K African American %K implementation science %D 2022 %7 8.4.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: African American youth in rural Alabama are clinically underserved and have limited knowledge about the human papillomavirus and the novel coronavirus 2019 (COVID-19) vaccines, including knowledge about the risk for developing cervical or oropharyngeal cancers or COVID-19. Objective: In this 30-month study, we propose to develop an in-clinic, youth-tailored, vaccine-promoting intervention for vaccine hesitancy reduction that can be seamlessly integrated into the existing environments of pediatric and family practice settings in rural Alabama. Methods: This exploratory, sequential mixed methods study will be conducted in 3 phases. In the first phase, we will assess stakeholders’ knowledge, sentiments, and beliefs related to vaccination in general, COVID-19 vaccination, and human papillomavirus vaccination. We will also assess stakeholders’ perceptions of barriers to vaccination that exist in rural Alabama. This will be followed by a second phase wherein we will use the data collected in the first phase to inform the development and finalization of a noninvasive, modular, synchronous counseling intervention that targets the behaviors of 15- to 26-year-old adolescents. In the third phase, we will conduct a pilot hybrid type 1 effectiveness-implementation cluster-randomized controlled trial to assess intervention acceptability and feasibility (clinics: N=4; African American youth: N=120) while assessing a “clinical signal” of effectiveness. We will document implementation contexts to provide real-world insight and support dissemination and scale-up. Results: The study was funded at the end of December 2020. Approval from the University of Alabama at Birmingham Institutional Review Board was obtained in May 2021, and the qualitative data collection process outlined in the first phase of this project concluded in November 2021. The entire study is expected to be complete at the end of December 2023. Conclusions: The results of the trial will provide much needed information on vaccine hesitancy in rural Alabama, and if found efficacious, the intervention could notably increase rates of vaccinations in one of the most underserved parts of the United States. The results from the trial will provide information that is valuable to public health practitioners and providers in rural settings to inform their efforts in increasing vaccination rates among 15- to 26-year-old African American youth in rural southern United States. Trial Registration: ClinicalTrials.gov NCT04604743; https://clinicaltrials.gov/ct2/show/NCT04604743 International Registered Report Identifier (IRRID): DERR1-10.2196/33982 %M 35212640 %R 10.2196/33982 %U https://www.researchprotocols.org/2022/4/e33982 %U https://doi.org/10.2196/33982 %U http://www.ncbi.nlm.nih.gov/pubmed/35212640 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 4 %P e36022 %T The Impact of COVID-19 on Mortality in Italy: Retrospective Analysis of Epidemiological Trends %A Rovetta,Alessandro %A Bhagavathula,Akshaya Srikanth %+ R & C Research, via Brede T2, Bovezzo (Brescia), 25073, Italy, 39 3927112808, rovetta.mresearch@gmail.com %K COVID-19 %K deniers %K excess deaths %K epidemiology %K infodemic %K infodemiology %K Italy %K longitudinal analysis %K mortality %K time series %K pandemic %K public health %D 2022 %7 7.4.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite the available evidence on its severity, COVID-19 has often been compared with seasonal flu by some conspirators and even scientists. Various public discussions arose about the noncausal correlation between COVID-19 and the observed deaths during the pandemic period in Italy. Objective: This paper aimed to search for endogenous reasons for the mortality increase recorded in Italy during 2020 to test this controversial hypothesis. Furthermore, we provide a framework for epidemiological analyses of time series. Methods: We analyzed deaths by age, sex, region, and cause of death in Italy from 2011 to 2019. Ordinary least squares (OLS) linear regression analyses and autoregressive integrated moving average (ARIMA) were used to predict the best value for 2020. A Grubbs 1-sided test was used to assess the significance of the difference between predicted and observed 2020 deaths/mortality. Finally, a 1-sample t test was used to compare the population of regional excess deaths to a null mean. The relationship between mortality and predictive variables was assessed using OLS multiple regression models. Since there is no uniform opinion on multicomparison adjustment and false negatives imply great epidemiological risk, the less-conservative Siegel approach and more-conservative Holm-Bonferroni approach were employed. By doing so, we provided the reader with the means to carry out an independent analysis. Results: Both ARIMA and OLS linear regression models predicted the number of deaths in Italy during 2020 to be between 640,000 and 660,000 (range of 95% CIs: 620,000-695,000) against the observed value of above 750,000. We found strong evidence supporting that the death increase in all regions (average excess=12.2%) was not due to chance (t21=7.2; adjusted P<.001). Male and female national mortality excesses were 18.4% (P<.001; adjusted P=.006) and 14.1% (P=.005; adjusted P=.12), respectively. However, we found limited significance when comparing male and female mortality residuals’ using the Mann-Whitney U test (P=.27; adjusted P=.99). Finally, mortality was strongly and positively correlated with latitude (R=0.82; adjusted P<.001). In this regard, the significance of the mortality increases during 2020 varied greatly from region to region. Lombardy recorded the highest mortality increase (38% for men, adjusted P<.001; 31% for women, P<.001; adjusted P=.006). Conclusions: Our findings support the absence of historical endogenous reasons capable of justifying the mortality increase observed in Italy during 2020. Together with the current knowledge on SARS-CoV-2, these results provide decisive evidence on the devastating impact of COVID-19. We suggest that this research be leveraged by government, health, and information authorities to furnish proof against conspiracy hypotheses that minimize COVID-19–related risks. Finally, given the marked concordance between ARIMA and OLS regression, we suggest that these models be exploited for public health surveillance. Specifically, meaningful information can be deduced by comparing predicted and observed epidemiological trends. %M 35238784 %R 10.2196/36022 %U https://publichealth.jmir.org/2022/4/e36022 %U https://doi.org/10.2196/36022 %U http://www.ncbi.nlm.nih.gov/pubmed/35238784 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 4 %P e29781 %T Frequency and Correlates of Online Consultations With Doctors or Therapists in Middle-Aged and Older Adults: Nationally Representative Cross-sectional Study %A Hajek,André %A König,Hans-Helmut %+ Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Martinistraße 52, Hamburg, 20246, Germany, 49 40 7410 528 77, a.hajek@uke.de %K online consultations %K doctor %K therapists %K telehealth %K COVID-19 %K SARS-CoV-2 %K digital health %D 2022 %7 7.4.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: A few studies have identified the frequency and correlates of online consultations with doctors or therapists. However, there is a lack of studies using nationally representative data from middle-aged and older adults in Germany. Objective: This study aims to determine the frequency and correlates of online consultations with doctors or therapists in Germany. Methods: For this study, cross-sectional data were taken from the nationally representative German Ageing Survey (DEAS; n=3067 in the analytical sample; age range 46-98 years). As part of the DEAS, a short survey was conducted between June 8 and July 22, 2020, examining the everyday life and living conditions among these middle-aged and older individuals during the COVID-19 pandemic. The frequency of online consultations with doctors or therapists served as the dependent variable (daily, several times a week, once a week, 1-3 times a month, less often, and never). Multiple logistic regressions were performed. Results: In sum, 10.02% (381/3806) of individuals with access to the internet had online consultations with doctors or therapists. Multiple logistic regressions showed that the likelihood of using online consultations with doctors or therapists (compared with those never using such services) was positively associated with higher education (compared with medium education; odds ratio [OR] 1.31, 95% CI 1.01-1.70), living with a partner in the same household (compared with single; OR 1.53, 95% CI 1.05-2.22), poorer self-rated health (OR 1.42, 95% CI 1.16-1.74), increased loneliness (OR 1.45, 95% CI 1.10-1.90), and increased satisfaction with life (OR 1.30, 95% CI 1.03-1.64). Conclusions: Study findings suggest that a non-negligible proportion of about 1 out of 10 individuals aged 46 years and over had online consultations with doctors or therapists. However, compared with other countries, this proportion remains small. Knowledge about the correlates of (non)use may assist in identifying corresponding individuals. In times of reshaping the health care system, these efforts in online consultations with doctors or therapists may contribute to addressing patient needs. Moreover, increased use of such services may reduce the risk of getting infected with SARS-CoV-2 by reducing social contact. %M 35389360 %R 10.2196/29781 %U https://www.jmir.org/2022/4/e29781 %U https://doi.org/10.2196/29781 %U http://www.ncbi.nlm.nih.gov/pubmed/35389360 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 2 %P e31272 %T Lessons Learned From the Resilience of Chinese Hospitals to the COVID-19 Pandemic: Scoping Review %A Stennett,Jack %A Hou,Renyou %A Traverson,Lola %A Ridde,Valéry %A Zinszer,Kate %A Chabrol,Fanny %+ Centre Population et Développement, Institut de Recherche pour le Développement, Université de Paris, 45 Rue des Saints-Pères, Paris, 75006, France, 33 01 76 53 34 52, jack.stennett@sciencespo.fr %K COVID-19 %K pandemic %K SARS-CoV-2 %K health care %K hospitals %K health care strategy %K hospital resilience %K interventions %K crisis response %K crisis preparedness %K public health %D 2022 %7 6.4.2022 %9 Review %J JMIRx Med %G English %X Background: The SARS-CoV-2 pandemic has brought substantial strain on hospitals worldwide; however, although the success of China’s COVID-19 strategy has been attributed to the achievements of the government, public health officials, and the attitudes of the public, the resilience shown by China’s hospitals appears to have been a critical factor in their successful response to the pandemic. Objective: This paper aims to determine the key findings, recommendations, and lessons learned in terms of hospital resilience during the pandemic; analyze the quality and limitations of research in this field at present; and contribute to the evaluation of the Chinese response to the COVID-19 outbreak, building on a growing literature on the role of hospital resilience in crisis situations. Methods: We conducted a scoping review of evidence on the resilience of hospitals in China during the COVID-19 crisis in the first half of 2020. Two online databases (the China National Knowledge Infrastructure and World Health Organization databases) were used to identify papers meeting the eligibility criteria. After extracting the data, we present an information synthesis using a resilience framework. Articles were included in the review if they were peer-reviewed studies published between December 2019 and July 2020 in English or Chinese and included empirical results pertaining to the resilience of Chinese hospitals in the COVID-19 pandemic. Results: From the publications meeting the criteria (n=59), we found that substantial research was rapidly produced in the first half of 2020 and described numerous strategies used to improve hospital resilience, particularly in three key areas: human resources; management and communication; and security, hygiene, and planning. Our search revealed a focus on interventions related to training, health care worker well-being, eHealth/telemedicine, and workplace organization, while other areas such as hospital financing, information systems, and health care infrastructure were less well represented in the literature. We also noted that the literature was dominated by descriptive case studies, often lacking consideration of methodological limitations, and that there was a lack of both highly focused research on specific interventions and holistic research that attempted to unite the topics within a resilience framework. Conclusions: We identified a number of lessons learned regarding how China’s hospitals have demonstrated resilience when confronted with the SARS-CoV-2 pandemic. Strategies involving interprovincial reinforcements, online platforms and technological interventions, and meticulous personal protective equipment use and disinfection, combined with the creation of new interdisciplinary teams and management strategies, reflect a proactive hospital response to the pandemic, with high levels of redundancy. Research on Chinese hospitals would benefit from a greater range of analyses to draw more nuanced and contextualized lessons from the responses to the crisis. %M 35435649 %R 10.2196/31272 %U https://med.jmirx.org/2022/2/e31272 %U https://doi.org/10.2196/31272 %U http://www.ncbi.nlm.nih.gov/pubmed/35435649 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e32619 %T The Rapid Development of Virtual Care Tools in Response to COVID-19: Case Studies in Three Australian Health Services %A Gray,Kathleen %A Chapman,Wendy %A Khan,Urooj R %A Borda,Ann %A Budge,Marc %A Dutch,Martin %A Hart,Graeme K %A Gilbert,Cecily %A Wani,Tafheem Ahmad %+ Centre for Digital Transformation of Health, University of Melbourne, Level 13, 305 Grattan Street, Melbourne, 3000, Australia, 61 3 8344 8936, kgray@unimelb.edu.au %K COVID-19 %K health system innovation %K rapid development and deployment methods %K remote patient monitoring %K software development %D 2022 %7 6.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: News of the impact of COVID-19 around the world delivered a brief opportunity for Australian health services to plan new ways of delivering care to large numbers of people while maintaining staff safety through greater physical separation. The rapid pivot to telemedicine and virtual care provided immediate and longer term benefits; however, such rapid-cycle development also created risks. Objective: The aim of this study was to understand the sociotechnical aspects of the rapid-cycle development of seven different COVID-19 virtual care tools, and to identify enablers, barriers, and risks at three health services in Victoria, Australia. Methods: A qualitative, embedded, multiple case study design was adopted. Researchers from three health services collaborated with university researchers who were independent from those health services to gather and analyze structured interview data from key people involved in either clinical or technical aspects of designing and deploying seven different virtual care tools. Results: The overall objectives of each health service reflected the international requirements for managing large numbers of patients safely but remotely and for protecting staff. However, the governance, digital maturity, and specific use cases at each institution shaped the methodology and specific outcomes required. Dependence on key individuals and their domain knowledge within an existing governance framework generally enabled rapid deployment, but sometimes posed barriers. Existing relationships with technical service developers enabled strong solutions, which in some cases were highly scalable. Conventional project methodologies such as steering committees, scope, budget control, tight functional specification, consumer engagement and codesign, universal accessibility, and postimplementation evaluation were ignored almost universally in this environment. Conclusions: These three health services took a variety of approaches to the rapid-cycle development of virtual care tools to meet their urgent needs for triaging and remote monitoring during the first year of the COVID-19 pandemic. Their experiences provided insights into many social and technical barriers and enablers to the development of virtual care tools. If these are addressed proactively, they will improve clinical governance and technical management of future virtual care. Some changes can be made within individual health services, while others entail health system policy reforms. Enhancing the environment for virtual care tool design and implementation now will yield returns not only during future health emergencies but also in many more routine care settings. %M 35297765 %R 10.2196/32619 %U https://formative.jmir.org/2022/4/e32619 %U https://doi.org/10.2196/32619 %U http://www.ncbi.nlm.nih.gov/pubmed/35297765 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 5 %N 1 %P e34936 %T Influence of the COVID-19 Pandemic on Clinical Trial Discontinuation in Anesthesiology: Cross-sectional Analysis %A Traxler,Brett D %A Rucker,Brayden M %A Greenough,Mary C %A Sajjadi,Nicholas B %A Hartwell,Micah %+ Office of Medical Student Research, College of Osteopathic Medicine, Oklahoma State University Center for Health Sciences, 1111 W 17th Street, Tulsa, OK, 74107, United States, 1 9185821972, nicholas.sajjadi@okstate.edu %K clinical trials %K anesthesia %K anesthesiology %K COVID-19 %K pandemic %K perioperative care %K lockdown %D 2022 %7 5.4.2022 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The COVID-19 pandemic drastically altered perioperative medical practice owing to safety concerns, postponing elective or nonemergent procedures, supply chain shortages, and reallocating perioperative staff to care for patients with COVID-19. However, the impact of the pandemic on the conduct on anesthesiology clinical research is unknown. Objective: The primary objective was to quantify the magnitude of the COVID-19 pandemic’s impact on anesthesiology clinical research. Methods: We performed a systematic search using ClinicalTrials.gov to identify clinical trials related to the practice of anesthesiology. We screened trials with status updates from January 1, 2020, through October 1, 2021, to capture trials potentially affected by the COVID-19 pandemic by the time of our search. Investigators screened for relevant studies and extracted trial characteristics along with the reason for discontinuation reported on the clinical trial registry. Results: A total of 823 clinical trials met inclusion criteria, and 146 clinical trials were discontinued within the designated date range. In total, 24 (16.4%) of the 146 clinical trials were halted explicitly owing to the COVID-19 pandemic. A significant association existed between trial enrollment numbers and the likelihood of discontinuation due to the COVID-19 pandemic, as larger trials were more likely to be disrupted (z=–2.914, P=.004). Conclusions: The COVID-19 pandemic is reportedly associated with the discontinuation of anesthesiology-related clinical trials. With the uncertain course of the COVID-19 pandemic, developing anesthesia trial protocols to help minimize social interaction and prevent premature trial disruption are imperative. %M 35358057 %R 10.2196/34936 %U https://periop.jmir.org/2022/1/e34936 %U https://doi.org/10.2196/34936 %U http://www.ncbi.nlm.nih.gov/pubmed/35358057 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 2 %P e34134 %T Application of a Web-based Self-assessment Triage Tool During the COVID-19 Pandemic: Descriptive Study %A Nowicka,Anna %A Jaszczak,Jakub %A Szymanek Pasternak,Anna %A Simon,Krzysztof %+ Provincial Specialist Hospital them. J. Gromkowski, Koszarowa 5, Wrocław, 51-149, Poland, 48 660427576, nowickanna@gmail.com %K COVID-19 %K symptom checker %K preclinical triage %K self-assessment tool %K online applications %K COVID-19 remote triage %K COVID-19 self-assessment %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic has sped up the implementation of telehealth solutions in medicine. A few symptom checkers dedicated for COVID-19 have been described, but it remains unclear whether and how they can affect patients and health systems. Objective: This paper demonstrates our experiences with the COVID-19 risk assessment (CRA) tool. We tried to determine who the user of the web-based COVID-19 triage app is and compare this group with patients in the infectious diseases ward’s admission room to evaluate who could benefit from implementing the COVID-19 online symptom checker as a remote triage solution. Methods: We analyzed the answers of 248,862 people interacting with an online World Health Organization–based triage tool for assessing the probability of SARS-CoV-2 infection. These users filled in an online questionnaire between April 7 and August 6, 2020. Based on the presented symptoms, risk factors, and demographics, the tool assessed whether the user’s answers were suggestive of COVID-19 and recommended appropriate action. Subsequently, we compared the sociodemographic and clinical characteristics of tool users with patients admitted to the Infectious Diseases Admission Room of J. Gromkowski Hospital in Wrocław. Results: The CRA tool tended to be used by asymptomatic or oligosymptomatic individuals (171,226 [68.80%] of all users). Most users were young (162,432 [65.27%] were below 40 years of age) and without comorbidities. Only 77,645 (31.20%) of the self-assessment app users were suspected of COVID-19 based on their reported symptoms. On the contrary, most admission room patients were symptomatic—symptoms such as fever, cough, and dyspnea were prevalent in both COVID-19-positive and COVID-19-negative patients. COVID-19-suspected patients in the CRA tool group presented similar COVID-19 symptoms as those who presented to the admission room. These were cough (25,062/40,007 [62.64%] in the CRA tool group vs 138/232 [59.48%] in the admission room group), fever (23,123/40,007 [57.80%] in the CRA tool group vs 146/232 [62.93%] in the admission room group), and shortness of breath (15,157/40,007 [37.89%] in the CRA tool group vs 87/232 [37.50%] in the admission room group). Conclusions: The comparison between the symptomatology of the users interacting with the CRA tool and those visiting the admission room revealed 2 major patient groups who could have benefited from the implementation of the self-assessment app in preclinical triage settings. The primary users of the CRA tool were young, oligosymptomatic individuals looking for screening for COVID-19 and reassurance early in the COVID-19 pandemic. The other group were users presenting the typical symptoms suggestive of COVID-19 at that time. The CRA tool recognized these individuals as potentially COVID-19 positive and directed them to the proper level of care. These use cases fulfil the idea of preclinical triage; however, the accuracy and influence on health care must be examined in the clinical setting. %M 35168192 %R 10.2196/34134 %U https://humanfactors.jmir.org/2022/2/e34134 %U https://doi.org/10.2196/34134 %U http://www.ncbi.nlm.nih.gov/pubmed/35168192 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 4 %P e32387 %T Effects of COVID-19 on Physical Activity and Its Relationship With Mental Health in a US Community Sample: Cross-sectional, Convenience Sampling–based Online Survey %A Zhang,Wei %A Velez,Dominick %+ Department of Psychology, New Jersey City University, 2039 John F. Kennedy Blvd, Jersey City, NJ, 07305, United States, 1 2012002000 ext 3063, wzhang@njcu.edu %K physical activity %K COVID-19 %K mental health %K depression %K anxiety %K United States %K survey %K cross-sectional %K distress %K risk %D 2022 %7 4.4.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 restrictions may make it difficult for people to engage in the recommended amounts of physical activity (PA). Objective: The influence of the COVID-19 pandemic on PA, as well as the links between PA and mental health, was investigated in this study. Methods: Participants were recruited using convenience sampling and responded to an online survey between April 15 and July 1, 2021, with ages ranging from 18 to 24 years (n=156, 40.9% of the sample) to ≥55 years (n=28, 7.4% of the sample). To assess general psychological distress, depression, anxiety, and pandemic anxiety, a battery of mental health assessments was used. The International Physical Activity Questionnaire - Short Form was used to collect PA data from participants, who were then classified as inactive, minimally active, or highly active. Participants also indicated the locations where they performed PA before and during COVID-19. Results: A sample of 381 individuals was included in this research. The logistic regression analysis results were interpreted as odds ratios (ORs), where an OR higher than 1 indicated a greater chance of an event occurring and an OR less than 1 implied a lower likelihood of an event occurring. Logistic regression results revealed that inactive individuals were more likely to develop psychological distress (OR 2.17, 95% CI 1.27-3.69, P=.004), depression (OR 3.81, 95% CI 1.92-7.57, P<.001), and anxiety (OR 1.86, 95% CI 0.99-3.47, P=.05) as compared to highly active individuals. Furthermore, when compared to highly active people, those who were only minimally active had a higher risk of depression (OR 2.14, 95% CI 1.05-4.33, P=.04). Wilcoxon signed-rank tests revealed that COVID-19 has a greater impact on reducing the chances of less active individuals engaging in PA outside and in public spaces. Highly active people's physical exercise locations had changed less, and their exercise frequency at home increased. Conclusions: Programmatic and policy interventions geared particularly toward enhancing PA among those less active may be a helpful strategy for addressing the worldwide pandemic’s mental health crisis. %M 35302509 %R 10.2196/32387 %U https://formative.jmir.org/2022/4/e32387 %U https://doi.org/10.2196/32387 %U http://www.ncbi.nlm.nih.gov/pubmed/35302509 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e36200 %T Physician Burnout and the Electronic Health Record Leading Up to and During the First Year of COVID-19: Systematic Review %A Kruse,Clemens Scott %A Mileski,Michael %A Dray,Gevin %A Johnson,Zakia %A Shaw,Cameron %A Shirodkar,Harsha %+ School of Health Administration, College of Health Professions, Texas State University, 601 University Dr, San Marcos, TX, 78666, United States, 1 5122454462, scottkruse@txstate.edu %K electronic health record %K physician burnout %K quality improvement %K psychiatry %K medical informatics %K COVID-19 %K pandemic %K health informatic %K health care %K health care professional %K health care infrastructure %K health care system %K mental health %K cognitive fatigue %D 2022 %7 31.3.2022 %9 Review %J J Med Internet Res %G English %X Background: Physician burnout was first documented in 1974, and the electronic health record (EHR) has been known to contribute to the symptoms of physician burnout. Authors pondered the extent of this effect, recognizing the increased use of telemedicine during the first year of COVID-19. Objective: The aim of this review was to objectively analyze the literature over the last 5 years for empirical evidence of burnout incident to the EHR and to identify barriers to, facilitators to, and associated patient satisfaction with using the EHR to improve symptoms of burnout. Methods: No human participants were involved in this review; however, 100% of participants in studies analyzed were adult physicians. We queried 4 research databases and 1 targeted journal for studies commensurate with the objective statement from January 1, 2016 through January 31, 2021 (n=25). Results: The hours spent in documentation and workflow are responsible for the sense of loss of autonomy, lack of work-life balance, lack of control of one’s schedule, cognitive fatigue, a general loss of autonomy, and poor relationships with colleagues. Researchers have identified training, local customization of templates and workflow, and the use of scribes as strategies to alleviate the administrative burden of the EHR and decrease symptoms of burnout. Conclusions: The solutions provided in the literature only addressed 2 of the 3 factors (workflow and documentation time) but not the third factor (usability). Practitioners and administrators should focus on the former 2 factors because they are within their sphere of control. EHR vendors should focus on empirical evidence to identify and improve the usability features with the greatest impact. Researchers should design experiments to explore solutions that address all 3 factors of the EHR that contribute to burnout. Trial Registration: PROSPERO International Prospective Register of Systematic Reviews CRD42020201820; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=201820 International Registered Report Identifier (IRRID): RR2-10.2196/15490 %M 35120019 %R 10.2196/36200 %U https://www.jmir.org/2022/3/e36200 %U https://doi.org/10.2196/36200 %U http://www.ncbi.nlm.nih.gov/pubmed/35120019 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e32449 %T Using Natural Language Processing to Explore Mental Health Insights From UK Tweets During the COVID-19 Pandemic: Infodemiology Study %A Marshall,Christopher %A Lanyi,Kate %A Green,Rhiannon %A Wilkins,Georgina C %A Pearson,Fiona %A Craig,Dawn %+ National Institute for Health Research Innovation Observatory, Newcastle University, The Catalyst, Newcastle, NE4 5TG, United Kingdom, 44 0191 2082259, chris.marshall@io.nihr.ac.uk %K Twitter %K mental health %K COVID-19 %K sentiment %K lockdown %K soft intelligence %K artificial intelligence %K machine learning %K natural language processing %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: There is need to consider the value of soft intelligence, leveraged using accessible natural language processing (NLP) tools, as a source of analyzed evidence to support public health research outputs and decision-making. Objective: The aim of this study was to explore the value of soft intelligence analyzed using NLP. As a case study, we selected and used a commercially available NLP platform to identify, collect, and interrogate a large collection of UK tweets relating to mental health during the COVID-19 pandemic. Methods: A search strategy comprised of a list of terms related to mental health, COVID-19, and lockdown restrictions was developed to prospectively collate relevant tweets via Twitter’s advanced search application programming interface over a 24-week period. We deployed a readily and commercially available NLP platform to explore tweet frequency and sentiment across the United Kingdom and identify key topics of discussion. A series of keyword filters were used to clean the initial data retrieved and also set up to track specific mental health problems. All collated tweets were anonymized. Results: We identified and analyzed 286,902 tweets posted from UK user accounts from July 23, 2020 to January 6, 2021. The average sentiment score was 50%, suggesting overall neutral sentiment across all tweets over the study period. Major fluctuations in volume (between 12,622 and 51,340) and sentiment (between 25% and 49%) appeared to coincide with key changes to any local and/or national social distancing measures. Tweets around mental health were polarizing, discussed with both positive and negative sentiment. Key topics of consistent discussion over the study period included the impact of the pandemic on people’s mental health (both positively and negatively), fear and anxiety over lockdowns, and anger and mistrust toward the government. Conclusions: Using an NLP platform, we were able to rapidly mine and analyze emerging health-related insights from UK tweets into how the pandemic may be impacting people’s mental health and well-being. This type of real-time analyzed evidence could act as a useful intelligence source that agencies, local leaders, and health care decision makers can potentially draw from, particularly during a health crisis. %M 36406146 %R 10.2196/32449 %U https://infodemiology.jmir.org/2022/1/e32449 %U https://doi.org/10.2196/32449 %U http://www.ncbi.nlm.nih.gov/pubmed/36406146 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e27402 %T A Web-Based App for Emotional Management During the COVID-19 Pandemic: Platform Development and Retrospective Analysis of its Use Throughout Two Waves of the Outbreak in Spain %A Fidel Kinori,Sara Guila %A Carot-Sans,Gerard %A Cuartero,Andrés %A Valero-Bover,Damià %A Roma Monfa,Rosa %A Garcia,Elisabet %A Pérez Sust,Pol %A Blanch,Jordi %A Piera-Jiménez,Jordi %A Ramos-Quiroga,Josep Antoni %+ Information Systems Directorate, Servei Català de la Salut, Barcelona, Spain, 34 651041515, jpieraj@uoc.edu %K web-based app %K emotional management %K lockdown %K COVID-19 %K posttraumatic stress disorder %K anxiety %K quarantine %K PTSD %K app %K emotion %K development %K platform %K retrospective %K usage %K utilization %D 2022 %7 31.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Quarantines and nationwide lockdowns implemented for containing the spread of the COVID-19 pandemic may lead to distress and increase the frequency of anxiety and depression symptoms among the general population. During the nationwide lockdown of the first wave of the COVID-19 outbreak in Spain, we developed and launched a web-based app to promote emotional self-care in the general population and facilitate contact with health care professionals. Objective: This study aimed to describe a web-based app and analyze its utilization pattern throughout 2 successive waves of the COVID-19 outbreak in Spain. Methods: Our web-based app targeted all individuals aged 18 years or more and was designed by adapting the contents of a mobile app for adjuvant treatment of posttraumatic stress disorder (ie, the PTSD Coach app) to the general population and the pandemic or lockdown scenario. We retrospectively assessed the utilization pattern of the web-based app using data systematically retrieved from Google Analytics. Data were grouped into 3 time periods, defined using Joinpoint regression analysis of COVID-19 incidence in our area: first wave, between-wave period, and second wave. Results: The resulting web-based app, named gesioemocional.cat, maintains the navigation structure of the PTSD Coach app, with three main modules: tools for emotional self-care, a self-assessment test, and professional resources for on-demand contact. The self-assessment test combines the Patient Health Questionnaire-2 and the 7-item Generalized Anxiety Disorder scale and offers professional contact in the advent of a high level of depression and anxiety; contact is prioritized in accordance with a screening questionnaire administered at the time of obtaining individual consent to be contacted. The tools for emotional self-care can be accessed either on-demand or symptom-driven. The utilization analysis showed a high number of weekly accesses during the first wave. In this period, press releases regarding critical events of the pandemic progression and government decisions on containment measures were followed by a utilization peak, irrespective of the sense (ie, positive or negative) of the information. Positive information pieces (eg, relaxation of containment measures due to a reduction of COVID-19 cases) resulted in a sharp increase in utilization immediately after information release, followed by a successive decline in utilization. The second wave was characterized by a lower and less responsive utilization of the web-based app. Conclusions: mHealth tools may help the general population cope with stressful conditions associated with the pandemic scenario. Future studies shall investigate the effectiveness of these tools among the general population—including individuals without diagnosed mental illnesses—and strategies to reach as many people as possible. %M 35142638 %R 10.2196/27402 %U https://formative.jmir.org/2022/3/e27402 %U https://doi.org/10.2196/27402 %U http://www.ncbi.nlm.nih.gov/pubmed/35142638 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 3 %P e35190 %T Mining Electronic Health Records for Drugs Associated With 28-day Mortality in COVID-19: Pharmacopoeia-wide Association Study (PharmWAS) %A Lerner,Ivan %A Serret-Larmande,Arnaud %A Rance,Bastien %A Garcelon,Nicolas %A Burgun,Anita %A Chouchana,Laurent %A Neuraz,Antoine %+ Inserm, Centre de Recherche des Cordeliers, Sorbonne Université, Université de Paris, 15 Rue de l'École de Médecine, Paris, 75006, France, 33 01 44 27 64 82, antoine.neuraz@aphp.fr %K COVID-19 %K drug repurposing %K wide association studies %K clinical data %K pharmacopeia %K electronic medical records %K health data %K mortality rate %K hospitalization %K patient data %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: Patients hospitalized for a given condition may be receiving other treatments for other contemporary conditions or comorbidities. The use of such observational clinical data for pharmacological hypothesis generation is appealing in the context of an emerging disease but particularly challenging due to the presence of drug indication bias. Objective: With this study, our main objective was the development and validation of a fully data-driven pipeline that would address this challenge. Our secondary objective was to generate pharmacological hypotheses in patients with COVID-19 and demonstrate the clinical relevance of the pipeline. Methods: We developed a pharmacopeia-wide association study (PharmWAS) pipeline inspired from the PheWAS methodology, which systematically screens for associations between the whole pharmacopeia and a clinical phenotype. First, a fully data-driven procedure based on adaptive least absolute shrinkage and selection operator (LASSO) determined drug-specific adjustment sets. Second, we computed several measures of association, including robust methods based on propensity scores (PSs) to control indication bias. Finally, we applied the Benjamini and Hochberg procedure of the false discovery rate (FDR). We applied this method in a multicenter retrospective cohort study using electronic medical records from 16 university hospitals of the Greater Paris area. We included all adult patients between 18 and 95 years old hospitalized in conventional wards for COVID-19 between February 1, 2020, and June 15, 2021. We investigated the association between drug prescription within 48 hours from admission and 28-day mortality. We validated our data-driven pipeline against a knowledge-based pipeline on 3 treatments of reference, for which experts agreed on the expected association with mortality. We then demonstrated its clinical relevance by screening all drugs prescribed in more than 100 patients to generate pharmacological hypotheses. Results: A total of 5783 patients were included in the analysis. The median age at admission was 69.2 (IQR 56.7-81.1) years, and 3390 (58.62%) of the patients were male. The performance of our automated pipeline was comparable or better for controlling bias than the knowledge-based adjustment set for 3 reference drugs: dexamethasone, phloroglucinol, and paracetamol. After correction for multiple testing, 4 drugs were associated with increased in-hospital mortality. Among these, diazepam and tramadol were the only ones not discarded by automated diagnostics, with adjusted odds ratios of 2.51 (95% CI 1.52-4.16, Q=.01) and 1.94 (95% CI 1.32-2.85, Q=.02), respectively. Conclusions: Our innovative approach proved useful in generating pharmacological hypotheses in an outbreak setting, without requiring a priori knowledge of the disease. Our systematic analysis of early prescribed treatments from patients hospitalized for COVID-19 showed that diazepam and tramadol are associated with increased 28-day mortality. Whether these drugs could worsen COVID-19 needs to be further assessed. %M 35275837 %R 10.2196/35190 %U https://medinform.jmir.org/2022/3/e35190 %U https://doi.org/10.2196/35190 %U http://www.ncbi.nlm.nih.gov/pubmed/35275837 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e30032 %T Subphenotyping of Mexican Patients With COVID-19 at Preadmission To Anticipate Severity Stratification: Age-Sex Unbiased Meta-Clustering Technique %A Zhou,Lexin %A Romero-García,Nekane %A Martínez-Miranda,Juan %A Conejero,J Alberto %A García-Gómez,Juan M %A Sáez,Carlos %+ Biomedical Data Science Lab, Instituto Universitario de Tecnologías de la Información y Comunicaciones, Universitat Politècnica de València, Camino de Vera s/n, Valencia, 46022, Spain, 34 963877000 ext 75278, carsaesi@upv.es %K COVID-19 %K subphenotypes %K clustering %K characterization %K observational %K epidemiology %K Mexico %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has led to an unprecedented global health care challenge for both medical institutions and researchers. Recognizing different COVID-19 subphenotypes—the division of populations of patients into more meaningful subgroups driven by clinical features—and their severity characterization may assist clinicians during the clinical course, the vaccination process, research efforts, the surveillance system, and the allocation of limited resources. Objective: We aimed to discover age-sex unbiased COVID-19 patient subphenotypes based on easily available phenotypical data before admission, such as pre-existing comorbidities, lifestyle habits, and demographic features, to study the potential early severity stratification capabilities of the discovered subgroups through characterizing their severity patterns, including prognostic, intensive care unit (ICU), and morbimortality outcomes. Methods: We used the Mexican Government COVID-19 open data, including 778,692 SARS-CoV-2 population-based patient-level data as of September 2020. We applied a meta-clustering technique that consists of a 2-stage clustering approach combining dimensionality reduction (ie, principal components analysis and multiple correspondence analysis) and hierarchical clustering using the Ward minimum variance method with Euclidean squared distance. Results: In the independent age-sex clustering analyses, 56 clusters supported 11 clinically distinguishable meta-clusters (MCs). MCs 1-3 showed high recovery rates (90.27%-95.22%), including healthy patients of all ages, children with comorbidities and priority in receiving medical resources (ie, higher rates of hospitalization, intubation, and ICU admission) compared with other adult subgroups that have similar conditions, and young obese smokers. MCs 4-5 showed moderate recovery rates (81.30%-82.81%), including patients with hypertension or diabetes of all ages and obese patients with pneumonia, hypertension, and diabetes. MCs 6-11 showed low recovery rates (53.96%-66.94%), including immunosuppressed patients with high comorbidity rates, patients with chronic kidney disease with a poor survival length and probability of recovery, older smokers with chronic obstructive pulmonary disease, older adults with severe diabetes and hypertension, and the oldest obese smokers with chronic obstructive pulmonary disease and mild cardiovascular disease. Group outcomes conformed to the recent literature on dedicated age-sex groups. Mexican states and several types of clinical institutions showed relevant heterogeneity regarding severity, potentially linked to socioeconomic or health inequalities. Conclusions: The proposed 2-stage cluster analysis methodology produced a discriminative characterization of the sample and explainability over age and sex. These results can potentially help in understanding the clinical patient and their stratification for automated early triage before further tests and laboratory results are available and even in locations where additional tests are not available or to help decide resource allocation among vulnerable subgroups such as to prioritize vaccination or treatments. %M 35144239 %R 10.2196/30032 %U https://publichealth.jmir.org/2022/3/e30032 %U https://doi.org/10.2196/30032 %U http://www.ncbi.nlm.nih.gov/pubmed/35144239 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32933 %T Patient Perspectives of Inpatient Telemedicine During the COVID-19 Pandemic: Qualitative Assessment %A Vilendrer,Stacie %A Sackeyfio,Sarah %A Akinbami,Eliel %A Ghosh,Roy %A Luu,Jacklyn Ha %A Pathak,Divya %A Shimada,Masahiro %A Williamson,Emmanuelle Elise %A Shieh,Lisa %+ Division of Primary Care and Population Health, Stanford University School of Medicine, 1265 Welch Rd, Stanford, CA, 94305, United States, 1 952 913 8883, staciev@stanford.edu %K telemedicine %K inpatient %K patient experience %K COVID-19 %K infection control %K quality of health care %K communication %K hospital %K perspective %K qualitative %D 2022 %7 30.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine has been adopted in the inpatient setting to facilitate clinical interactions between on-site clinicians and isolated hospitalized patients. Such remote interactions have the potential to reduce pathogen exposure and use of personal protective equipment but may also pose new safety concerns given prior evidence that isolated patients can receive suboptimal care. Formal evaluations of the use and practical acceptance of inpatient telemedicine among hospitalized patients are lacking. Objective: We aimed to evaluate the experience of patients hospitalized for COVID-19 with inpatient telemedicine introduced as an infection control measure during the pandemic. Methods: We conducted a qualitative evaluation in a COVID-19 designated non–intensive care hospital unit at a large academic health center (Stanford Health Care) from October 2020 through January 2021. Semistructured qualitative interviews focused on patient experience, impact on quality of care, communication, and mental health. Purposive sampling was used to recruit participants representing diversity across varying demographics until thematic saturation was reached. Interview transcripts were qualitatively analyzed using an inductive-deductive approach. Results: Interviews with 20 hospitalized patients suggested that nonemergency clinical care and bridging to in-person care comprised the majority of inpatient telemedicine use. Nurses were reported to enter the room and call on the tablet far more frequently than physicians, who typically entered the room at least daily. Patients reported broad acceptance of the technology, citing improved convenience and reduced anxiety, but preferred in-person care where possible. Quality of care was believed to be similar to in-person care with the exception of a few patients who wanted more frequent in-person examinations. Ongoing challenges included low audio volume, shifting tablet location, and inconsistent verbal introductions from the clinical team. Conclusions: Patient experiences with inpatient telemedicine were largely favorable. Although most patients expressed a preference for in-person care, telemedicine was acceptable given the circumstances associated with the COVID-19 pandemic. Improvements in technical and care team use may enhance acceptability. Further evaluation is needed to understand the impact of inpatient telemedicine and the optimal balance between in-person and virtual care in the hospital setting. %M 35147510 %R 10.2196/32933 %U https://formative.jmir.org/2022/3/e32933 %U https://doi.org/10.2196/32933 %U http://www.ncbi.nlm.nih.gov/pubmed/35147510 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 10 %N 3 %P e35216 %T Pandemic-Related Impairment in the Monitoring of Patients With Hypertension and Diabetes and the Development of a Digital Solution for the Community Health Worker: Quasiexperimental and Implementation Study %A Cimini,Christiane Correa Rodrigues %A Maia,Junia Xavier %A Pires,Magda Carvalho %A Ribeiro,Leonardo Bonisson %A Pinto,Vânia Soares de Oliveira e Almeida %A Batchelor,James %A Ribeiro,Antonio Luiz Pinho %A Marcolino,Milena Soriano %+ Medical School and Telehealth Center, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Rua do Cruzeiro, 01, Bairro Jardim São Paulo, Teófilo Otoni-MG, 38803-371, Brazil, 55 33988900906, christiane.cimini@gmail.com %K hypertension %K diabetes mellitus %K COVID-19 %K pandemic %K primary health care %K telemedicine %K clinical decision support systems %K patient care management %D 2022 %7 29.3.2022 %9 Original Paper %J JMIR Med Inform %G English %X Background: The restrictions imposed by the COVID-19 pandemic reduced health service access by patients with chronic diseases. The discontinuity of care is a cause of great concern, mainly in vulnerable regions. Objective: This study aimed to assess the impact of the COVID-19 pandemic on people with hypertension and diabetes mellitus (DM) regarding the frequency of consultations and whether their disease was kept under control. The study also aimed to develop and implement a digital solution to improve monitoring at home. Methods: This is a multimethodological study. A quasiexperimental evaluation assessed the impact of the pandemic on the frequency of consultations and control of patients with hypertension and DM in 34 primary health care centers in 10 municipalities. Then, an implementation study developed an app with a decision support system (DSS) for community health workers (CHWs) to identify and address at-risk patients with uncontrolled hypertension or DM. An expert panel assessment evaluated feasibility, usability, and utility of the software. Results: Of 5070 patients, 4810 (94.87%) had hypertension, 1371 (27.04%) had DM, and 1111 (21.91%) had both diseases. There was a significant reduction in the weekly number of consultations (107, IQR 60.0-153.0 before vs 20.0, IQR 7.0-29.0 after social restriction; P<.001). Only 15.23% (772/5070) of all patients returned for a consultation during the pandemic. Individuals with hypertension had lower systolic (120.0, IQR 120.0-140.0 mm Hg) and diastolic (80.0, IQR 80.0-80.0 mm Hg) blood pressure than those who did not return (130.0, IQR 120.0-140.0 mm Hg and 80.0, IQR 80.0-90.0 mm Hg, respectively; P<.001). Also, those who returned had a higher proportion of controlled hypertension (64.3% vs 52.8%). For DM, there were no differences in glycohemoglobin levels. Concerning the DSS, the experts agreed that the CHWs can easily incorporate it into their routines and the app can identify patients at risk and improve treatment. Conclusions: The COVID-19 pandemic caused a significant drop in the number of consultations for patients with hypertension and DM in primary care. A DSS for CHW has proved to be feasible, useful, and easily incorporated into their routines. %M 35191842 %R 10.2196/35216 %U https://medinform.jmir.org/2022/3/e35216 %U https://doi.org/10.2196/35216 %U http://www.ncbi.nlm.nih.gov/pubmed/35191842 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e35016 %T Tracking Public Attitudes Toward COVID-19 Vaccination on Tweets in Canada: Using Aspect-Based Sentiment Analysis %A Jang,Hyeju %A Rempel,Emily %A Roe,Ian %A Adu,Prince %A Carenini,Giuseppe %A Janjua,Naveed Zafar %+ British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada, 1 778 580 9113, hyejuj@cs.ubc.ca %K COVID-19 %K vaccination %K Twitter %K aspect-based sentiment analysis %K Canada %K social media %K pandemic %K content analysis %K vaccine rollout %K sentiment analysis %K public sentiment %K public health %K health promotion %K vaccination promotion %D 2022 %7 29.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The development and approval of COVID-19 vaccines have generated optimism for the end of the COVID-19 pandemic and a return to normalcy. However, vaccine hesitancy, often fueled by misinformation, poses a major barrier to achieving herd immunity. Objective: We aim to investigate Twitter users’ attitudes toward COVID-19 vaccination in Canada after vaccine rollout. Methods: We applied a weakly supervised aspect-based sentiment analysis (ABSA) technique, which involves the human-in-the-loop system, on COVID-19 vaccination–related tweets in Canada. Automatically generated aspect and opinion terms were manually corrected by public health experts to ensure the accuracy of the terms and make them more domain-specific. Then, based on these manually corrected terms, the system inferred sentiments toward the aspects. We observed sentiments toward key aspects related to COVID-19 vaccination, and investigated how sentiments toward “vaccination” changed over time. In addition, we analyzed the most retweeted or liked tweets by observing most frequent nouns and sentiments toward key aspects. Results: After applying the ABSA system, we obtained 170 aspect terms (eg, “immunity” and “pfizer”) and 6775 opinion terms (eg, “trustworthy” for the positive sentiment and “jeopardize” for the negative sentiment). While manually verifying or editing these terms, our public health experts selected 20 key aspects related to COVID-19 vaccination for analysis. The sentiment analysis results for the 20 key aspects revealed negative sentiments related to “vaccine distribution,” “side effects,” “allergy,” “reactions,” and “anti-vaxxer,” and positive sentiments related to “vaccine campaign,” “vaccine candidates,” and “immune response.” These results indicate that the Twitter users express concerns about the safety of vaccines but still consider vaccines as the option to end the pandemic. In addition, compared to the sentiment of the remaining tweets, the most retweeted or liked tweets showed more positive sentiment overall toward key aspects (P<.001), especially vaccines (P<.001) and vaccination (P=.009). Further investigation of the most retweeted or liked tweets revealed two opposing trends in Twitter users who showed negative sentiments toward vaccines: the “anti-vaxxer” population that used negative sentiments as a means to discourage vaccination and the “Covid Zero” population that used negative sentiments to encourage vaccinations while critiquing the public health response. Conclusions: Our study examined public sentiments toward COVID-19 vaccination on tweets over an extended period in Canada. Our findings could inform public health agencies to design and implement interventions to promote vaccination. %M 35275835 %R 10.2196/35016 %U https://www.jmir.org/2022/3/e35016 %U https://doi.org/10.2196/35016 %U http://www.ncbi.nlm.nih.gov/pubmed/35275835 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e25803 %T Adverse Events of Interest Following Influenza Vaccination in the First Season of Adjuvanted Trivalent Immunization: Retrospective Cohort Study %A de Lusignan,Simon %A Tsang,Ruby S M %A Akinyemi,Oluwafunmi %A Lopez Bernal,Jamie %A Amirthalingam,Gayatri %A Sherlock,Julian %A Smith,Gillian %A Zambon,Maria %A Howsam,Gary %A Joy,Mark %+ University of Oxford, Eagle House 7, Walton Well road, Oxford, OX2 6ED, United Kingdom, 44 7713632524, simon.delusignan@phc.ox.ac.uk %K influenza %K influenza vaccines %K adverse events of interest %K computerized medical record systems %K sentinel surveillance %D 2022 %7 28.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Vaccination is the most effective form of prevention of seasonal influenza; the United Kingdom has a national influenza vaccination program to cover targeted population groups. Influenza vaccines are known to be associated with some common minor adverse events of interest (AEIs), but it is not known if the adjuvanted trivalent influenza vaccine (aTIV), first offered in the 2018/2019 season, would be associated with more AEIs than other types of vaccines. Objective: We aim to compare the incidence of AEIs associated with different types of seasonal influenza vaccines offered in the 2018/2019 season. Methods: We carried out a retrospective cohort study using computerized medical record data from the Royal College of General Practitioners Research and Surveillance Centre sentinel network database. We extracted data on vaccine exposure and consultations for European Medicines Agency–specified AEIs for the 2018/2019 influenza season. We used a self-controlled case series design; computed relative incidence (RI) of AEIs following vaccination; and compared the incidence of AEIs associated with aTIV, the quadrivalent influenza vaccine, and the live attenuated influenza vaccine. We also compared the incidence of AEIs for vaccinations that took place in a practice with those that took place elsewhere. Results: A total of 1,024,160 individuals received a seasonal influenza vaccine, of which 165,723 individuals reported a total of 283,355 compatible symptoms in the 2018/2019 season. Most AEIs occurred within 7 days following vaccination, with a seasonal effect observed. Using aTIV as the reference group, the quadrivalent influenza vaccine was associated with a higher incidence of AEIs (RI 1.46, 95% CI 1.41-1.52), whereas the live attenuated influenza vaccine was associated with a lower incidence of AEIs (RI 0.79, 95% CI 0.73-0.83). No effect of vaccination setting on the incidence of AEIs was observed. Conclusions: Routine sentinel network data offer an opportunity to make comparisons between safety profiles of different vaccines. Evidence that supports the safety of newer types of vaccines may be reassuring for patients and could help improve uptake in the future. %M 35343907 %R 10.2196/25803 %U https://publichealth.jmir.org/2022/3/e25803 %U https://doi.org/10.2196/25803 %U http://www.ncbi.nlm.nih.gov/pubmed/35343907 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e25658 %T A Bayesian Network to Predict the Risk of Post Influenza Vaccination Guillain-Barré Syndrome: Development and Validation Study %A Huang,Yun %A Luo,Chongliang %A Jiang,Ying %A Du,Jingcheng %A Tao,Cui %A Chen,Yong %A Hao,Yuantao %+ Department of Medical Statistics, Sun Yat-Sen University, No. 74 Zhongshan II Road, Guangzhou, 510080, China, 86 02087331587, haoyt@mail.sysu.edu.cn %K adverse events %K Bayesian network %K Guillain-Barré syndrome %K risk prediction %K trivalent influenza vaccine %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Identifying the key factors of Guillain-Barré syndrome (GBS) and predicting its occurrence are vital for improving the prognosis of patients with GBS. However, there are scarcely any publications on a forewarning model of GBS. A Bayesian network (BN) model, which is known to be an accurate, interpretable, and interaction-sensitive graph model in many similar domains, is worth trying in GBS risk prediction. Objective: The aim of this study is to determine the most significant factors of GBS and further develop and validate a BN model for predicting GBS risk. Methods: Large-scale influenza vaccine postmarketing surveillance data, including 79,165 US (obtained from the Vaccine Adverse Event Reporting System between 1990 and 2017) and 12,495 European (obtained from the EudraVigilance system between 2003 and 2016) adverse events (AEs) reports, were extracted for model development and validation. GBS, age, gender, and the top 50 prevalent AEs were included for initial BN construction using the R package bnlearn. Results: Age, gender, and 10 AEs were identified as the most significant factors of GBS. The posttest probability of GBS suggested that male vaccinees aged 50-64 years and without erythema should be on the alert or be warned by clinicians about an increased risk of GBS, especially when they also experience symptoms of asthenia, hypesthesia, muscular weakness, or paresthesia. The established BN model achieved an area under the receiver operating characteristic curve of 0.866 (95% CI 0.865-0.867), sensitivity of 0.752 (95% CI 0.749-0.756), specificity of 0.882 (95% CI 0.879-0.885), and accuracy of 0.882 (95% CI 0.879-0.884) for predicting GBS risk during the internal validation and obtained values of 0.829, 0.673, 0.854, and 0.843 for area under the receiver operating characteristic curve, sensitivity, specificity, and accuracy, respectively, during the external validation. Conclusions: The findings of this study illustrated that a BN model can effectively identify the most significant factors of GBS, improve understanding of the complex interactions among different postvaccination symptoms through its graphical representation, and accurately predict the risk of GBS. The established BN model could further assist clinical decision-making by providing an estimated risk of GBS for a specific vaccinee or be developed into an open-access platform for vaccinees’ self-monitoring. %M 35333192 %R 10.2196/25658 %U https://publichealth.jmir.org/2022/3/e25658 %U https://doi.org/10.2196/25658 %U http://www.ncbi.nlm.nih.gov/pubmed/35333192 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34539 %T Recommendations for Researchers on Synchronous, Online, Nominal Group Sessions in Times of COVID-19: Fishbone Analysis %A Timmermans,Lotte %A Huybrechts,Ine %A Decat,Peter %A Foulon,Veerle %A Van Hecke,Ann %A Vermandere,Mieke %A Schoenmakers,Birgitte %+ Academic Centre of General Practice, KU Leuven, Kapucijnenvoer 7, Box 7001, Leuven, 3000, Belgium, 32 16 37 45 98, lotte.timmermans@kuleuven.be %K COVID-19 %K fishbone diagram %K nominal group technique %K video conferencing %K primary health care %K qualitative research %D 2022 %7 25.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: In times of COVID-19, we are challenged to experiment with alternative platforms or software to connect people. In particular, the struggle that arose in health research was how to interact with patients and care professionals. The latter is additionally faced with an extreme workload to fight the pandemic crisis. Creative strategies have been developed to continue research among patients and care professionals to improve quality of care. This paper addresses the issue of synchronous, online, nominal group sessions, a common consensus method used for group brainstorming. Objective: The purpose of this study was to share our experiences with performing online, nominal group sessions using the video conference software Microsoft Teams. In addition, we aimed to create a practical guide with recommendations for researchers. Methods: We critically analyzed the procedures for the online nominal group technique, according to the Fishbone methodology. Results: Performing synchronous, online, nominal group sessions is challenging but offers opportunities. Although interaction with and among the attendees complicates the process, the major advantage of online sessions is their accessibility and comfort because of reduced barriers to participation (eg, lower time investment). The role of the moderators is of major importance, and good preparation beforehand is required. Recommendations for future online, nominal research were formulated. Conclusions: Online, nominal group sessions seem to be a promising alternative for the real-life commonly used technique. Especially during the COVID-19 pandemic, the benefits must be highlighted. More expertise is needed to further refine the practical guide for using digital software in research and to achieve optimal performance. %M 35225814 %R 10.2196/34539 %U https://formative.jmir.org/2022/3/e34539 %U https://doi.org/10.2196/34539 %U http://www.ncbi.nlm.nih.gov/pubmed/35225814 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34544 %T The Evaluation of a Social Media Campaign to Increase COVID-19 Testing in Migrant Groups: Cluster Randomized Trial %A Elgersma,Ingeborg Hess %A Fretheim,Atle %A Indseth,Thor %A Munch,Anita Thorolvsen %A Johannessen,Live Bøe %A Hansen,Christine Engh %+ Centre for Epidemic Interventions Research, Norwegian Institute of Public Health, Postboks 222, Skøyen, Oslo, 0213, Norway, 47 91584782, ingeborghess.elgersma@fhi.no %K COVID-19 %K SARS-CoV-2 %K social media %K campaign %K cluster randomized trial %K nonpharmaceutical interventions %K migrant %K intervention %K testing %K strategy %K public health %K Facebook %K communication %D 2022 %7 24.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: A low test positivity rate is key to keeping the COVID-19 pandemic under control. Throughout the pandemic, several migrant groups in Norway have seen higher rates of confirmed COVID-19 and related hospitalizations, while test positivity has remained high in the same groups. The Norwegian government has used several platforms for communication, and targeted social media advertisements have in particular been an important part of the communication strategy to reach these groups. Objective: In this study, we aimed to investigate whether such a targeted Facebook campaign increased the rate of COVID-19 tests performed in certain migrant groups. Methods: We randomly assigned 386 Norwegian municipalities and city districts to intervention or control groups. Individuals born in Eritrea, Iraq, Pakistan, Poland, Russia, Somalia, Syria, and Turkey residing in intervention areas were targeted with a social media campaign aiming at increasing the COVID-19 test rate. The campaign message was in a simple language and conveyed in the users’ main language or in English. Results: During the 2-week follow-up period, the predicted probability of having a COVID-19 test taken was 4.82% (95% CI 4.47%-5.18%) in the control group, and 5.58% (95% CI 5.20%-5.99%) in the intervention group (P=.004). Conclusions: Our targeted social media intervention led to a modest increase in test rates among certain migrant groups in Norway. Trial Registration: ClinicalTrials.gov NCT04866589; https://clinicaltrials.gov/ct2/show/NCT04866589 %M 35285811 %R 10.2196/34544 %U https://www.jmir.org/2022/3/e34544 %U https://doi.org/10.2196/34544 %U http://www.ncbi.nlm.nih.gov/pubmed/35285811 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32477 %T Competition and Integration of US Health Systems in the Post-COVID-19 New Normal: Cross-sectional Survey %A Khuntia,Jiban %A Ning,Xue %A Stacey,Rulon %+ Business School, University of Colorado Denver, 1475 Lawrence St., Denver, CO, 80202, United States, 1 303 315 8424, jiban.khuntia@ucdenver.edu %K post-COVID-19 %K health system %K competition %K vertical integration %K horizontal integration %K COVID-19 %K integration %K cross-sectional %K survey %K United States %K characteristic %K perception %K decision %D 2022 %7 24.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: How do health systems in the United States view the concept of merger and acquisition (M&A) in a post-COVID 19 “new normal”? How do new entrants to the market and incumbents influence horizontal and vertical integration of health systems? Traditionally, it has been argued that M&A activity is designed to reduce inequities in the market, shift toward value-based care, or enhance the number and quality of health care offerings in a given market. However, the recent history of M&A activity has yielded fewer noble results. As might be expected, the smaller the geographical region in which M&A activity is pursued, the higher the likelihood that monopolistic tendencies will result. Objective: We focused on three types of competition perceptions, external environment uncertainty–related competition, technology disruption–driven competition, and customer service–driven competition, and two integration plans, vertical integration and horizontal integration. We examined (1) how health system characteristics help discern competition perceptions and integration decisions, and (2) how environment-, technology-, and service-driven competition aspects influence vertical and horizontal integration among US health systems in the post-COVID-19 new normal. Methods: We used data for this study collected through a consultant from a robust group of health system chief executive officers (CEOs) across the United States from February to March 2021. Among the 625 CEOs, 135 (21.6%) responded to our survey. We considered competition and integration aspects from the literature and ratified them via expert consensus. We collected secondary data from the Agency for Healthcare Research and Quality (AHRQ) Compendium of the US Health Systems, leading to a matched data set for 124 health systems. We used inferential statistical comparisons to assess differences across health systems regarding competition and integration, and we used ordered logit estimations to relate competition and integration. Results: Health systems generally have a high level of the four types of competition perceptions, with the greatest concern being technology disruption–driven competition rather than environment uncertainty–related competition and customer service–driven competition. The first set of estimation results showed that size, teaching status, revenue, and uncompensated care burden are the main contingent factors influencing the three competition perceptions. The second set of estimation results revealed the relationships between different competition perceptions and integration plans. For vertical integration, environment uncertainty–related competition had a significant positive influence (P<.001), while the influence of technology disruption–driven competition was significant but negative (P<.001). The influence of customer service–driven competition on vertical integration was not evident. For horizontal integration, the results were similar for environment uncertainty–related competition and technology disruption–driven competition; however, the significance of technology disruption–driven competition was weak (P=.05). The influence of customer service–driven competition in the combined model was significant and negative (P<.001). Conclusions: Competition-driven integration has subtle influences across health systems. Environment uncertainty–related competition is a significant factor, with underlying contingent factors such as revenue concerns and leadership as the leading causes of integration plans. However, technology disruption may hinder integrations. Undoubtedly, small- and low-revenue health systems facing a high level of competition are likely to merge to navigate the health care business successfully. This trend should be a focus of policy to avoid monopolistic markets. %M 35133973 %R 10.2196/32477 %U https://formative.jmir.org/2022/3/e32477 %U https://doi.org/10.2196/32477 %U http://www.ncbi.nlm.nih.gov/pubmed/35133973 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31449 %T Social Media–Delivered Patient Education to Enhance Self-management and Attitudes of Patients with Type 2 Diabetes During the COVID-19 Pandemic: Randomized Controlled Trial %A Leong,Cheng Man %A Lee,Ting-I %A Chien,Yu-Mei %A Kuo,Li-Na %A Kuo,Yu-Feng %A Chen,Hsiang-Yin %+ Department of Clinical Pharmacy, School of Pharmacy, Taipei Medical University, R714, 7th Floor, Health and Science Building, No.250, Wuxing St., Xinyi Dist., Taipei, 110, Taiwan, 886 2 2736 1661 ext 6175, shawn@tmu.edu.tw %K diabetes %K COVID-19 %K education %K video %K social media %K health literacy %K self-care activity %K type 2 diabetes %K attitude %K mHealth %D 2022 %7 23.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of mobile health technologies has been necessary to deliver patient education to patients with diabetes during the COVID-19 pandemic. Objective: This open-label randomized controlled trial evaluated the effects of a diabetes educational platform—Taipei Medical University–LINE Oriented Video Education—delivered through a social media app. Methods: Patients with type 2 diabetes were recruited from a clinic through physician referral. The social media–based program included 51 videos: 10 about understanding diabetes, 10 about daily care, 6 about nutrition care, 21 about diabetes drugs, and 4 containing quizzes. The intervention group received two or three videos every week and care messages every 2 weeks through the social media platform for 3 months, in addition to usual care. The control group only received usual care. Outcomes were measured at clinical visits through self-reported face-to-face questionnaires at baseline and at 3 months after the intervention, including the Simplified Diabetes Knowledge Scale (true/false version), the Diabetes Care Profile–Attitudes Toward Diabetes Scales, the Summary of Diabetes Self-Care Activities, and glycated hemoglobin (HbA1c) levels. Health literacy was measured at baseline using the Newest Vital Sign tool. Differences in HbA1c levels and questionnaire scores before and after the intervention were compared between groups. The associations of knowledge, attitudes, and self-care activities with health literacy were assessed. Results: Patients with type 2 diabetes completed the 3-month study, with 91 out of 181 (50.3%) patients in the intervention group and 90 (49.7%) in the control group. The change in HbA1c did not significantly differ between groups (intervention group: mean 6.9%, SD 0.8% to mean 7.0%, SD 0.9%, P=.34; control group: mean 6.7%, SD 0.6% to mean 6.7%, SD 0.7%, P=.91). Both groups showed increased mean knowledge scores at 12 weeks, increasing from 68.3% (SD 16.4%) to 76.7% (SD 11.7%; P<.001) in the intervention group and from 64.8% (SD 18.2%) to 73.2% (SD 12.6%; P<.001) in the control group. Positive improvements in attitudes and self-care activities were only observed in the intervention group (attitudes: mean difference 0.2, SD 0.5, P=.001; self-care activities: mean difference 0.3, SD 1.2, P=.03). A 100% utility rate was achieved for 8 out of 21 (38%) medication-related videos. Low health literacy was a significant risk factor for baseline knowledge scores in the intervention group, with an odds ratio of 2.80 (95% CI 1.28-6.12; P=.01); this became insignificant after 3 months. Conclusions: The social media–based program was effective at enhancing the knowledge, attitudes, and self-care activities of patients with diabetes. This intervention was also helpful for patients with low health literacy in diabetes knowledge. The program represents a potentially useful tool for delivering diabetes education to patients through social media, especially during the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04876274; https://clinicaltrials.gov/ct2/show/results/NCT04876274 %M 35319478 %R 10.2196/31449 %U https://www.jmir.org/2022/3/e31449 %U https://doi.org/10.2196/31449 %U http://www.ncbi.nlm.nih.gov/pubmed/35319478 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e35066 %T How Vaccine Ambivalence Can Lead People Who Inject Drugs to Decline COVID-19 Vaccination and Ways This Can Be Addressed: Qualitative Study %A Aronson,Ian David %A Bennett,Alex S %A Ardouin-Guerrier,Mary-Andrée %A Rivera-Castellar,German %A Gibson,Brent %A Santoscoy,Samantha %A Vargas-Estrella,Brittney %+ Department of Social and Behavioral Sciences, School of Global Public Health, New York University, 708 Broadway, New York, NY, 10003, United States, 1 (212) 992 6741, ia14@nyu.edu %K SARS-CoV-2 %K COVID-19 %K people who inject drugs %K vaccine %K vaccine hesitancy %K barrier %K vaccination %K drugs %K hesitancy %K qualitative %K impact %K interview %K United States %K communication %K danger %K community %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People who inject drugs are disproportionately impacted by SARS-CoV-2 and COVID-19, yet they do not frequently accept vaccination against SARS-CoV-2 when offered. Objective: This study aimed to explore why people who inject drugs decline free vaccines against SARS-CoV-2 and how barriers to vaccination can potentially be addressed. Methods: We conducted semistructured qualitative interviews with 17 unvaccinated adult persons who inject drugs during August and September 2021 at a New York City syringe service program, where approximately three-fourth of participants identified as Latino (55%) or African American (22%). Interviews lasted roughly 20 minutes. The interview guide examined reasons for declining vaccination, participants’ understanding of COVID-19 risks, and how messages could be developed to encourage vaccine uptake among people who inject drugs. Results: Participants acknowledged that they faced increased risk from SARS-CoV-2 owing to their injection drug use but feared that long-term substance use may have weakened their health, making them especially vulnerable to side effects. Fears of possible side effects, compounded by widespread medical mistrust and questions about the overall value of vaccination contributed to marked ambivalence among our sample. The desire to protect children and older family members emerged as key potential facilitators of vaccination. Conclusions: Community-developed messages are needed in outreach efforts to explain the importance of vaccination, including the far greater dangers of COVID-19 compared to possible unintended side effects. Messages that emphasize vaccines’ ability to prevent inadvertently infecting loved ones, may help increase uptake. Community-focused messaging strategies, such as those used to increase HIV and hepatitis C virus testing and overdose prevention among people who inject drugs, may prove similarly effective. %M 35191841 %R 10.2196/35066 %U https://formative.jmir.org/2022/3/e35066 %U https://doi.org/10.2196/35066 %U http://www.ncbi.nlm.nih.gov/pubmed/35191841 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32403 %T The Impact of Telemedicine Visits on the Controlling High Blood Pressure Quality Measure During the COVID-19 Pandemic: Retrospective Cohort Study %A Ye,Siqin %A Anstey,D Edmund %A Grauer,Anne %A Metser,Gil %A Moise,Nathalie %A Schwartz,Joseph %A Kronish,Ian %A Abdalla,Marwah %+ Department of Medicine, Columbia University Irving Medical Center, 622 West 168th Street, PH 9-318, New York, NY, 10033, United States, 1 7737100114, sy2357@cumc.columbia.edu %K telemedicine %K hypertension %K blood pressure %K quality of care %K impact %K COVID-19 %K cohort %K cardiology %K telehealth %K retrospective %D 2022 %7 23.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Telemedicine visit use vastly expanded during the COVID-19 pandemic, and this has had an uncertain impact on cardiovascular care quality. Objective: We sought to examine the association between telemedicine visits and the failure to meet the Controlling High Blood Pressure (BP) quality measure from the Centers for Medicare & Medicaid Services. Methods: This was a retrospective cohort study of 32,727 adult patients with hypertension who were seen in primary care and cardiology clinics at an urban, academic medical center from February to December 2020. The primary outcome was a failure to meet the Controlling High Blood Pressure quality measure, which was defined as having no BP recorded or having a last recorded BP of ≥140/90 mm Hg (ie, poor BP control). Multivariable logistic regression was used to assess the association between telemedicine visit use during the study period (none, 1 telemedicine visit, or ≥2 telemedicine visits) and poor BP control; we adjusted for demographic and clinical characteristics. Results: During the study period, no BP was recorded for 2.3% (486/20,745) of patients with in-person visits only, 27.1% (1863/6878) of patients with 1 telemedicine visit, and 25% (1277/5104) of patients with ≥2 telemedicine visits. After adjustment, telemedicine use was associated with poor BP control (1 telemedicine visit: odds ratio [OR] 2.06, 95% CI 1.94-2.18; P<.001; ≥2 telemedicine visits: OR 2.49, 95% CI 2.31-2.68; P<.001; reference: in-person visits only). This effect disappeared when the analysis was restricted to patients with at least 1 recorded BP (1 telemedicine visit: OR 0.89, 95% CI 0.83-0.95; P=.001; ≥2 telemedicine visits: OR 0.91, 95% CI 0.83-0.99; P=.03). Conclusions: Increased telemedicine visit use is associated with poorer performance on the Controlling High Blood Pressure quality measure. However, telemedicine visit use may not negatively impact BP control when BP is recorded. %M 35138254 %R 10.2196/32403 %U https://formative.jmir.org/2022/3/e32403 %U https://doi.org/10.2196/32403 %U http://www.ncbi.nlm.nih.gov/pubmed/35138254 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e31088 %T Stratified Impacts of the Infodemic During the COVID-19 Pandemic: Cross-sectional Survey in 6 Asian Jurisdictions %A Chen,Xi %A Lin,Fen %A Cheng,Edmund W %+ Department of Media and Communication, City University of Hong Kong, M5086, 5/F, Run Run Shaw Creative Media Centre, 18 Tat Hong Avenue, Kowloon Tong, Hong Kong, 852 34428691, fenlin@cityu.edu.hk %K infodemic %K information overload %K psychological distress %K protective behavior %K cross-national survey %K Asia %K COVID-19 %D 2022 %7 22.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Although timely and accurate information during the COVID-19 pandemic is essential for containing the disease and reducing mental distress, an infodemic, which refers to an overabundance of information, may trigger unpleasant emotions and reduce compliance. Prior research has shown the negative consequences of an infodemic during the pandemic; however, we know less about which subpopulations are more exposed to the infodemic and are more vulnerable to the adverse psychological and behavioral effects. Objective: This study aimed to examine how sociodemographic factors and information-seeking behaviors affect the perceived information overload during the COVID-19 pandemic. We also investigated the effect of perceived information overload on psychological distress and protective behavior and analyzed the socioeconomic differences in the effects. Methods: The data for this study were obtained from a cross-national survey of residents in 6 jurisdictions in Asia in May 2020. The survey targeted residents aged 18 years or older. A probability-based quota sampling strategy was adopted to ensure that the selected samples matched the population’s geographical and demographic characteristics released by the latest available census in each jurisdiction. The final sample included 10,063 respondents. Information overload about COVID-19 was measured by asking the respondents to what extent they feel overwhelmed by news related to COVID-19. The measure of psychological distress was adapted from the Posttraumatic Stress Disorder Checklist for Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). Protective behaviors included personal hygienic behavior and compliance with social distancing measures. Results: Younger respondents and women (b=0.20, 95% CI 0.14 to 0.26) were more likely to perceive information overload. Participants self-perceived as upper or upper-middle class (b=0.19, 95% CI 0.09 to 0.30) and those with full-time jobs (b=0.11, 95% CI 0.04 to 0.17) tended to perceive higher information overload. Respondents who more frequently sought COVID-19 information from newspapers (b=0.12, 95% CI 0.11 to 0.14), television (b=0.07, 95% CI 0.05 to 0.09), and family and friends (b=0.11, 95% CI 0.09 to 0.14) were more likely to feel overwhelmed. In contrast, obtaining COVID-19 information from online news outlets and social media was not associated with perceived information overload. There was a positive relationship between perceived information overload and psychological distress (b=2.18, 95% CI 2.09 to 2.26). Such an association was stronger among urban residents, full-time employees, and those living in privately owned housing. The effect of perceived information overload on protective behavior was not significant. Conclusions: Our findings revealed that respondents who were younger, were female, had a higher socioeconomic status (SES), and had vulnerable populations in the household were more likely to feel overwhelmed by COVID-19 information. Perceived information overload tended to increase psychological distress, and people with higher SES were more vulnerable to this adverse psychological consequence. Effective policies and interventions should be promoted to target vulnerable populations who are more susceptible to the occurrence and negative psychological influence of perceived information overload. %M 35103601 %R 10.2196/31088 %U https://www.jmir.org/2022/3/e31088 %U https://doi.org/10.2196/31088 %U http://www.ncbi.nlm.nih.gov/pubmed/35103601 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e35280 %T COVID-19 Mental Health Stressors of Health Care Providers in the Pandemic Acceptance and Commitment to Empowerment Response (PACER) Intervention: Qualitative Study %A Sato,Christa %A Adumattah,Anita %A Abulencia,Maria Krisel %A Garcellano,Peter Dennis %A Li,Alan Tai-Wai %A Fung,Kenneth %A Poon,Maurice Kwong-Lai %A Vahabi,Mandana %A Wong,Josephine Pui-Hing %+ Daphne Cockwell School of Nursing, Ryerson University, 350 Victoria Street, Toronto, ON, M5B2K3, Canada, 1 416 979 5000 ext 556303, jph.wong@ryerson.ca %K COVID-19 %K COVID-19 in Canada %K health care providers %K pandemic stressors %K health impact %K caregiving roles %K situational identities %K emotional labor %K hero discourse %K social ecological framework %D 2022 %7 22.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the pandemic, more Canadians have reported poorer mental health. A vital group experiencing a high level of stressors consists of health care providers (HCPs) caring for COVID-19 patients, carrying out public health responses, or working with vulnerable populations. The mental health of HCPs is negatively affected by the pandemic, not only at work but also at home and in the community. Intersecting stressors at multiple levels contribute to HCPs’ experiences of fatigue, insomnia, anxiety, depression, and posttraumatic stress symptoms. Objective: The aim of this qualitative study was to explore the pandemic stressors experienced by HCPs at work, at home, and in the community before participating in the Pandemic Acceptance and Commitment to Empowerment Response (PACER) online intervention. Methods: Informed by a social ecological approach, we used a qualitative reflective approach to engage 74 HCPs in diverse roles. Data were collected during the first 2 waves of the COVID-19 pandemic (June 2020 to February 2021) in Canada. Results: Informed by a social ecological framework, 5 overarching themes were identified in our thematic analysis: (1) personal level stressors that highlight HCPs’ identities and responsibilities beyond the workplace; (2) interpersonal level stressors from disrupted social relationships; (3) organizational stressors that contributed to unsettled workplaces and moral distress; (4) community and societal stressors attributed to vicarious trauma and emotional labor; and (5) the multilevel and cumulative impacts of COVID-19 stressors on HCPs’ health. Conclusions: COVID-19 is not merely a communicable disease but also a social and political phenomenon that intensifies the effects of social inequities. Current understanding of pandemic stressors affecting HCPs is largely partial in nature. Although workplace stressors of HCPs are real and intense, they need to be explored and understood in the context of stressors that exist in other domains of HCPs’ lives such as family and community to ensure these experiences are not being silenced by the “hero” discourses or overshadowed by professional demands. %M 35138256 %R 10.2196/35280 %U https://formative.jmir.org/2022/3/e35280 %U https://doi.org/10.2196/35280 %U http://www.ncbi.nlm.nih.gov/pubmed/35138256 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e34674 %T Evaluating Voice Assistants' Responses to COVID-19 Vaccination in Portuguese: Quality Assessment %A Seródio Figueiredo,Carlos Maurício %A de Melo,Tiago %A Goes,Raphaela %+ Escola Superior de Tecnologia, Universidade do Estado do Amazonas, Av. Darcy Vargas, 1.200 - Parque Dez de Novembro, Manaus, 69050-020, Brazil, 55 92988120877, cfigueiredo@uea.edu.br %K voice assistant %K natural user interface %K Portuguese language %K health information %K COVID-19 %K vaccine %K immunization %K health device %K digital health %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Voice assistants (VAs) are devices that respond to human voices and can be commanded to do a variety of tasks. Nowadays, VAs are being used to obtain health information, which has become a critical point of analysis for researchers in terms of question understanding and quality of response. Particularly, the COVID-19 pandemic has and still is severely affecting people worldwide, which demands studies on how VAs can be used as a tool to provide useful information. Objective: This work aimed to perform a quality analysis of different VAs’ responses regarding the actual and important subject of COVID-19 vaccines. We focused on this important subject since vaccines are now available and society has urged for the population to be rapidly immunized. Methods: The proposed study was based on questions that were collected from the official World Health Organization website. These questions were submitted to the 5 dominant VAs (Alexa, Bixby, Cortana, Google Assistant, and Siri), and responses were evaluated according to a rubric based on the literature. We focused this study on the Portuguese language as an additional contribution, since previous works are mainly focused on the English language, and we believe that VAs cannot be optimized to foreign languages. Results: Results showed that Google Assistant has a better overall performance, and only this VA and Samsung Bixby achieved high scores on question understanding in the Portuguese language. Regarding the obtained answers, the study also showed the best Google Assistant overall performance. Conclusions: Under the urgent context of COVID-19 vaccination, this work can help to understand how VAs must be improved to be more useful to the society and how careful people must be when considering VAs as a source of health information. VAs have been demonstrated to perform well regarding comprehension and user-friendliness. However, this work has found that they must be better integrated to their information sources to be useful as health information tools. %M 35041617 %R 10.2196/34674 %U https://humanfactors.jmir.org/2022/1/e34674 %U https://doi.org/10.2196/34674 %U http://www.ncbi.nlm.nih.gov/pubmed/35041617 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30486 %T Exploring Patient and Staff Experiences With Video Consultations During COVID-19 in an English Outpatient Care Setting: Secondary Data Analysis of Routinely Collected Feedback Data %A Bradwell,Hannah %A Baines,Rebecca %A Edwards,Katie J %A Stevens,Sebastian %A Atkinson,Kate %A Wilkinson,Ellen %A Chatterjee,Arunangsu %A Jones,Ray B %+ Centre for Health Technology, University of Plymouth, Drake Circus, Plymouth, PL4 8AA, United Kingdom, 44 07975927341, hannah.bradwell@plymouth.ac.uk %K COVID-19 %K video consultations %K remote consultation %K Attend Anywhere %K patient feedback %K patient experience %K staff feedback %K outpatients %K pandemic %D 2022 %7 21.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Video consultations (VCs) were rapidly implemented in response to COVID-19 despite modest progress before. Objective: We aim to explore staff and patient experiences with VCs implemented during COVID-19 and use feedback insights to support quality improvement and service development. Methods: Secondary data analysis was conducted on 955 patient and 521 staff responses (from 4234 consultations; 955/4234, 22.6% and 521/4234, 12.3%, respectively) routinely collected following a VC between June and July 2020 in a rural, older adult, and outpatient care setting at a National Health Service Trust. Responses were summarized using descriptive statistics and inductive thematic analysis and presented to Trust stakeholders. Results: Most patients (890/955, 93.2%) reported having good (210/955, 22%) or very good (680/955, 71.2%) experience with VCs and felt listened to and understood (904/955, 94.7%). Most patients accessed their VC alone (806/955, 84.4%) except for those aged ≥71 years (23/58, 40%), with ease of joining VCs negatively associated with age (P<.001). Despite more difficulties joining, older adults were most likely to be satisfied with the technology (46/58, 79%). Patients and staff generally felt that patients’ needs had been met (860/955, 90.1% and 453/521, 86.9%, respectively), although staff appeared to overestimate patient dissatisfaction with VC outcomes (P=.02). Patients (848/955, 88.8%) and staff (419/521, 80.5%) felt able to communicate everything they wanted, although patients were significantly more positive than staff (P<.001). Patient satisfaction with communication was positively associated with technical performance satisfaction (P<.001). Most staff members (466/521, 89.4%) reported positive (185/521, 35.5%) or very positive (281/521, 53.9%) experiences with joining and managing VCs. Staff reported reductions in carbon footprint (380/521, 72.9%) and time (373/521, 71.6%). Most patients (880/955, 92.1%) would choose VCs again. We identified three themes in responses: barriers, including technological difficulties, patient information, and suitability concerns; potential benefits, including reduced stress, enhanced accessibility, cost, and time savings; and suggested improvements, including trial calls, turning music off, photo uploads, expanding written character limit, supporting other internet browsers, and shared online screens. This routine feedback, including evidence to suggest that patients were more satisfied than clinicians had anticipated, was presented to relevant Trust stakeholders, allowing for improved processes and supporting the development of a business case to inform the Trust decision on continuing VCs beyond COVID-19 restrictions. Conclusions: The findings highlight the importance of regularly reviewing and responding to routine feedback following digital service implementation. The feedback helped the Trust improve the VC service, challenge clinician-held assumptions about patient experience, and inform future use of VCs. It has focused improvement efforts on patient information; technological improvements such as blurred backgrounds and interactive whiteboards; and responding to the needs of patients with dementia, communication or cognitive impairment, or lack of appropriate technology. These findings have implications for other health care providers. %M 35311688 %R 10.2196/30486 %U https://formative.jmir.org/2022/3/e30486 %U https://doi.org/10.2196/30486 %U http://www.ncbi.nlm.nih.gov/pubmed/35311688 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e35181 %T Impact of a Conformité Européenne (CE) Certification–Marked Medical Software Sensor on COVID-19 Pandemic Progression Prediction: Register-Based Study Using Machine Learning Methods %A Limingoja,Leevi %A Antila,Kari %A Jormanainen,Vesa %A Röntynen,Joel %A Jägerroos,Vilma %A Soininen,Leena %A Nordlund,Hanna %A Vepsäläinen,Kristian %A Kaikkonen,Risto %A Lallukka,Tea %+ Department of Public Health, University of Helsinki, PO Box 20 (Tukholmankatu 8 B), Helsinki, FIN-00014, Finland, 358 400344644, leevi.limingoja@helsinki.fi %K health care %K health technology assessment %K machine learning %K COVID-19 %K COVID-19 forecasting %K pandemic %K health technology %K digital health %K online symptom checker %K health data %K admission data %K viral spread %D 2022 %7 17.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To address the current COVID-19 and any future pandemic, we need robust, real-time, and population-scale collection and analysis of data. Rapid and comprehensive knowledge on the trends in reported symptoms in populations provides an earlier window into the progression of viral spread, and helps to predict the needs and timing of professional health care. Objective: The objective of this study was to use a Conformité Européenne (CE)-marked medical online symptom checker service, Omaolo, and validate the data against the national demand for COVID-19–related care to predict the pandemic progression in Finland. Methods: Our data comprised real-time Omaolo COVID-19 symptom checker responses (414,477 in total) and daily admission counts in nationwide inpatient and outpatient registers provided by the Finnish Institute for Health and Welfare from March 16 to June 15, 2020 (the first wave of the pandemic in Finland). The symptom checker responses provide self-triage information input to a medically qualified algorithm that produces a personalized probability of having COVID-19, and provides graded recommendations for further actions. We trained linear regression and extreme gradient boosting (XGBoost) models together with F-score and mutual information feature preselectors to predict the admissions once a week, 1 week in advance. Results: Our models reached a mean absolute percentage error between 24.2% and 36.4% in predicting the national daily patient admissions. The best result was achieved by combining both Omaolo and historical patient admission counts. Our best predictor was linear regression with mutual information as the feature preselector. Conclusions: Accurate short-term predictions of COVID-19 patient admissions can be made, and both symptom check questionnaires and daily admissions data contribute to the accuracy of the predictions. Thus, symptom checkers can be used to estimate the progression of the pandemic, which can be considered when predicting the health care burden in a future pandemic. %M 35179497 %R 10.2196/35181 %U https://formative.jmir.org/2022/3/e35181 %U https://doi.org/10.2196/35181 %U http://www.ncbi.nlm.nih.gov/pubmed/35179497 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31732 %T Sustained Reductions in Online Search Interest for Communicable Eye and Other Conditions During the COVID-19 Pandemic: Infodemiology Study %A Deiner,Michael S %A Seitzman,Gerami D %A Kaur,Gurbani %A McLeod,Stephen D %A Chodosh,James %A Lietman,Thomas M %A Porco,Travis C %+ Francis I Proctor Foundation, University of California San Francisco, Floor 2 Box 0944, 490 Illinois St, San Francisco, CA, 94143, United States, 1 4154764101, travis.porco@ucsf.edu %K COVID-19 %K pandemic %K communicable disease %K social distancing %K infodemiology %K Google Trends %K influenza %K conjunctivitis %K ocular symptoms %K seasonality %K trend %K online health information %K information-seeking %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X 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. %M 35320981 %R 10.2196/31732 %U https://infodemiology.jmir.org/2022/1/e31732 %U https://doi.org/10.2196/31732 %U http://www.ncbi.nlm.nih.gov/pubmed/35320981 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e33587 %T Spread of COVID-19 Vaccine Misinformation in the Ninth Inning: Retrospective Observational Infodemic Study %A Calac,Alec J %A Haupt,Michael R %A Li,Zhuoran %A Mackey,Tim %+ Global Health Program, Department of Anthropology, University of California San Diego, 9500 Gilman Drive, Mail Code: 0505, La Jolla, CA, 92093, United States, 1 9514914161, tmackey@ucsd.edu %K infoveillance %K infodemiology %K COVID-19 %K vaccine %K Twitter %K social listening %K social media %K misinformation %K spread %K observational %K hesitancy %K communication %K discourse %D 2022 %7 16.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Shortly after Pfizer and Moderna received emergency use authorizations from the Food and Drug Administration, there were increased reports of COVID-19 vaccine-related deaths in the Vaccine Adverse Event Reporting System (VAERS). In January 2021, Major League Baseball legend and Hall of Famer, Hank Aaron, passed away at the age of 86 years from natural causes, just 2 weeks after he received the COVID-19 vaccine. Antivaccination groups attempted to link his death to the Moderna vaccine, similar to other attempts misrepresenting data from the VAERS to spread COVID-19 misinformation. Objective: This study assessed the spread of misinformation linked to erroneous claims about Hank Aaron’s death on Twitter and then characterized different vaccine misinformation and hesitancy themes generated from users who interacted with this misinformation discourse. Methods: An initial sample of tweets from January 31, 2021, to February 6, 2021, was queried from the Twitter Search Application Programming Interface using the keywords “Hank Aaron” and “vaccine.” The sample was manually annotated for misinformation, reporting or news media, and public reaction. Nonmedia user accounts were also classified if they were verified by Twitter. A second sample of tweets, representing direct comments or retweets to misinformation-labeled content, was also collected. User sentiment toward misinformation, positive (agree) or negative (disagree), was recorded. The Strategic Advisory Group of Experts Vaccine Hesitancy Matrix from the World Health Organization was used to code the second sample of tweets for factors influencing vaccine confidence. Results: A total of 436 tweets were initially sampled from the Twitter Search Application Programming Interface. Misinformation was the most prominent content type (n=244, 56%) detected, followed by public reaction (n=122, 28%) and media reporting (n=69, 16%). No misinformation-related content reviewed was labeled as misleading by Twitter at the time of the study. An additional 1243 comments on misinformation-labeled tweets from 973 unique users were also collected, with 779 comments deemed relevant to study aims. Most of these comments expressed positive sentiment (n=612, 78.6%) to misinformation and did not refute it. Based on the World Health Organization Strategic Advisory Group of Experts framework, the most common vaccine hesitancy theme was individual or group influences (n=508, 65%), followed by vaccine or vaccination-specific influences (n=110, 14%) and contextual influences (n=93, 12%). Common misinformation themes observed included linking the death of Hank Aaron to “suspicious” elderly deaths following vaccination, claims about vaccines being used for depopulation, death panels, federal officials targeting Black Americans, and misinterpretation of VAERS reports. Four users engaging with or posting misinformation were verified on Twitter at the time of data collection. Conclusions: Our study found that the death of a high-profile ethnic minority celebrity led to the spread of misinformation on Twitter. This misinformation directly challenged the safety and effectiveness of COVID-19 vaccines at a time when ensuring vaccine coverage among minority populations was paramount. Misinformation targeted at minority groups and echoed by other verified Twitter users has the potential to generate unwarranted vaccine hesitancy at the expense of people such as Hank Aaron who sought to promote public health and community immunity. %M 35320982 %R 10.2196/33587 %U https://infodemiology.jmir.org/2022/1/e33587 %U https://doi.org/10.2196/33587 %U http://www.ncbi.nlm.nih.gov/pubmed/35320982 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e32831 %T Risk Factors of COVID-19 Critical Outcomes in the Eastern Mediterranean Region: Multicountry Retrospective Study %A Lami,Faris %A Elfadul,Maisa %A Rashak,Hiba %A Al Nsour,Mohannad %A Akhtar,Hashaam %A Khader,Yousef %A Hussein,Ahmed M %A Naciri,Mariam %A Samy,Sahar %A Ghaleb,Yasser %A Taha,Hana %A Hussein,Alaa %A Ali,Nameer A %A Hussein,Raheem %A Ikram,Aamer %A Rahman,Fazal ur %A Khan,Mohammad Mujeeb %A Adam,Reema %A Ahmed,Abdulrazaq Yusuf %A Afifi,Salma %+ Public and Tropical Health Programs, Epidemiology and Biostatistics, University of Medical Sciences and Technology, Airport Avenue, PO Box 12810, Khartoum, 11111, Sudan, 249 924622759, melfadul7@gmail.com %K critical outcomes %K COVID-19 %K severity %K mortality %K outcome %K risk factor %K retrospective %K implementation %K demographic %K pattern %K trend %K risk %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The establishment of empirical evidence in the Eastern Mediterranean Region necessitates the implementation of wide-scale studies to describe the demographic, clinical features, and severity profile of patients with COVID-19. Objective: This study aims to assess the patterns of COVID-19 severity and mortality in seven countries, and to determine the risk factors of COVID-19 severity and mortality. Methods: This multicountry study was based on a retrospective review of medical records of hospitalized patients confirmed to have COVID-19. This study includes data from Iraq, Pakistan, Sudan, Somalia, Morocco, Egypt, and Yemen. All demographic and clinical data were extracted from hospital records (paper files) by trained data collectors. Results: A total of 4141 patients were included in this study from seven countries. Comorbidities were reported by nearly half of the patients, with hypertension (n=1021, 24.7%) and diabetes (n=939, 22.7%) being the most common. Older age, diabetes mellitus, hypertension, and heart diseases were significantly associated with COVID-19 severity and mortality. Ever smoking and renal diseases were significantly associated with severity but not mortality, while male gender, respiratory diseases, and malignancy were significantly associated with mortality but not severity. Conclusions: The study confirms the role of comorbidities and demographic features on the severity and mortality of COVID-19. Understanding the contributing factors ensures attentive care and informs clinical management of patients with poorer prognoses in the early stages of diseases. %M 34736222 %R 10.2196/32831 %U https://publichealth.jmir.org/2022/3/e32831 %U https://doi.org/10.2196/32831 %U http://www.ncbi.nlm.nih.gov/pubmed/34736222 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e34003 %T Official Websites Providing Information on COVID-19 Vaccination: Readability and Content Analysis %A Yeung,Andy Wai Kan %A Wochele-Thoma,Thomas %A Eibensteiner,Fabian %A Klager,Elisabeth %A Hribersek,Mojca %A Parvanov,Emil D %A Hrg,Dalibor %A Völkl-Kernstock,Sabine %A Kletecka-Pulker,Maria %A Schaden,Eva %A Willschke,Harald %A Atanasov,Atanas G %+ Ludwig Boltzmann Institute for Digital Health and Patient Safety, Spitalgasse 23, Vienna, 1090, Austria, 43 664 1929 852, atanas.atanasov@univie.ac.at %K COVID-19 %K coronavirus %K SARS-CoV-2 %K vaccine %K readability %K content quality %K online health information %K side effect %K public health %K medicine %K quality %K perception %D 2022 %7 15.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Online information on COVID-19 vaccination may influence people’s perception and willingness to be vaccinated. Official websites of vaccination programs have not been systematically assessed before. Objective: This study aims to assess and compare the readability and content quality of web-based information on COVID-19 vaccination posted on official/governmental websites. Furthermore, the relationship between evaluated website parameters and country vaccination rates were calculated. Methods: By referring to an open data set hosted at Our World in Data, the 58 countries/regions with the highest total vaccination count as of July 8, 2021, were identified. Together with the websites from the World Health Organization and European Union, a total of 60 vaccination campaign websites were targeted. The “frequently asked questions” or “questions and answers” section of the websites were evaluated in terms of readability (Flesch Reading Ease score and Flesch-Kincaid Grade Level), quality (Health On the Net Foundation code [HONcode] certification and Quality Evaluation Scoring Tool), and content stating vaccination duration of protection and potential side effects. Results: In terms of readability, the Flesch Reading Ease score of the vaccination frequently asked questions websites ranged between 11.2 and 69.5, with a mean of 40.9 (SD 13.2). Meanwhile, the Flesch-Kincaid Grade Level ranged between 6.5 and 17.6, with a mean of 12.1 (SD 2.8). In terms of quality, only 2 websites were HONcode certified, and the Quality Evaluation Scoring Tool score of the websites ranged between 7 and 20, with a mean of 15.3 (SD 3.1). Half of the websites (25/50) did not present a publication date or date of the last update. Regarding the duration of protection offered by the vaccines, 46% (23/50) of the websites stated that they do not know, and another 40% (20/50) did not address it. Five side effects of the vaccinations were most frequently mentioned, namely, fever/chill (41/50, 82%), various injection site discomfort events (eg, swelling, redness, or pain; 39/50, 78%), headache (36/50, 72%), fatigue (33/50, 66%), and muscle/joint pain (31/50, 62%). Conclusions: In general, the content quality of most of the evaluated websites was good, but HONcode certification should be considered, content should be written in a more readable manner, and a publication date or date of the last update should be presented. %M 35073276 %R 10.2196/34003 %U https://publichealth.jmir.org/2022/3/e34003 %U https://doi.org/10.2196/34003 %U http://www.ncbi.nlm.nih.gov/pubmed/35073276 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e32452 %T COVID-19 and Vitamin D Misinformation on YouTube: Content Analysis %A Quinn,Emma K %A Fenton,Shelby %A Ford-Sahibzada,Chelsea A %A Harper,Andrew %A Marcon,Alessandro R %A Caulfield,Timothy %A Fazel,Sajjad S %A Peters,Cheryl E %+ Department of Occupational and Environmental Hygiene, School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, T2T 1Z3, Canada, 1 403 809 1289, equinn99@student.ubc.ca %K COVID-19 %K vitamin D %K misinformation %K YouTube %K content analysis %K social media %K video %K infodemic %K risk %K prevention %K health information %K immunity %K immune system %K supplements %K natural medicine %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The “infodemic” accompanying the SARS-CoV-2 virus pandemic has the potential to increase avoidable spread as well as engagement in risky health behaviors. Although social media platforms, such as YouTube, can be an inexpensive and effective method of sharing accurate health information, inaccurate and misleading information shared on YouTube can be dangerous for viewers. The confusing nature of data and claims surrounding the benefits of vitamin D, particularly in the prevention or cure of COVID-19, influences both viewers and the general “immune boosting” commercial interest. Objective: The aim of this study was to ascertain how information on vitamin D and COVID-19 was presented on YouTube in 2020. Methods: YouTube video results for the search terms “COVID,” “coronavirus,” and “vitamin D” were collected and analyzed for content themes and deemed useful or misleading based on the accuracy or inaccuracy of the content. Qualitative content analysis and simple statistical analysis were used to determine the prevalence and frequency of concerning content, such as confusing correlation with causation regarding vitamin D benefits. Results: In total, 77 videos with a combined 10,225,763 views (at the time of data collection) were included in the analysis, with over three-quarters of them containing misleading content about COVID-19 and vitamin D. In addition, 45 (58%) of the 77 videos confused the relationship between vitamin D and COVID-19, with 46 (85%) of 54 videos stating that vitamin D has preventative or curative abilities. The major contributors to these videos were medical professionals with YouTube accounts. Vitamin D recommendations that do not align with the current literature were frequently suggested, including taking supplementation higher than the recommended safe dosage or seeking intentional solar UV radiation exposure. Conclusions: The spread of misinformation is particularly alarming when spread by medical professionals, and existing data suggesting vitamin D has immune-boosting abilities can add to viewer confusion or mistrust in health information. Further, the suggestions made in the videos may increase the risks of other poor health outcomes, such as skin cancer from solar UV radiation. %M 35310014 %R 10.2196/32452 %U https://infodemiology.jmir.org/2022/1/e32452 %U https://doi.org/10.2196/32452 %U http://www.ncbi.nlm.nih.gov/pubmed/35310014 %0 Journal Article %@ 2563-3570 %I JMIR Publications %V 3 %N 1 %P e31536 %T The Easy-to-Use SARS-CoV-2 Assembler for Genome Sequencing: Development Study %A Rueca,Martina %A Giombini,Emanuela %A Messina,Francesco %A Bartolini,Barbara %A Di Caro,Antonino %A Capobianchi,Maria Rosaria %A Gruber,Cesare EM %+ Laboratory of Microbiology and Biological Bank, National Institute for Infectious Diseases “Lazzaro Spallanzani”, Istituto di Ricovero e Cura a Carattere Scientifico, Via Portuense 292, Rome, 00149, Italy, 39 0655170668, francesco.messina@inmi.it %K SARS-CoV-2 genome %K bioinformatics tool %K NGS data analysis %K COVID-19 %K genome %K health informatics %K bioinformatic %K digital tools %K algorithms %D 2022 %7 14.3.2022 %9 Original Paper %J JMIR Bioinform Biotech %G English %X Background: Early sequencing and quick analysis of the SARS-CoV-2 genome have contributed to the understanding of the dynamics of COVID-19 epidemics and in designing countermeasures at a global level. Objective: Amplicon-based next-generation sequencing (NGS) methods are widely used to sequence the SARS-CoV-2 genome and to identify novel variants that are emerging in rapid succession as well as harboring multiple deletions and amino acid–changing mutations. Methods: To facilitate the analysis of NGS sequencing data obtained from amplicon-based sequencing methods, here, we propose an easy-to-use SARS-CoV-2 genome assembler: the Easy-to-use SARS-CoV-2 Assembler (ESCA) pipeline. Results: Our results have shown that ESCA could perform high-quality genome assembly from Ion Torrent and Illumina raw data and help the user in easily correct low-coverage regions. Moreover, ESCA includes the possibility of comparing assembled genomes of multisample runs through an easy table format. Conclusions: In conclusion, ESCA automatically furnished a variant table output file, fundamental to rapidly recognizing variants of interest. Our pipeline could be a useful method for obtaining a complete, rapid, and accurate analysis even with minimal knowledge in bioinformatics. %M 35309411 %R 10.2196/31536 %U https://bioinform.jmir.org/2022/1/e31536 %U https://doi.org/10.2196/31536 %U http://www.ncbi.nlm.nih.gov/pubmed/35309411 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e33076 %T Assessing Determinants of Programmatic Performance of Community Management of Malaria, Pneumonia, and Diarrhea in Children in Africa: Protocol and Data Collection for a Mixed Methods Evaluation of Integrated Community Case Management %A Karim,Aliya %A de Savigny,Don %A Ngaima,Jean Serge %A Mäusezahl,Daniel %A Cobos Muñoz,Daniel %A Tshefu,Antoinette %+ University of Basel, Petersplatz 1, Basel, 4001, Switzerland, 41 061 207 31 11, aliya.karim@unibas.ch %K iCCM %K integrated community case management %K systems thinking %K malaria %K study design %K systems methods %K child health %K program evaluation %D 2022 %7 14.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Integrated community case management (iCCM) is a child health program designed to provide integrated community-based care for children with pneumonia, malaria, or diarrhea in hard-to-reach areas of low- and middle-income countries. The foundation of the intervention is service delivery by community health workers (CHWs) who depend on reliable provision of drugs and supplies, consistent supervision, comprehensive training, and community acceptance and participation to perform optimally. The effectiveness of the program may also depend on a number of other elements, including an enabling policy environment, financing mechanisms from the national to the local level, data transmission systems, and appropriate monitoring and evaluation. The extent to which these factors act upon each other to influence the effectiveness and viability of iCCM is both variable and challenging to assess, especially across different implementation contexts. Objective: In this paper, we describe a mixed methods systems-based study protocol to assess the programmatic components of iCCM that are associated with intervention effectiveness and report preliminary results of data collection. Methods: This protocol uses a mixed qualitative and quantitative study design based on a systems thinking approach within four iCCM programs in Malawi, Democratic Republic of the Congo, and Niger State and Abia State in Nigeria. Routine monitoring data are collected to determine intervention effectiveness, namely testing, treatment, and referral outcomes. Surveys with CHWs, supervisors, and caregivers are performed to collect quantitative data on their demographics, activities, and experiences within the program and how these relate to the areas of intervention effectiveness. Focus group discussions are conducted with these stakeholders as well as local traditional leaders to contextualize these data. Key informant interviews are undertaken with national- and district-level program stakeholders and officers knowledgeable in critical program processes. Results: We performed 3836 surveys and 45 focus group discussions of 379 participants with CHWs, supervisors, caregivers, and traditional leaders, as well as 120 key informant interviews with district- and national-level program managers, health officers, and ministry officials. Policy and program documents were additionally collected for review. Conclusions: We expect that evidence from this study will inform child health programs and practice in low- and middle-income settings as well as future policy development within the iCCM intervention. International Registered Report Identifier (IRRID): DERR1-10.2196/33076 %M 35285813 %R 10.2196/33076 %U https://www.researchprotocols.org/2022/3/e33076 %U https://doi.org/10.2196/33076 %U http://www.ncbi.nlm.nih.gov/pubmed/35285813 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e33531 %T Improving the Development and Implementation of Audit and Feedback Systems to Support Health Care Workers in Limiting Antimicrobial Resistance in the Hospital: Scoping Review %A Keizer,Julia %A Bente,Britt E %A Al Naiemi,Nashwan %A Van Gemert-Pijnen,Lisette JEWC %A Beerlage-De Jong,Nienke %+ Centre for eHealth and Wellbeing Research, Section of Psychology, Health and Technology, University of Twente, PO Box 217, Enschede, 7500 AE, Netherlands, 31 53 489 1289, j.keizer@utwente.nl %K scoping review %K audit and feedback %K eHealth %K development %K implementation %K antimicrobial resistance %K antibiotic stewardship %K infection control %D 2022 %7 11.3.2022 %9 Review %J J Med Internet Res %G English %X 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. %M 35275082 %R 10.2196/33531 %U https://www.jmir.org/2022/3/e33531 %U https://doi.org/10.2196/33531 %U http://www.ncbi.nlm.nih.gov/pubmed/35275082 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 10 %N 3 %P e30691 %T Digital Contact Tracing Apps for COVID-19: Development of a Citizen-Centered Evaluation Framework %A Tsvyatkova,Damyanka %A Buckley,Jim %A Beecham,Sarah %A Chochlov,Muslim %A O’Keeffe,Ian R %A Razzaq,Abdul %A Rekanar,Kaavya %A Richardson,Ita %A Welsh,Thomas %A Storni,Cristiano %A , %+ Department of Computer Science and Information Systems, University of Limerick, Computer Science Building, Plassey Park Rd, Limerick, V94 T9PX, Ireland, 353 61 202632, Cristiano.Storni@ul.ie %K COVID-19 %K mHealth %K digital contact tracing apps %K framework %K evaluation %K mobile health %K health apps %K digital health %K contact tracing %D 2022 %7 11.3.2022 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The silent transmission of COVID-19 has led to an exponential growth of fatal infections. With over 4 million deaths worldwide, the need to control and stem transmission has never been more critical. New COVID-19 vaccines offer hope. However, administration timelines, long-term protection, and effectiveness against potential variants are still unknown. In this context, contact tracing and digital contact tracing apps (CTAs) continue to offer a mechanism to help contain transmission, keep people safe, and help kickstart economies. However, CTAs must address a wide range of often conflicting concerns, which make their development/evolution complex. For example, the app must preserve citizens’ privacy while gleaning their close contacts and as much epidemiological information as possible. Objective: In this study, we derived a compare-and-contrast evaluative framework for CTAs that integrates and expands upon existing works in this domain, with a particular focus on citizen adoption; we call this framework the Citizen-Focused Compare-and-Contrast Evaluation Framework (C3EF) for CTAs. Methods: The framework was derived using an iterative approach. First, we reviewed the literature on CTAs and mobile health app evaluations, from which we derived a preliminary set of attributes and organizing pillars. These attributes and the probing questions that we formulated were iteratively validated, augmented, and refined by applying the provisional framework against a selection of CTAs. Each framework pillar was then subjected to internal cross-team scrutiny, where domain experts cross-checked sufficiency, relevancy, specificity, and nonredundancy of the attributes, and their organization in pillars. The consolidated framework was further validated on the selected CTAs to create a finalized version of C3EF for CTAs, which we offer in this paper. Results: The final framework presents seven pillars exploring issues related to CTA design, adoption, and use: (General) Characteristics, Usability, Data Protection, Effectiveness, Transparency, Technical Performance, and Citizen Autonomy. The pillars encompass attributes, subattributes, and a set of illustrative questions (with associated example answers) to support app design, evaluation, and evolution. An online version of the framework has been made available to developers, health authorities, and others interested in assessing CTAs. Conclusions: Our CTA framework provides a holistic compare-and-contrast tool that supports the work of decision-makers in the development and evolution of CTAs for citizens. This framework supports reflection on design decisions to better understand and optimize the design compromises in play when evolving current CTAs for increased public adoption. We intend this framework to serve as a foundation for other researchers to build on and extend as the technology matures and new CTAs become available. %M 35084338 %R 10.2196/30691 %U https://mhealth.jmir.org/2022/3/e30691 %U https://doi.org/10.2196/30691 %U http://www.ncbi.nlm.nih.gov/pubmed/35084338 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34275 %T Creating Effective, Evidence-Based Video Communication of Public Health Science (COVCOM Study): Protocol for a Sequential Mixed Methods Effect Study %A Røislien,Jo %A O'Hara,Jane K %A Smeets,Ionica %A Brønnick,Kolbjørn %A Berg,Siv Hilde %A Shortt,Marie Therese %A Lungu,Daniel Adrian %A Thune,Henriette %A Wiig,Siri %+ SHARE - Centre for Resilience in Healthcare, Faculty of Health Sciences, University of Stavanger, Kjell Arholms gate 41, Stavanger, 4021, Norway, 47 51 83 10 00, jo.roislien@uis.no %K pandemics %K risk %K public health %K science communication %K mixed methods %K evidence-based medicine %K COVID-19 %D 2022 %7 11.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The nonlinear nature of contagious diseases and the potential for exponential growth can be difficult to grasp for the general public. This has strong implications for public health communication, which needs to be both easily accessible and efficient. A pandemic is an extreme situation, and the accompanying strict societal measures are generally easier to accept if one understands the underlying reasoning behind them. Bringing about informed attitude change and achieving compliance to strict restrictions requires explanations of scientific concepts and terminologies that laypersons can understand. Objective: The aim of the project is to develop effective, evidence-based modes of video communication for translating complex, but important, health messages about pandemics to both the general population and decision makers. The study uses COVID-19 as a case to learn and prepare society for handling the ongoing and future pandemics, as well as to provide evidence-based tools for the science communication toolbox. Methods: The project applies a mixed methods design, combining qualitative methods (eg, interviews, observational studies, literature reviews) and quantitative methods (eg, randomized controlled trials [RCTs]). The project brings together researchers from a wide range of academic fields, as well as communication industry professionals. Results: This study has received funding from the Trond Mohn Foundation through the Research Council of Norway’s “COVID-19 Emergency Call for Proposals” March 2020. Recruitment and data collection for the exploratory first phase of the project ran from February 2021 to March 2021. Creative communication work started in May 2021, and the production of videos for use in the RCTs in the final phase of the project started in September 2021. Conclusions: The COVCOM project will take on several grand challenges within the field of communicating science and provide evidence-based tools to the science communication toolbox. A long-term goal of the project is to contribute to the creation of a more resilient health care system by developing communication responses tailormade for different audiences, preparing society for any future pandemic. International Registered Report Identifier (IRRID): DERR1-10.2196/34275 %M 35147500 %R 10.2196/34275 %U https://www.researchprotocols.org/2022/3/e34275 %U https://doi.org/10.2196/34275 %U http://www.ncbi.nlm.nih.gov/pubmed/35147500 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e25532 %T 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 %A Morel,Benoit %A Bouleux,Guillaume %A Viallon,Alain %A Maignan,Maxime %A Provoost,Luc %A Bernadac,Jean-Christophe %A Devidal,Sarah %A Pillet,Sylvie %A Cantais,Aymeric %A Mory,Olivier %+ Department of Pediatric Emergency, University Hospital of Saint Etienne, Saint Etienne, France, 33 477828134, aymeric.cantais@chu-st-etienne.fr %K respiratory infections %K emergency departments %K flu outbreak %K bronchiolitis outbreak %K cardiorespiratory illness %K time series analysis %K influenza %K bronchiolitis %K outbreak %K pediatrics %D 2022 %7 10.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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: χ23=102.7, P<.001; CHU Grenoble: χ23=126.67, P<.001) and were quite dependent in both hospital settings (CHU Saint Etienne: Spearman ρ=0.64; CHU Grenoble: Spearman ρ=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. %M 35266876 %R 10.2196/25532 %U https://publichealth.jmir.org/2022/3/e25532 %U https://doi.org/10.2196/25532 %U http://www.ncbi.nlm.nih.gov/pubmed/35266876 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33883 %T The Effect of the Imacoco Care Psychoeducation Website on Improving Psychological Distress Among Workers During the COVID-19 Pandemic: Randomized Controlled Trial %A Imamura,Kotaro %A Sasaki,Natsu %A Sekiya,Yuki %A Watanabe,Kazuhiro %A Sakuraya,Asuka %A Matsuyama,Yutaka %A Nishi,Daisuke %A Kawakami,Norito %+ Department of Mental Health, Graduate School of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo, 113-0033, Japan, 81 3 5841 3522, nkawakami@m.u-tokyo.ac.jp %K COVID-19 %K education %K internet-based intervention %K occupational groups %K psychological distress %K mental health %K digital health %K health intervention %K psychoeducation %D 2022 %7 10.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The prolonged COVID-19 pandemic has affected mental health among workers. Psychoeducational intervention via a website could be effective for primary prevention of mental illness among workers in the current COVID-19 pandemic. Objective: The aim of this randomized controlled trial is to examine the effect of a newly developed online psychoeducational website named Imacoco Care on reducing psychological distress and fear about COVID-19 infection among workers. Methods: Participants in the study were recruited from registered members of a web survey company in Japan. Participants who fulfilled the eligibility criteria were randomly allocated to the intervention or control group. Participants in the intervention group were invited to access the Imacoco Care program within a month after the baseline survey. The Kessler Psychological Distress Scale (K6) and the Fear of COVID-19 Scale (FCV-19S) scores were obtained at baseline and at 1- and 3-month follow-ups. Results: A total of 1200 workers were randomly allocated to the intervention and control groups (n=600 [50%] per group). The Imacoco Care intervention group showed a significant favorable effect on K6 scores (P=.03) with a small effect size (ES; Cohen d=–0.14) and an adverse effect on FCV-19S scores (P=.01) with a small ES (Cohen d=0.16) at 3-month follow-up. In the per protocol analysis (including only participants who had read the Imacoco Care content at least 1 time), the Imacoco Care intervention group also showed a significant favorable effect on reducing K6 scores (P=.03), while an adverse effect on FCV-19S scores was not significant (P=.06) in the intervention group at 3-month follow-up. Conclusions: A web-based psychoeducation approach may be effective for improving psychological distress among workers; however, it may be important not only to distribute information but also to encourage active engagement with the content of the program to prevent adverse effects of psychoeducational intervention. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry (UMIN-CTR) UMIN000042556; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000048548 %M 35133972 %R 10.2196/33883 %U https://formative.jmir.org/2022/3/e33883 %U https://doi.org/10.2196/33883 %U http://www.ncbi.nlm.nih.gov/pubmed/35133972 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 3 %P e34152 %T Evaluating the Effect of Supported Systematic Work Environment Management During the COVID-19 Pandemic: Protocol for a Mixed Methods Study %A Haraldsson,Patrik %A Ros,Axel %A Jonker,Dirk %A Areskoug Josefsson,Kristina %+ School of Health and Welfare, Jönköping Academy for Improvement of Health and Welfare, Jönköping University, Gjuterigatan 5, Jönköping, 553 18, Sweden, 46 10 2447892, patrik.haraldsson@ju.se %K occupational health interventions %K implementation %K mixed methods %K COVID-19 pandemic %K COVID-19 %K pandemic %K occupational health %K health interventions %K health care %K support services %K employee health %D 2022 %7 10.3.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The work environment is a complex phenomenon in which many factors interact. Scientific research indicates a relation between the work environment and employee health, staff turnover, patient satisfaction, and patient safety. There is a great need for knowledge on how to conduct work environment interventions and practical work environment management to maximize benefits to the employees. Objective: The aim of this study is to explore how Occupational Health Service (OHS) support will affect the work environment, sick leave, staff turnover, patient satisfaction, and patient safety during and following the COVID-19 pandemic in a medical ward setting. Methods: A mixed methods evaluation of a concurrent work environment quality improvement project at the Department of Internal Medicine and Geriatrics in a local hospital in the south of Sweden will be performed. Results: The mixed methods evaluation of the quality improvement project received funding from Futurum–Academy for Health and Care, Jönköping County Council and Region Jönköping County, and the study protocol was approved by the Swedish Ethical Review Authority. The work environment quality improvement project will continue between May 2020 and December 2021. Conclusions: The study might contribute to increased knowledge of how work environment interventions and practical work environment management can impact the work environment, and employee health, staff turnover, patient satisfaction, and patient safety. There is a need for knowledge in this area for OHS management to provide increased benefits to employees, employers, and society as a whole. International Registered Report Identifier (IRRID): DERR1-10.2196/34152 %M 35234649 %R 10.2196/34152 %U https://www.researchprotocols.org/2022/3/e34152 %U https://doi.org/10.2196/34152 %U http://www.ncbi.nlm.nih.gov/pubmed/35234649 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e34088 %T System-Level Factors Associated With Telephone and Video Visit Use: Survey of Safety-Net Clinicians During the Early Phase of the COVID-19 Pandemic %A Sharma,Anjana E %A Khoong,Elaine C %A Sierra,Maribel %A Rivadeneira,Natalie A %A Nijagal,Malini A %A Su,George %A Lyles,Courtney R %A DeFries,Triveni %A Tuot,Delphine S %A Sarkar,Urmimala %+ Department of Family & Community Medicine, University of California San Francisco, 995 Potrero Ave, Ward 83, San Francisco, CA, 94110, United States, 1 4155708619, anjana.sharma@ucsf.edu %K telemedicine %K safety-net hospitals %K health care delivery %K ambulatory care %K vulnerable populations %K COVID-19 %K survey %K vulnerable %K telehealth %K hospital %K safety %K delivery %K video %K implementation %K health system %D 2022 %7 10.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic prompted safety-net health care systems to rapidly implement telemedicine services with little prior experience, causing disparities in access to virtual visits. While much attention has been given to patient barriers, less is known regarding system-level factors influencing telephone versus video-visit adoption. As telemedicine remains a preferred service for patients and providers, and reimbursement parity will not continue for audio visits, health systems must evaluate how to support higher-quality video visit access. Objective: This study aimed to assess health system–level factors and their impact on telephone and video visit adoption to inform sustainability of telemedicine for ambulatory safety-net sites. Methods: We conducted a cross-sectional survey among ambulatory care clinicians at a hospital-linked ambulatory clinic network serving a diverse, publicly insured patient population between May 28 and July 14, 2020. We conducted bivariate analyses assessing health care system–level factors associated with (1) high telephone adoption (4 or more visits on average per session); and (2) video visit adoption (at least 1 video visit on average per session). Results: We collected 311 responses from 643 eligible clinicians, yielding a response rate of 48.4%. Clinician respondents (N=311) included 34.7% (n=108) primary or urgent care, 35.1% (n=109) medical, and 7.4% (n=23) surgical specialties. Our sample included 178 (57.2%) high telephone adopters and 81 (26.05%) video adopters. Among high telephone adopters, 72.2% utilized personal devices for telemedicine (vs 59.0% of low telephone adopters, P=.04). Video nonadopters requested more training in technical aspects than adopters (49.6% vs 27.2%, P<.001). Primary or urgent care had the highest proportion of high telephone adoption (84.3%, compared to 50.4% of medical and 37.5% of surgical specialties, P<.001). Medical specialties had the highest proportion of video adoption (39.1%, compared to 14.8% of primary care and 12.5% of surgical specialties, P<.001). Conclusions: Personal device access and department specialty were major factors associated with high telephone and video visit adoption among safety-net clinicians. Desire for training was associated with lower video visit use. Secure device access, clinician technical trainings, and department-wide assessments are priorities for safety-net systems implementing telemedicine. %M 35148271 %R 10.2196/34088 %U https://formative.jmir.org/2022/3/e34088 %U https://doi.org/10.2196/34088 %U http://www.ncbi.nlm.nih.gov/pubmed/35148271 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e27469 %T The Mental Health Impact of the COVID-19 Pandemic Among Physicians, Nurses, and Other Health Care Providers in Alberta: Cross-sectional Survey %A El Gindi,Hany %A Shalaby,Reham %A Gusnowski,April %A Vuong,Wesley %A Surood,Shireen %A Hrabok,Marianne %A Greenshaw,Andrew J %A Agyapong,Vincent %+ Department of Psychiatry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 780 215 7771, agyapong@ualberta.ca %K COVID-19 %K health care worker %K mobile technology %K Text4Hope %K anxiety %K depression %K stress %K pandemic %K e-mental health %K mental health %K impact %K physician %K nurse %K Canada %D 2022 %7 9.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, threats to mental health, psychological safety, and well-being are evident, particularly among the first responders and the health care staff. Objective: This study aims to examine the prevalence and potential predictors of the likely stress, generalized anxiety disorder, and major depressive disorder among health care workers (HCWs). Methods: A cross-sectional survey was used through a survey link sent to gather demographic information and responses on several self-report scales, including the Perceived Stress Scale, the Generalized Anxiety Disorder 7-item scale, and the Patient Health Questionnaire-9 among HCWs enrolled in the Text4Hope program. Results: The result from this study suggests that during the COVID-19 pandemic, HCWs reported a high likelihood of moderate-to-high perceived stress (n=840, 81.2%), moderate-to-severe anxiety (n=369, 38.6%), and depression (n=317, 32.7%) symptoms. Nurses and other HCWs were significantly more likely to report depressive symptoms compared to physicians (F(2, 159.47)=15.89, 95% CI –5.05 to –2.04). Younger age groups of HCWs (≤30 years) were more prone to report likely stress, anxiety, and depressive symptoms compared to HCWs 41-50 and >50 years old (odds ratio [OR] 1.82-3.03). Similarly, females and those who reported a lack of social support (separated/divorced and single) among HCWs had a higher likelihood to report likely stress and depressive symptoms, respectively (OR 1.8 and 1.6, respectively). Conclusions: This cross-sectional study explored a high level of mental health burdens during the COVID-19 pandemic among HCWs in Alberta. Levels of psychological symptoms were more noticeable in the female gender and the nursing profession. %M 34995203 %R 10.2196/27469 %U https://formative.jmir.org/2022/3/e27469 %U https://doi.org/10.2196/27469 %U http://www.ncbi.nlm.nih.gov/pubmed/34995203 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e36119 %T Identifying COVID-19 Outbreaks From Contact-Tracing Interview Forms for Public Health Departments: Development of a Natural Language Processing Pipeline %A Caskey,John %A McConnell,Iain L %A Oguss,Madeline %A Dligach,Dmitriy %A Kulikoff,Rachel %A Grogan,Brittany %A Gibson,Crystal %A Wimmer,Elizabeth %A DeSalvo,Traci E %A Nyakoe-Nyasani,Edwin E %A Churpek,Matthew M %A Afshar,Majid %+ University of Wisconsin–Madison, 1685 Highland Avenue, 5158 Medical Foundation Centennial Building, Madison, WI, 53705, United States, 1 3125459462, majid.afshar@wisc.edu %K natural language processing %K public health informatics %K named entity recognition %K contact tracing %K COVID-19 %K outbreaks %K neural language model %K disease surveillance %K digital health %K electronic surveillance %K public health %K digital surveillance tool %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In Wisconsin, COVID-19 case interview forms contain free-text fields that need to be mined to identify potential outbreaks for targeted policy making. We developed an automated pipeline to ingest the free text into a pretrained neural language model to identify businesses and facilities as outbreaks. Objective: We aimed to examine the precision and recall of our natural language processing pipeline against existing outbreaks and potentially new clusters. Methods: Data on cases of COVID-19 were extracted from the Wisconsin Electronic Disease Surveillance System (WEDSS) for Dane County between July 1, 2020, and June 30, 2021. Features from the case interview forms were fed into a Bidirectional Encoder Representations from Transformers (BERT) model that was fine-tuned for named entity recognition (NER). We also developed a novel location-mapping tool to provide addresses for relevant NER. Precision and recall were measured against manually verified outbreaks and valid addresses in WEDSS. Results: There were 46,798 cases of COVID-19, with 4,183,273 total BERT tokens and 15,051 unique tokens. The recall and precision of the NER tool were 0.67 (95% CI 0.66-0.68) and 0.55 (95% CI 0.54-0.57), respectively. For the location-mapping tool, the recall and precision were 0.93 (95% CI 0.92-0.95) and 0.93 (95% CI 0.92-0.95), respectively. Across monthly intervals, the NER tool identified more potential clusters than were verified in WEDSS. Conclusions: We developed a novel pipeline of tools that identified existing outbreaks and novel clusters with associated addresses. Our pipeline ingests data from a statewide database and may be deployed to assist local health departments for targeted interventions. %M 35144241 %R 10.2196/36119 %U https://publichealth.jmir.org/2022/3/e36119 %U https://doi.org/10.2196/36119 %U http://www.ncbi.nlm.nih.gov/pubmed/35144241 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e32694 %T The Transition of Social Isolation and Related Psychological Factors in 2 Mild Lockdown Periods During the COVID-19 Pandemic in Japan: Longitudinal Survey Study %A Sugaya,Nagisa %A Yamamoto,Tetsuya %A Suzuki,Naho %A Uchiumi,Chigusa %+ Graduate School of Technology, Industrial and Social Sciences, Tokushima University, 1-1, Minamijosanjima-cho, Tokushima, 770-8502, Japan, 81 88 656 7617, t.yamamoto@tokushima-u.ac.jp %K coronavirus disease 2019 %K mild lockdown %K social isolation %K longitudinal survey %K public health %K surveillance %K epidemiology %K COVID-19 %K pandemic %K lockdown %K psychological behavior %K social factors %K mental health %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Lockdowns and stay-at-home orders announced internationally for COVID-19 have led to physical and social distancing, with reports of many individuals experiencing social isolation (SI) and loneliness. Although the emergency declaration in Japan was declared as a “mild” lockdown requested by the government without penalties for violations, the lockdown measures, including SI, had several influences on people’s lives and mental health as in other countries. Furthermore, Japan declared a state of emergency multiple times; thus, it is necessary to examine the influence of the transition of SI caused by repeated emergency declarations and the deterioration of mental health associated with these changes. Objective: This study longitudinally investigated the transition of SI and its related factors during the mild lockdown under 2 declared states of emergency in Japan and analyzed psychosocial characteristics by extracting clusters where people with specific transition patterns of SI predominated. Methods: We collected data on 7893 inhabitants (3694 [46.8%] women, 49.6 [SD 13.7] years old) living in the 7 prefectures where the initial emergency declaration was applied. The investigations took place online in the final phase of the first and second states of emergency: phase 1 (between May 11 and 12, 2020) and phase 2 (between February 24 and 28, 2021). Nonparametric Bayesian coclustering was used to visualize the exhaustive interaction structure between the transition pattern of SI and the psychosocial variables. Results: There were no improvements in social networks and loneliness between the 2 phases, although psychological distress significantly improved and depression slightly decreased. Overall, 3868 (49%) of the 7893 participants remained socially isolated through phases 1 and 2, and 947 (12%) were socially isolated in phase 2, even though they were not socially isolated in phase 1. More participants experienced persistent SI in unmarried, childless, and low-household-income groups. The persistent-SI group had fewer cohabitants than other transition pattern groups. The nonparametric Bayesian coclustering results showed that most clusters, including participants without SI throughout phases 1 and 2, had healthy behaviors, more interactions, good relationships, and less loneliness and psychological stress. Furthermore, the cluster in which relationships deteriorated in phase 1 recovered in phase 2. Comparatively, the clusters with SI throughout phases 1 and 2 were divided into clusters with increased loneliness and psychological stress; clusters were close to participants’ average scores in this study. The clusters with increased loneliness and psychological stress were notable for deteriorating relationships and less online interaction. Conclusions: This study revealed the actual state of transition of SI and related psychological, social, and behavioral factors under repeated declarations of a state of emergency. These results should help construct intervention methods that fit individual characteristics of people in SI during a pandemic. %M 35107428 %R 10.2196/32694 %U https://publichealth.jmir.org/2022/3/e32694 %U https://doi.org/10.2196/32694 %U http://www.ncbi.nlm.nih.gov/pubmed/35107428 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e25055 %T Engagement With Web-Based Fitness Videos on YouTube and Instagram During the COVID-19 Pandemic: Longitudinal Study %A Sui,Wuyou %A Rush,Jonathan %A Rhodes,Ryan E %+ Exercise and Health Psychology Lab, Western University, 1151 Richmond St, London, ON, N6A 3K7, Canada, 1 5196612111 ext 81189, yoahsui@gmail.com %K eHealth %K physical activity %K adults %K adherence %K COVID-19 %K fitness %K video %K YouTube %K Instagram %K social media %K longitudinal %D 2022 %7 8.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has drastically changed the physical activity (PA) landscape through the closures of gymnasiums, schools, and many outdoor spaces. Physical distancing guidelines have also reduced opportunity for PA. The popularity of free web-based home fitness videos on video hosting platforms (eg, YouTube and Instagram) has spiked during the pandemic. Many web-based fitness videos offer a convenient, accessible, and cost-effective means of engaging in PA through regularly posted videos or discrete programs. Notably, traditional PA programs often suffer from poor adherence and high dropout rates, despite many advantages over web-based workout programs (eg, equipment, feedback, and in-person engagement). Thus, notwithstanding clear advantages of these web-based fitness videos, their ability to maintain long-term engagement and adherence is unknown. Objective: We explored patterns of engagement (ie, views, likes, and comments) for channels posting daily or program-based web-based fitness videos since the declaration of COVID-19 as a pandemic, over 4 months. Our secondary objective was to examine potential moderators of engagement metrics. Methods: An environmental scan was used to identify eligible channels. Eligible channels were (1) freely available on YouTube or Instagram and (2) posted daily or weekday series workouts or offered quarantine-specific workout programs. Searches for eligible channels were conducted on June 1 and 4, 2020. Engagement metrics of views, likes, and comments were then collected from channels’ videos posted between March 11 and June 26 or 30, 2020, inclusive, on June 26 or July 8, 2020. A series of multilevel modeling analyses were conducted to examine longitudinal changes in each of the 3 outcome variables. Results: Ten channels were deemed eligible and included in analyses; 6 posted regularly, while the other 4 posted discrete workout programs. Multilevel models revealed that both views and likes significantly decreased across days. Visually, channels display the sharpest drop in engagement within the first week. Linear change estimate indicates that the number of views initially declined by 24,700 per day (95% CI –44,400 to –11,300, P=.01) on average across all the channels. Channels with more subscribers declined in their views, likes, and comments at a significantly higher rate than those with fewer subscribers (P≤.04). The day of the week a video is posted, “virality,” and content of a video appear to influence engagement. Integrating behavior change techniques and posting new and varied videos often may help garner further engagement with these videos. Future research should examine common elements of videos, which drive engagement. Conclusions: Despite raw engagement metrics, each channel demonstrated peak engagement with the initial video followed by decreased engagement with subsequent videos. As many countries maintain restrictions on traditional PA facilities owing to the COVID-19 pandemic, determining methods to improve engagement and adherence with web-based fitness videos becomes increasingly important. %M 35258459 %R 10.2196/25055 %U https://formative.jmir.org/2022/3/e25055 %U https://doi.org/10.2196/25055 %U http://www.ncbi.nlm.nih.gov/pubmed/35258459 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34040 %T Social-Cyber Maneuvers During the COVID-19 Vaccine Initial Rollout: Content Analysis of Tweets %A Blane,Janice T %A Bellutta,Daniele %A Carley,Kathleen M %+ School of Computer Science, Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA, 15213, United States, 1 412 268 6016, jblane@andrew.cmu.edu %K social cybersecurity %K social-cyber maneuvers %K social network analysis %K disinformation %K BEND maneuvers %K COVID-19 %K coronavirus %K social media %K vaccine %K anti-vaccine %K pro-vaccine %K ORA-PRO %K cybersecurity %K security %K Twitter %K community %K communication %K health information %K manipulation %K belief %D 2022 %7 7.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: During the time surrounding the approval and initial distribution of Pfizer-BioNTech’s COVID-19 vaccine, large numbers of social media users took to using their platforms to voice opinions on the vaccine. They formed pro- and anti-vaccination groups toward the purpose of influencing behaviors to vaccinate or not to vaccinate. The methods of persuasion and manipulation for convincing audiences online can be characterized under a framework for social-cyber maneuvers known as the BEND maneuvers. Previous studies have been conducted on the spread of COVID-19 vaccine disinformation. However, these previous studies lacked comparative analyses over time on both community stances and the competing techniques of manipulating both the narrative and network structure to persuade target audiences. Objective: This study aimed to understand community response to vaccination by dividing Twitter data from the initial Pfizer-BioNTech COVID-19 vaccine rollout into pro-vaccine and anti-vaccine stances, identifying key actors and groups, and evaluating how the different communities use social-cyber maneuvers, or BEND maneuvers, to influence their target audiences and the network as a whole. Methods: COVID-19 Twitter vaccine data were collected using the Twitter application programming interface (API) for 1-week periods before, during, and 6 weeks after the initial Pfizer-BioNTech rollout (December 2020 to January 2021). Bot identifications and linguistic cues were derived for users and tweets, respectively, to use as metrics for evaluating social-cyber maneuvers. Organization Risk Analyzer (ORA)-PRO software was then used to separate the vaccine data into pro-vaccine and anti-vaccine communities and to facilitate identification of key actors, groups, and BEND maneuvers for a comparative analysis between each community and the entire network. Results: Both the pro-vaccine and anti-vaccine communities used combinations of the 16 BEND maneuvers to persuade their target audiences of their particular stances. Our analysis showed how each side attempted to build its own community while simultaneously narrowing and neglecting the opposing community. Pro-vaccine users primarily used positive maneuvers such as excite and explain messages to encourage vaccination and backed leaders within their group. In contrast, anti-vaccine users relied on negative maneuvers to dismay and distort messages with narratives on side effects and death and attempted to neutralize the effectiveness of the leaders within the pro-vaccine community. Furthermore, nuking through platform policies showed to be effective in reducing the size of the anti-vaccine online community and the quantity of anti-vaccine messages. Conclusions: Social media continues to be a domain for manipulating beliefs and ideas. These conversations can ultimately lead to real-world actions such as to vaccinate or not to vaccinate against COVID-19. Moreover, social media policies should be further explored as an effective means for curbing disinformation and misinformation online. %M 35044302 %R 10.2196/34040 %U https://www.jmir.org/2022/3/e34040 %U https://doi.org/10.2196/34040 %U http://www.ncbi.nlm.nih.gov/pubmed/35044302 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e36006 %T Epidemiology, Secondary School Curricula, and Preparing the Next Generation for Global Citizenship %A Basch,Charles E %A Basch,Corey H %+ William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, United States, 1 973 720 2603, baschc@wpunj.edu %K COVID-19 %K epidemiology %K secondary school %K global citizenship %K emerging infectious disease %K public health %K teaching %K student %K high school education %K population health %D 2022 %7 7.3.2022 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Because COVID-19 and other emerging infectious diseases are likely to play an increasingly important role in shaping American and global society in years to come, there is a need to prepare young people to make informed decisions in this changing global context. One way to do so is teaching and learning about basic principles of epidemiology in secondary schools. Improved understanding about the agent of infection, mechanisms of transmission, factors that increase or decrease susceptibility, place variation and environmental factors that facilitate or hinder transmission, reservoirs of infection (where the agent lives and multiplies), and when the disease is more or less likely to occur comprise the main facts about an infectious disease relevant to prevention and control. Improved understanding of these basic concepts could help future generations make informed decisions in a changing global context with emerging infectious diseases and a plethora of widely disseminated misinformation and disinformation. This viewpoint considers why learning about epidemiology in secondary school would benefit population health using COVID-19 as an illustration. %M 35254281 %R 10.2196/36006 %U https://publichealth.jmir.org/2022/3/e36006 %U https://doi.org/10.2196/36006 %U http://www.ncbi.nlm.nih.gov/pubmed/35254281 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e33277 %T Precision Public Health and Structural Racism in the United States: Promoting Health Equity in the COVID-19 Pandemic Response %A Geneviève,Lester Darryl %A Martani,Andrea %A Wangmo,Tenzin %A Elger,Bernice Simone %+ Institute for Biomedical Ethics, University of Basel, Bernoullistrasse 28, Basel, 4056, Switzerland, 41 612071782, lester.genevieve@unibas.ch %K precision public health %K structural racism %K COVID-19 %K pandemic %K social justice %K health equity %K SARS-CoV-2 %K stigma %K discrimination %K disparity %K inequality %K precision health %K public health %K racism %K inequality %K equity %K mortality %K morbidity %D 2022 %7 4.3.2022 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 pandemic has revealed deeply entrenched structural inequalities that resulted in an excess of mortality and morbidity in certain racial and ethnic groups in the United States. Therefore, this paper examines from the US perspective how structural racism and defective data collection on racial and ethnic minorities can negatively influence the development of precision public health (PPH) approaches to tackle the ongoing COVID-19 pandemic. Importantly, the effects of structural and data racism on the development of fair and inclusive data-driven components of PPH interventions are discussed, such as with the use of machine learning algorithms to predict public health risks. The objective of this viewpoint is thus to inform public health policymaking with regard to the development of ethically sound PPH interventions against COVID-19. Particular attention is given to components of structural racism (eg, hospital segregation, implicit and organizational bias, digital divide, and sociopolitical influences) that are likely to hinder such approaches from achieving their social justice and health equity goals. %M 35089868 %R 10.2196/33277 %U https://publichealth.jmir.org/2022/3/e33277 %U https://doi.org/10.2196/33277 %U http://www.ncbi.nlm.nih.gov/pubmed/35089868 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e33314 %T Public Perception of the Use of Digital Contact-Tracing Tools After the COVID-19 Lockdown: Sentiment Analysis and Opinion Mining %A Huang,Zhilian %A Tay,Evonne %A Wee,Dillon %A Guo,Huiling %A Lim,Hannah Yee-Fen %A Chow,Angela %+ Department of Clinical Epidemiology, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore, 65 63577477, Angela_Chow@ttsh.com.sg %K infectious disease %K sentiment analysis %K opinion mining %K COVID-19 %K contact tracing %K public health %K opinion %K data mining %K survey %K cross-sectional %D 2022 %7 4.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Singapore’s national digital contact-tracing (DCT) tool—TraceTogether—attained an above 70% uptake by December 2020 after a slew of measures. Sentiment analysis can help policymakers to assess public sentiments on the implementation of new policy measures in a short time, but there is a paucity of sentiment analysis studies on the usage of DCT tools. Objective: We sought to understand the public’s knowledge of, concerns with, and sentiments on the use of TraceTogether over time and their preferences for the type of TraceTogether tool. Methods: We conducted a cross-sectional survey at a large public hospital in Singapore after the COVID-19 lockdown, from July 2020 through February 2021. In total, 4097 respondents aged 21-80 years were sampled proportionately by sex and 4 age groups. The open-ended responses were processed and analyzed using natural language processing tools. We manually corrected the language and logic errors and replaced phrases with words available in the syuzhet sentiment library without altering the original meaning of the phrases. The sentiment scores were computed by summing the scores of all the tokens (phrases split into smaller units) in the phrase. Stopwords (prepositions and connectors) were removed, followed by implementing the bag-of-words model to calculate the bigram and trigram occurrence in the data set. Demographic and time filters were applied to segment the responses. Results: Respondents’ knowledge of and concerns with TraceTogether changed from a focus on contact tracing and Bluetooth activation in July-August 2020 to QR code scanning and location check-ins in January-February 2021. Younger males had the highest TraceTogether uptake (24/40, 60%), while older females had the lowest uptake (8/34, 24%) in the first half of July 2020. This trend was reversed in mid-October after the announcement on mandatory TraceTogether check-ins at public venues. Although their TraceTogether uptake increased over time, older females continued to have lower sentiment scores. The mean sentiment scores were the lowest in January 2021 when the media reported that data collected by TraceTogether were used for criminal investigations. Smartphone apps were initially preferred over tokens, but the preference for the type of TraceTogether tool equalized over time as tokens became accessible to the whole population. The sentiments on token-related comments became more positive as the preference for tokens increased. Conclusions: The public’s knowledge of and concerns with the use of a mandatory DCT tool varied with the national regulations and public communications over time with the evolution of the COVID-19 pandemic. Effective communications tailored to subpopulations and greater transparency in data handling will help allay public concerns with data misuse and improve trust in the authorities. Having alternative forms of the DCT tool can increase the uptake of and positive sentiments on DCT. %M 35120017 %R 10.2196/33314 %U https://formative.jmir.org/2022/3/e33314 %U https://doi.org/10.2196/33314 %U http://www.ncbi.nlm.nih.gov/pubmed/35120017 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e24787 %T Social Media Images as an Emerging Tool to Monitor Adherence to COVID-19 Public Health Guidelines: Content Analysis %A Young,Sean D %A Zhang,Qingpeng %A Zeng,Daniel Dajun %A Zhan,Yongcheng %A Cumberland,William %+ Department of Informatics, University of California Institute for Prediction Technology, University of California, Irvine, 6091 Bren Hall, Irvine, CA, 92617, United States, 1 650 223 5448, syoung5@hs.uci.edu %K internet %K social media %K health informatics %K tool %K monitor %K adherence %K COVID-19 %K public health %K guidelines %K content analysis %K policy %D 2022 %7 3.3.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Innovative surveillance methods are needed to assess adherence to COVID-19 recommendations, especially methods that can provide near real-time or highly geographically targeted data. Use of location-based social media image data (eg, Instagram images) is one possible approach that could be explored to address this problem. Objective: We seek to evaluate whether publicly available near real-time social media images might be used to monitor COVID-19 health policy adherence. Methods: We collected a sample of 43,487 Instagram images in New York from February 7 to April 11, 2020, from the following location hashtags: #Centralpark (n=20,937), #Brooklyn Bridge (n=14,875), and #Timesquare (n=7675). After manually reviewing images for accuracy, we counted and recorded the frequency of valid daily posts at each of these hashtag locations over time, as well as rated and counted whether the individuals in the pictures at these location hashtags were social distancing (ie, whether the individuals in the images appeared to be distanced from others vs next to or touching each other). We analyzed the number of images posted over time and the correlation between trends among hashtag locations. Results: We found a statistically significant decline in the number of posts over time across all regions, with an approximate decline of 17% across each site (P<.001). We found a positive correlation between hashtags (#Centralpark and #Brooklynbridge: r=0.40; #BrooklynBridge and #Timesquare: r=0.41; and #Timesquare and #Centralpark: r=0.33; P<.001 for all correlations). The logistic regression analysis showed a mild statistically significant increase in the proportion of posts over time with people appearing to be social distancing at Central Park (P=.004) and Brooklyn Bridge (P=.02) but not for Times Square (P=.16). Conclusions: Results suggest the potential of using location-based social media image data as a method for surveillance of COVID-19 health policy adherence. Future studies should further explore the implementation and ethical issues associated with this approach. %M 34995205 %R 10.2196/24787 %U https://www.jmir.org/2022/3/e24787 %U https://doi.org/10.2196/24787 %U http://www.ncbi.nlm.nih.gov/pubmed/34995205 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 3 %P e32364 %T United States Influenza Search Patterns Since the Emergence of COVID-19: Infodemiology Study %A Cai,Owen %A Sousa-Pinto,Bernardo %+ Department of Community Medicine, Information and Health Decision Sciences, Faculty of Medicine, University of Porto, Rua Plácido Costa s/n, Porto, 4200-450, Portugal, 351 225513622, bernardosousapinto@protonmail.com %K COVID-19 %K influenza %K surveillance %K media coverage %K Google Trends %K infodemiology %K monitoring %K trend %K United States %K information-seeking %K online health information %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The emergence and media coverage of COVID-19 may have affected influenza search patterns, possibly affecting influenza surveillance results using Google Trends. Objective: We aimed to investigate if the emergence of COVID-19 was associated with modifications in influenza search patterns in the United States. Methods: We retrieved US Google Trends data (relative number of searches for specified terms) for the topics influenza, Coronavirus disease 2019, and symptoms shared between influenza and COVID-19. We calculated the correlations between influenza and COVID-19 search data for a 1-year period after the first COVID-19 diagnosis in the United States (January 21, 2020 to January 20, 2021). We constructed a seasonal autoregressive integrated moving average model and compared predicted search volumes, using the 4 previous years, with Google Trends relative search volume data. We built a similar model for shared symptoms data. We also assessed correlations for the past 5 years between Google Trends influenza data, US Centers for Diseases Control and Prevention influenza-like illness data, and influenza media coverage data. Results: We observed a nonsignificant weak correlation (ρ= –0.171; P=0.23) between COVID-19 and influenza Google Trends data. Influenza search volumes for 2020-2021 distinctly deviated from values predicted by seasonal autoregressive integrated moving average models—for 6 weeks within the first 13 weeks after the first COVID-19 infection was confirmed in the United States, the observed volume of searches was higher than the upper bound of 95% confidence intervals for predicted values. Similar results were observed for shared symptoms with influenza and COVID-19 data. The correlation between Google Trends influenza data and CDC influenza-like-illness data decreased after the emergence of COVID-19 (2020-2021: ρ=0.643; 2019-2020: ρ=0.902), while the correlation between Google Trends influenza data and influenza media coverage volume remained stable (2020-2021: ρ=0.746; 2019-2020: ρ=0.707). Conclusions: Relevant differences were observed between predicted and observed influenza Google Trends data the year after the onset of the COVID-19 pandemic in the United States. Such differences are possibly due to media coverage, suggesting limitations to the use of Google Trends as a flu surveillance tool. %M 34878996 %R 10.2196/32364 %U https://publichealth.jmir.org/2022/3/e32364 %U https://doi.org/10.2196/32364 %U http://www.ncbi.nlm.nih.gov/pubmed/34878996 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31813 %T Identifying the Socioeconomic, Demographic, and Political Determinants of Social Mobility and Their Effects on COVID-19 Cases and Deaths: Evidence From US Counties %A Jalali,Niloofar %A Tran,N Ken %A Sen,Anindya %A Morita,Plinio Pelegrini %+ School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 31372, plinio.morita@uwaterloo.ca %K COVID-19 %K cases %K deaths %K mobility %K Google mobility data %K clustering %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The spread of COVID-19 at the local level is significantly impacted by population mobility. The U.S. has had extremely high per capita COVID-19 case and death rates. Efficient nonpharmaceutical interventions to control the spread of COVID-19 depend on our understanding of the determinants of public mobility. Objective: This study used publicly available Google data and machine learning to investigate population mobility across a sample of US counties. Statistical analysis was used to examine the socioeconomic, demographic, and political determinants of mobility and the corresponding patterns of per capita COVID-19 case and death rates. Methods: Daily Google population mobility data for 1085 US counties from March 1 to December 31, 2020, were clustered based on differences in mobility patterns using K-means clustering methods. Social mobility indicators (retail, grocery and pharmacy, workplace, and residence) were compared across clusters. Statistical differences in socioeconomic, demographic, and political variables between clusters were explored to identify determinants of mobility. Clusters were matched with daily per capita COVID-19 cases and deaths. Results: Our results grouped US counties into 4 Google mobility clusters. Clusters with more population mobility had a higher percentage of the population aged 65 years and over, a greater population share of Whites with less than high school and college education, a larger percentage of the population with less than a college education, a lower percentage of the population using public transit to work, and a smaller share of voters who voted for Clinton during the 2016 presidential election. Furthermore, clusters with greater population mobility experienced a sharp increase in per capita COVID-19 case and death rates from November to December 2020. Conclusions: Republican-leaning counties that are characterized by certain demographic characteristics had higher increases in social mobility and ultimately experienced a more significant incidence of COVID-19 during the latter part of 2020. %M 35287305 %R 10.2196/31813 %U https://infodemiology.jmir.org/2022/1/e31813 %U https://doi.org/10.2196/31813 %U http://www.ncbi.nlm.nih.gov/pubmed/35287305 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 5 %N 1 %P e29189 %T COVID-19 and Pregnancy: Citation Network Analysis and Evidence Synthesis %A Ruiz-Roman,Rebeca %A Martinez-Perez,Clara %A Gil Prados,Inés %A Cristóbal,Ignacio %A Sánchez-Tena,Miguel Ángel %+ Department of Gynecology and Obstetrics, Hospital Clínico San Carlos, Calle del Prof Martín Lagos, s/n, Madrid, 28040, Spain, 34 913303000, rebecaruizroman@gmail.com %K pandemic %K COVID-19 %K SARS-CoV-2 %K pregnancy %K perinatal %K citation %K bibliometric %K network analysis %K women %K maternal health %K fetal health %K research %K literature %K transmission %K delivery %K impact %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: COVID-19 spread quickly around the world shortly after the first outbreaks of the new coronavirus disease at the end of December 2019, affecting all populations, including pregnant women. Objective: The aim of this study was to analyze the relationship between different publications on COVID-19 in pregnancy and their authors through citation networks, as well as to identify the research areas and to determine the publication that has been the most highly cited. Methods: The search for publications was carried out through the Web of Science database using terms such as “pregnancy,” “SARS-CoV-2,” “pregnant,” and “COVID-19” for the period between January and December 2020. Citation Network Explorer software was used for publication analysis and VOSviewer software was used to construct the figures. This approach enabled an in-depth network analysis to visualize the connections between the related elements and explain their network structure. Results: A total of 1330 publications and 5531 citation networks were identified in the search, with July being the month with the largest number of publications, and the United States, China, and England as the countries with the greatest number of publications. The most cited publication was “Clinical characteristics and intrauterine vertical transmission potential of COVID-19 infection in nine pregnant women: a retrospective review of medical records” by Chen and colleagues, which was published in March 2020. Six groups identified as being close in the citation network reflect multidisciplinary research, including clinical characteristics and outcomes in pregnancy, vertical transmission, delivery mode, and psychological impacts of the pandemic on pregnant women. Conclusions: Thousands of articles on COVID-19 have been published in several journals since the disease first emerged. Identifying relevant publications and obtaining a global view of the main papers published on COVID-19 and pregnancy can lead to a better understanding of the topic. With the accumulation of scientific knowledge, we now know that the clinical features of COVID-19 during pregnancy are generally similar to those of infected nonpregnant women. There is a small increase in frequency of preterm birth and cesarean birth, related to severe maternal illness. Vaccination for all pregnant women is recommended. Several agents are being evaluated for the treatment of COVID-19, but with minimal or no information on safety in pregnancy. These results could form the basis for further research. Future bibliometric and scientometric studies on COVID-19 should provide updated information to analyze other relevant indicators in this field. %M 35044301 %R 10.2196/29189 %U https://pediatrics.jmir.org/2022/1/e29189 %U https://doi.org/10.2196/29189 %U http://www.ncbi.nlm.nih.gov/pubmed/35044301 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e32871 %T Informal Coping Strategies Among People Who Use Opioids During COVID-19: Thematic Analysis of Reddit Forums %A Arshonsky,Josh %A Krawczyk,Noa %A Bunting,Amanda M %A Frank,David %A Friedman,Samuel R %A Bragg,Marie A %+ Department of Population Health, New York University Grossman School of Medicine, 180 Madison Ave, New York, NY, 10016, United States, 1 646 501 2717, SeedProgramPaperSubmissions@nyulangone.org %K opioid use %K Reddit %K coping strategies %K COVID-19 %K opioid %K drug %K coping %K social media %K strategy %K content analysis %K abstain %K addiction %K data mining %K support %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has transformed how people seeking to reduce opioid use access treatment services and navigate efforts to abstain from using opioids. Social distancing policies have drastically reduced access to many forms of social support, but they may have also upended some perceived barriers to reducing or abstaining from opioid use. Objective: This qualitative study aims to identify informal coping strategies for reducing and abstaining from opioid use among Reddit users who have posted in opioid-related subreddits at the beginning of the COVID-19 pandemic. Methods: We extracted data from 2 major opioid-related subreddits. Thematic data analysis was used to evaluate subreddit posts dated from March 5 to May 13, 2020, that referenced COVID-19 and opioid use, resulting in a final sample of 300 posts that were coded and analyzed. Results: Of the 300 subreddit posts, 100 (33.3%) discussed at least 1 type of informal coping strategy. Those strategies included psychological and behavioral coping skills, adoption of healthy habits, and use of substances to manage withdrawal symptoms. In addition, 12 (4%) subreddit posts explicitly mentioned using social distancing as an opportunity for cessation of or reduction in opioid use. Conclusions: Reddit discussion forums have provided a community for people to share strategies for reducing opioid use and support others during the COVID-19 pandemic. Future research needs to assess the impact of COVID-19 on opioid use behaviors, especially during periods of limited treatment access and isolation, as these can inform future efforts in curbing the opioid epidemic and other substance-related harms. %M 35084345 %R 10.2196/32871 %U https://formative.jmir.org/2022/3/e32871 %U https://doi.org/10.2196/32871 %U http://www.ncbi.nlm.nih.gov/pubmed/35084345 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e30085 %T Readability of Korean-Language COVID-19 Information from the South Korean National COVID-19 Portal Intended for the General Public: Cross-sectional Infodemiology Study %A Moon,Hana %A Lee,Geon Ho %A Cho,Yoon Jeong %+ Department of Family Medicine, Daegu Catholic University School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea, 82 53 650 4696, totoslee@cu.ac.kr %K COVID-19 %K health literacy %K readability %K public health %K health equity %K consumer health information %K information dissemination %K health education %K eHealth %K online %K social media %K pandemic %K infodemic %D 2022 %7 3.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The coronavirus pandemic has increased reliance on the internet as a tool for disseminating information; however, information is useful only when it can be understood. Prior research has shown that web-based health information is not always easy to understand. It is not yet known whether the Korean-language COVID-19 information from the internet is easy for the general public to understand. Objective: We aimed to evaluate the readability of Korean-language COVID-19 information intended for the general public from the national COVID-19 portal of South Korea. Methods: A total of 122 publicly available COVID-19 information documents written in Korean were obtained from the South Korean national COVID-19 portal. We determined the level of readability (at or below ninth grade, 10th to 12th grade, college, or professional) of each document using a readability tool for Korean-language text. We measured the reading time, character count, word count, sentence count, and paragraph count for each document. We also evaluated the characteristics of difficult-to-read documents to modify the readability from difficult to easy. Results: The median readability level was at a professional level; 90.2% (110/122) of the information was difficult to read. In all 4 topics, few documents were easy to read (overview: 5/12, 41.7%; prevention: 6/97, 6.2%; test: 0/5, 0%; treatment: 1/8, 12.5%; P=.006), with a median 11th-grade readability level for overview, a median professional readability level for prevention, and median college readability levels for test and treatment. Difficult-to-read information had the following characteristics in common: literacy style, medical jargon, and unnecessary detail. Conclusions: In all 4 topics, most of the Korean-language COVID-19 web-based information intended for the general public provided by the national COVID-19 portal of South Korea was difficult to read; the median readability levels exceeded the recommended ninth-grade level. Readability should be a key consideration in developing public health documents, which play an important role in disease prevention and health promotion. %M 35072633 %R 10.2196/30085 %U https://formative.jmir.org/2022/3/e30085 %U https://doi.org/10.2196/30085 %U http://www.ncbi.nlm.nih.gov/pubmed/35072633 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34098 %T An Innovative Telemedical Network to Improve Infectious Disease Management in Critically Ill Patients and Outpatients (TELnet@NRW): Stepped-Wedge Cluster Randomized Controlled Trial %A Marx,Gernot %A Greiner,Wolfgang %A Juhra,Christian %A Elkenkamp,Svenja %A Gensorowsky,Daniel %A Lemmen,Sebastian %A Englbrecht,Jan %A Dohmen,Sandra %A Gottschalk,Antje %A Haverkamp,Miriam %A Hempen,Annette %A Flügel-Bleienheuft,Christian %A Bause,Daniela %A Schulze-Steinen,Henna %A Rademacher,Susanne %A Kistermann,Jennifer %A Hoch,Stefan %A Beckmann,Hans-Juergen %A Lanckohr,Christian %A Lowitsch,Volker %A Peine,Arne %A Juzek-Kuepper,Fabian %A Benstoem,Carina %A Sperling,Kathrin %A Deisz,Robert %+ Department of Intensive Care Medicine and Intermediate Care, Medical Faculty RWTH Aachen, Pauwelsstr. 30, Aachen, 52074, Germany, 49 2418080444, gmarx@ukaachen.de %K telemedicine %K infectious disease medicine %K sepsis %K evidence-based medicine %K eHealth %D 2022 %7 2.3.2022 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 35103604 %R 10.2196/34098 %U https://www.jmir.org/2022/3/e34098 %U https://doi.org/10.2196/34098 %U http://www.ncbi.nlm.nih.gov/pubmed/35103604 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 3 %P e34870 %T The Unclear Role of the Physician on Social Media During the COVID-19 Pandemic. Comment on “Emergency Physician Twitter Use in the COVID-19 Pandemic as a Potential Predictor of Impending Surge: Retrospective Observational Study” %A MacLeod,Spencer %A Singh,Nikhi Paul %A Boyd,Carter Joseph %+ School of Medicine, The University of Alabama at Birmingham, 1670 University Blvd, Birmingham, AL, 35233, United States, 1 205 563 3208, nsingh@uab.edu %K COVID-19 pandemic %K emergency medicine %K disaster medicine %K crisis standards of care %K latent Dirichlet allocation %K topic modeling %K Twitter %K sentiment analysis %K surge capacity %K physician wellness %K social media %K internet %K infodemiology %K COVID-19 %D 2022 %7 2.3.2022 %9 Letter to the Editor %J J Med Internet Res %G English %X   %M 35120018 %R 10.2196/34870 %U https://www.jmir.org/2022/3/e34870 %U https://doi.org/10.2196/34870 %U http://www.ncbi.nlm.nih.gov/pubmed/35120018 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 3 %P e31992 %T Psychometric Evaluation of a Fear of COVID-19 Scale in China: Cross-sectional Study %A Choi,Edmond P H %A Duan,Wenjie %A Fong,Daniel Y T %A Lok,Kris Y W %A Ho,Mandy %A Wong,Janet Y H %A Lin,Chia-Chin %+ School of Nursing, The University of Hong Kong, 21 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 39176645, dytfong@hku.hk %K Chinese %K COVID-19 %K fear %K psychometric %K validation %K scale %K mental health %K information %K cross-sectional %K validity %K reliability %K support %D 2022 %7 2.3.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: At the very beginning of the COVID-19 pandemic, information about fear of COVID-19 was very limited in Chinese populations, and there was no standardized and validated scale to measure the fear associated with the pandemic. Objective: This cross-sectional study aimed to adapt and validate a fear scale to determine the levels of fear of COVID-19 among the general population in mainland China and Hong Kong. Methods: A web-based questionnaire platform was developed for data collection; the study instruments were an adapted version of the 8-item Breast Cancer Fear Scale (“Fear Scale”) and the 4-item Patient Health Questionnaire. The internal construct validity, convergent validity, known group validity, and reliability of the adapted Fear Scale were assessed, and descriptive statistics were used to summarize the participants’ fear levels. Results: A total of 2822 study participants aged 18 years or older were included in the analysis. The reliability of the adapted scale was satisfactory, with a Cronbach α coefficient of .93. The item-total correlations corrected for overlap were >0.4, confirming their internal construct validity. Regarding convergent validity, a small-to-moderate correlation between the Fear Scale and the 4-item Patient Health Questionnaire scores was found. Regarding known group validity, we found that the study participants who were recruited from Hong Kong had a higher level of fear than the study participants from mainland China. Older adults had a higher level of fear compared with younger adults. Furthermore, having hypertension, liver disease, heart disease, cancer, anxiety, and insomnia were associated with a higher fear level. The descriptive analysis found that more than 40% of the study participants reported that the thought of COVID-19 scared them. About one-third of the study participants reported that when they thought about COVID-19, they felt nervous, uneasy, and depressed. Conclusions: The psychometric properties of the adapted Fear Scale are acceptable to measure the fear of COVID-19 among Chinese people. Our study stresses the need for more psychosocial support and care to help this population cope with their fears during the pandemic. %M 35072632 %R 10.2196/31992 %U https://formative.jmir.org/2022/3/e31992 %U https://doi.org/10.2196/31992 %U http://www.ncbi.nlm.nih.gov/pubmed/35072632 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e30397 %T Monitoring COVID-19 on Social Media: Development of an End-to-End Natural Language Processing Pipeline Using a Novel Triage and Diagnosis Approach %A Hasan,Abul %A Levene,Mark %A Weston,David %A Fromson,Renate %A Koslover,Nicolas %A Levene,Tamara %+ Department of Computer Science and Information Systems, Birkbeck, University of London, Malet Street, Bloomsbury, London, WC1E 7HX, United Kingdom, 44 020 7631 8147, abulhasan@dcs.bbk.ac.uk %K COVID-19 %K conditional random fields %K disease detection and surveillance %K medical social media %K natural language processing %K severity and prevalence %K support vector machines %K triage and diagnosis %D 2022 %7 28.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has created a pressing need for integrating information from disparate sources in order to assist decision makers. Social media is important in this respect; however, to make sense of the textual information it provides and be able to automate the processing of large amounts of data, natural language processing methods are needed. Social media posts are often noisy, yet they may provide valuable insights regarding the severity and prevalence of the disease in the population. Here, we adopt a triage and diagnosis approach to analyzing social media posts using machine learning techniques for the purpose of disease detection and surveillance. We thus obtain useful prevalence and incidence statistics to identify disease symptoms and their severities, motivated by public health concerns. Objective: This study aims to develop an end-to-end natural language processing pipeline for triage and diagnosis of COVID-19 from patient-authored social media posts in order to provide researchers and public health practitioners with additional information on the symptoms, severity, and prevalence of the disease rather than to provide an actionable decision at the individual level. Methods: The text processing pipeline first extracted COVID-19 symptoms and related concepts, such as severity, duration, negations, and body parts, from patients’ posts using conditional random fields. An unsupervised rule-based algorithm was then applied to establish relations between concepts in the next step of the pipeline. The extracted concepts and relations were subsequently used to construct 2 different vector representations of each post. These vectors were separately applied to build support vector machine learning models to triage patients into 3 categories and diagnose them for COVID-19. Results: We reported macro- and microaveraged F1 scores in the range of 71%-96% and 61%-87%, respectively, for the triage and diagnosis of COVID-19 when the models were trained on human-labeled data. Our experimental results indicated that similar performance can be achieved when the models are trained using predicted labels from concept extraction and rule-based classifiers, thus yielding end-to-end machine learning. In addition, we highlighted important features uncovered by our diagnostic machine learning models and compared them with the most frequent symptoms revealed in another COVID-19 data set. In particular, we found that the most important features are not always the most frequent ones. Conclusions: Our preliminary results show that it is possible to automatically triage and diagnose patients for COVID-19 from social media natural language narratives, using a machine learning pipeline in order to provide information on the severity and prevalence of the disease for use within health surveillance systems. %M 35142636 %R 10.2196/30397 %U https://www.jmir.org/2022/2/e30397 %U https://doi.org/10.2196/30397 %U http://www.ncbi.nlm.nih.gov/pubmed/35142636 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29519 %T Telehealth Before and During the COVID-19 Pandemic: Analysis of Health Care Workers' Opinions %A Nitiema,Pascal %+ Division of Management Information Systems, Price College of Business, University of Oklahoma, 307 W Brooks Suite 307, Norman, OK, 73019, United States, 1 4053255721, pascal.nitiema-1@ou.edu %K telehealth %K telemedicine %K COVID-19 %K pandemic %K physical examination %K sentiment score %K structural topic modeling %K opinion %K health care worker %K social media %K discussion %D 2022 %7 25.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic and the lockdowns for controlling the spread of infection have led to a surge in telehealth adoption by many health care organizations. It is unclear how this pandemic has impacted health professionals’ view about telehealth. The analysis of textual data, such as comments posted on a discussion forum, can uncover information that may not be captured by a structured survey. Objective: This study aims to examine the opinions of health care workers about telehealth services during the time frame of March 2013-December 2020. Methods: Comments about telehealth posted by health care workers from at least 46 countries were collected from an online discussion forum dedicated to health professionals. The analysis included the computation of sentiment scores from the textual data and the use of structural topic modeling to identify the topics of discussions as well as the factors that may be associated with the prevalence of these topics. Results: The analysis of the comments revealed positive opinions about the perceived benefits of telehealth services before and during the pandemic, especially the ability to reach patients who cannot come to the health facility for diverse reasons. However, opinions about these benefits were less positive during the pandemic compared to the prepandemic period. Specific issues raised during the pandemic included technical difficulties encountered during telehealth sessions and the inability to perform certain care routines through telehealth platforms. Although comments on the quality of care provided through telehealth were associated with a negative sentiment score overall, the average score was less negative during the pandemic compared to the prepandemic period, signaling a shift in opinion about the quality of telehealth services. In addition, the analysis uncovered obstacles to the adoption of telehealth, including the absence of adequate legal dispositions for telehealth services and issues regarding the payment of these services by health insurance organizations. Conclusions: Enhancing the adoption of telehealth services beyond the pandemic requires addressing issues related to the quality of care, payment of services, and legal dispositions for delivering these services. %M 34978532 %R 10.2196/29519 %U https://www.jmir.org/2022/2/e29519 %U https://doi.org/10.2196/29519 %U http://www.ncbi.nlm.nih.gov/pubmed/34978532 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e33029 %T The Moderating Role of Community Capacity for Age-friendly Communication in Mitigating Anxiety of Older Adults During the COVID-19 Infodemic: Cross-sectional Survey %A Wong,Frankie Ho Chun %A Leung,Dara Kiu Yi %A Wong,Edwin Lok Yan %A Liu,Tianyin %A Lu,Shiyu %A Chan,On Fung %A Wong,Gloria Hoi Yan %A Lum,Terry Yat Sang %+ Department of Social Work and Social Administration, The University of Hong Kong, CJT-514, The Jockey Club Tower, Centennial Campus, Hong Kong, China (Hong Kong), 852 39178569, tlum@hku.hk %K COVID-19 %K mental health %K information technology %K media trust %K social media %K Hong Kong %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Older adults were perceived as a vulnerable group during the COVID-19 pandemic due to the health and mental health challenges they faced. The pandemic was accompanied by an “infodemic” of overabundant and questionable information that has affected older adults’ mental health. As the infodemic and ageist narratives were prevalent online, more anxiety symptoms have been induced among older adults who used social media. Age-friendly communication, advocated by the World Health Organization’s Age-friendly City (AFC) guide, could be an antidote by providing tailored information via appropriate channels for older adults. Objective: This study investigated the role of community capacity for age-friendly communication in mitigating anxiety during the pandemic. We hypothesized that age-friendly communication would moderate the effects of infection risks and social media use on anxiety. A double-moderating effect was hypothesized in the context of diminished trust in traditional media. Methods: Data were collected from a cross-sectional telephone survey conducted in Hong Kong in 2020. Older adults (N=3421, age≥60 years) were interviewed about their well-being and daily lives. Community capacity for age-friendly communication was measured in a living district–based evaluation. It had 2 components: the reach of appropriate information to older adults (AFC-Information) and the age-friendliness of communication technologies (AFC-Communication Technology) in the community. We tested the hypothesized moderation and double-moderation effects with ordinary least squares regressions. Results: Perceived COVID-19 infection risk (b=0.002, P=.02) and use of social media for COVID-19 information (b=0.08, P=.04) were associated with more anxiety symptoms. The effect of using social media was moderated by AFC-Information (b=–0.39, P=.002) and AFC-Communication Technology (b=–1.06, P<.001), and the effect of perceived COVID-19 infection risk was moderated by AFC-Information (b=–0.03, P=.002) and AFC-Communication Technology (b=–0.05, P<.001). Lower trust in traditional media exacerbated anxiety symptoms associated with social media use (b=–0.08, P=.02). Higher AFC-Information alleviated this moderation effect (AFC-Information × media trust b=–0.65, P<.001; AFC-Information × social media use b=–2.18, P<.001; 3-way interaction b=0.40, P=.003). Conclusions: Our findings highlight the role of community age-friendly communication in mitigating anxiety related to the infodemic. Although using social media may have exacerbated the impact of the infodemic on older adults, it has the potential to deliver timely information for an adequate health response. Although the amplifying effects of low media trust was associated with social media use, age-friendly communication determined its strength. Instead of discouraging the use of digital technologies for COVID-19 information, efforts should be made in tailoring information and communication technologies in local communities for older adults. %M 35257090 %R 10.2196/33029 %U https://infodemiology.jmir.org/2022/1/e33029 %U https://doi.org/10.2196/33029 %U http://www.ncbi.nlm.nih.gov/pubmed/35257090 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e35776 %T A Brief, Daily, Online Mental Health and Well-being Intervention for University Staff During the COVID-19 Pandemic: Program Description and Outcomes Using a Mixed Methods Design %A Parker,Alexandra %A Dash,Sarah %A Bourke,Matthew %A Patten,Rhiannon %A Craike,Melinda %A Baldwin,Peter %A Hosking,Warwick %A Levinger,Itamar %A Apostolopoulos,Vasso %A de Courten,Maximilian %A Sharples,Jenny %A Naslund,Monika %A Stavropoulos,Vasileios %A Woessner,Mary %A Sonn,Christopher %A Stansen,Caroline %A Pascoe,Michaela %+ Institute for Health and Sport, Victoria University, Ballarat Road, Melbourne, 3011, Australia, 61 399195874, alex.parker@vu.edu.au %K workplace mental health %K well-being %K mental health promotion %K online intervention %K telehealth %K COVID-19 pandemic %K COVID-19 %K pandemic %K health promotion %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The unprecedented changes and isolation measures to contain COVID-19 have had multiple psychological and social impacts, with implications for professional and personal functioning. Evidence-informed interventions that can be rapidly implemented under pandemic conditions to support mental health during such times are urgently needed. Objective: The aim of this study was to determine the acceptability and preliminary outcomes of a daily online mental health promotion program for tertiary education staff during the COVID-19 pandemic. Methods: The “Victoria University (VU) Elevenses” program was delivered as an uncontrolled intervention at Victoria University (VU) in the western metropolitan region of Melbourne, Australia. In April 2020, an email invitation was sent to all academic and professional staff inviting them to: (1) participate in the program and (2) opt-in to the research component. The “VU Elevenses” program provided 10-15–minute microinterventions comprising lifestyle and well-being strategies to promote mental health via an online meeting platform at 11 AM each weekday. A mixed methods approach was used to evaluate the program, combining structured questionnaires with semistructured interviews to investigate the experiences of staff who participated in the program. Results: Between 16 and 90 participants provided weekly program feedback. A total of 106 university staff opted into the longitudinal research component and 10 staff participated in the interviews. Participants reported high levels of satisfaction with sessions and perceived benefits for mental health. Approximately one quarter of participants reported moderate to severe symptoms of depression, anxiety, and stress at baseline, with significant reductions in these symptoms in the first 7 weeks of the program, corresponding with easing in mandatory isolation (“lockdown”) restrictions. Symptoms of depression, anxiety, and stress all increased when lockdown measures were reintroduced, but not to the same levels as found during the initial lockdown period. Overall changes in depression and anxiety from baseline to the end of the program were explained by changes in COVID-19–related distress, whereas changes in self-compassion explained changes in stress. Conclusions: We show that it is feasible and acceptable to develop and deliver a program of brief interventions in a timely manner, using a simple and accessible online platform. Although participation in the program was initially associated with reduced symptoms of depression, anxiety, and stress, participants’ mental health worsened with the reintroduction of a “lockdown” period. However, as symptoms of depression, anxiety, and stress did not return to levels observed at the start of the VU Elevenses program, participation in the uncontrolled intervention may have offered a protective benefit against the impact of the second significant lockdown period. %M 35044304 %R 10.2196/35776 %U https://formative.jmir.org/2022/2/e35776 %U https://doi.org/10.2196/35776 %U http://www.ncbi.nlm.nih.gov/pubmed/35044304 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e31533 %T Use of Social Networks in the Context of the Dietitian’s Practice in Brazil and Changes During the COVID-19 Pandemic: Exploratory Study %A Sbardelotto,Jackson %A Martins,Bárbara Birck %A Buss,Caroline %+ Department of Nutrition, Graduate Study Program in Health Sciences, Federal University of Health Sciences of Porto Alegre, R. Sarmento Leite, 245, Porto Alegre, 90050-170, Brazil, 55 513303 8830, carolinebuss@ufcspa.edu.br %K dietitian %K social networks %K nutrition %K health communication %K COVID-19 %K social media %K Brazil %K perception %K health information %K usage %K behavior %D 2022 %7 25.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Social networks have been pointed out as 1 of the greatest means of spreading information. A large part of the population is already present on these platforms, looking up subjects such as health, nutrition, and food. To reach this audience, it may be important for dietitians to explore social networks. However, there is a gap in scientific studies on exploring the ways in which these platforms are used by dietitians in Brazil, and the roles they play in the profession have not been well defined. Objective: This study aims to describe the roles that social networks play in dietitians' practice in Brazil and their mode of use of social networks. This study also aims to identify professionals’ perceptions and opinions regarding the use of these tools, as well as changes in behavior on social network usage caused by the COVID-19 pandemic. Methods: We carried out a quantitative cross-sectional study, collecting data through an online questionnaire, submitted between October 2020 and January 2021 to dietitians registered on the Federal Council of Dietitians. All participants included in the study answered questions about the use of social networks in their professional context. Results: In total, 264 (91.7%) of the 288 participants reported using social networks for professional practice. Instagram was the social network most often used by professionals (224/264, 84.8%). Dietitians (N=288) related to the use of social networks (always to almost always) for sharing information about their services (n=114-72 [39.6%-25%], respectively), following the work of other dietitians (n=172-64 [59.7%-22.2%], respectively), and writing about topics related to food and nutrition (n=166-53 [57.6%-18.4%], respectively). The roles played by social networks in the professional context of dietitians were attracting more clients (210/289, 72.7%) and keeping in touch with them (195/289, 67.5%). Furthermore, 227 (78.5%) of the 289 dietitians strongly agreed that social networks are good tools to promote their services. During the COVID-19 pandemic, 216 (74.7%) of the 289 participants noticed changes in their behavior, feelings, or beliefs on the use of social networks related to professional practice, and 149 (51.6%) have increased the frequency of sharing information about nutrition and health in general on social networks. Conclusions: The main roles of social networks in the professional context of dietitians are to attract clients and to facilitate the contact between professional and client. The modes of use reported by the professionals included sharing information about their services, following the work of professional colleagues, and writing about topics related to nutrition. Most of them reported believing that social networks are an effective way to disseminate their services. Moreover, most professionals claimed to have noticed changes in their behaviors or beliefs on social media during the COVID-19 pandemic. %M 35023837 %R 10.2196/31533 %U https://formative.jmir.org/2022/2/e31533 %U https://doi.org/10.2196/31533 %U http://www.ncbi.nlm.nih.gov/pubmed/35023837 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e28737 %T COVID-19 Surveillance Updates in US Metropolitan Areas: Dynamic Panel Data Modeling %A Oehmke,Theresa B %A Moss,Charles B %A Oehmke,James F %+ Department of Civil and Environmental Engineering, University of California, Berkeley, 202 O'Brien Hall, Berkeley, CA, 94720, United States, 1 5108986406, toehmke@berkeley.edu %K surveillance system %K COVID-19 %K coronavirus %K Sars-CoV-2 %K Houston %K dynamic panel data model %K speed %K jerk %K acceleration %K 7-Day persistence %K modeling %K data %K surveillance %K monitoring %K public health %K United States %K transmission %K response %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite the availability of vaccines, the US incidence of new COVID-19 cases per day nearly doubled from the beginning of July to the end of August 2021, fueled largely by the rapid spread of the Delta variant. While the “Delta wave” appears to have peaked nationally, some states and municipalities continue to see elevated numbers of new cases. Vigilant surveillance including at a metropolitan level can help identify any reignition and validate continued and strong public health policy responses in problem localities. Objective: This surveillance report aimed to provide up-to-date information for the 25 largest US metropolitan areas about the rapidity of descent in the number of new cases following the Delta wave peak, as well as any potential reignition of the pandemic associated with declining vaccine effectiveness over time, new variants, or other factors. Methods: COVID-19 pandemic dynamics for the 25 largest US metropolitan areas were analyzed through September 19, 2021, using novel metrics of speed, acceleration, jerk, and 7-day persistence, calculated from the observed data on the cumulative number of cases as reported by USAFacts. Statistical analysis was conducted using dynamic panel data models estimated with the Arellano-Bond regression techniques. The results are presented in tabular and graphic forms for visual interpretation. Results: On average, speed in the 25 largest US metropolitan areas declined from 34 new cases per day per 100,000 population, during the week ending August 15, 2021, to 29 new cases per day per 100,000 population, during the week ending September 19, 2021. This average masks important differences across metropolitan areas. For example, Miami’s speed decreased from 105 for the week ending August 15, 2021, to 40 for the week ending September 19, 2021. Los Angeles, San Francisco, Riverside, and San Diego had decreasing speed over the sample period and ended with single-digit speeds for the week ending September 19, 2021. However, Boston, Washington DC, Detroit, Minneapolis, Denver, and Charlotte all had their highest speed of the sample during the week ending September 19, 2021. These cities, as well as Houston and Baltimore, had positive acceleration for the week ending September 19, 2021. Conclusions: There is great variation in epidemiological curves across US metropolitan areas, including increasing numbers of new cases in 8 of the largest 25 metropolitan areas for the week ending September 19, 2021. These trends, including the possibility of waning vaccine effectiveness and the emergence of resistant variants, strongly indicate the need for continued surveillance and perhaps a return to more restrictive public health guidelines for some areas. %M 34882569 %R 10.2196/28737 %U https://publichealth.jmir.org/2022/2/e28737 %U https://doi.org/10.2196/28737 %U http://www.ncbi.nlm.nih.gov/pubmed/34882569 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e33704 %T The Impact of Long COVID-19 on Mental Health: Observational 6-Month Follow-Up Study %A Houben-Wilke,Sarah %A Goërtz,Yvonne MJ %A Delbressine,Jeannet M %A Vaes,Anouk W %A Meys,Roy %A Machado,Felipe VC %A van Herck,Maarten %A Burtin,Chris %A Posthuma,Rein %A Franssen,Frits ME %A Vijlbrief,Herman %A Spies,Yvonne %A van 't Hul,Alex J %A Spruit,Martijn A %A Janssen,Daisy JA %+ Department of Research and Education, Ciro, Hornerheide 1, Horn, 6085 NM, Netherlands, 31 475587602, sarahwilke@ciro-horn.nl %K SARS-CoV-2 %K corona %K COVID-19 %K post-traumatic stress disorder %K anxiety %K depression %K PASC %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The psychological impact of COVID-19 can be substantial. However, knowledge about long-term psychological outcomes in patients with COVID-19 is scarce. Objective: In this longitudinal, observational study, we aimed to reveal symptoms of posttraumatic stress disorder (PTSD) and symptoms of anxiety and depression up to 6 months after the onset of COVID-19–related symptoms in patients with confirmed COVID-19 and persistent complaints. To demonstrate the impact in nonhospitalized patients, we further aimed to compare these outcomes between nonhospitalized and hospitalized patients. Methods: Demographics, symptoms of PTSD (Trauma Screening Questionnaire [TSQ] ≥6 points) and symptoms of anxiety and depression (Hospital Anxiety and Depression Scale [HADS] ≥8 points) were assessed at 3 and 6 months after the onset of COVID-19–related symptoms in members of online long COVID-19 peer support groups. Results: Data from 239 patients with confirmed COVID-19 (198/239, 82.8% female; median age: 50 [IQR 39-56] years) were analyzed. At the 3-month follow-up, 37.2% (89/239) of the patients had symptoms of PTSD, 35.6% (85/239) had symptoms of anxiety, and 46.9% (112/239) had symptoms of depression, which remained high at the 6-month follow-up (64/239, 26.8%, P=.001; 83/239, 34.7%, P=.90; 97/239, 40.6%, P=.08, respectively; versus the 3-month follow-up). TSQ scores and HADS anxiety and depression scores were strongly correlated at the 3- and 6-month follow-ups (r=0.63-0.71, P<.001). Symptoms of PTSD, anxiety, and depression were comparable between hospitalized (n=62) and nonhospitalized (n=177) patients. Conclusions: A substantial percentage of patients with confirmed COVID-19 and persistent complaints reported symptoms of PTSD, anxiety, or depression 3 and 6 months after the onset of COVID-19–related symptoms. The prevalence rates of symptoms of PTSD, anxiety, and depression were comparable between hospitalized and nonhospitalized patients and merely improved over time. Health care professionals need to be aware of these psychological complications and intervene on time in post-COVID-19 patients with persistent complaints. Trial Registration: Netherlands Trial Register NTR8705; https://www.trialregister.nl/trial/8705. %M 35200155 %R 10.2196/33704 %U https://mental.jmir.org/2022/2/e33704 %U https://doi.org/10.2196/33704 %U http://www.ncbi.nlm.nih.gov/pubmed/35200155 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31793 %T (Mis)Information on Digital Platforms: Quantitative and Qualitative Analysis of Content From Twitter and Sina Weibo in the COVID-19 Pandemic %A Kreps,Sarah %A George,Julie %A Watson,Noah %A Cai,Gloria %A Ding,Keyi %+ Department of Government, Cornell University, 313 White Hall, Ithaca, NY, 14853, United States, 1 703 403 6550, sarah.kreps@cornell.edu %K internet %K social media %K misinformation %K COVID-19 %K Twitter %K Weibo %K prevalence %K discourse %K content %K communication %K public health %K context %K content analysis %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Misinformation about COVID-19 on social media has presented challenges to public health authorities during the pandemic. This paper leverages qualitative and quantitative content analysis on cross-platform, cross-national discourse and misinformation in the context of COVID-19. Specifically, we investigated COVID-19-related content on Twitter and Sina Weibo—the largest microblogging sites in the United States and China, respectively. Objective: Using data from 2 prominent microblogging platform, Twitter, based in the United States, and Sina Weibo, based in China, we compared the content and relative prevalence of misinformation to better understand public discourse of public health issues across social media and cultural contexts. Methods: A total of 3,579,575 posts were scraped from both Sina Weibo and Twitter, focusing on content from January 30, 2020, within 24 hours of when WHO declared COVID-19 a “public health emergency of international concern,” and a week later, on February 6, 2020. We examined how the use and engagement measured by keyword frequencies and hashtags differ across the 2 platforms. A 1% random sample of tweets that contained both the English keywords “coronavirus” and “covid-19” and the equivalent Chinese characters was extracted and analyzed based on changes in the frequencies of keywords and hashtags and the Viterbi algorithm. We manually coded a random selection of 5%-7% of the content to identify misinformation on each platform and compared posts using the WHO fact-check page to adjudicate accuracy of content. Results: Both platforms posted about the outbreak and transmission, but posts on Sina Weibo were less likely to reference topics such as WHO, Hong Kong, and death and more likely to cite themes of resisting, fighting, and cheering against coronavirus. Misinformation constituted 1.1% of Twitter content and 0.3% of Sina Weibo content—almost 4 times as much on Twitter compared to Sina Weibo. Conclusions: Quantitative and qualitative analysis of content on both platforms points to lower degrees of misinformation, more content designed to bolster morale, and less reference to topics such as WHO, death, and Hong Kong on Sina Weibo than on Twitter. %M 36406147 %R 10.2196/31793 %U https://infodemiology.jmir.org/2022/1/e31793 %U https://doi.org/10.2196/31793 %U http://www.ncbi.nlm.nih.gov/pubmed/36406147 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e34895 %T Clinicians’ Perceptions of the Benefits and Challenges of Teleoncology as Experienced Through the COVID-19 Pandemic: Qualitative Study %A Alpert,Jordan M %A Taylor,Greenberry %A Hampton,Chelsea N %A Paige,Samantha %A Markham,Merry Jennifer %A Bylund,Carma L %+ College of Journalism and Communications, University of Florida, 2093 Weimer Hall, 1885 Stadium Road, Gainesville, FL, 32611, United States, 1 3523920453, jordan.alpert@ufl.edu %K teleoncology %K telemedicine %K qualitative %K COVID-19 %K telehealth %K cancer care %K cancer %K oncology %K digital health %K pandemic %D 2022 %7 24.2.2022 %9 Original Paper %J JMIR Cancer %G English %X Background: COVID-19 thrust both patients and clinicians to use telemedicine in place of traditional in-person visits. Prepandemic, limited research had examined clinician-patient communication in telemedicine visits. The shift to telemedicine in oncology, or teleoncology, has placed attention on how the technology can be utilized to provide care for patients with cancer. Objective: Our objective was to describe oncology clinicians’ experiences with teleoncology and to uncover its benefits and challenges during the first 10 months of the COVID-19 pandemic. Methods: In-depth, semistructured qualitative interviews were conducted with oncology clinicians. Using an inductive, thematic approach, the most prevalent themes were identified. Results: In total, 21 interviews with oncology clinicians revealed the following themes: benefits of teleoncology, such as (1) reducing patients’ travel time and expenses, (2) limiting COVID-19 exposure, and (3) enabling clinicians to “see” a patients’ lifestyle and environment, and challenges, such as (1) technological connection difficulties, (2) inability to physically examine patients, and (3) patients’ frustration related to clinicians being late to teleoncology appointments. Conclusions: Teleoncology has many benefits and is well suited for specific types of appointments. Challenges could be addressed through improved communication when scheduling appointments to make patients aware about what to expect. Ensuring patients have the proper technology to participate in teleoncology and an understanding about how it functions are necessary. %M 35142622 %R 10.2196/34895 %U https://cancer.jmir.org/2022/1/e34895 %U https://doi.org/10.2196/34895 %U http://www.ncbi.nlm.nih.gov/pubmed/35142622 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 8 %N 1 %P e34392 %T Cancer Screening Recommendations During the COVID-19 Pandemic: Scoping Review %A Shah,Sumit K %A McElfish,Pearl A %+ College of Medicine, University of Arkansas for Medical Sciences Northwest, 1125 N College Avenue, Fayetteville, AR, 72703, United States, 1 (479) 713 8680, pamcelfish@uams.edu %K COVID-19 %K cancer prevention and early detection %K cancer screenings %K breast cancer screening %K cervical cancer screening %K colorectal cancer screening %D 2022 %7 24.2.2022 %9 Review %J JMIR Cancer %G English %X Background: Cancer screening tests are recommended to prevent cancer-associated mortality by detecting precancerous and cancerous lesions in early stages. The COVID-19 pandemic disrupted the use of preventive health care services. Although there was an increase in the number of cancer screening tests beginning in late 2020, screenings remained 29% to 36% lower than in the prepandemic era. Objective: The aim of this review is to assist health care providers in identifying approaches for prioritizing patients and increasing breast, cervical, and colorectal cancer screening during the uncertainty of the COVID-19 pandemic. Methods: We used the scoping review framework to identify articles on PubMed and EBSCO databases. A total of 403 articles were identified, and 23 articles were selected for this review. The literature review ranged from January 1, 2020, to September 30, 2021. Results: The articles included two primary categories of recommendations: (1) risk stratification and triage to prioritize screenings and (2) alternative methods to conduct cancer screenings. Risk stratification and triage recommendations focused on prioritizing high-risk patients with an abnormal or suspicious result on the previous screening test, patients in certain age groups and sex, patients with a personal medical or family cancer history, patients that are currently symptomatic, and patients that are predisposed to hereditary cancers and cancer-causing mutations. Other recommended strategies included identifying areas facing the most disparities, creating algorithms and using artificial intelligence to create cancer risk scores, leveraging in-person visits to assess cancer risk, and providing the option of open access screenings where patients can schedule screenings and can be assigned a priority category by health care staff. Some recommended using telemedicine to categorize patients and determine screening eligibility for patients with new complaints. Several articles noted the importance of implementing preventive measures such as COVID-19 screening prior to the procedures, maintaining hygiene measures, and social distancing in waiting rooms. Alternative screening methods that do not require an in-person clinic visit and can effectively screen patients for cancers included mailing self-collection sampling kits for cervical and colorectal cancers, and implementing or expanding mobile screening units. Conclusions: Although the COVID-19 pandemic had devastating effects on population health globally, it could be an opportunity to adapt and evolve cancer screening methods. Disruption often creates innovation, and focus on alternative methods for cancer screenings may help reach rural and underresourced areas after the pandemic has ended. %M 35142621 %R 10.2196/34392 %U https://cancer.jmir.org/2022/1/e34392 %U https://doi.org/10.2196/34392 %U http://www.ncbi.nlm.nih.gov/pubmed/35142621 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e33062 %T Digital Health Technologies to Improve Medication Adherence and Treatment Outcomes in Patients With Tuberculosis: Systematic Review of Randomized Controlled Trials %A Ridho,Abdurahman %A Alfian,Sofa D %A van Boven,Job F M %A Levita,Jutti %A Yalcin,Esin Aki %A Le,Ly %A Alffenaar,Jan-Willem %A Hak,Eelko %A Abdulah,Rizky %A Pradipta,Ivan S %+ Department of Pharmacology and Clinical Pharmacy, Faculty of Pharmacy, Universitas Padjadjaran, Jl. Raya Bandung-Sumedang Km. 21, Jatinangor, Sumedang, 45363, Indonesia, 62 842 888888 ext 3510, ivanpradipta@unpad.ac.id %K tuberculosis %K intervention %K eHealth %K medication adherence technology %K nonadherence %K digital health %K systematic review %K treatment outcomes %D 2022 %7 23.2.2022 %9 Review %J J Med Internet Res %G English %X Background: Nonadherence to medication in tuberculosis (TB) hampers optimal treatment outcomes. Digital health technology (DHT) seems to be a promising approach to managing problems of nonadherence to medication and improving treatment outcomes. Objective: This paper systematically reviews the effect of DHT in improving medication adherence and treatment outcomes in patients with TB. Methods: A literature search in PubMed and Cochrane databases was conducted. Randomized controlled trials (RCTs) that analyzed the effect of DHT interventions on medication adherence outcomes (treatment completion, treatment adherence, missed doses, and noncompleted rate) and treatment outcomes (cure rate and smear conversion) were included. Adult patients with either active or latent TB infection were included. The Jadad score was used for evaluating the study quality. The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guideline was followed to report study findings. Results: In all, 16 RCTs were selected from 552 studies found, and 6 types of DHT interventions for TB were identified: 3 RCTs examined video directly observed therapy (VDOT), 1 examined video-observed therapy (VOT), 1 examined an ingestible sensor, 1 examined phone call reminders, 2 examined medication monitor boxes, and 8 examined SMS text message reminders. The outcomes used were treatment adherence, including treatment completion, treatment adherence, missed dose, and noncompleted rate, as well as clinical outcomes, including cure rate and smear conversion. In treatment completion, 4 RCTs (VDOT, VOT, ingestible sensor, SMS reminder) found significant effects, with odds ratios and relative risks (RRs) ranging from 1.10 to 7.69. Treatment adherence was increased in 1 study by SMS reminders (RR 1.05; 95% CI 1.04-1.06), and missed dose was reduced in 1 study by a medication monitor box (mean ratio 0.58; 95% CI 0.42-0.79). In contrast, 3 RCTs of VDOT and 3 RCTs of SMS reminders did not find significant effects for treatment completion. Moreover, no improvement was found in treatment adherence in 1 RCT of VDOT, missed dose in 1 RCT of SMS reminder, and noncompleted rate in 1 RCT of a monitor box, and 2 RCTs of SMS reminders. For clinical outcomes such as cure rate, 2 RCTs reported that phone calls (RR 1.30; 95% CI 1.07-1.59) and SMS reminders (OR 2.47; 95% CI 1.13-5.43) significantly affected cure rates. However, 3 RCTs found that SMS reminders did not have a significant impact on cure rate or smear conversion. Conclusions: It was found that DHT interventions can be a promising approach. However, the interventions exhibited variable effects regarding effect direction and the extent of improving TB medication adherence and clinical outcomes. Developing DHT interventions with personalized feedback is required to have a consistent and beneficial effect on medication adherence and outcomes among patients with TB. %M 35195534 %R 10.2196/33062 %U https://www.jmir.org/2022/2/e33062 %U https://doi.org/10.2196/33062 %U http://www.ncbi.nlm.nih.gov/pubmed/35195534 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e31909 %T Crowdsourced Community Support Resources Among Patients Discharged From the Emergency Department During the COVID-19 Pandemic: Pilot Feasibility Study %A Agarwal,Anish K %A Southwick,Lauren %A Schneider,Rachelle %A Pelullo,Arthur %A Ortiz,Robin %A Klinger,Elissa V %A Gonzales,Rachel E %A Rosin,Roy %A Merchant,Raina M %+ Department of Emergency Medicine, University of Pennsylvania, 3600 Civic Center Boulevard, Philadelphia, PA, 19104, United States, 1 2674280125, Anish.Agarwal@pennmedicine.upenn.edu %K COVID-19 %K mHealth %K CHW %K digital health %K platform %K crowdsource %K support %K community %K health system %K monitoring %K virtual care %K text message %K model %K community health worker %K pilot study %K feasibility %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has placed strains on communities. During this public health crisis, health systems have created remote methods of monitoring symptom progression and delivering care virtually. Objective: Using an SMS text message-based system, we sought to build and test a remote model to explore community needs, connect individuals to curated resources, and facilitate community health worker intervention when needed during the pandemic. The primary aims of this pilot study were to establish the feasibility (ie, engagement with the text line) and acceptability (ie, participant ratings of resources and service) of delivering automated well-being resources via smartphone technology. Methods: Eligible patients (aged 18 years or older, having a cell phone with SMS text messaging capability, and recently visited the emergency department) were identified using the electronic health record. The patients were consented to enroll and begin receiving COVID-19–related information and links to community resources. We collected open-ended and close-ended resource and mood ratings. We calculated the frequencies and conducted a thematic review of the open-ended responses. Results: In 7 weeks, 356 participants were enrolled; 13,917 messages were exchanged including 333 resource ratings (mean 4) and 673 well-being scores (mean 6.8). We received and coded 386 open-ended responses, most of which elaborated upon their self-reported mood score (29%). Overall, 77% (n=274) of our participants rated the platform as a service they would highly recommend to a family member or friend. Conclusions: This approach is designed to broaden the reach of health systems, tailor to community needs in real time, and connect at-risk individuals with robust community health support. %M 35037886 %R 10.2196/31909 %U https://mental.jmir.org/2022/2/e31909 %U https://doi.org/10.2196/31909 %U http://www.ncbi.nlm.nih.gov/pubmed/35037886 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 8 %N 1 %P e23845 %T A Comprehensive COVID-19 Daily News and Medical Literature Briefing to Inform Health Care and Policy in New Mexico: Implementation Study %A Jarratt,LynnMarie %A Situ,Jenny %A King,Rachel D %A Montanez Ramos,Estefania %A Groves,Hannah %A Ormesher,Ryen %A Cossé,Melissa %A Raboff,Alyse %A Mahajan,Avanika %A Thompson,Jennifer %A Ko,Randy F %A Paltrow-Krulwich,Samantha %A Price,Allison %A Hurwitz,Ariel May-Ling %A CampBell,Timothy %A Epler,Lauren T %A Nguyen,Fiona %A Wolinsky,Emma %A Edwards-Fligner,Morgan %A Lobo,Jolene %A Rivera,Danielle %A Langsjoen,Jens %A Sloane,Lori %A Hendrix,Ingrid %A Munde,Elly O %A Onyango,Clinton O %A Olewe,Perez K %A Anyona,Samuel B %A Yingling,Alexandra V %A Lauve,Nicolas R %A Kumar,Praveen %A Stoicu,Shawn %A Nestsiarovich,Anastasiya %A Bologa,Cristian G %A Oprea,Tudor I %A Tollestrup,Kristine %A Myers,Orrin B %A Anixter,Mari %A Perkins,Douglas J %A Lambert,Christophe Gerard %+ Center for Global Health, Division of Translational Informatics, Department of Internal Medicine, University of New Mexico Health Sciences Center, BRF #323A, MSC10-5550, 915 Camino de Salud NE, Albuquerque, NM, 87131, United States, 1 505 272 9709, cglambert@unm.edu %K COVID-19 %K pandemic %K daily report %K policy %K epidemics %K global health %K SARS-CoV-2 %K New Mexico %K medical education %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Med Educ %G English %X Background: On March 11, 2020, the New Mexico Governor declared a public health emergency in response to the COVID-19 pandemic. The New Mexico medical advisory team contacted University of New Mexico (UNM) faculty to form a team to consolidate growing information on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its disease to facilitate New Mexico’s pandemic management. Thus, faculty, physicians, staff, graduate students, and medical students created the “UNM Global Health COVID-19 Intelligence Briefing.” Objective: In this paper, we sought to (1) share how to create an informative briefing to guide public policy and medical practice and manage information overload with rapidly evolving scientific evidence; (2) determine the qualitative usefulness of the briefing to its readers; and (3) determine the qualitative effect this project has had on virtual medical education. Methods: Microsoft Teams was used for manual and automated capture of COVID-19 articles and composition of briefings. Multilevel triaging saved impactful articles to be reviewed, and priority was placed on randomized controlled studies, meta-analyses, systematic reviews, practice guidelines, and information on health care and policy response to COVID-19. The finalized briefing was disseminated by email, a listserv, and posted on the UNM digital repository. A survey was sent to readers to determine briefing usefulness and whether it led to policy or medical practice changes. Medical students, unable to partake in direct patient care, proposed to the School of Medicine that involvement in the briefing should count as course credit, which was approved. The maintenance of medical student involvement in the briefings as well as this publication was led by medical students. Results: An average of 456 articles were assessed daily. The briefings reached approximately 1000 people by email and listserv directly, with an unknown amount of forwarding. Digital repository tracking showed 5047 downloads across 116 countries as of July 5, 2020. The survey found 108 (95%) of 114 participants gained relevant knowledge, 90 (79%) believed it decreased misinformation, 27 (24%) used the briefing as their primary source of information, and 90 (79%) forwarded it to colleagues. Specific and impactful public policy decisions were informed based on the briefing. Medical students reported that the project allowed them to improve on their scientific literature assessment, stay current on the pandemic, and serve their community. Conclusions: The COVID-19 briefings succeeded in informing and guiding New Mexico policy and clinical practice. The project received positive feedback from the community and was shown to decrease information burden and misinformation. The virtual platforms allowed for the continuation of medical education. Variability in subject matter expertise was addressed with training, standardized article selection criteria, and collaborative editing led by faculty. %M 35142625 %R 10.2196/23845 %U https://mededu.jmir.org/2022/1/e23845 %U https://doi.org/10.2196/23845 %U http://www.ncbi.nlm.nih.gov/pubmed/35142625 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e27286 %T The Beneficial Effect of the First COVID-19 Lockdown on Undergraduate Students of Education: Prospective Cohort Study %A Joseph,Gili %A Schori,Hadas %+ Department of Physical Activity and Movement, Faculty of Science, Seminar Hakibbutzim College of Education, 149 Namir Drive, Tel Aviv, 6250769, Israel, 972 544577095, gilijosephphd@gmail.com %K sleep quality %K exercise %K well-being %K undergraduate students %K COVID-19 lockdown %K COVID-19 %D 2022 %7 23.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has been spreading consistently since the beginning of 2020. On February 27, 2020, the first patient with coronavirus was diagnosed in Israel. On March 14, 2020, the Israeli government declared a general lockdown that lasted about a month, which altered the lives of the entire population. Objective: The objective of this paper is to evaluate the change in the well-being, physical activity, and sleep quality of undergraduate students of education at 2 time points: before (November 2019) and during (April 2020) the first COVID-19 lockdown. Methods: In total, 533 undergraduate students of education submitted an online questionnaire before the lockdown and at its end. The questionnaire comprised 4 parts: a (1) sociodemographic and (2) weekly exercise questionnaire taken from the International Physical Activity Questionnaire–Short Form; (3) sleep quality, rated using the Mini Sleep Questionnaire; and (4) well-being, rated using the short version of the Mental Health Inventory. This was a pre-post prospective cohort questionnaire study. Results: It was predicted that there would be a decrease in the aforementioned parameters. Contrary to all expectations, an increase was observed in all 3. Results showed that during the lockdown, there was an increase in the level of exercise students engaged in. Overall, 102 (61.4%) of 166 students engaged in a greater amount of physical activity during the COVID-19 lockdown compared to 150 (40.9%) of 367 students who engaged in a greater amount of physical activity before COVID-19. Levels of sleep quality (mean 5.34 [SD 0.92] vs mean 5.12 [SD 0.46], P=.02) and well-being (mean 3.79 [SD 0.62] vs mean 3.67 [SD 0.59], P=.02) were also higher during the COVID-19 lockdown. Conclusions: These findings indicate that undergraduate students seem to have taken advantage of the change in lifestyle due to the lockdown, directing the free time toward improving health by engaging in more physical activity, thus improving sleep quality and well-being. %M 35072635 %R 10.2196/27286 %U https://formative.jmir.org/2022/2/e27286 %U https://doi.org/10.2196/27286 %U http://www.ncbi.nlm.nih.gov/pubmed/35072635 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e28268 %T Diagnostic Accuracy of an At-Home, Rapid Self-test for Influenza: Prospective Comparative Accuracy Study %A Geyer,Rachel E %A Kotnik,Jack Henry %A Lyon,Victoria %A Brandstetter,Elisabeth %A Zigman Suchsland,Monica %A Han,Peter D %A Graham,Chelsey %A Ilcisin,Misja %A Kim,Ashley E %A Chu,Helen Y %A Nickerson,Deborah A %A Starita,Lea M %A Bedford,Trevor %A Lutz,Barry %A Thompson,Matthew J %+ Department of Family Medicine, University of Washington, 4225 Roosevelt Way NE Suite 308, Seattle, WA, 98195, United States, 1 2066163961, geyerr@uw.edu %K influenza %K influenza %K rapid testing %K acute respiratory illness %K self-collection %K self-testing %K mHealth %K mobile health %K home collection %K home testing %K mobile phone %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 35191852 %R 10.2196/28268 %U https://publichealth.jmir.org/2022/2/e28268 %U https://doi.org/10.2196/28268 %U http://www.ncbi.nlm.nih.gov/pubmed/35191852 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31259 %T Understanding the #longCOVID and #longhaulers Conversation on Twitter: Multimethod Study %A Santarossa,Sara %A Rapp,Ashley %A Sardinas,Saily %A Hussein,Janine %A Ramirez,Alex %A Cassidy-Bushrow,Andrea E %A Cheng,Philip %A Yu,Eunice %+ Department of Public Health Sciences, Henry Ford Health System, 1 Ford Place, Detroit, MI, 48202, United States, 1 3138747960, ssantar1@hfhs.org %K COVID-19 %K postacute sequela of COVID-19 %K PASC %K patient-centered care %K social media %K social network analysis %K long term %K symptom %K Twitter %K communication %K insight %K perception %K experience %K patient-centered %D 2022 %7 22.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The scientific community is just beginning to uncover the potential long-term effects of COVID-19, and one way to start gathering information is by examining the present discourse on the topic. The conversation about long COVID-19 on Twitter provides insight into related public perception and personal experiences. Objective: The aim of this study was to investigate the #longCOVID and #longhaulers conversations on Twitter by examining the combined effects of topic discussion and social network analysis for discovery on long COVID-19. Methods: A multipronged approach was used to analyze data (N=2500 records from Twitter) about long COVID-19 and from people experiencing long COVID-19. A text analysis was performed by both human coders and Netlytic, a cloud-based text and social networks analyzer. The social network analysis generated Name and Chain networks that showed connections and interactions between Twitter users. Results: Among the 2010 tweets about long COVID-19 and 490 tweets by COVID-19 long haulers, 30,923 and 7817 unique words were found, respectively. For both conversation types, “#longcovid” and “covid” were the most frequently mentioned words; however, through visually inspecting the data, words relevant to having long COVID-19 (ie, symptoms, fatigue, pain) were more prominent in tweets by COVID-19 long haulers. When discussing long COVID-19, the most prominent frames were “support” (1090/1931, 56.45%) and “research” (435/1931, 22.53%). In COVID-19 long haulers conversations, “symptoms” (297/483, 61.5%) and “building a community” (152/483, 31.5%) were the most prominent frames. The social network analysis revealed that for both tweets about long COVID-19 and tweets by COVID-19 long haulers, networks are highly decentralized, fragmented, and loosely connected. Conclusions: This study provides a glimpse into the ways long COVID-19 is framed by social network users. Understanding these perspectives may help generate future patient-centered research questions. %M 35229074 %R 10.2196/31259 %U https://infodemiology.jmir.org/2022/1/e31259 %U https://doi.org/10.2196/31259 %U http://www.ncbi.nlm.nih.gov/pubmed/35229074 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e32426 %T The Use of Cremation Data for Timely Mortality Surveillance During the COVID-19 Pandemic in Ontario, Canada: Validation Study %A Postill,Gemma %A Murray,Regan %A Wilton,Andrew S %A Wells,Richard A %A Sirbu,Renee %A Daley,Mark J %A Rosella,Laura %+ Epidemiology Division, Dalla Lana School of Public Health, 155 College Street, Suite 600, Toronto, ON, M5T 3M7, Canada, 1 416 978 0901, laura.rosella@utoronto.ca %K excess deaths %K real-time mortality %K cremation %K COVID-19 %K SARS-CoV-2 %K mortality %K estimate %K impact %K public health %K validation %K pattern %K trend %K utility %K Canada %K mortality data %K pandemic %K death %K cremation data %K cause of death %K vital statistics %K excess mortality %D 2022 %7 21.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Early estimates of excess mortality are crucial for understanding the impact of COVID-19. However, there is a lag of several months in the reporting of vital statistics mortality data for many jurisdictions, including across Canada. In Ontario, a Canadian province, certification by a coroner is required before cremation can occur, creating real-time mortality data that encompasses the majority of deaths within the province. Objective: This study aimed to validate the use of cremation data as a timely surveillance tool for all-cause mortality during a public health emergency in a jurisdiction with delays in vital statistics data. Specifically, this study aimed to validate this surveillance tool by determining the stability, timeliness, and robustness of its real-time estimation of all-cause mortality. Methods: Cremation records from January 2020 until April 2021 were compared to the historical records from 2017 to 2019, grouped according to week, age, sex, and whether COVID-19 was the cause of death. Cremation data were compared to Ontario’s provisional vital statistics mortality data released by Statistics Canada. The 2020 and 2021 records were then compared to previous years (2017-2019) to determine whether there was excess mortality within various age groups and whether deaths attributed to COVID-19 accounted for the entirety of the excess mortality. Results: Between 2017 and 2019, cremations were performed for 67.4% (95% CI 67.3%-67.5%) of deaths. The proportion of cremated deaths remained stable throughout 2020, even within age and sex categories. Cremation records are 99% complete within 3 weeks of the date of death, which precedes the compilation of vital statistics data by several months. Consequently, during the first wave (from April to June 2020), cremation records detected a 16.9% increase (95% CI 14.6%-19.3%) in all-cause mortality, a finding that was confirmed several months later with cremation data. Conclusions: The percentage of Ontarians cremated and the completion of cremation data several months before vital statistics did not change meaningfully during the COVID-19 pandemic period, establishing that the pandemic did not significantly alter cremation practices. Cremation data can be used to accurately estimate all-cause mortality in near real-time, particularly when real-time mortality estimates are needed to inform policy decisions for public health measures. The accuracy of this excess mortality estimation was confirmed by comparing it with official vital statistics data. These findings demonstrate the utility of cremation data as a complementary data source for timely mortality information during public health emergencies. %M 35038302 %R 10.2196/32426 %U https://publichealth.jmir.org/2022/2/e32426 %U https://doi.org/10.2196/32426 %U http://www.ncbi.nlm.nih.gov/pubmed/35038302 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e29279 %T SMART COVID Navigator, a Clinical Decision Support Tool for COVID-19 Treatment: Design and Development Study %A Suraj,Varun %A Del Vecchio Fitz,Catherine %A Kleiman,Laura B %A Bhavnani,Suresh K %A Jani,Chinmay %A Shah,Surbhi %A McKay,Rana R %A Warner,Jeremy %A Alterovitz,Gil %+ Medicine and Biomedical Informatics, Vanderbilt University, 2525 West End Ave, Suite 1500, Nashville, TN, 37203, United States, 1 615 936 3524, jeremy.warner@vumc.org %K COVID-19 %K clinical decision support %K precision medicine %K web application %K FHIR %D 2022 %7 18.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 caused by SARS-CoV-2 has infected 219 million individuals at the time of writing of this paper. A large volume of research findings from observational studies about disease interactions with COVID-19 is being produced almost daily, making it difficult for physicians to keep track of the latest information on COVID-19’s effect on patients with certain pre-existing conditions. Objective: In this paper, we describe the creation of a clinical decision support tool, the SMART COVID Navigator, a web application to assist clinicians in treating patients with COVID-19. Our application allows clinicians to access a patient’s electronic health records and identify disease interactions from a large set of observational research studies that affect the severity and fatality due to COVID-19. Methods: The SMART COVID Navigator takes a 2-pronged approach to clinical decision support. The first part is a connection to electronic health record servers, allowing the application to access a patient’s medical conditions. The second is accessing data sets with information from various observational studies to determine the latest research findings about COVID-19 outcomes for patients with certain medical conditions. By connecting these 2 data sources, users can see how a patient’s medical history will affect their COVID-19 outcomes. Results: The SMART COVID Navigator aggregates patient health information from multiple Fast Healthcare Interoperability Resources–enabled electronic health record systems. This allows physicians to see a comprehensive view of patient health records. The application accesses 2 data sets of over 1100 research studies to provide information on the fatality and severity of COVID-19 for several pre-existing conditions. We also analyzed the results of the collected studies to determine which medical conditions result in an increased chance of severity and fatality of COVID-19 progression. We found that certain conditions result in a higher likelihood of severity and fatality probabilities. We also analyze various cancer tissues and find that the probabilities for fatality vary greatly depending on the tissue being examined. Conclusions: The SMART COVID Navigator allows physicians to predict the fatality and severity of COVID-19 progression given a particular patient’s medical conditions. This can allow physicians to determine how aggressively to treat patients infected with COVID-19 and to prioritize different patients for treatment considering their prior medical conditions. %M 34932493 %R 10.2196/29279 %U https://www.jmir.org/2022/2/e29279 %U https://doi.org/10.2196/29279 %U http://www.ncbi.nlm.nih.gov/pubmed/34932493 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e32372 %T Partisan Differences in Legislators’ Discussion of Vaccination on Twitter During the COVID-19 Era: Natural Language Processing Analysis %A Engel-Rebitzer,Eden %A Stokes,Daniel C %A Meisel,Zachary F %A Purtle,Jonathan %A Doyle,Rebecca %A Buttenheim,Alison M %+ School of Nursing, University of Pennsylvania, 418 Curie Blvd, Philadelphia, PA, 19104, United States, 1 (215) 898 8281, abutt@nursing.upenn.edu %K social media %K Twitter %K vaccination %K partisanship %K COVID-19 %K vaccine %K natural language processing %K NLP %K hesitancy %K politicization %K communication %K linguistic %K pattern %D 2022 %7 18.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 era has been characterized by the politicization of health-related topics. This is especially concerning given evidence that politicized discussion of vaccination may contribute to vaccine hesitancy. No research, however, has examined the content and politicization of legislator communication with the public about vaccination during the COVID-19 era. Objective: The aim of this study was to examine vaccine-related tweets produced by state and federal legislators during the COVID-19 era to (1) describe the content of vaccine-related tweets; (2) examine the differences in vaccine-related tweet content between Democrats and Republicans; and (3) quantify (and describe trends over time in) partisan differences in vaccine-related communication. Methods: We abstracted all vaccine-related tweets produced by state and federal legislators between February 01, 2020, and December 11, 2020. We used latent Dirichlet allocation to define the tweet topics and used descriptive statistics to describe differences by party in the use of topics and changes in political polarization over time. Results: We included 14,519 tweets generated by 1463 state legislators and 521 federal legislators. Republicans were more likely to use words (eg, “record time,” “launched,” and “innovation”) and topics (eg, Operation Warp Speed success) that were focused on the successful development of a SARS-CoV-2 vaccine. Democrats used a broader range of words (eg, “anti-vaxxers,” “flu,” and “free”) and topics (eg, vaccine prioritization, influenza, and antivaxxers) that were more aligned with public health messaging related to the vaccine. Polarization increased over most of the study period. Conclusions: Republican and Democratic legislators used different language in their Twitter conversations about vaccination during the COVID-19 era, leading to increased political polarization of vaccine-related tweets. These communication patterns have the potential to contribute to vaccine hesitancy. %M 35229075 %R 10.2196/32372 %U https://infodemiology.jmir.org/2022/1/e32372 %U https://doi.org/10.2196/32372 %U http://www.ncbi.nlm.nih.gov/pubmed/35229075 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e34385 %T Concerns Around Opposition to the Green Pass in Italy: Social Listening Analysis by Using a Mixed Methods Approach %A Spitale,Giovanni %A Biller-Andorno,Nikola %A Germani,Federico %+ Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, Zurich, 8006, Switzerland, 1 44 634 40 14, federico.germani@ibme.uzh.ch %K green pass %K COVID-19 %K COVID-19 pandemic %K vaccines %K vaccination hesitancy %K freedom %K social listening %K social media %K infodemic %K bioethics %K telegram %D 2022 %7 16.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The recent introduction of COVID-19 certificates in several countries, including the introduction of the European green pass, has been met with protests and concerns by a fraction of the population. In Italy, the green pass has been used as a nudging measure to incentivize vaccinations because a valid green pass is needed to enter restaurants, bars, museums, or stadiums. As of December 2021, a valid green pass can be obtained by being fully vaccinated with an approved vaccine, recovered from COVID-19, or tested. However, a green pass obtained with a test has a short validity (48 hours for the rapid test, 72 hours for the polymerase chain reaction test) and does not allow access to several indoor public places. Objective: This study aims to understand and describe the concerns of individuals opposed to the green pass in Italy, the main arguments of their discussions, and their characterization. Methods: We collected data from Telegram chats and analyzed the arguments and concerns that were raised by the users by using a mixed methods approach. Results: Most individuals opposing the green pass share antivaccine views, but doubts and concerns about vaccines are generally not among the arguments raised to oppose the green pass. Instead, the discussion revolves around the legal aspects and the definition of personal freedom. We explain the differences and similarities between antivaccine and anti–green pass discourses, and we discuss the ethical ramifications of our research, focusing on the use of Telegram chats as a social listening tool for public health. Conclusions: A large portion of individuals opposed to the green pass share antivaccine views. We suggest public health and political institutions to provide a legal explanation and a context for the use of the green pass, as well as to continue focusing on vaccine communication to inform vaccine-hesitant individuals. Further work is needed to define a consensual ethical framework for social listening for public health. %M 35156930 %R 10.2196/34385 %U https://www.jmir.org/2022/2/e34385 %U https://doi.org/10.2196/34385 %U http://www.ncbi.nlm.nih.gov/pubmed/35156930 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e27704 %T COVID-19 Treatments Sold Online Without Prescription Requirements in the United States: Cross-sectional Study Evaluating Availability, Safety and Marketing of Medications %A Ozawa,Sachiko %A Billings,Joanna %A Sun,Yujiao %A Yu,Sushan %A Penley,Benjamin %+ Division of Practice Advancement and Clinical Education, Eshelman School of Pharmacy, University of North Carolina at Chapel Hill, CB# 7574, Beard Hall 115G, Chapel Hill, NC, 27599, United States, 1 919 966 2626, ozawa@unc.edu %K COVID-19 %K medication %K internet %K online pharmacy %K drug %D 2022 %7 16.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has increased online purchases and heightened interest in existing treatments. Dexamethasone, hydroxychloroquine, and lopinavir-ritonavir have been touted as potential COVID-19 treatments. Objective: This study assessed the availability of 3 potential COVID-19 treatments online and evaluated the safety and marketing characteristics of websites selling these products during the pandemic. Methods: A cross-sectional study was conducted in the months of June 2020 to August 2020, by searching the first 100 results on Google, Bing, and Yahoo! mimicking a US consumer. Unique websites were included if they sold targeted medicines, were in English, offered US shipping, and were free to access. Identified online pharmacies were categorized as rogue, unclassified, or legitimate based on LegitScript classifications. Patient safety characteristics, marketing techniques, price, legitimacy, IP addresses, and COVID-19 mentions were recorded. Results: We found 117 websites: 30 selling dexamethasone (19/30, 63% rogue), 39 selling hydroxychloroquine (22/39, 56% rogue), and 48 selling lopinavir-ritonavir (33/48, 69% rogue). This included 89 unique online pharmacies: 70% were rogue (n=62), 22% were unapproved (n=20), and 8% were considered legitimate (n=7). Prescriptions were not required among 100% (19/19), 61% (20/33), and 50% (11/22) of rogue websites selling dexamethasone, lopinavir-ritonavir, and hydroxychloroquine, respectively. Overall, only 32% (24/74) of rogue websites required prescriptions to buy these medications compared with 94% (31/33) of unapproved and 100% (10/10) of legitimate websites (P<.001). Rogue sites rarely offered pharmacist counseling (1/33, 3% for lopinavir-ritonavir to 2/22, 9% for hydroxychloroquine). Drug warnings were unavailable in 86% (6/7) of unapproved dexamethasone sites. It was difficult to distinguish between rogue, unapproved, and legitimate online pharmacies solely based on website marketing characteristics. Illegitimate pharmacies were more likely to offer bulk discounts and claim price discounts, yet dexamethasone and hydroxychloroquine were more expensive online. An inexpensive generic version of lopinavir-ritonavir that is not authorized for use in the United States was available online offering US shipping. Some websites claimed hydroxychloroquine and lopinavir-ritonavir were effective COVID-19 treatments despite lack of scientific evidence. In comparing IP addresses to locations claimed on the websites, only 8.5% (7/82) matched their claimed locations. Conclusions: The lack of safety measures by illegitimate online pharmacies endanger patients, facilitating access to medications without appropriate oversight by health care providers to monitor clinical response, drug interactions, and adverse effects. We demonstrated how easy it is to go online to buy medications that are touted to treat COVID-19 even when current clinical evidence does not support their use for self-treatment. We documented that illegitimate online pharmacies sidestep prescription requirements, skirt pharmacist counseling, and make false claims regarding efficacy for COVID-19 treatment. Health care professionals must urgently educate the public of the dangers of purchasing drugs from illegitimate websites and highlight the importance of seeking treatment through authentic avenues of care. %M 34662286 %R 10.2196/27704 %U https://www.jmir.org/2022/2/e27704 %U https://doi.org/10.2196/27704 %U http://www.ncbi.nlm.nih.gov/pubmed/34662286 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e33959 %T Longitudinal Changes of COVID-19 Symptoms in Social Media: Observational Study %A Sarabadani,Sarah %A Baruah,Gaurav %A Fossat,Yan %A Jeon,Jouhyun %+ Applied Sciences, Klick Inc, 175 Bloor Street East, Suite 300, Toronto, ON, M4W 3R8, Canada, 1 4162144977, cjeon@klick.com %K COVID-19 %K symptom %K diagnosis %K treatment %K social media %K Reddit %K longitudinal %K observational %K machine learning %D 2022 %7 16.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: In December 2019, the COVID-19 outbreak started in China and rapidly spread around the world. Many studies have been conducted to understand the clinical characteristics of COVID-19, and recently postinfection sequelae of this disease have begun to be investigated. However, there is little consensus on the longitudinal changes of lasting physical or psychological symptoms from prior COVID-19 infection. Objective: This study aims to investigate and analyze public social media data from Reddit to understand the longitudinal impact of COVID-19 symptoms before and after recovery from COVID-19. Methods: We collected 22,890 Reddit posts that were generated by 14,401 authors from March 14 to December 16, 2020. Using active learning and intensive manual inspection, 292 (2.03%) active authors, who were infected by COVID-19 and frequently reported disease progress on Reddit, along with their 2213 (9.67%) longitudinal posts, were identified. Machine learning tools to extract biomedical information were applied to identify COVID-19 symptoms mentioned in the Reddit posts. We then examined longitudinal changes in individual physiological and psychological characteristics before and after recovery from COVID-19 infection. Results: In total, 58 physiological and 3 psychological symptoms were identified in social media before and after recovery from COVID-19 infection. From the analyses, we found that symptoms of patients with COVID-19 lasted 2.5 months. On average, symptoms appeared around a month before recovery and remained for 1.5 months after recovery. Well-known COVID-19 symptoms, such as fever, cough, and chest congestion, appeared relatively earlier in patient journeys and were frequently observed before recovery from COVID-19. Meanwhile, mental discomfort or distress, such as brain fog or stress, fatigue, and manifestations on toes or fingers, were frequently mentioned after recovery and remained as intermediate- and longer-term sequelae. Conclusions: In this study, we showed the dynamic changes in COVID-19 symptoms during the infection and recovery phases of the disease. Our findings suggest the feasibility of using social media data for investigating disease states and understanding the evolution of the physiological and psychological characteristics of COVID-19 infection over time. %M 35076400 %R 10.2196/33959 %U https://www.jmir.org/2022/2/e33959 %U https://doi.org/10.2196/33959 %U http://www.ncbi.nlm.nih.gov/pubmed/35076400 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e33149 %T Control Centre for Intensive Care as a Tool for Effective Coordination, Real-Time Monitoring, and Strategic Planning During the COVID-19 Pandemic %A Komenda,Martin %A Černý,Vladimír %A Šnajdárek,Petr %A Karolyi,Matěj %A Hejný,Miloš %A Panoška,Petr %A Jarkovský,Jiří %A Gregor,Jakub %A Bulhart,Vojtěch %A Šnajdrová,Lenka %A Májek,Ondřej %A Vymazal,Tomáš %A Blatný,Jan %A Dušek,Ladislav %+ Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Kamenice 126/3, Brno, 62500, Czech Republic, 420 549 49 4469, komenda@iba.muni.cz %K COVID-19 %K coronavirus %K intensive care %K inpatient care %K online control center %K prescription %K open data %K ICU %K monitoring %K strategy %K development %K app %K function %K Czech Republic %K inpatient %K crisis management %D 2022 %7 16.2.2022 %9 Viewpoint %J J Med Internet Res %G English %X In the Czech Republic, the strategic data-based and organizational support for individual regions and for providers of acute care at the nationwide level is coordinated by the Ministry of Health. At the beginning of the COVID-19 pandemic, the country needed to very quickly implement a system for the monitoring, reporting, and overall management of hospital capacities. The aim of this viewpoint is to describe the purpose and basic functions of a web-based application named “Control Centre for Intensive Care,” which was developed and made available to meet the needs of systematic online technical support for the management of intensive inpatient care across the Czech Republic during the first wave of the pandemic in spring 2020. Two tools of key importance are described in the context of national methodology: one module for regular online updates and overall monitoring of currently free capacities of intensive care in real time, and a second module for online entering and overall record-keeping of requirements on medications for COVID-19 patients. A total of 134 intensive care providers and 927 users from hospitals across all 14 regions of the Czech Republic were registered in the central Control Centre for Intensive Care database as of March 31, 2021. This web-based application enabled continuous monitoring and decision-making during the mass surge of critical care from autumn 2020 to spring 2021. The Control Center for Intensive Care has become an indispensable part of a set of online tools that are employed on a regular basis for crisis management at the time of the COVID-19 pandemic. %M 34995207 %R 10.2196/33149 %U https://www.jmir.org/2022/2/e33149 %U https://doi.org/10.2196/33149 %U http://www.ncbi.nlm.nih.gov/pubmed/34995207 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e34176 %T The Accessibility of YouTube Fitness Videos for Individuals Who Are Disabled Before and During the COVID-19 Pandemic: Preliminary Application of a Text Analytics Approach %A Kadakia,Shevali %A Stratton,Catherine %A Wu,Yinfei %A Feliciano,Josemari %A Tuakli-Wosornu,Yetsa A %+ Department of Physical Medicine and Rehabilitation, University of Pittsburgh Medical Center, 3471 Fifth Ave, Pittsburgh, PA, 15213, United States, 1 4436104322, yetsa.tuakli-wosornu@yale.edu %K persons with disabilities %K disability %K exercise %K physical activity %K digital health %K YouTube %K accessibility %K fitness %K COVID-19 %K text analysis %K social media %K video %D 2022 %7 15.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: People with disabilities face barriers to in-person physical activity (PA), including a lack of adaptive equipment and knowledgeable instructors. Given this and the increased need for digital resources due to widespread COVID-19 lockdowns, it is necessary to assess the accessibility of digital fitness resources for people with disabilities. To investigate whether YouTube fitness content creators have made videos accessible to people with disabilities would be informative about access to PA during COVID-19 and could also provide insight into the feasibility of individuals who are disabled relying on YouTube for PA in a post–COVID-19 world. Objective: This study aims to ascertain if disability-friendly PA videos on YouTube are accessible through searching general fitness terms and whether a change in the availability of accessible fitness resources for people with disabilities occurred on YouTube between before and during the COVID-19 pandemic on “Hospital/Medical Institutions,” “Individual(s),” and “Other(s)” channels. Secondary aims are to investigate if different categories of YouTube channels produce more accessible fitness content and highlight any disparities in disability-friendly PA content on YouTube. Methods: A cross-sectional text analysis of exercise-related YouTube videos was conducted. The authors used Python (version 3.0) to access the YouTube database via its data application programming interface. Terms pertaining to PA that were searched on YouTube were at-home exercise, exercise at home, exercise no equipment, home exercise, home-based exercise, no equipment workout, and workout no equipment. Various elements (eg, view count and content generation) of the videos published between January 1 and June 30, 2019 (n=700), were compared to the elements of videos published between January 1 and June 30, 2020 (n=700). To capture a broad idea of disability-friendly videos on YouTube, videos were labeled “accessible” if they were found in the first 100 video results and if their title, description, or tags contained the following terms: para, paralympic, adaptive, adapted, disabled, disability, differently abled, disability-friendly, wheelchair accessible, and inclusive. Each video and channel were categorized as “Hospitals/Medical Institutions,” “Individuals,” or “Other(s).” Results: The analysis revealed a statistically significant increase in viewership of fitness content on YouTube (P=.001) and in fitness content generated by Hospitals/Medical Institutions (P=.004). Accessible terms applicable to people with disabilities had minimal appearances in 2019 (21 videos) and 2020 (19 videos). None of the top viewed fitness videos that populated on YouTube from 2019 or 2020 were accessible. Conclusions: The proportion of accessible disability-friendly videos remains diminutive relative to the prevalence of disability in the general population, revealing that disability-friendly videos are seldom findable on YouTube. Thus, the need for disability-friendly fitness content to be easily searched and found remains urgent if access to digital fitness resources is to improve. %M 35044305 %R 10.2196/34176 %U https://formative.jmir.org/2022/2/e34176 %U https://doi.org/10.2196/34176 %U http://www.ncbi.nlm.nih.gov/pubmed/35044305 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32443 %T Assessing COVID-19 Health Information on Google Using the Quality Evaluation Scoring Tool (QUEST): Cross-sectional and Readability Analysis %A Bachu,Vismaya S %A Mahjoub,Heba %A Holler,Albert E %A Crihalmeanu,Tudor %A Bachu,Dheevena M %A Ayyaswami,Varun %A Parker,Pearman D %A Prabhu,Arpan V %+ Department of Radiation Oncology, University of Arkansas for Medical Sciences, Winthrop P Rockefeller Cancer Institute, 4130 Shuffield Dr, Little Rock, AR, 72205, United States, 1 5016644568, avprabhu@uams.edu %K COVID-19 %K COVID-19 pandemic %K health literacy %K readability %K QUEST %K online health information %K cross-sectional %K trend %K internet %K spread %K symptom %K quality %K United States %D 2022 %7 11.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic spurred an increase in online information regarding disease spread and symptomatology. Objective: Our purpose is to systematically assess the quality and readability of articles resulting from frequently Google-searched COVID-19 terms in the United States. Methods: We used Google Trends to determine the 25 most commonly searched health-related phrases between February 29 and April 30, 2020. The first 30 search results for each term were collected, and articles were analyzed using the Quality Evaluation Scoring Tool (QUEST). Three raters scored each article in authorship, attribution, conflict of interest, currency, complementarity, and tone. A readability analysis was conducted. Results: Exactly 709 articles were screened, and 195 fulfilled inclusion criteria. The mean article score was 18.4 (SD 2.6) of 28, with 7% (14/189) scoring in the top quartile. National news outlets published the largest share (70/189, 36%) of articles. Peer-reviewed journals attained the highest average QUEST score compared to national/regional news outlets, national/state government sites, and global health organizations (all P<.05). The average reading level was 11.7 (SD 1.9, range 5.4-16.9). Only 3 (1.6%) articles were written at the recommended sixth grade level. Conclusions: COVID-19–related articles are vastly varied in their attributes and levels of bias, and would benefit from revisions for increased readability. %M 34995206 %R 10.2196/32443 %U https://formative.jmir.org/2022/2/e32443 %U https://doi.org/10.2196/32443 %U http://www.ncbi.nlm.nih.gov/pubmed/34995206 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e32638 %T Determining the Case Fatality Rate of COVID-19 in Italy: Novel Epidemiological Study %A Yan,Mengqing %A Kang,Wenjun %A Guo,Zhifeng %A Wang,Qi %A Wang,Peizhong Peter %A Zhu,Yun %A Yang,Yongli %A Wang,Wei %+ Department of Occupational and Environmental Health, College of Public Health, Zhengzhou University, No.100, Science Avenue, Zhengzhou, 450001, China, 86 371 67781466, ww375@zzu.edu.cn %K COVID-19 %K case fatality rate %K discharged case fatality rate %K new infectious diseases %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19, which emerged in December 2019, has spread rapidly around the world and has become a serious public health event endangering human life. With regard to COVID-19, there are still many unknowns, such as the exact case fatality rate (CFR). Objective: The main objective of this study was to explore the value of the discharged CFR (DCFR) to make more accurate forecasts of epidemic trends of COVID-19 in Italy. Methods: We retrieved the epidemiological data of COVID-19 in Italy published by the John Hopkins Coronavirus Resource Center. We then used the proportion of deaths to discharged cases（including deaths and recovered cases） to calculate the total DCFR (tDCFR), monthly DCFR (mDCFR), and stage DCFR (sDCFR). Furthermore, we analyzed the trend in the mDCFR between January and December 2020 using joinpoint regression analysis, used ArcGIS version 10.7 to visualize the spatial distribution of the epidemic CFR, and assigned different colors to each province based on the CFR or tDCFR. Results: We calculated the numbers and obtained the new indices of the tDCFR and mDCFR for calculating the fatality rate. The results showed that the tDCFR and mDCFR fluctuated greatly from January to May. They first showed a rapid increase followed by a rapid decline after reaching the peak. The map showed that the provinces with a high tDCFR were Emilia-Romagna, Puglia, and Lombardia. The change trend of the mDCFR over time was divided into the following 2 stages: the first stage (from January to May) and the second stage (from June to December). With regard to worldwide COVID-19 statistics, among 6 selected countries, the United States had the highest tDCFR (4.26%), while the tDCFR of the remaining countries was between 0.98% and 2.72%. Conclusions: We provide a new perspective for assessing the fatality of COVID-19 in Italy, which can use ever-changing data to calculate a more accurate CFR and scientifically predict the development trend of the epidemic. %M 34963659 %R 10.2196/32638 %U https://publichealth.jmir.org/2022/2/e32638 %U https://doi.org/10.2196/32638 %U http://www.ncbi.nlm.nih.gov/pubmed/34963659 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e29246 %T Constituents’ Inferences of Local Governments’ Goals and the Relationship Between Political Party and Belief in COVID-19 Misinformation: Cross-sectional Survey of Twitter Followers of State Public Health Departments %A Stevens,Hannah %A Palomares,Nicholas A %+ Department of Communication, College of Letters and Science, University of California, Davis, One Shields Ave, Davis, CA, 95616, United States, 1 530 752 0966, hrstevens@ucdavis.edu %K COVID-19 %K outbreak %K mass communication %K Twitter %K goal inferences %K political agendas %K misinformation %K infodemic %K partisanship %K health information %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Amid the COVID-19 pandemic, social media have influenced the circulation of health information. Public health agencies often use Twitter to disseminate and amplify the propagation of such information. Still, exposure to local government–endorsed COVID-19 public health information does not make one immune to believing misinformation. Moreover, not all health information on Twitter is accurate, and some users may believe misinformation and disinformation just as much as those who endorse more accurate information. This situation is complicated, given that elected officials may pursue a political agenda of re-election by downplaying the need for COVID-19 restrictions. The politically polarized nature of information and misinformation on social media in the United States has fueled a COVID-19 infodemic. Because pre-existing political beliefs can both facilitate and hinder persuasion, Twitter users’ belief in COVID-19 misinformation is likely a function of their goal inferences about their local government agencies’ motives for addressing the COVID-19 pandemic. Objective: We shed light on the cognitive processes of goal understanding that underlie the relationship between partisanship and belief in health misinformation. We investigate how the valence of Twitter users’ goal inferences of local governments’ COVID-19 efforts predicts their belief in COVID-19 misinformation as a function of their political party affiliation. Methods: We conducted a web-based cross-sectional survey of US Twitter users who followed their state’s official Department of Public Health Twitter account (n=258) between August 10 and December 23, 2020. Inferences about local governments’ goals, demographics, and belief in COVID-19 misinformation were measured. State political affiliation was controlled. Results: Participants from all 50 states were included in the sample. An interaction emerged between political party affiliation and goal inference valence for belief in COVID-19 misinformation (∆R2=0.04; F8,249=4.78; P<.001); positive goal inference valence predicted increased belief in COVID-19 misinformation among Republicans (β=.47; t249=2.59; P=.01) but not among Democrats (β=.07; t249=0.84; P=.40). Conclusions: Our results reveal that favorable inferences about local governments’ COVID-19 efforts can accelerate belief in misinformation among Republican-identifying constituents. In other words, accurate COVID-19 transmission knowledge is a function of constituents' sentiment toward politicians rather than science, which has significant implications on public health efforts for minimizing the spread of the disease, as convincing misinformed constituents to practice safety measures might be a political issue just as much as it is a health one. Our work suggests that goal understanding processes matter for misinformation about COVID-19 among Republicans. Those responsible for future COVID-19 public health messaging aimed at increasing belief in valid information about COVID-19 should recognize the need to test persuasive appeals that address partisans’ pre-existing political views in order to prevent individuals’ goal inferences from interfering with public health messaging. %M 37113808 %R 10.2196/29246 %U https://infodemiology.jmir.org/2022/1/e29246 %U https://doi.org/10.2196/29246 %U http://www.ncbi.nlm.nih.gov/pubmed/37113808 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e31502 %T Patient Outcomes and Lessons Learned From Treating Patients With Severe COVID-19 at a Long-term Acute Care Hospital: Single-Center Retrospective Study %A Grevelding,Pete %A Hrdlicka,Henry Charles %A Holland,Steve %A Cullen,Lorraine %A Meyer,Amanda %A Connors,Catherine %A Cooper,Darielle %A Greco,Allison %+ Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, CT, 06492, United States, 1 203 741 3386, pgrevelding@gaylord.org %K COVID-19 %K SARS-CoV-2 %K post–COVID-19 %K subacute COVID-19 %K postacute care %K long-term acute care hospital %K pulmonary %K speech therapy %K speech-language pathology %K rehabilitation %K physical therapy %K occupational therapy %K respiratory therapy %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: With the continuation of the COVID-19 pandemic, shifting active COVID-19 care from short-term acute care hospitals (STACHs) to long-term acute care hospitals (LTACHs) could decrease STACH census during critical stages of the pandemic and maximize limited resources. Objective: This study aimed to describe the characteristics, clinical management, and patient outcomes during and after the acute COVID-19 phase in an LTACH in the Northeastern United States. Methods: This was a single-center group comparative retrospective analysis of the electronic medical records of patients treated for COVID-19–related impairments from March 19, 2020, through August 14, 2020, and a reference population of medically complex patients discharged between December 1, 2019, and February 29, 2020. This study was conducted to evaluate patient outcomes in response to the holistic treatment approach of the facility. Results: Of the 127 total COVID-19 admissions, 118 patients were discharged by the data cutoff. At admission, 29.9% (38/127) of patients tested positive for SARS-CoV-2 infection. The mean age of the COVID-19 cohort was lower than that of the reference cohort (63.3, 95% CI 61.1-65.4 vs 65.5, 95% CI 63.2-67.8 years; P=.04). There were similar proportions of males and females between cohorts (P=.38); however, the proportion of non-White/non-Caucasian patients was higher in the COVID-19 cohort than in the reference cohort (odds ratio 2.79, 95% CI 1.5-5.2; P=.001). The mean length of stay in the COVID-19 cohort was similar to that in the reference cohort (25.5, 95% CI 23.2-27.9 vs 29.9, 95% CI 24.7-35.2 days; P=.84). Interestingly, a positive correlation between patient age and length of stay was observed in the COVID-19 cohort (r2=0.05; P=.02), but not in the reference cohort. Ambulation assistance scores improved in both the reference and COVID-19 cohorts from admission to discharge (P<.001). However, the mean assistance score was greater in the COVID-19 cohort than in the reference cohort at discharge (4.9, 95% CI 4.6-5.3 vs 4.1, 95% CI 3.7-4.7; P=.001). Similarly, the mean change in gait distance was greater in the COVID-19 cohort than in the reference cohort (221.1, 95% CI 163.2-279.2 vs 146.4, 95% CI 85.6-207.3 feet; P<.001). Of the 16 patients mechanically ventilated at admission, 94% (15/16) were weaned before discharge (mean 11.3 days). Of the 75 patients admitted with a restricted diet, 75% (56/75) were discharged on a regular diet. Conclusions: The majority of patients treated at the LTACH for severe COVID-19 and related complications benefited from coordinated care and rehabilitation. In comparison to the reference cohort, patients treated for COVID-19 were discharged with greater improvements in ambulation distance and assistance needs during a similar length of stay. These findings indicate that other patients with COVID-19 would benefit from care in an LTACH. %M 35023835 %R 10.2196/31502 %U https://rehab.jmir.org/2022/1/e31502 %U https://doi.org/10.2196/31502 %U http://www.ncbi.nlm.nih.gov/pubmed/35023835 %0 Journal Article %@ 2369-2529 %I JMIR Publications %V 9 %N 1 %P e30794 %T Occupational and Physical Therapy Strategies for the Rehabilitation of COVID-19-Related Guillain-Barré Syndrome in the Long-term Acute Care Hospital Setting: Case Report %A Connors,Catherine %A McNeill,Stephanie %A Hrdlicka,Henry Charles %+ Milne Institute for Healthcare Innovation, Gaylord Specialty Healthcare, 50 Gaylord Farm Road, Wallingford, CT, 06492, United States, 1 203 284 2864, hhrdlicka@gaylord.org %K Gullian-Barre syndrome %K COVID-19 %K SARS-CoV-2 %K occupational therapy %K physical therapy %K long-term acute care hospital %K rehabilitation %K case report %K treatment %K diagnosis %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Rehabil Assist Technol %G English %X Background: Although several reports have described the diagnosis and treatment of patients with COVID-19-associated Guillain-Barré syndrome (GBS), there is a paucity of literature describing the occupational and physical therapy (OT and PT) strategies used in the long-term acute care hospital (LTACH) setting to rehabilitate these patients. Objective: To expand this body of literature, we present a case report highlighting the treatment strategies used to rehabilitate and discharge an individual from an independent LTACH facility, following diagnosis and treatment of COVID-19-related GBS at a regional ACH. Methods: A 61-year-old male was admitted to an LTACH for the rehabilitation of GBS following COVID-19 infection and intravenous immunoglobulin treatment. Rehabilitation in the LTACH setting uses a variety of skilled treatment interventions to meet patient-driven goals and maximize their function to the highest level possible in preparation of their discharge to a subacute or homecare setting. In this case, this was accomplished through individual OT and PT sessions, OT/PT cotreatment sessions, and targeted group therapy sessions focused on leg, arm, and fine motor coordination exercises. Results: With the OT and PT standard of care, the patient’s improvement was demonstrated by several outcome measures, including manual muscle testing, range of motion, grip strength, and the activity measure for postacute care. The patient was successfully rehabilitated and returned to the community after presenting with COVID-19-associated GBS. Conclusions: This report highlights the complex rehabilitation needs patients require to regain independence after diagnosis of COVID-19-associated GBS. %M 35023838 %R 10.2196/30794 %U https://rehab.jmir.org/2022/1/e30794 %U https://doi.org/10.2196/30794 %U http://www.ncbi.nlm.nih.gov/pubmed/35023838 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 9 %N 2 %P e34645 %T Risk Factors for COVID-19 in College Students Identified by Physical, Mental, and Social Health Reported During the Fall 2020 Semester: Observational Study Using the Roadmap App and Fitbit Wearable Sensors %A Gilley,Kristen N %A Baroudi,Loubna %A Yu,Miao %A Gainsburg,Izzy %A Reddy,Niyanth %A Bradley,Christina %A Cislo,Christine %A Rozwadowski,Michelle Lois %A Clingan,Caroline Ashley %A DeMoss,Matthew Stephen %A Churay,Tracey %A Birditt,Kira %A Colabianchi,Natalie %A Chowdhury,Mosharaf %A Forger,Daniel %A Gagnier,Joel %A Zernicke,Ronald F %A Cunningham,Julia Lee %A Cain,Stephen M %A Tewari,Muneesh %A Choi,Sung Won %+ Department of Pediatrics, University of Michigan Medical School, 1200 E Hospital Dr, Medical Professional Building D4118, Ann Arbor, MI, 48109, United States, 1 734 615 2263, sungchoi@med.umich.edu %K mHealth %K mobile health %K college student %K mental health %K wearable devices %K wearable %K student %K risk factor %K risk %K COVID-19 %K physical health %K observational %K crisis %K self-report %K outcome %K physical activity %K wellbeing %K well-being %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic triggered a seismic shift in education to web-based learning. With nearly 20 million students enrolled in colleges across the United States, the long-simmering mental health crisis in college students was likely further exacerbated by the pandemic. Objective: This study leveraged mobile health (mHealth) technology and sought to (1) characterize self-reported outcomes of physical, mental, and social health by COVID-19 status; (2) assess physical activity through consumer-grade wearable sensors (Fitbit); and (3) identify risk factors associated with COVID-19 positivity in a population of college students prior to release of the vaccine. Methods: After completing a baseline assessment (ie, at Time 0 [T0]) of demographics, mental, and social health constructs through the Roadmap 2.0 app, participants were instructed to use the app freely, wear the Fitbit, and complete subsequent assessments at T1, T2, and T3, followed by a COVID-19 assessment of history and timing of COVID-19 testing and diagnosis (T4: ~14 days after T3). Continuous measures were described using mean (SD) values, while categorical measures were summarized as n (%) values. Formal comparisons were made on the basis of COVID-19 status. The multivariate model was determined by entering all statistically significant variables (P<.05) in univariable associations at once and then removing one variable at a time through backward selection until the optimal model was obtained. Results: During the fall 2020 semester, 1997 participants consented, enrolled, and met criteria for data analyses. There was a high prevalence of anxiety, as assessed by the State Trait Anxiety Index, with moderate and severe levels in 465 (24%) and 970 (49%) students, respectively. Approximately one-third of students reported having a mental health disorder (n=656, 33%). The average daily steps recorded in this student population was approximately 6500 (mean 6474, SD 3371). Neither reported mental health nor step count were significant based on COVID-19 status (P=.52). Our analyses revealed significant associations of COVID-19 positivity with the use of marijuana and alcohol (P=.02 and P=.046, respectively) and with lower belief in public health measures (P=.003). In addition, graduate students were less likely and those with ≥20 roommates were more likely to report a COVID-19 diagnosis (P=.009). Conclusions: Mental health problems were common in this student population. Several factors, including substance use, were associated with the risk of COVID-19. These data highlight important areas for further attention, such as prioritizing innovative strategies that address health and well-being, considering the potential long-term effects of COVID-19 on college students. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID): RR2-10.2196/29561 %M 34992051 %R 10.2196/34645 %U https://mental.jmir.org/2022/2/e34645 %U https://doi.org/10.2196/34645 %U http://www.ncbi.nlm.nih.gov/pubmed/34992051 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e31473 %T The Evolution of Public Sentiments During the COVID-19 Pandemic: Case Comparisons of India, Singapore, South Korea, the United Kingdom, and the United States %A Lwin,May O %A Sheldenkar,Anita %A Lu,Jiahui %A Schulz,Peter Johannes %A Shin,Wonsun %A Panchapakesan,Chitra %A Gupta,Raj Kumar %A Yang,Yinping %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore, 637718, Singapore, 65 82623610, anitas@ntu.edu.sg %K COVID-19 %K public sentiment %K Twitter %K crisis communication %K cross-country comparison %K sentiment %K social media %K communication %K public health %K health information %K emotion %K perception %K health literacy %K information literacy %K digital literacy %K community health %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Public sentiments are an important indicator of crisis response, with the need to balance exigency without adding to panic or projecting overconfidence. Given the rapid spread of the COVID-19 pandemic, governments have enacted various nationwide measures against the disease with social media platforms providing the previously unparalleled communication space for the global populations. Objective: This research aims to examine and provide a macro-level narrative of the evolution of public sentiments on social media at national levels, by comparing Twitter data from India, Singapore, South Korea, the United Kingdom, and the United States during the current pandemic. Methods: A total of 67,363,091 Twitter posts on COVID-19 from January 28, 2020, to April 28, 2021, were analyzed from the 5 countries with “wuhan,” “corona,” “nCov,” and “covid” as search keywords. Change in sentiments (“very negative,” “negative,” “neutral or mixed,” “positive,” “very positive”) were compared between countries in connection with disease milestones and public health directives. Results: Country-specific assessments show that negative sentiments were predominant across all 5 countries during the initial period of the global pandemic. However, positive sentiments encompassing hope, resilience, and support arose at differing intensities across the 5 countries, particularly in Asian countries. In the next stage of the pandemic, India, Singapore, and South Korea faced escalating waves of COVID-19 cases, resulting in negative sentiments, but positive sentiments appeared simultaneously. In contrast, although negative sentiments in the United Kingdom and the United States increased substantially after the declaration of a national public emergency, strong parallel positive sentiments were slow to surface. Conclusions: Our findings on sentiments across countries facing similar outbreak concerns suggest potential associations between government response actions both in terms of policy and communications, and public sentiment trends. Overall, a more concerted approach to government crisis communication appears to be associated with more stable and less volatile public sentiments over the evolution of the COVID-19 pandemic. %M 37113803 %R 10.2196/31473 %U https://infodemiology.jmir.org/2022/1/e31473 %U https://doi.org/10.2196/31473 %U http://www.ncbi.nlm.nih.gov/pubmed/37113803 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e31131 %T An Association of Influenza Epidemics in Children With Mobile App Data: Population-Based Observational Study in Osaka, Japan %A Katayama,Yusuke %A Kiyohara,Kosuke %A Hirose,Tomoya %A Ishida,Kenichiro %A Tachino,Jotaro %A Nakao,Shunichiro %A Noda,Tomohiro %A Ojima,Masahiro %A Kiguchi,Takeyuki %A Matsuyama,Tasuku %A Kitamura,Tetsuhisa %+ Department of Traumatology and Acute Critical Medicine, Osaka University Graduate School of Medicine, 2-15 Yamada-oka, Suita, Japan, 81 6 6879 5707, orion13@hp-emerg.med.osaka-u.ac.jp %K syndromic surveillance %K mobile app %K influenza %K epidemic %K children %D 2022 %7 10.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Early surveillance to prevent the spread of influenza is a major public health concern. If there is an association of influenza epidemics with mobile app data, it may be possible to forecast influenza earlier and more easily. Objective: We aimed to assess the relationship between seasonal influenza and the frequency of mobile app use among children in Osaka Prefecture, Japan. Methods: This was a retrospective observational study that was performed over a three-year period from January 2017 to December 2019. Using a linear regression model, we calculated the R2 value of the regression model to evaluate the relationship between the number of “fever” events selected in the mobile app and the number of influenza patients ≤14 years of age. We conducted three-fold cross-validation using data from two years as the training data set and the data of the remaining year as the test data set to evaluate the validity of the regression model. And we calculated Spearman correlation coefficients between the calculated number of influenza patients estimated using the regression model and the number of influenza patients, limited to the period from December to April when influenza is prevalent in Japan. Results: We included 29,392 mobile app users. The R2 value for the linear regression model was 0.944, and the adjusted R2 value was 0.915. The mean Spearman correlation coefficient for the three regression models was 0.804. During the influenza season (December–April), the Spearman correlation coefficient between the number of influenza patients and the calculated number estimated using the linear regression model was 0.946 (P<.001). Conclusions: In this study, the number of times that mobile apps were used was positively associated with the number of influenza patients. In particular, there was a good association of the number of influenza patients with the number of “fever” events selected in the mobile app during the influenza epidemic season. %M 35142628 %R 10.2196/31131 %U https://formative.jmir.org/2022/2/e31131 %U https://doi.org/10.2196/31131 %U http://www.ncbi.nlm.nih.gov/pubmed/35142628 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e35164 %T Loss of Weight Gained During the COVID-19 Pandemic: Content Analysis of YouTube Videos %A Tang,Hao %A Kim,Sungwoo %A Laforet,Priscila E %A Tettey,Naa-Solo %A Basch,Corey H %+ Department of Health and Behavior Studies, Teachers College, Columbia University, 528 West 121st Street, New York, NY, 10027, United States, 1 2126783964, ht2489@tc.columbia.edu %K COVID-19 %K quarantine %K weight loss %K weight gain %K social media %K YouTube %D 2022 %7 9.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Many people experienced unintended weight gain during the COVID-19 pandemic, which has been discussed widely on social media. Objective: This study aims to describe the content of weight loss videos on YouTube (Google LLC) during the COVID-19 pandemic. Methods: By using the keywords weight loss during quarantine, the 100 most viewed English-language videos were identified and coded for content related to losing weight gained during the COVID-19 pandemic. Results: In total, 9 videos were excluded due to having non-English content or posting data before the COVID-19 pandemic. The 91 videos included in the study sample acquired 407,326 views at the time of study and were roughly 14 minutes long. A total of 48% (44/91) of the sample videos included graphic comparisons to illustrate weight change. Videos that included a graphic comparison were more likely to have content related to trigger warnings (χ21=6.05; P=.01), weight loss (χ21=13.39; P<.001), negative feelings during quarantine (χ21=4.75; P=.03), instructions for losing weight (χ21=9.17; P=.002), self-love (χ21=6.01; P=.01), body shaming (χ21=4.36; P=.04), and special dietary practices (χ21=11.10; P<.001) but were less likely to include food recipes (χ21=5.05; P=.03). Our regression analysis results suggested that mentioning quarantine (P=.05), fat-gaining food (P=.04), self-care and self-love (P=.05), and body shaming (P=.008) and having presenters from both sexes (P<.001) are significant predictors for a higher number of views. Our adjusted regression model suggested that videos with content about routine change have significantly lower view counts (P=.03) than those of videos without such content. Conclusions: The findings of this study indicate the ways in which YouTube is being used to showcase COVID-19–related weight loss in a pre-post fashion. The use of graphic comparisons garnered a great deal of attention. Additional studies are needed to understand the role of graphic comparisons in social media posts. Further studies that focus on people’s attitudes and behaviors toward weight change during the COVID-19 pandemic and the implications of social media on these attitudes and behaviors are warranted. %M 34978534 %R 10.2196/35164 %U https://formative.jmir.org/2022/2/e35164 %U https://doi.org/10.2196/35164 %U http://www.ncbi.nlm.nih.gov/pubmed/34978534 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e30063 %T COVID-19 Assessment and Testing in Rural Communities During the Pandemic: Cross-sectional Analysis %A Fitzsimon,Jonathan %A Gervais,Oliver %A Lanos,Chelsea %+ Department of Family Medicine, University of Ottawa, Suite 201, 600 Peter Morand Crescent, Ottawa, ON, K1G 5Z3, Canada, 1 613 878 8225, jfitzsi2@uottawa.ca %K healthcare %K virtual care %K access %K COVID-19 %K pandemic %K assessment %K testing %K community paramed %K digital health %K online health %K physician %K virtual health %D 2022 %7 8.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 35022158 %R 10.2196/30063 %U https://publichealth.jmir.org/2022/2/e30063 %U https://doi.org/10.2196/30063 %U http://www.ncbi.nlm.nih.gov/pubmed/35022158 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e31726 %T COVID-19 Vaccine Tweets After Vaccine Rollout: Sentiment–Based Topic Modeling %A Huangfu,Luwen %A Mo,Yiwen %A Zhang,Peijie %A Zeng,Daniel Dajun %A He,Saike %+ The State Key Laboratory of Management and Control for Complex Systems, Institute of Automation, Chinese Academy of Sciences, 95 Zhongguancun East Road, Haidian District, Beijing, 100190, China, 86 (010)82544537, saike.he@ia.ac.cn %K COVID-19 %K COVID-19 vaccine %K sentiment evolution %K topic modeling %K social media %K text mining %D 2022 %7 8.2.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 vaccines are one of the most effective preventive strategies for containing the pandemic. Having a better understanding of the public’s conceptions of COVID-19 vaccines may aid in the effort to promptly and thoroughly vaccinate the community. However, because no empirical research has yet fully explored the public’s vaccine awareness through sentiment–based topic modeling, little is known about the evolution of public attitude since the rollout of COVID-19 vaccines. Objective: In this study, we specifically focused on tweets about COVID-19 vaccines (Pfizer, Moderna, AstraZeneca, and Johnson & Johnson) after vaccines became publicly available. We aimed to explore the overall sentiments and topics of tweets about COVID-19 vaccines, as well as how such sentiments and main concerns evolved. Methods: We collected 1,122,139 tweets related to COVID-19 vaccines from December 14, 2020, to April 30, 2021, using Twitter’s application programming interface. We removed retweets and duplicate tweets to avoid data redundancy, which resulted in 857,128 tweets. We then applied sentiment–based topic modeling by using the compound score to determine sentiment polarity and the coherence score to determine the optimal topic number for different sentiment polarity categories. Finally, we calculated the topic distribution to illustrate the topic evolution of main concerns. Results: Overall, 398,661 (46.51%) were positive, 204,084 (23.81%) were negative, 245,976 (28.70%) were neutral, 6899 (0.80%) were highly positive, and 1508 (0.18%) were highly negative sentiments. The main topics of positive and highly positive tweets were planning for getting vaccination (251,979/405,560, 62.13%), getting vaccination (76,029/405,560, 18.75%), and vaccine information and knowledge (21,127/405,560, 5.21%). The main concerns in negative and highly negative tweets were vaccine hesitancy (115,206/205,592, 56.04%), extreme side effects of the vaccines (19,690/205,592, 9.58%), and vaccine supply and rollout (17,154/205,592, 8.34%). During the study period, negative sentiment trends were stable, while positive sentiments could be easily influenced. Topic heatmap visualization demonstrated how main concerns changed during the current widespread vaccination campaign. Conclusions: To the best of our knowledge, this is the first study to evaluate public COVID-19 vaccine awareness and awareness trends on social media with automated sentiment–based topic modeling after vaccine rollout. Our results can help policymakers and research communities track public attitudes toward COVID-19 vaccines and help them make decisions to promote the vaccination campaign. %M 34783665 %R 10.2196/31726 %U https://www.jmir.org/2022/2/e31726 %U https://doi.org/10.2196/31726 %U http://www.ncbi.nlm.nih.gov/pubmed/34783665 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e32378 %T Charting the Information and Misinformation Landscape to Characterize Misinfodemics on Social Media: COVID-19 Infodemiology Study at a Planetary Scale %A Chen,Emily %A Jiang,Julie %A Chang,Ho-Chun Herbert %A Muric,Goran %A Ferrara,Emilio %+ Information Sciences Institute, University of Southern California, 4676 Admiralty Way, #1001, Marina del Rey, CA, 90292, United States, 1 310 448 8661, emiliofe@usc.edu %K social media %K social networks %K Twitter %K COVID-19 %K infodemics %K misinfodemics %K infodemiology %K misinformation %D 2022 %7 8.2.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The novel coronavirus, also known as SARS-CoV-2, has come to define much of our lives since the beginning of 2020. During this time, countries around the world imposed lockdowns and social distancing measures. The physical movements of people ground to a halt, while their online interactions increased as they turned to engaging with each other virtually. As the means of communication shifted online, information consumption also shifted online. Governing authorities and health agencies have intentionally shifted their focus to use social media and online platforms to spread factual and timely information. However, this has also opened the gate for misinformation, contributing to and accelerating the phenomenon of misinfodemics. Objective: We carried out an analysis of Twitter discourse on over 1 billion tweets related to COVID-19 over a year to identify and investigate prevalent misinformation narratives and trends. We also aimed to describe the Twitter audience that is more susceptible to health-related misinformation and the network mechanisms driving misinfodemics. Methods: We leveraged a data set that we collected and made public, which contained over 1 billion tweets related to COVID-19 between January 2020 and April 2021. We created a subset of this larger data set by isolating tweets that included URLs with domains that had been identified by Media Bias/Fact Check as being prone to questionable and misinformation content. By leveraging clustering and topic modeling techniques, we identified major narratives, including health misinformation and conspiracies, which were present within this subset of tweets. Results: Our focus was on a subset of 12,689,165 tweets that we determined were representative of COVID-19 misinformation narratives in our full data set. When analyzing tweets that shared content from domains known to be questionable or that promoted misinformation, we found that a few key misinformation narratives emerged about hydroxychloroquine and alternative medicines, US officials and governing agencies, and COVID-19 prevention measures. We further analyzed the misinformation retweet network and found that users who shared both questionable and conspiracy-related content were clustered more closely in the network than others, supporting the hypothesis that echo chambers can contribute to the spread of health misinfodemics. Conclusions: We presented a summary and analysis of the major misinformation discourse surrounding COVID-19 and those who promoted and engaged with it. While misinformation is not limited to social media platforms, we hope that our insights, particularly pertaining to health-related emergencies, will help pave the way for computational infodemiology to inform health surveillance and interventions. %M 35190798 %R 10.2196/32378 %U https://infodemiology.jmir.org/2022/1/e32378 %U https://doi.org/10.2196/32378 %U http://www.ncbi.nlm.nih.gov/pubmed/35190798 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 2 %P e32680 %T An Evaluation of the Text Illness Monitoring (TIM) Platform for COVID-19: Cross-sectional Online Survey of Public Health Users %A Joseph,Heather A %A Ingber,Susan Z %A Austin,Chelsea %A Westnedge,Caroline %A Strona,F V %A Lee,Leslie %A Shah,Ami B %A Roper,Lauren %A Patel,Anita %+ Division of Environmental Health Science and Practice, National Center for Environmental Health, Centers for Disease Control and Prevention, Mailstop 106, 4770 Buford Hwy, Chamblee, GA, 30341, United States, 1 4046392636, hbj7@cdc.gov %K COVID-19 %K contact tracing %K SMS text system %K symptom monitoring %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The US public health response to the COVID-19 pandemic has required contact tracing and symptom monitoring at an unprecedented scale. The US Centers for Disease Control and Prevention and several partners created the Text Illness Monitoring (TIM) platform in 2015 to assist US public health jurisdictions with symptom monitoring for potential novel influenza virus outbreaks. Since May 2020, 142 federal, state, and local public health agencies have deployed TIM for COVID-19 symptom monitoring. Objective: The aim of this study was to evaluate the utility, benefits, and challenges of TIM to help guide decision-making for improvements and expansion to support future public health emergency response efforts. Methods: We conducted a brief online survey of previous and current TIM administrative users (admin users) from November 28 through December 21, 2020. Closed- and open-ended questions inquired about the onboarding process, decision to use TIM, groups monitored with TIM, comparison of TIM to other symptom monitoring systems, technical challenges and satisfaction with TIM, and user support. A total of 1479 admin users were invited to participate. Results: A total of 97 admin users from 43 agencies responded to the survey. Most admin users represented the Indian Health Service (35/97, 36%), state health departments (26/97, 27%), and local or county health departments (18/97, 19%), and almost all were current users of TIM (85/94, 90%). Among the 43 agencies represented, 11 (26%) used TIM for monitoring staff exclusively, 13 (30%) monitored community members exclusively, and 19 (44%) monitored both staff and community members. Agencies most frequently used TIM to monitor symptom development in contacts of cases among community members (28/43, 65%), followed by symptom development among staff (27/43, 63%) and among staff contacts of cases (24/43, 56%). Agencies also reported using TIM to monitor patients with COVID-19 for the worsening of symptoms among staff (21/43, 49%) and community members (18/43, 42%). When asked to compare TIM to previous monitoring systems, 78% (40/51) of respondents rated TIM more favorably than their previous monitoring system, 20% (10/51) said there was no difference, and 2% (1/51) rated the previous monitoring system more favorably than TIM. Most respondents found TIM favorable in terms of time burden, staff burden, timeliness of the data, and the ability to monitor large population sizes. TIM compared negatively to other systems in terms of effort to enroll participants (ie, persons TIM monitors) and accuracy of the data. Most respondents (76/85, 89%) reported that they would highly or somewhat recommend TIM to others for symptom monitoring. Conclusions: This evaluation of TIM showed that agencies used TIM for a variety of purposes and rated TIM favorably compared to previously used monitoring systems. We also identified opportunities to improve TIM; for example, enhancing the flexibility of alert deliveries would better meet admin users’ varying needs. We also suggest continuous program evaluation practices to assess and respond to implementation gaps. %M 34882572 %R 10.2196/32680 %U https://publichealth.jmir.org/2022/2/e32680 %U https://doi.org/10.2196/32680 %U http://www.ncbi.nlm.nih.gov/pubmed/34882572 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32000 %T Fertility Workup With Video Consultation During the COVID-19 Pandemic: Pilot Quantitative and Qualitative Study %A Grens,Hilde %A de Bruin,Jan Peter %A Huppelschoten,Aleida %A Kremer,Jan A M %+ Department of Obstetrics and Gynaecology, Jeroen Bosch Hospital, Henri Dunantstraat 1, 's-Hertogenbosch, 5223 GZ, Netherlands, 31 073 5538660, h.grens@jbz.nl %K COVID-19 %K patient centeredness %K video consultation %K fertility care %K telemedicine %K shared decision making %D 2022 %7 7.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Due to the COVID-19 pandemic, major parts of elective health care in the Netherlands, such as reproductive medicine, were paused. When health care was resumed, video consultation was used as a new solution to continue consultations with the new governmental rules of social distancing. Prior to this COVID-19 situation, video consultation was not used extensively in the Netherlands; therefore, physicians and patients are not familiar with this way of consultation. Objective: The purpose of this study was to measure the level of patient centeredness and shared decision making in infertile couples who have undergone fertility workup through video consultation. Methods: This is a questionnaire study with an additional qualitative part for a more in depth understanding. Infertile couples (ie, male and female partners with an unfulfilled wish for a child after 1 year of unprotected intercourse) were referred to a fertility center and underwent fertility workup through video consultation. The fertility workup consisted of 2 separate video consultations, with diagnostic tests according to a protocol. After the last video consultation couples received a digital questionnaire, which consisted of a modified version of the Patient-Centered Questionnaire-Infertility (PCQ-I) and CollaboRATE questionnaire. Fifty-three eligible infertile couples were approached, and of these, 22 participated. Four women were approached for a semistructured interview. Results: The median score on the modified PCQ-I (scale of 0 to 3) was 2.64. The highest rating was for the subscale communication and information, and the lowest rating was for the subscale organization of care. The median score on the CollaboRATE questionnaire (scale of 1 to 9) was 8 for all 3 subquestions. Patients mentioned privacy, less travel time, and easy use of the program as possible benefits of video consultation. However, patients preferred the first consultation with their physician to be face-to-face consultation as video consultation was considered less personal. Conclusions: The high levels of patient centeredness and shared decision making show that video consultation is a promising way of providing care remotely, although attention has to be payed to mitigate the more impersonal setting of video consultation when compared with face-to-face consultation. %M 34936981 %R 10.2196/32000 %U https://formative.jmir.org/2022/2/e32000 %U https://doi.org/10.2196/32000 %U http://www.ncbi.nlm.nih.gov/pubmed/34936981 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 2 %P e32193 %T An mHealth App for Fibromyalgia-like Post–COVID-19 Syndrome: Protocol for the Analysis of User Experience and Clinical Data %A Blanchard,Marc %A Backhaus,Lars %A Ming Azevedo,Pedro %A Hügle,Thomas %+ Department of Rheumatology, University Hospital of Lausanne, University of Lausanne, Avenue Pierre-Decker 4, Lausanne, Vaud, 1005, Switzerland, 41 794266883, marc_blanchard@bluewin.ch %K post–COVID-19 syndrome %K COVID-19 %K SARS-CoV-2 %K mobile health %K application %K user experience %K testing %K user interface %K long-covid syndrome %K mHealth %K app %K user interface %K protocol %K reinforcement %K learning %K strategy %K symptom %K outcome %K patient-reported outcome %K therapy %K rehabilitation %K monitoring %D 2022 %7 4.2.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Post–COVID-19 syndrome, also referred as “long covid,” describes persisting symptoms after SARS-CoV-2 infection, including myalgia, fatigue, respiratory, or neurological symptoms. Objective symptoms are often lacking, thus resembling a fibromyalgia-like syndrome. Digital therapeutics have shown efficiency in similar chronic disorders such as fibromyalgia, offering specific disease monitoring and interventions such as cognitive behavioral therapy or physical and respiratory exercise guidance. Objective: This protocol aims to study the requirements and features of a new mobile health (mHealth) app among patients with fibromyalgia-like post–COVID-19 syndrome in a clinical trial. Methods: We created a web application prototype for the post–COVID-19 syndrome called “POCOS,” as a web-based rehabilitation tool aiming to improve clinical outcomes. Patients without organ damage or ongoing inflammation will be included in the study. App use will be assessed through user experience questionnaires, focus groups, and clinical data analysis. Subsequently, we will analyze cross-sectional and longitudinal clinical data. Results: The developed mHealth app consists of a clinically adapted app interface with a simplified patient-reported outcome assessment, monitoring of medical interventions, and disease activity as well as web-based instructions for specific physical and respiratory exercises, stress reduction, and lifestyle instructions. The enrollment of participants is expected to be carried out in November 2021. Conclusions: User experience plays an important role in digital therapeutics and needs to be clinically tested to allow further improvement. We here describe this process for a new app for the treatment of the fibromyalgia-like post–COVID-19 syndrome and discuss the relevance of the potential outcomes such as natural disease course and disease phenotypes. International Registered Report Identifier (IRRID): PRR1-10.2196/32193 %M 34982039 %R 10.2196/32193 %U https://www.researchprotocols.org/2022/2/e32193 %U https://doi.org/10.2196/32193 %U http://www.ncbi.nlm.nih.gov/pubmed/34982039 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 9 %N 1 %P e33034 %T Trends in Remote Health Care Consumption in Sweden: Comparison Before and During the First Wave of the COVID-19 Pandemic %A Milos Nymberg,Veronica %A Ellegård,Lina Maria %A Kjellsson,Gustav %A Wolff,Moa %A Borgström Bolmsjö,Beata %A Wallman,Thorne %A Calling,Susanna %+ Center for Primary Health Care Research, Department of Clinical Sciences Malmö, Lund University, Building 28, Floor 11, Jan Waldenströms Street 35, Malmö, 20502, Sweden, 46 767700240, veronica.milos_nymberg@med.lu.se %K remote health care %K telemedicine %K primary health care %K respiratory tract infections %K COVID-19 %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Remote assessment of respiratory tract infections (RTIs) has been a controversial topic during the fast development of private telemedicine providers in Swedish primary health care. The possibility to unburden the traditional care has been put against a questionable quality of care as well as risks of increased utilization and costs. The COVID-19 pandemic has contributed to a changed management of patient care to decrease viral spread, with an expected shift in contact types from in-person to remote ones. Objective: The main aim of this study was to compare health care consumption and type of contacts (in-person or remote) for RTIs before and during the COVID-19 pandemic. The second aim was to study whether the number of follow-up contacts after an index contact for RTIs changed during the study period, and whether the number of follow-up contacts differed if the index contact was in-person or remote. A third aim was to study whether the pattern of follow-up contacts differed depending on whether the index contact was with a traditional or a private telemedicine provider. Methods: The study design was an observational retrospective analysis with a description of all index contacts and follow-up contacts with physicians in primary care and emergency rooms in a Swedish region (Skåne) for RTIs including patients of all ages and comparison for the same periods in 2018, 2019, and 2020. Results: Compared with 2018 and 2019, there were fewer index contacts for RTIs per 1000 inhabitants in 2020. By contrast, the number of follow-up contacts, both per 1000 inhabitants and per index contact, was higher in 2020. The composition of both index and follow-up contacts changed as the share of remote contacts, in particular for traditional care providers, increased. Conclusions: During the COVID-19 pandemic in 2020, fewer index contacts for RTIs but more follow-up contacts were conducted, compared with 2018-2019. The share of both index and follow-up contacts that were conducted remotely increased. Further studies are needed to study the reasons behind the increase in remote contacts, and if it will last after the pandemic, and more clinical guidelines for remote assessments of RTI are warranted. %M 34846304 %R 10.2196/33034 %U https://humanfactors.jmir.org/2022/1/e33034 %U https://doi.org/10.2196/33034 %U http://www.ncbi.nlm.nih.gov/pubmed/34846304 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e32384 %T A New Performance Metric to Estimate the Risk of Exposure to Infection in a Health Care Setting: Descriptive Study %A Hadian,Kimia %A Fernie,Geoff %A Roshan Fekr,Atena %+ The KITE Research Institute, Toronto Rehabilitation Institute, University Health Network, 550 University Ave, Toronto, ON, M5G 2A2, Canada, 1 4164558109, kimia.hadian@mail.utoronto.ca %K hand hygiene %K health care-acquired %K infection control %K compliance %K electronic monitoring %K exposure %K risk %K hygiene %K monitoring %K surveillance %K performance %K metric %K method %K estimate %K predict %K development %D 2022 %7 2.2.2022 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 35107424 %R 10.2196/32384 %U https://formative.jmir.org/2022/2/e32384 %U https://doi.org/10.2196/32384 %U http://www.ncbi.nlm.nih.gov/pubmed/35107424 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 2 %P e35552 %T A Deadly Infodemic: Social Media and the Power of COVID-19 Misinformation %A Gisondi,Michael A %A Barber,Rachel %A Faust,Jemery Samuel %A Raja,Ali %A Strehlow,Matthew C %A Westafer,Lauren M %A Gottlieb,Michael %+ The Precision Education and Assessment Research Lab, Department of Emergency Medicine, Stanford University, 900 Welch Road - Suite 350, Palo Alto, CA, 94304, United States, 1 650 721 4023, mgisondi@stanford.edu %K COVID-19 %K social media %K misinformation %K disinformation %K infodemic %K ethics %K vaccination %K vaccine hesitancy %K infoveillance %K vaccine %D 2022 %7 1.2.2022 %9 Editorial %J J Med Internet Res %G English %X COVID-19 is currently the third leading cause of death in the United States, and unvaccinated people continue to die in high numbers. Vaccine hesitancy and vaccine refusal are fueled by COVID-19 misinformation and disinformation on social media platforms. This online COVID-19 infodemic has deadly consequences. In this editorial, the authors examine the roles that social media companies play in the COVID-19 infodemic and their obligations to end it. They describe how fake news about the virus developed on social media and acknowledge the initially muted response by the scientific community to counteract misinformation. The authors then challenge social media companies to better mitigate the COVID-19 infodemic, describing legal and ethical imperatives to do so. They close with recommendations for better partnerships with community influencers and implementation scientists, and they provide the next steps for all readers to consider. This guest editorial accompanies the Journal of Medical Internet Research special theme issue, “Social Media, Ethics, and COVID-19 Misinformation.” %M 35007204 %R 10.2196/35552 %U https://www.jmir.org/2022/2/e35552 %U https://doi.org/10.2196/35552 %U http://www.ncbi.nlm.nih.gov/pubmed/35007204 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 2 %P e29012 %T The Impact of Artificial Intelligence on Waiting Time for Medical Care in an Urgent Care Service for COVID-19: Single-Center Prospective Study %A Bin,Kaio Jia %A Melo,Adler Araujo Ribeiro %A da Rocha,José Guilherme Moraes Franco %A de Almeida,Renata Pivi %A Cobello Junior,Vilson %A Maia,Fernando Liebhart %A de Faria,Elizabeth %A Pereira,Antonio José %A Battistella,Linamara Rizzo %A Ono,Suzane Kioko %+ Hospital das Clinicas, Faculdade de Medicina, Universidade de Sao Paulo, Rua Dr. Ovidio Pires de Campos 225, Sao Paulo, 05403-110, Brazil, 55 1126616208, kaiobin@gmail.com %K COVID-19 %K artificial intelligence %K robotic process automation %K digital health %K health care management %K pandemic %K waiting time %K queue %K nonvalue-added activities %D 2022 %7 1.2.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: To demonstrate the value of implementation of an artificial intelligence solution in health care service, a winning project of the Massachusetts Institute of Technology Hacking Medicine Brazil competition was implemented in an urgent care service for health care professionals at Hospital das Clínicas of the Faculdade de Medicina da Universidade de São Paulo during the COVID-19 pandemic. Objective: The aim of this study was to determine the impact of implementation of the digital solution in the urgent care service, assessing the reduction of nonvalue-added activities and its effect on the nurses’ time required for screening and the waiting time for patients to receive medical care. Methods: This was a single-center, comparative, prospective study designed according to the Public Health England guide “Evaluating Digital Products for Health.” A total of 38,042 visits were analyzed over 18 months to determine the impact of implementing the digital solution. Medical care registration, health screening, and waiting time for medical care were compared before and after implementation of the digital solution. Results: The digital solution automated 92% of medical care registrations. The time for health screening increased by approximately 16% during the implementation and in the first 3 months after the implementation. The waiting time for medical care after automation with the digital solution was reduced by approximately 12 minutes compared with that required for visits without automation. The total time savings in the 12 months after implementation was estimated to be 2508 hours. Conclusions: The digital solution was able to reduce nonvalue-added activities, without a substantial impact on health screening, and further saved waiting time for medical care in an urgent care service in Brazil during the COVID-19 pandemic. %M 35103611 %R 10.2196/29012 %U https://formative.jmir.org/2022/2/e29012 %U https://doi.org/10.2196/29012 %U http://www.ncbi.nlm.nih.gov/pubmed/35103611 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e35763 %T Has Omicron Changed the Evolution of the Pandemic? %A Lundberg,Alexander L %A Lorenzo-Redondo,Ramon %A Ozer,Egon A %A Hawkins,Claudia A %A Hultquist,Judd F %A Welch,Sarah B %A Prasad,PV Vara %A Oehmke,James F %A Achenbach,Chad J %A Murphy,Robert L %A White,Janine I %A Havey,Robert J %A Post,Lori Ann %+ Buehler Center for Health Policy and Economics, Robert J. Havey, MD Institute for Global Health, Northwestern University, 750 N. Lake Shore Drive, Chicago, IL, 60611, United States, 1 312 503 5659, lori.post@northwestern.edu %K Omicron %K SARS-CoV-2 %K public health surveillance %K VOC %K variant of concern %K Delta %K Beta %K COVID-19 %K sub-Saharan Africa %K public health %K pandemic %K epidemiology %D 2022 %7 31.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Variants of the SARS-CoV-2 virus carry differential risks to public health. The Omicron (B.1.1.529) variant, first identified in Botswana on November 11, 2021, has spread globally faster than any previous variant of concern. Understanding the transmissibility of Omicron is vital in the development of public health policy. Objective: The aim of this study is to compare SARS-CoV-2 outbreaks driven by Omicron to those driven by prior variants of concern in terms of both the speed and magnitude of an outbreak. Methods: We analyzed trends in outbreaks by variant of concern with validated surveillance metrics in several southern African countries. The region offers an ideal setting for a natural experiment given that most outbreaks thus far have been driven primarily by a single variant at a time. With a daily longitudinal data set of new infections, total vaccinations, and cumulative infections in countries in sub-Saharan Africa, we estimated how the emergence of Omicron has altered the trajectory of SARS-CoV-2 outbreaks. We used the Arellano-Bond method to estimate regression coefficients from a dynamic panel model, in which new infections are a function of infections yesterday and last week. We controlled for vaccinations and prior infections in the population. To test whether Omicron has changed the average trajectory of a SARS-CoV-2 outbreak, we included an interaction between an indicator variable for the emergence of Omicron and lagged infections. Results: The observed Omicron outbreaks in this study reach the outbreak threshold within 5-10 days after first detection, whereas other variants of concern have taken at least 14 days and up to as many as 35 days. The Omicron outbreaks also reach peak rates of new cases that are roughly 1.5-2 times those of prior variants of concern. Dynamic panel regression estimates confirm Omicron has created a statistically significant shift in viral spread. Conclusions: The transmissibility of Omicron is markedly higher than prior variants of concern. At the population level, the Omicron outbreaks occurred more quickly and with larger magnitude, despite substantial increases in vaccinations and prior infections, which should have otherwise reduced susceptibility to new infections. Unless public health policies are substantially altered, Omicron outbreaks in other countries are likely to occur with little warning. %M 35072638 %R 10.2196/35763 %U https://publichealth.jmir.org/2022/1/e35763 %U https://doi.org/10.2196/35763 %U http://www.ncbi.nlm.nih.gov/pubmed/35072638 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 11 %N 1 %P e29880 %T Quantifying the Impact of COVID-19 on Telemedicine Utilization: Retrospective Observational Study %A Vogt,Emily Louise %A Welch,Brandon M %A Bunnell,Brian E %A Barrera,Janelle F %A Paige,Samantha R %A Owens,Marisa %A Coffey,Patricia %A Diazgranados,Nancy %A Goldman,David %+ Lab of Neurogenetics, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, 5625 Fishers Lane, Rm 3S-32: MSC 9412, Rockville, MD, 20892, United States, 1 301 443 0059, davidgoldman@mail.nih.gov %K telemedicine %K COVID-19 %K utilization %K impact %K retrospective %K observational %K trend %K telehealth %K health policy %K policy %D 2022 %7 28.1.2022 %9 Original Paper %J Interact J Med Res %G English %X Background: While telemedicine has been expanding over the past decade, the COVID-19–related restrictions regarding in-person care have led to unprecedented levels of telemedicine utilization. To the authors’ knowledge, no studies to date have quantitatively analyzed both national and regional trends in telemedicine utilization during the pandemic, both of which have key implications for informing health policy. Objective: This study aimed to investigate how trends in telemedicine utilization changed across the course of the COVID-19 pandemic. Methods: Using data from doxy.me, the largest free telemedicine platform, and the NIH (National Institutes of Health) Clinical Center, the largest clinical research hospital in the United States, we assessed changes in total telemedicine minutes, new provider registrations, monthly sessions, and average session length from March to November 2020. We also conducted a state-level analysis of how telemedicine expansion differed by region. Results: National telemedicine utilization peaked in April 2020 at 291 million minutes and stabilized at 200 to 220 million monthly minutes from May to November 2020. Surges were strongest in New England and weakest in the South and West. Greater telemedicine expansion during the COVID-19 pandemic was geographically associated with fewer COVID-19 cases per capita. The nature of telemedicine visits also changed, as the average monthly visits per provider doubled and the average visit length decreased by 60%. Conclusions: The COVID-19 pandemic led to an abrupt and subsequently sustained uptick in telemedicine utilization. Regional and institute-level differences in telemedicine utilization should be further investigated to inform policy and procedures for sustaining meaningful telemedicine use in clinical practice. %M 34751158 %R 10.2196/29880 %U https://www.i-jmr.org/2022/1/e29880 %U https://doi.org/10.2196/29880 %U http://www.ncbi.nlm.nih.gov/pubmed/34751158 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 2 %N 1 %P e29894 %T Misinformation About and Interest in Chlorine Dioxide During the COVID-19 Pandemic in Mexico Identified Using Google Trends Data: Infodemiology Study %A Chejfec-Ciociano,Jonathan Matias %A Martínez-Herrera,Juan Pablo %A Parra-Guerra,Alexa Darianna %A Chejfec,Ricardo %A Barbosa-Camacho,Francisco José %A Ibarrola-Peña,Juan Carlos %A Cervantes-Guevara,Gabino %A Cervantes-Cardona,Guillermo Alonso %A Fuentes-Orozco,Clotilde %A Cervantes-Pérez,Enrique %A García-Reyna,Benjamín %A González-Ojeda,Alejandro %+ Unidad de Investigación Biomédica 02, Hospital de Especialidades del Centro Médico Nacional de Occidente, Instituto Mexicano del Seguro Social, Belisario Domínguez 1000, Guadalajara, 44349, Mexico, 52 3331294165, avygail5@gmail.com %K coronavirus %K COVID-19 %K Google Trends %K chlorine dioxide %K COVID-19 misinformation %K public health surveillance %K infodemiology %K internet behavior %K digital epidemiology %K internet %K mHealth %K mobile health %K pandemic %K tele-epidemiology %D 2022 %7 27.1.2022 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic has prompted the increasing popularity of several emerging therapies or preventives that lack scientific evidence or go against medical directives. One such therapy involves the consumption of chlorine dioxide, which is commonly used in the cleaning industry and is available commercially as a mineral solution. This substance has been promoted as a preventive or treatment agent for several diseases, including SARS-CoV-2 infection. As interest in chlorine dioxide has grown since the start of the pandemic, health agencies, institutions, and organizations worldwide have tried to discourage and restrict the consumption of this substance. Objective: The aim of this study is to analyze search engine trends in Mexico to evaluate changes in public interest in chlorine dioxide since the beginning of the COVID-19 pandemic. Methods: We retrieved public query data for the Spanish equivalent of the term “chlorine dioxide” from the Google Trends platform. The location was set to Mexico, and the time frame was from March 3, 2019, to February 21, 2021. A descriptive analysis was performed. The Kruskal-Wallis and Dunn tests were used to identify significant changes in search volumes for this term between four consecutive time periods, each of 13 weeks, from March 1, 2020, to February 27, 2021. Results: From the start of the pandemic in Mexico (February 2020), an upward trend was observed in the number of searches compared with that in 2019. Maximum volume trends were recorded during the week of July 19-25, 2020. The search volumes declined between September and November 2020, but another peak was registered in December 2020 through February 2021, which reached a maximum value on January 10. Percentage change from the first to the fourth time periods was +312.85, –71.35, and +228.18, respectively. Pairwise comparisons using the Kruskal-Wallis and Dunn tests showed significant differences between the four periods (P<.001). Conclusions: Misinformation is a public health risk because it can lower compliance with the recommended measures and encourage the use of therapies that have not been proven safe. The ingestion of chlorine dioxide presents a danger to the population, and several adverse reactions have been reported. Programs should be implemented to direct those interested in this substance to accurate medical information. %M 35155994 %R 10.2196/29894 %U https://infodemiology.jmir.org/2022/1/e29894 %U https://doi.org/10.2196/29894 %U http://www.ncbi.nlm.nih.gov/pubmed/35155994 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 3 %N 1 %P e29539 %T COVID-19 Infection and Symptoms Among Emergency Medicine Residents and Fellows in an Urban Academic Hospital Setting: Cross-sectional Questionnaire Study %A Frisch,Stacey %A Jones,Sarah %A Willis,James %A Sinert,Richard %+ Department of Emergency Medicine, SUNY Downstate Health Sciences University, 450 Clarkson Ave, Brooklyn, NY, 11203, United States, 1 718 245 3318, staceyfrischmd@gmail.com %K COVID-19 %K emergency medicine %K housestaff wellness %K medical education %K training %K frontline health care workers %K frontline %K personal protective equipment %K pandemic %K infectious disease %K emergency %D 2022 %7 27.1.2022 %9 Original Paper %J JMIRx Med %G English %X 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. %M 35263391 %R 10.2196/29539 %U https://med.jmirx.org/2022/1/e29539 %U https://doi.org/10.2196/29539 %U http://www.ncbi.nlm.nih.gov/pubmed/35263391 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32713 %T The Role of Unobtrusive Home-Based Continuous Sensing in the Management of Postacute Sequelae of SARS CoV-2 %A Corman,Benjamin Harris Peterson %A Rajupet,Sritha %A Ye,Fan %A Schoenfeld,Elinor Randi %+ Department of Electrical and Computer Engineering, College of Engineering and Applied Science, Stony Brook University, Light Engineering Building, Room 217, Stony Brook, NY, 11794-2350, United States, 1 631 632 8393, fan.ye@stonybrook.edu %K SARS CoV-2 %K COVID-19 %K post-acute sequelae of SARS CoV-2 (PASC) %K post-COVID %K long COVID %K continuous sensing %K passive monitoring %K wearable sensors %K contactless sensors %K vital sign monitoring %D 2022 %7 26.1.2022 %9 Viewpoint %J J Med Internet Res %G English %X Amid the COVID-19 pandemic, it has been reported that greater than 35% of patients with confirmed or suspected COVID-19 develop postacute sequelae of SARS CoV-2 (PASC). PASC is still a disease for which preliminary medical data are being collected—mostly measurements collected during hospital or clinical visits—and pathophysiological understanding is yet in its infancy. The disease is notable for its prevalence and its variable symptom presentation, and as such, management plans could be more holistically made if health care providers had access to unobtrusive home-based wearable and contactless continuous physiologic and physical sensor data. Such between-hospital or between-clinic data can quantitatively elucidate a majority of the temporal evolution of PASC symptoms. Although not universally of comparable accuracy to gold standard medical devices, home-deployed sensors offer great insights into the development and progression of PASC. Suitable sensors include those providing vital signs and activity measurements that correlate directly or by proxy to documented PASC symptoms. Such continuous, home-based data can give care providers contextualized information from which symptom exacerbation or relieving factors may be classified. Such data can also improve the collective academic understanding of PASC by providing temporally and activity-associated symptom cataloging. In this viewpoint, we make a case for the utilization of home-based continuous sensing that can serve as a foundation from which medical professionals and engineers may develop and pursue long-term mitigation strategies for PASC. %M 34932496 %R 10.2196/32713 %U https://www.jmir.org/2022/1/e32713 %U https://doi.org/10.2196/32713 %U http://www.ncbi.nlm.nih.gov/pubmed/34932496 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33697 %T Patient Preferences for Patient Portal–Based Telepsychiatry in a Safety Net Hospital Setting During COVID-19: Cross-sectional Study %A Yue,Han %A Mail,Victoria %A DiSalvo,Maura %A Borba,Christina %A Piechniczek-Buczek,Joanna %A Yule,Amy M %+ Department of Psychiatry, Boston Medical Center, 720 Harrison Avenue, Suite 915, Boston, MA, 02118, United States, 1 2402719122, han.yue@bmc.org %K patient portal %K telemedicine %K telepsychiatry %K COVID-19 %K portal %K mental health %K psychiatry %K engagement %K behavior %K video %K hospital %K urban %K outreach %D 2022 %7 26.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Patient portals are a safe and secure way for patients to connect with providers for video-based telepsychiatry and help to overcome the financial and logistical barriers associated with face-to-face mental health care. Due to the COVID-19 pandemic, telepsychiatry has become increasingly important to obtaining mental health care. However, financial and technological barriers, termed the “digital divide,” prevent some patients from accessing the technology needed to use telepsychiatry services. Objective: As an extension to a clinic’s outreach project during COVID-19 to improve patient engagement with video-based visits through the hospital’s patient portal among adult behavioral health patients at an urban safety net hospital, we aim to assess patient preference for patient portal–based video visits or telephone-only visits and to identify the demographic variables associated with their preference. Methods: Patients in an outpatient psychiatry clinic were contacted by phone, and preference for telepsychiatry by phone or video through a patient portal, as well as device preference for video-based visits, were documented. Patient demographic characteristics were collected from the electronic medical record. Results: A total of 128 patients were reached by phone. A total of 79 (61.7%) patients chose video-based visits, and 69.6% (n=55) of these patients preferred to access the patient portal through a smartphone. Older patients were significantly less likely to agree to video-based visits. Conclusions: Among behavioral health patients at a safety net hospital, there was relatively low engagement with video-based visits through the hospital’s patient portal, particularly among older adults. %M 34932497 %R 10.2196/33697 %U https://formative.jmir.org/2022/1/e33697 %U https://doi.org/10.2196/33697 %U http://www.ncbi.nlm.nih.gov/pubmed/34932497 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e29892 %T Immune-Mediated Mechanisms in Patients Testing Positive for SARS-CoV-2: Protocol for a Multianalysis Study %A Ietto,Giuseppe %A Mortara,Lorenzo %A Dalla Gasperina,Daniela %A Iovino,Domenico %A Azzi,Lorenzo %A Baj,Andreina %A Ageno,Walter %A Genoni,Angelo Paolo %A Acquati,Francesco %A Gallazzi,Matteo %A Spina,Giorgia %A Coco,Grace %A Pierin,Federica %A Noonan,Douglas %A Vigezzi,Andrea %A Monti,Elisa %A Iori,Valentina %A Masci,Federica %A Franchi,Caterina %A Di Saverio,Salomone %A Carcano,Giulio %+ General Emergency and Transplant Surgery Department, University of Insubria, V Guicciardini, 9, Varese, 21100, Italy, 39 3398758024, giuseppe.ietto@gmail.com %K SARS-CoV-2 %K COVID-19 %K immunomodulation %K severe acute respiratory syndrome %K mechanism %K phenotype %K immunology %K white blood cell %K immune system %K monocyte %K natural killer cell %K blood %K infectious disease %K immune response %K antigen %K vaccine %K immunity %K protection %K genetics %K epidemiology %D 2022 %7 25.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The novel coronavirus has a high mortality rate (over 1% for patients older than 50 years). This can only be partially ascribed to other comorbidities. A possible explanation is a factor that assures a prompt response to SARS-CoV-2 in younger people, independent from the novelty of the virus itself. A factor is believed to stimulate the immune system and provide immunity against more antigens. The only external stimulation received by healthy people is vaccination (eg, the diphtheria, tetanus, and pertussis [DTP] vaccine). One hypothesis is that vaccination helps develop specific immunity but generates sprouting immunity against antigens in transit. The underlying immunological phenomena are the “bystander effect” and “trained immunity.” The developed immunity gives protection for years until it naturally fades out. After the fifth decade of life, the immune system is almost incompetent when a viral infection occurs, and thus, at this stage, the novel coronavirus can enter the body and cause acute respiratory distress syndrome. Objective: The initial aim is to demonstrate that blood monocytes and natural killer cells show overpowering hyperactivity, while CD4+ and CD8+ T cells experience impediments to their defensive functions in patients with severe SARS-CoV-2 infection. The secondary objectives are to correlate clinical data and vaccination history with laboratory immune patterns in order to identify protective factors. Subsequently, we are also interested in characterizing the phenotypes and state of the degree of activation of peripheral blood mononuclear cells, including monocytes, natural killer cells, and CD4+ and CD8+ T cells, in healthy subjects vaccinated with the Pfizer vaccine. Methods: Data will be collected using the following 3 approaches: (1) an experimental analysis to study the innate immune response and to identify genetic profiles; (2) an epidemiological analysis to identify the patients’ vaccination history; and (3) a clinical analysis to detect the immunological profile. Results: The protocol was approved by the Ethics Committee on April 16, 2020, and the study started on April 27, 2020. As of February 2021, enrollment has been completed. Immunological analysis is ongoing, and we expect to complete this analysis by December 2022. Conclusions: We will recognize different populations of patients, each one with a specific immunological pattern in terms of cytokines, soluble factor serum levels, and immune cell activity. Anamnestic data, such as preceding vaccinations and comorbidities, biochemical findings like lymphocyte immunophenotyping, and pre-existing persistent cytomegalovirus infection, allow depicting the risk profile of severe COVID-19. Proof of the roles of these immunological phenomena in the development of COVID-19 can be the basis for the implementation of therapeutic immunomodulatory treatments. Trial Registration: ClinicalTrials.gov NCT04375176; https://clinicaltrials.gov/ct2/show/NCT04375176 International Registered Report Identifier (IRRID): DERR1-10.2196/29892 %M 34854818 %R 10.2196/29892 %U https://www.researchprotocols.org/2022/1/e29892 %U https://doi.org/10.2196/29892 %U http://www.ncbi.nlm.nih.gov/pubmed/34854818 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e34966 %T COVID-19 Preventive Behaviors and Health Literacy, Information Evaluation, and Decision-making Skills in Japanese Adults: Cross-sectional Survey Study %A Nakayama,Kazuhiro %A Yonekura,Yuki %A Danya,Hitomi %A Hagiwara,Kanako %+ Department of Nursing Informatics, Graduate School of Nursing Science, St. Luke’s International University, 10-1, Akashi-cho, Chuo-ku, Tokyo, 104-0044, Japan, 81 3 5550 2284, nakayama@slcn.ac.jp %K coronavirus %K COVID-19 %K health literacy %K health information %K decision-making %K health promotion %K prevention %K behavior %K survey %K evaluation %D 2022 %7 24.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Health literacy is important for the prevention of COVID-19 transmission. Research in Japan shows that health literacy is related to skills in evaluating information and decision-making (skills that are not necessarily limited to information about health). Such basic skills are important, particularly when individuals encounter new health issues for which there is insufficient evidence. Objective: We aimed to determine the extent to which COVID-19 preventive behaviors were associated with health literacy and skills in evaluating information and making decisions. Methods: A web-based questionnaire survey was conducted using a Japanese internet research company. The measures comprised 8 items on COVID-19 preventive behaviors, health literacy items (European Health Literacy Survey Questionnaire), 5 items on information evaluation, and 4 items on decision-making process. Pearson correlations between these variables were calculated. Multivariable analyses were also conducted using the COVID-19 preventive behavior score as a dependent variable. Results: A total of 3914 valid responses were received.COVID-19 preventive behaviors were significantly correlated with health literacy (r=0.23), information evaluation (r=0.24), and decision-making process (r=0.30). Standardized regression coefficients (health literacy: β=.11; information evaluation: β=.13; decision-making: β=.18) showed that decision-making process contributed the most. Conclusions: Although comprehensive health literacy is necessary for COVID-19 preventive behaviors, the skills to evaluate a wide range of information and to make appropriate decisions are no less important. Opportunities for people to acquire these skills should be available at all times. %M 34982036 %R 10.2196/34966 %U https://formative.jmir.org/2022/1/e34966 %U https://doi.org/10.2196/34966 %U http://www.ncbi.nlm.nih.gov/pubmed/34982036 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31549 %T The Development and Validation of Simplified Machine Learning Algorithms to Predict Prognosis of Hospitalized Patients With COVID-19: Multicenter, Retrospective Study %A He,Fang %A Page,John H %A Weinberg,Kerry R %A Mishra,Anirban %+ Amgen Inc, Center for Observational Research, 1120 Veterans Boulevard, South San Francisco, CA, 94080, United States, 1 925 216 1658, fhe01@amgen.com %K COVID-19 %K predictive algorithm %K prognostic model %K machine learning %D 2022 %7 21.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: The current COVID-19 pandemic is unprecedented; under resource-constrained settings, predictive algorithms can help to stratify disease severity, alerting physicians of high-risk patients; however, there are only few risk scores derived from a substantially large electronic health record (EHR) data set, using simplified predictors as input. Objective: The objectives of this study were to develop and validate simplified machine learning algorithms that predict COVID-19 adverse outcomes; to evaluate the area under the receiver operating characteristic curve (AUC), sensitivity, specificity, and calibration of the algorithms; and to derive clinically meaningful thresholds. Methods: We performed machine learning model development and validation via a cohort study using multicenter, patient-level, longitudinal EHRs from the Optum COVID-19 database that provides anonymized, longitudinal EHR from across the United States. The models were developed based on clinical characteristics to predict 28-day in-hospital mortality, intensive care unit (ICU) admission, respiratory failure, and mechanical ventilator usages at inpatient setting. Data from patients who were admitted from February 1, 2020, to September 7, 2020, were randomly sampled into development, validation, and test data sets; data collected from September 7, 2020, to November 15, 2020, were reserved as the postdevelopment prospective test data set. Results: Of the 3.7 million patients in the analysis, 585,867 patients were diagnosed or tested positive for SARS-CoV-2, and 50,703 adult patients were hospitalized with COVID-19 between February 1 and November 15, 2020. Among the study cohort (n=50,703), there were 6204 deaths, 9564 ICU admissions, 6478 mechanically ventilated or EMCO patients, and 25,169 patients developed acute respiratory distress syndrome or respiratory failure within 28 days since hospital admission. The algorithms demonstrated high accuracy (AUC 0.89, 95% CI 0.89-0.89 on the test data set [n=10,752]), consistent prediction through the second wave of the pandemic from September to November (AUC 0.85, 95% CI 0.85-0.86) on the postdevelopment prospective test data set [n=14,863], great clinical relevance, and utility. Besides, a comprehensive set of 386 input covariates from baseline or at admission were included in the analysis; the end-to-end pipeline automates feature selection and model development. The parsimonious model with only 10 input predictors produced comparably accurate predictions; these 10 predictors (age, blood urea nitrogen, SpO2, systolic and diastolic blood pressures, respiration rate, pulse, temperature, albumin, and major cognitive disorder excluding stroke) are commonly measured and concordant with recognized risk factors for COVID-19. Conclusions: The systematic approach and rigorous validation demonstrate consistent model performance to predict even beyond the period of data collection, with satisfactory discriminatory power and great clinical utility. Overall, the study offers an accurate, validated, and reliable prediction model based on only 10 clinical features as a prognostic tool to stratifying patients with COVID-19 into intermediate-, high-, and very high-risk groups. This simple predictive tool is shared with a wider health care community, to enable service as an early warning system to alert physicians of possible high-risk patients, or as a resource triaging tool to optimize health care resources. %M 34951865 %R 10.2196/31549 %U https://www.jmir.org/2022/1/e31549 %U https://doi.org/10.2196/31549 %U http://www.ncbi.nlm.nih.gov/pubmed/34951865 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 5 %N 1 %P e34578 %T From the Cochrane Library: Interventions for Necrotizing Soft Tissue Infections in Adults %A Shakshouk,Hadir %A Hua,Camille %A Adler,Brandon L %A Ortega-Loayza,Alex G %+ Department of Dermatology, Oregon Health & Science University, 3303 SW Bond Ave, CH16D, Portland, OR, 97239, United States, 1 9196194096, ortegalo@ohsu.edu %K necrotizing soft tissue infections %K therapy %K intervention %K systematic review %K infections %K management %K evidence-based medicine %K dermatology %K skin infection %D 2022 %7 21.1.2022 %9 Research Letter %J JMIR Dermatol %G English %X %M 37632849 %R 10.2196/34578 %U https://derma.jmir.org/2022/1/e34578 %U https://doi.org/10.2196/34578 %U http://www.ncbi.nlm.nih.gov/pubmed/37632849 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e30078 %T School Attendance Registers for the Syndromic Surveillance of Infectious Intestinal Disease in UK Children: Protocol for a Retrospective Analysis %A Donaldson,Anna L %A Harris,John P %A Vivancos,Roberto %A Hungerford,Daniel %A Hall,Ian %A O'Brien,Sarah J %+ NIHR Health Protection Research Unit in Gastrointestinal Infections, University of Liverpool, 2nd Floor, Block F, Waterhouse Buildings, 1-5 Brownlow Street, Liverpool, L69 3GL, United Kingdom, 44 151 795 8347, A.Donaldson2@liverpool.ac.uk %K syndromic surveillance %K schools %K children %K absenteeism %K infectious intestinal disease %K diarrhea and vomiting %K school attendance registers %D 2022 %7 20.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: Infectious intestinal disease (IID) is common, and children are more likely than adults both to have IID and to transmit infection onto others. Before the introduction of the vaccine, rotavirus was the leading cause of severe childhood diarrhea, with norovirus and Campylobacter predominate pathogens. Public health surveillance of IID is primarily based on health care data, and as such, illness that is managed within the community will often go undetected. School attendance registers offer a novel data set that has the potential to identify community cases and outbreaks of IID that would otherwise be missed by current health surveillance systems. Although studies have explored the role of school attendance registers in the monitoring of influenza among children, no studies have been identified that consider this approach in the surveillance of IID. Objective: The aim of this study is to explore the role and utility of school attendance registers in the detection and surveillance of IID in children. The secondary aims are to estimate the burden of IID on school absenteeism and to assess the impact of the rotavirus vaccine on illness absence among school-aged children. Methods: This study is a retrospective analysis of school attendance registers to investigate whether school absences due to illness can be used to capture seasonal trends and outbreaks of infectious intestinal disease among school-aged children. School absences in Merseyside, United Kingdom will be compared and combined with routine health surveillance data from primary care, laboratories, and telehealth services. These data will be used to model spatial and temporal variations in the incidence of IID and to apportion likely causes to changes in school absenteeism trends. This will be used to assess the potential utility of school attendance data in the surveillance of IID and to estimate the burden of IID absenteeism in schools. It will also inform an analysis of the impact of the rotavirus vaccine on disease within this age group. Results: This study has received ethical approval from the University of Liverpool Research Ethics Committee (reference number 1819). Use of general practice data has been approved for the evaluation of rotavirus vaccination in Merseyside by NHS Research Ethics Committee, South Central-Berkshire REC Reference 14/SC/1140. Conclusions: This study is unique in considering whether school attendance registers could be used to enhance the surveillance of IID. Such data have multiple potential applications and could improve the identification of outbreaks within schools, allowing early intervention to reduce transmission both within and outside of school settings. These data have the potential to act as an early warning system, identifying infections circulating within the community before they enter health care settings. School attendance data could also inform the evaluation of vaccination programs, such as rotavirus and, in time, norovirus. International Registered Report Identifier (IRRID): DERR1-10.2196/30078 %M 35049509 %R 10.2196/30078 %U https://www.researchprotocols.org/2022/1/e30078 %U https://doi.org/10.2196/30078 %U http://www.ncbi.nlm.nih.gov/pubmed/35049509 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e29635 %T Health Care Providers’ and Professionals’ Experiences With Telehealth Oncology Implementation During the COVID-19 Pandemic: A Qualitative Study %A Turner,Kea %A Bobonis Babilonia,Margarita %A Naso,Cristina %A Nguyen,Oliver %A Gonzalez,Brian D %A Oswald,Laura B %A Robinson,Edmondo %A Elston Lafata,Jennifer %A Ferguson,Robert J %A Alishahi Tabriz,Amir %A Patel,Krupal B %A Hallanger-Johnson,Julie %A Aldawoodi,Nasrin %A Hong,Young-Rock %A Jim,Heather S L %A Spiess,Philippe E %+ Department of Health Outcomes and Behavior, Moffitt Cancer Center, 12902 USF Magnolia Drive, MRC-CANCONT, Tampa, FL, 33612-9416, United States, 1 (813) 745 5213, kea.turner@moffitt.org %K telehealth %K telemedicine %K teleoncology %K digital health %K remote monitoring %K cancer %K oncology %K coronavirus disease %K COVID-19 %D 2022 %7 19.1.2022 %9 Original Paper %J J Med Internet Res %G English %X Background: Rapid implementation of telehealth for cancer care during COVID-19 required innovative and adaptive solutions among oncology health care providers and professionals (HPPs). Objective: The aim of this qualitative study was to explore oncology HPPs’ experiences with telehealth implementation during the COVID-19 pandemic. Methods: This study was conducted at Moffitt Cancer Center (Moffitt), an NCI (National Cancer Institute)-Designated Comprehensive Cancer Center. Prior to COVID-19, Moffitt piloted telehealth visits on a limited basis. After COVID-19, Moffitt rapidly expanded telehealth visits. Telehealth visits included real-time videoconferencing between HPPs and patients and virtual check-ins (ie, brief communication with an HPP by telephone only). We conducted semistructured interviews with 40 oncology HPPs who implemented telehealth during COVID-19. The interviews were recorded, transcribed verbatim, and analyzed for themes using Dedoose software (version 4.12). Results: Approximately half of the 40 participants were physicians (n=22, 55%), and one-quarter of the participants were advanced practice providers (n=10, 25%). Other participants included social workers (n=3, 8%), psychologists (n=2, 5%), dieticians (n=2, 5%), and a pharmacist (n=1, 3%). Five key themes were identified: (1) establishing and maintaining patient-HPP relationships, (2) coordinating care with other HPPs and informal caregivers, (3) adapting in-person assessments for telehealth, (4) developing workflows and allocating resources, and (5) future recommendations. Participants described innovative strategies for implementing telehealth, such as coordinating interdisciplinary visits with multiple HPPs and inviting informal caregivers (eg, spouse) to participate in telehealth visits. Health care workers discussed key challenges, such as workflow integration, lack of physical exam and biometric data, and overcoming the digital divide (eg, telehealth accessibility among patients with communication-related disabilities). Participants recommended policy advocacy to support telehealth (eg, medical licensure policies) and monitoring how telehealth affects patient outcomes and health care delivery. Conclusions: To support telehealth growth, implementation strategies are needed to ensure that HPPs and patients have the tools necessary to effectively engage in telehealth. At the same time, cancer care organizations will need to engage in advocacy to ensure that policies are supportive of oncology telehealth and develop systems to monitor the impact of telehealth on patient outcomes, health care quality, costs, and equity. %M 34907900 %R 10.2196/29635 %U https://www.jmir.org/2022/1/e29635 %U https://doi.org/10.2196/29635 %U http://www.ncbi.nlm.nih.gov/pubmed/34907900 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e27270 %T Risk Factors of Dengue Fever in Urban Areas of Rawalpindi District in Pakistan During 2017: A Case Control Study %A Awan,Najma Javed %A Chaudhry,Ambreen %A Hussain,Zakir %A Baig,Zeeshan Iqbal %A Baig,Mirza Amir %A Asghar,Rana Jawad %A Khader,Yousef %A Ikram,Aamer %+ Field Epidemiology and Laboratory Training Program, National Institute of Health Pakistan, Park Road, Chak Shehzad, Islamabad, 44000, Pakistan, 92 519255302, ambr.chaudhry@gmail.com %K dengue fever %K outbreak %K Rawalpindi %K risk factors %K stored water %K urban %D 2022 %7 19.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During August 2017, increased numbers of suspected dengue fever cases were reported in the hospitals of Rawalpindi district. A case control study was conducted to determine the risk factors among urban areas, dengue serotype, and recommend preventive measures. Objective: The objective of the investigation was to determine the risk factors among urban areas, dengue serotype, and recommend preventive measures. Methods: A case was defined as having acute febrile illness with one or more of the following symptoms: retro-orbital pain, headache, rash, myalgia, arthralgia, and hemorrhage. The cases were residents of Rawalpindi and were confirmed for dengue fever from August 30, 2017, to October 30, 2017. All NS1 confirmed cases from urban areas of Rawalpindi were recruited from tertiary care hospitals. Age- and sex-matched controls were selected from the same community with a 1:1 ratio. Frequency, univariate, and multivariate analyses were performed at 95% CI with P<.05 considered statistically significant. Results: Totally 373 cases were recruited. The mean age was 36 (SD 2.9) years (range 10-69 years), and 280 cases (75%) were male. The most affected age group was 21-30 years (n=151, attack rate [AR] 40%), followed by 31-40 years (n=66, AR 23%). Further, 2 deaths were reported (case fatality rate of 0.53%). The most frequent signs or symptoms were fever (n=373, 100%), myalgia and headache (n=320, 86%), and retro-orbital pain (n=272, 73%). Serotype identification was carried out in 322 cases, and DEN-2 was the dominant serotype (n=126, 34%). Contact with a confirmed dengue case (odds ratio [OR] 4.27; 95% CI 3.14-5.81; P<.001), stored water in open containers at home (OR 2.04; 95% CI 1.53-2.73; P<.001), and travel to a dengue outbreak area (OR 2.88; 95% CI 2.12-3.92; P<.001) were the main reasons for the outbreak, whereas use of mosquito repellents (OR 0.12; 95% CI 0.09-0.18; P<.001) and regular water supply at home (OR 0.03; 95% CI 0.02-0.04; P<.001) showed protective effects. The geographical distribution of cases was limited to densely populated areas and all the 5 randomly collected water samples tested positive for dengue larvae. Conclusions: Stored water in containers inside houses and subsequent mosquito breeding were the most probable causes of this outbreak. Based on the study findings, undertaking activities to improve the use of mosquito repellents and removing sources of breeding (uncovered water stored indoors) are some recommendations for preventing dengue outbreaks. %M 35044313 %R 10.2196/27270 %U https://publichealth.jmir.org/2022/1/e27270 %U https://doi.org/10.2196/27270 %U http://www.ncbi.nlm.nih.gov/pubmed/35044313 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e32567 %T Dissemination and Implementation of a Google Apple Exposure Notification System for COVID-19 Risk Mitigation at a National Public University: Protocol for a Pilot Evaluation Study in a Real-World Setting %A Melvin,Cathy Lee %A Sterba,Katherine Regan %A Gimbel,Ron %A Lenert,Leslie Andrew %A Cartmell,Kathleen B %A , %+ Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 68 President St. Room BE103, Charleston, SC, 29425, United States, 1 843 876 2426, melvinc@musc.edu %K COVID-19 %K risk %K mitigation %K mobile phone technology %K exposure notification system %K university setting %K implementation science %K implementation %K dissemination %K notification %K university %K exposure %K transmission %K communication %K strategy %K outcome %K acceptability %K adoption %K usage %D 2022 %7 19.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: As SARS-CoV-2, the virus that causes COVID-19, spread rapidly across the United States in the spring of 2020, institutions of higher education faced numerous challenges associated with minimizing risk of exposure to COVID-19 among their students, faculty, staff, and surrounding communities. This paper describes the protocol, South Carolina (SC) Safer Together, developed by Clemson University (Clemson) to design, deploy, and evaluate multi-level communication and dissemination and implementation (D&I) strategies in line with recommendations from governmental and educational agencies to mitigate the risk of exposure to COVID-19. Safer Together was enhanced by the addition of the Google/Apple Exposure Notification app, an alternative strategy to support a recommendation of COVID-19 testing outcomes: contact tracing, isolation, and quarantine. Objective: This study aimed to (1) describe the content and intended audiences of D&I strategies used to deploy recommended COVID-19 mitigation strategies on a major college campus; (2) determine the reach, acceptability, adoption, and use of D&I strategies among target audiences among university students, faculty, and staff; and (3) characterize barriers and facilitators to the implementation and use of recommended mitigation strategies. Methods: The study team incorporated elements of the Health Belief Model, the Technology Acceptance Model, communication and social marketing models, and the Reach, Effectiveness, Adoption, Implementation, and Maintenance (RE-AIM) framework to identify and develop appropriate constructs and specific outcomes for inclusion in our approach to evaluate the communication, dissemination and implementation processes related to deployment of Safer Together at Clemson. A parallel convergent mixed methods design was used to (1) inform implementation strategies used to launch the program and (2) evaluate program reach, acceptability, adoption, and use guided by the RE-AIM framework. Data collection tools include surveys, data analytics–tracking, and focus groups or interviews with key stakeholders (students, employees, and university leadership). Results: Rigorously studying both the dissemination and implementation of Safer Together in a national public university setting is expected to yield lessons that will be valuable at many organizational and governmental settings. On a local level, broad adoption and use of the Safer Together may help reduce COVID-19 transmission and keep the university “open.” On a larger scale, lessons learned on how to influence student and employee behavior with respect to the use of a public health outbreak prevention tool including Safer Together may be applicable in future pandemic and outbreak situations. Conclusions: This study proposes a structured, theory-driven approach to evaluate dissemination and implementation strategies associated with the deployment of Safer Together in a university setting from the viewpoint of students, employees, and university leadership. Our results will inform future implementation of apps such as Safer Together at major state universities in SC. International Registered Report Identifier (IRRID): DERR1-10.2196/32567 %M 34978533 %R 10.2196/32567 %U https://www.researchprotocols.org/2022/1/e32567 %U https://doi.org/10.2196/32567 %U http://www.ncbi.nlm.nih.gov/pubmed/34978533 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e26868 %T COVID-19 Mask Usage and Social Distancing in Social Media Images: Large-scale Deep Learning Analysis %A Singh,Asmit Kumar %A Mehan,Paras %A Sharma,Divyanshu %A Pandey,Rohan %A Sethi,Tavpritesh %A Kumaraguru,Ponnurangam %+ Indraprastha Institute of Information Technology Delhi, Okhla Industrial Estate, Phase III, New Delhi, 110020, India, 91 11 26907533, tavpriteshsethi@iiitd.ac.in %K COVID-19 %K mask detection %K deep learning %K classification %K segmentation %K social media analysis %D 2022 %7 18.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The adoption of nonpharmaceutical interventions and their surveillance are critical for detecting and stopping possible transmission routes of COVID-19. A study of the effects of these interventions can help shape public health decisions. The efficacy of nonpharmaceutical interventions can be affected by public behaviors in events, such as protests. We examined mask use and mask fit in the United States, from social media images, especially during the Black Lives Matter (BLM) protests, representing the first large-scale public gatherings in the pandemic. Objective: This study assessed the use and fit of face masks and social distancing in the United States and events of large physical gatherings through public social media images from 6 cities and BLM protests. Methods: We collected and analyzed 2.04 million public social media images from New York City, Dallas, Seattle, New Orleans, Boston, and Minneapolis between February 1, 2020, and May 31, 2020. We evaluated correlations between online mask usage trends and COVID-19 cases. We looked for significant changes in mask use patterns and group posting around important policy decisions. For BLM protests, we analyzed 195,452 posts from New York and Minneapolis from May 25, 2020, to July 15, 2020. We looked at differences in adopting the preventive measures in the BLM protests through the mask fit score. Results: The average percentage of group pictures dropped from 8.05% to 4.65% after the lockdown week. New York City, Dallas, Seattle, New Orleans, Boston, and Minneapolis observed increases of 5.0%, 7.4%, 7.4%, 6.5%, 5.6%, and 7.1%, respectively, in mask use between February 2020 and May 2020. Boston and Minneapolis observed significant increases of 3.0% and 7.4%, respectively, in mask use after the mask mandates. Differences of 6.2% and 8.3% were found in group pictures between BLM posts and non-BLM posts for New York City and Minneapolis, respectively. In contrast, the differences in the percentage of masked faces in group pictures between BLM and non-BLM posts were 29.0% and 20.1% for New York City and Minneapolis, respectively. Across protests, 35% of individuals wore a mask with a fit score greater than 80%. Conclusions: The study found a significant drop in group posting when the stay-at-home laws were applied and a significant increase in mask use for 2 of 3 cities where masks were mandated. Although a positive trend toward mask use and social distancing was observed, a high percentage of posts showed disregard for the guidelines. BLM-related posts captured the lack of seriousness to safety measures, with a high percentage of group pictures and low mask fit scores. Thus, the methodology provides a directional indication of how government policies can be indirectly monitored through social media. %M 34479183 %R 10.2196/26868 %U https://publichealth.jmir.org/2022/1/e26868 %U https://doi.org/10.2196/26868 %U http://www.ncbi.nlm.nih.gov/pubmed/34479183 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e32140 %T Patterns of Suicide Ideation Across Eight Countries in Four Continents During the COVID-19 Pandemic Era: Repeated Cross-sectional Study %A Schluter,Philip J %A Généreux,Mélissa %A Hung,Kevin KC %A Landaverde,Elsa %A Law,Ronald P %A Mok,Catherine Pui Yin %A Murray,Virginia %A O'Sullivan,Tracey %A Qadar,Zeeshan %A Roy,Mathieu %+ School of Health Sciences, University of Canterbury - Te Whare Wananga o Waitaha, Private Bag 4800, Christchurch, 8140, New Zealand, 64 275106239, philip.schluter@canterbury.ac.nz %K pandemic %K infodemic %K psychosocial impacts %K sense of coherence %K suicide ideation %K epidemiology %K suicide %K pattern %K COVID-19 %K cross-sectional %K mental health %K misinformation %K risk %K prevalence %K gender %K age %K sociodemographic %D 2022 %7 17.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic and countries’ response measures have had a globally significant mental health impact. This mental health burden has also been fueled by an infodemic: an information overload that includes misinformation and disinformation. Suicide, the worst mental health outcome, is a serious public health problem that can be prevented with timely, evidence-based, and often low-cost interventions. Suicide ideation, one important risk factor for suicide, is thus important to measure and monitor, as are the factors that may impact on it. Objective: This investigation had 2 primary aims: (1) to estimate and compare country-specific prevalence of suicide ideation at 2 different time points, overall and by gender and age groups, and (2) to investigate the influence of sociodemographic and infodemic variables on suicide ideation. Methods: A repeated, online, 8-country (Canada, the United States, England, Switzerland, Belgium, Hong Kong, Philippines, and New Zealand), cross-sectional study was undertaken with adults aged ≥18 years, with measurement wave 1 conducted from May 29, 2020 to June 12, 2020 and measurement wave 2 conducted November 6-18, 2021. Self-reported suicide ideation was derived from item 9 of the Patient Health Questionnaire-9 (PHQ-9). Age-standardized suicide ideation rates were reported, a binomial regression model was used to estimate suicide ideation indication rates for each country and measurement wave, and logistic regression models were then employed to relate sociodemographic, pandemic, and infodemic variables to suicide ideation. Results: The final sample totaled 17,833 adults: 8806 (49.4%) from measurement wave 1 and 9027 (50.6%) from wave 2. Overall, 24.2% (2131/8806) and 27.5% (2486/9027) of participants reported suicide ideation at measurement waves 1 and 2, respectively, a difference that was significant (P<.001). Considerable variability was observed in suicide ideation age-standardized rates between countries, ranging from 15.6% in Belgium (wave 1) to 42.9% in Hong Kong (wave 2). Frequent social media usage was associated with increased suicide ideation at wave 2 (adjusted odds ratio [AOR] 1.47, 95% CI 1.25-1.72; P<.001) but not wave 1 (AOR 1.11, 95% CI 0.96-1.23; P=.16). However, having a weaker sense of coherence (SOC; AOR 3.80, 95% CI 3.18-4.55 at wave 1 and AOR 4.39, 95% CI 3.66-5.27 at wave 2; both P<.001) had the largest overall effect size. Conclusions: Suicide ideation is prevalent and significantly increasing over time in this COVID-19 pandemic era, with considerable variability between countries. Younger adults and those residing in Hong Kong carried disproportionately higher rates. Social media appears to have an increasingly detrimental association with suicide ideation, although having a stronger SOC had a larger protective effect. Policies and promotion of SOC, together with disseminating health information that explicitly tackles the infodemic’s misinformation and disinformation, may importantly reduce the rising mental health morbidity and mortality triggered by this pandemic. %M 34727524 %R 10.2196/32140 %U https://publichealth.jmir.org/2022/1/e32140 %U https://doi.org/10.2196/32140 %U http://www.ncbi.nlm.nih.gov/pubmed/34727524 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e22113 %T Reasons for Nonuse, Discontinuation of Use, and Acceptance of Additional Functionalities of a COVID-19 Contact Tracing App: Cross-sectional Survey Study %A Walrave,Michel %A Waeterloos,Cato %A Ponnet,Koen %+ MIOS Research Group and GOVTRUST Centre of Excellence, Department of Communication Studies, Faculty of Social Sciences, University of Antwerp, Sint-Jacobstraat 2, Antwerp, 2000, Belgium, 32 475459785, michel.walrave@uantwerp.be %K COVID-19 %K SARS-CoV-2 %K coronavirus %K contact tracing %K proximity tracing %K mHealth %K mobile app %K user acceptability %K surveillance %K privacy %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In several countries, contact tracing apps (CTAs) have been introduced to warn users if they have had high-risk contacts that could expose them to SARS-CoV-2 and could, therefore, develop COVID-19 or further transmit the virus. For CTAs to be effective, a sufficient critical mass of users is needed. Until now, adoption of these apps in several countries has been limited, resulting in questions on which factors prevent app uptake or stimulate discontinuation of app use. Objective: The aim of this study was to investigate individuals’ reasons for not using, or stopping use of, a CTA, in particular, the Coronalert app. Users’ and nonusers’ attitudes toward the app’s potential impact was assessed in Belgium. To further stimulate interest and potential use of a CTA, the study also investigated the population’s interest in new functionalities. Methods: An online survey was administered in Belgium to a sample of 1850 respondents aged 18 to 64 years. Data were collected between October 30 and November 2, 2020. Sociodemographic differences were assessed between users and nonusers. We analyzed both groups’ attitudes toward the potential impact of CTAs and their acceptance of new app functionalities. Results: Our data showed that 64.9% (1201/1850) of our respondents were nonusers of the CTA under study; this included individuals who did not install the app, those who downloaded but did not activate the app, and those who uninstalled the app. While we did not find any sociodemographic differences between users and nonusers, attitudes toward the app and its functionalities seemed to differ. The main reasons for not downloading and using the app were a perceived lack of advantages (308/991, 31.1%), worries about privacy (290/991, 29.3%), and, to a lesser extent, not having a smartphone (183/991, 18.5%). Users of the CTA agreed more with the potential of such apps to mitigate the consequences of the pandemic. Overall, nonusers found the possibility of extending the CTA with future functionalities to be less acceptable than users. However, among users, acceptability also tended to differ. Among users, functionalities relating to access and control, such as digital certificates or “green cards” for events, were less accepted (358/649, 55.2%) than functionalities focusing on informing citizens about the spread of the virus (453/649, 69.8%) or making an appointment to get tested (525/649, 80.9%). Conclusions: Our results show that app users were more convinced of the CTA’s utility and more inclined to accept new app features than nonusers. Moreover, nonusers had more CTA-related privacy concerns. Therefore, to further stimulate app adoption and use, its potential advantages and privacy-preserving mechanisms need to be stressed. Building further knowledge on the forms of resistance among nonusers is important for responding to these barriers through the app’s further development and communication campaigns. %M 34794117 %R 10.2196/22113 %U https://publichealth.jmir.org/2022/1/e22113 %U https://doi.org/10.2196/22113 %U http://www.ncbi.nlm.nih.gov/pubmed/34794117 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 5 %N 1 %P e35274 %T Investigating #covidnurse Messages on TikTok: Descriptive Study %A Yalamanchili,Bhavya %A Donelle,Lorie %A Jurado,Leo-Felix %A Fera,Joseph %A Basch,Corey H %+ William Paterson University, 300 Pompton Rd, Wayne, NJ, 07470, United States, 1 9737202603, baschc@wpunj.edu %K COVID-19 pandemic %K nurse %K burnout %K social media %K stress %K TikTok %K nursing %K COVID-19 %K pandemic %K social support %K digital peer support %K health communication %K peer support %D 2022 %7 14.1.2022 %9 Original Paper %J JMIR Nursing %G English %X Background: During a time of high stress and decreased social interaction, nurses have turned to social media platforms like TikTok as an outlet for expression, entertainment, and communication. Objective: The purpose of this cross-sectional content analysis study is to describe the content of videos with the hashtag #covidnurse on TikTok, which included 100 videos in the English language. Methods: At the time of the study, this hashtag had 116.9 million views. Each video was coded for content-related to what nurses encountered and were feeling during the COVID-19 pandemic. Results: Combined, the 100 videos sampled received 47,056,700 views; 76,856 comments; and 5,996,676 likes. There were 4 content categories that appeared in a majority (>50) of the videos: 83 showed the individual as a nurse, 72 showed the individual in professional attire, 58 mentioned/suggested stress, 55 used music, and 53 mentioned/suggested frustration. Those that mentioned stress and those that mentioned frustration received less than 50% of the total views (n=21,726,800, 46.17% and n=16,326,300, 34.69%, respectively). Although not a majority, 49 of the 100 videos mentioned the importance of nursing. These videos garnered 37.41% (n=17,606,000) of the total views, 34.82% (n=26,759) of the total comments, and 23.85% (n=1,430,213) of the total likes. So, despite nearly half of the total videos mentioning how important nurses are, these videos received less than half of the total views, comments, and likes. Conclusions: Social media and increasingly video-related online messaging such as TikTok are important platforms for social networking, social support, entertainment, and education on diverse topics, including health in general and COVID-19 specifically. This presents an opportunity for future research to assess the utility of the TikTok platform for meaningful engagement and health communication on important public health issues. %M 35029536 %R 10.2196/35274 %U https://nursing.jmir.org/2022/1/e35274 %U https://doi.org/10.2196/35274 %U http://www.ncbi.nlm.nih.gov/pubmed/35029536 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e30749 %T Determining the Prevalence and Incidence of SARS-CoV-2 Infection in Prisons in England: Protocol for a Repeated Panel Survey and Enhanced Outbreak Study %A Plugge,Emma %A Burke,Danielle %A Czachorowski,Maciej %A Gutridge,Kerry %A Maxwell,Fiona %A McGrath,Nuala %A O'Mara,Oscar %A O'Moore,Eamonn %A Parkes,Julie %+ University of Southampton, Southampton General Hospital, Southampton, SO16 6YD, United Kingdom, 44 07789033336, emma.plugge@phe.gov.uk %K COVID-19 %K epidemiology %K prison %K outbreak %K testing %K health inequalities %K SARS-CoV-2 %D 2022 %7 12.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: There are over 80,000 people imprisoned in England and Wales in 117 prisons. The management of the COVID-19 pandemic presents particular challenges in this setting where confined, crowded, and poorly ventilated conditions facilitate the rapid spread of infectious diseases. Objective: The COVID-19 in Prison Study aims to examine the epidemiology of SARS-CoV-2 in prisons in England in order to inform public health policy and practice during the pandemic and recovery. The primary objective is to estimate the proportion of positive tests of SARS-CoV-2 infection among residents and staff within selected prisons. The secondary objectives include estimating the incidence rate of SARS-CoV-2 infection and examining how the proportion of positive tests and the incidence rate vary among individual, institutional, and system level factors. Methods: Phase 1 comprises a repeated panel survey of prison residents and staff in a representative sample of 28 prisons across England. All residents and staff in the study prisons are eligible for inclusion. Participants will be tested for SARS-CoV-2 using a nasopharyngeal swab twice (6 weeks apart). Staff will also be tested for antibodies to SARS-CoV-2. Phase 2 focuses on SARS-CoV-2 infection in prisons with recognized COVID-19 outbreaks. Any prison in England will be eligible to participate if an outbreak is declared. In 3 outbreak prisons, all participating staff and residents will be tested for SARS-CoV-2 antigens at the following 3 timepoints: as soon as possible after the outbreak is declared (day 0), 7 days later (day 7), and at day 28. They will be swabbed twice (a nasal swab for lateral flow device testing and a nasopharyngeal swab for polymerase chain reaction testing). Testing will be done by external contractors. Data will also be collected on individual, prison level, and community factors. Data will be stored and handled at the University of Southampton and Public Health England. Summary statistics will summarize the prison and participant characteristics. For the primary objective, simple proportions of individuals testing positive for SARS-CoV-2 and incidence rates will be calculated. Linear regression will examine the individual, institutional, system, and community factors associated with SARS-CoV-2 infection within prisons. Results: The UK Government’s Department for Health and Social Care funds the study. Data collection started on July 20, 2020, and will end on May 31, 2021. As of May 2021, we had enrolled 4192 staff members and 6496 imprisoned people in the study. Data analysis has started, and we expect to publish the initial findings in summer/autumn 2021. The main ethical consideration is the inclusion of prisoners, who are vulnerable participants. Conclusions: This study will provide unique data to inform the public health management of SARS-CoV-2 in prisons. Its findings will be of relevance to health policy makers and practitioners working in prisons. International Registered Report Identifier (IRRID): DERR1-10.2196/30749 %M 34751157 %R 10.2196/30749 %U https://www.researchprotocols.org/2022/1/e30749 %U https://doi.org/10.2196/30749 %U http://www.ncbi.nlm.nih.gov/pubmed/34751157 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e31066 %T The Role of Information and Communications Technology Policies and Infrastructure in Curbing the Spread of the Novel Coronavirus: Cross-country Comparative Study %A Eum,Nam Ji %A Kim,Seung Hyun %+ School of Business, Yonsei University, 50 Yonsei-ro, Sinchon-dong, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2123 2506, seungkim@yonsei.ac.kr %K health policy %K telehealth %K physical distancing %K disease transmission %K COVID-19 %D 2022 %7 7.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite worldwide efforts, control of COVID-19 transmission and its after effects is lagging. As seen from the cases of SARS-CoV-2 and influenza, worldwide crises associated with infections and their side effects are likely to recur in the future because of extensive international interactions. Consequently, there is an urgent need to identify the factors that can mitigate disease spread. We observed that the transmission speed and severity of consequences of COVID-19 varied substantially across countries, signaling the need for a country-level investigation. Objective: We aimed to investigate how distancing-enabling information and communications technology (ICT) infrastructure and medical ICT infrastructure, and related policies have affected the cumulative number of confirmed cases, fatality rate, and initial speed of transmission across different countries. Methods: We analyzed the determinants of COVID-19 transmission during the relatively early days of the pandemic by conducting regression analysis based on our data for country-level characteristics, including demographics, culture, ICT infrastructure, policies, economic status, and transmission of COVID-19. To gain further insights, we conducted a subsample analysis for countries with low population density. Results: Our full sample analysis showed that implied telehealth policy, which refers to the lack of a specific telehealth-related policy but presence of a general eHealth policy, was associated with lower fatality rates when controlled for cultural characteristics (P=.004). In particular, the fatality rate for countries with an implied telehealth policy was lower than that for others by 2.7%. Interestingly, stated telehealth policy, which refers to the existence of a specified telehealth policy, was found to not be associated with lower fatality rates (P=.30). Furthermore, countries with a government-run health website had 36% fewer confirmed cases than those without it, when controlled for cultural characteristics (P=.03). Our analysis further revealed that the interaction between implied telehealth policy and training ICT health was significant (P=.01), suggesting that implied telehealth policy may be more effective when in-service training on ICT is provided to health professionals. In addition, credit card ownership, as an enabler of convenient e-commerce transactions and distancing, showed a negative association with fatality rates in the full sample analysis (P=.04), but not in the subsample analysis (P=.76), highlighting that distancing-enabling ICT is more useful in densely populated countries. Conclusions: Our findings demonstrate important relationships between national traits and COVID-19 infections, suggesting guidelines for policymakers to minimize the negative consequences of pandemics. The findings suggest physicians’ autonomous use of medical ICT and strategic allocation of distancing-enabling ICT infrastructure in countries with high population density to maximize efficiency. This study also encourages further research to investigate the role of health policies in combatting COVID-19 and other pandemics. %M 34817392 %R 10.2196/31066 %U https://publichealth.jmir.org/2022/1/e31066 %U https://doi.org/10.2196/31066 %U http://www.ncbi.nlm.nih.gov/pubmed/34817392 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e32329 %T Direct and Indirect Associations of Media Use With COVID-19 Vaccine Hesitancy in South Korea: Cross-sectional Web-Based Survey %A Lee,Minjung %A You,Myoungsoon %+ Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 02 880 2773, msyou@snu.ac.kr %K COVID-19 %K coronavirus %K vaccination %K vaccine hesitancy %K media use %K social media %K public health %K pandemic %K epidemiology %K online information %K health information %D 2022 %7 6.1.2022 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34870605 %R 10.2196/32329 %U https://www.jmir.org/2022/1/e32329 %U https://doi.org/10.2196/32329 %U http://www.ncbi.nlm.nih.gov/pubmed/34870605 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e30006 %T Individuals With SARS-CoV-2 Infection During the First and Second Waves in Catalonia, Spain: Retrospective Observational Study Using Daily Updated Data %A Alves-Cabratosa,Lia %A Comas-Cufí,Marc %A Blanch,Jordi %A Martí-Lluch,Ruth %A Ponjoan,Anna %A Castro-Guardiola,Antoni %A Hurtado-Ganoza,Abelardo %A Pérez-Jaén,Ana %A Rexach-Fumaña,Maria %A Faixedas-Brunsoms,Delfi %A Gispert-Ametller,Maria Angels %A Guell-Cargol,Anna %A Rodriguez-Batista,Maria %A Santaularia-Font,Ferran %A Orriols,Ramon %A Bonnin-Vilaplana,Marc %A Calderón López,Juan Carlos %A Sabater-Talaverano,Gladis %A Queralt Moles,Francesc Xavier %A Rodriguez-Requejo,Sara %A Avellana-Revuelta,Esteve %A Balló,Elisabet %A Fages-Masmiquel,Ester %A Sirvent,Josep-Maria %A Lorencio,Carol %A Morales-Pedrosa,Josep Miquel %A Ortiz-Ballujera,Patricia %A Ramos,Rafel %+ Vascular Health Research Group of Girona, Institut Universitari per a la Recerca en Atenció Primària Jordi Gol i Gurina, Maluquer Salvador, 11, Girona, 17002, Spain, 34 972487968, rramos.girona.ics@gencat.cat %K epidemiology %K SARS-CoV-2 %K COVID-19 %K timeline %K comparison %K pandemic %K waves %K population characteristics %D 2022 %7 6.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34797774 %R 10.2196/30006 %U https://publichealth.jmir.org/2022/1/e30006 %U https://doi.org/10.2196/30006 %U http://www.ncbi.nlm.nih.gov/pubmed/34797774 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e33792 %T Toward Using Twitter Data to Monitor COVID-19 Vaccine Safety in Pregnancy: Proof-of-Concept Study of Cohort Identification %A Klein,Ari Z %A O'Connor,Karen %A Gonzalez-Hernandez,Graciela %+ Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine, University of Pennsylvania, Blockley Hall, 4th Fl., 423 Guardian Dr., Philadelphia, PA, 19104, United States, 1 215 746 1101, ariklein@pennmedicine.upenn.edu %K natural language processing %K social media %K COVID-19 %K data mining %K COVID-19 vaccine %K pregnancy outcomes %D 2022 %7 6.1.2022 %9 Short Paper %J JMIR Form Res %G English %X Background: COVID-19 during pregnancy is associated with an increased risk of maternal death, intensive care unit admission, and preterm birth; however, many people who are pregnant refuse to receive COVID-19 vaccination because of a lack of safety data. Objective: The objective of this preliminary study was to assess whether Twitter data could be used to identify a cohort for epidemiologic studies of COVID-19 vaccination in pregnancy. Specifically, we examined whether it is possible to identify users who have reported (1) that they received COVID-19 vaccination during pregnancy or the periconception period, and (2) their pregnancy outcomes. Methods: We developed regular expressions to search for reports of COVID-19 vaccination in a large collection of tweets posted through the beginning of July 2021 by users who have announced their pregnancy on Twitter. To help determine if users were vaccinated during pregnancy, we drew upon a natural language processing (NLP) tool that estimates the timeframe of the prenatal period. For users who posted tweets with a timestamp indicating they were vaccinated during pregnancy, we drew upon additional NLP tools to help identify tweets that reported their pregnancy outcomes. Results: We manually verified the content of tweets detected automatically, identifying 150 users who reported on Twitter that they received at least one dose of COVID-19 vaccination during pregnancy or the periconception period. We manually verified at least one reported outcome for 45 of the 60 (75%) completed pregnancies. Conclusions: Given the limited availability of data on COVID-19 vaccine safety in pregnancy, Twitter can be a complementary resource for potentially increasing the acceptance of COVID-19 vaccination in pregnant populations. The results of this preliminary study justify the development of scalable methods to identify a larger cohort for epidemiologic studies. %M 34870607 %R 10.2196/33792 %U https://formative.jmir.org/2022/1/e33792 %U https://doi.org/10.2196/33792 %U http://www.ncbi.nlm.nih.gov/pubmed/34870607 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e33989 %T Administration of Parenteral Vitamin C in Patients With Severe Infection: Protocol for a Systematic Review and Meta-analysis %A Agarwal,Arnav %A Basmaji,John %A Fernando,Shannon M %A Ge,Fang Zhou %A Xiao,Yingqi %A Faisal,Haseeb %A Honarmand,Kimia %A Hylands,Mathieu %A Lau,Vincent I %A Lewis,Kimberley %A Couban,Rachel %A Lamontagne,François %A Adhikari,Neill KJ %+ Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Room D1 08, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada, 1 4164804522, neill.adhikari@utoronto.ca %K vitamin C %K ascorbic acid %K severe infection %K sepsis %K COVID-19 %K SARS-CoV-2 %K infection %K parenteral %K vitamin %K infectious disease %K protocol %K review %K meta-analysis %K treatment %K inflammation %K oxidation %K effectiveness %K safety %K critical care %D 2022 %7 6.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 34910661 %R 10.2196/33989 %U https://www.researchprotocols.org/2022/1/e33989 %U https://doi.org/10.2196/33989 %U http://www.ncbi.nlm.nih.gov/pubmed/34910661 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 11 %N 1 %P e24931 %T COCARDE Study–Cardiac Imaging Phenotype in Patients With COVID-19: Protocol for a Prospective Observational Study %A Lairez,Olivier %A Blanchard,Virginie %A Balardy,Laurent %A Vardon-Bounes,Fanny %A Cazalbou,Stéphanie %A Ruiz,Stéphanie %A Collot,Samia %A Houard,Valérie %A Rolland,Yves %A Conil,Jean-Marie %A Minville,Vincent %+ Department of Cardiology, Rangueil University Hospital, 1 Avenue Jean Poulhès, Toulouse, 1059, France, 33 5 61 32 28 73, lairez@gmail.com %K COVID-19 %K SARS-CoV-2 %K cardiac imaging %K echocardiography %K cardiac MRI %K cardiac imaging %K hyperinflammation %K inflammation %D 2022 %7 6.1.2022 %9 Protocol %J JMIR Res Protoc %G English %X Background: The effects of SARS-CoV-2 (COVID-19) on the myocardium and their role in the clinical course of infected patients are still unknown. The severity of SARS-CoV-2 is driven by hyperinflammation, and the effects of SARS-CoV-2 on the myocardium may be significant. This study proposes to use bedside observations and biomarkers to characterize the association of COVID-19 with myocardial injury. Objective: The aim of the study is to describe the myocardial function and its evolution over time in patients infected with SARS-CoV-2 and to investigate the link between inflammation and cardiac injury. Methods: This prospective, monocentric, observational study enrolled 150 patients with suspected or confirmed SARS-CoV-2 infection at Toulouse University Hospital, Toulouse, France. Patients admitted to the intensive care unit (ICU), regular cardiologic ward, and geriatric ward of our tertiary university hospital were included during the pandemic period. Blood sampling, electrocardiography, echocardiography, and morphometric and demographic data were prospectively collected. Results: A total of 100 patients were included. The final enrolment day was March 31, 2020, with first report of results at the end of the first quarter of 2021. The first echocardiographic results at admission of 31 patients of the COCARDE-ICU substudy population show that biological myocardial injury in COVID-19 has low functional impact on left ventricular systolic function. Conclusions: A better understanding of the effects of COVID-19 on myocardial function and its link with inflammation would improve patient follow-up and care. Trial Registration: Clinicaltrials.gov NCT04358952; https://clinicaltrials.gov/ct2/show/NCT04358952 International Registered Report Identifier (IRRID): DERR1-10.2196/24931 %M 34751159 %R 10.2196/24931 %U https://www.researchprotocols.org/2022/1/e24931 %U https://doi.org/10.2196/24931 %U http://www.ncbi.nlm.nih.gov/pubmed/34751159 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 8 %N 1 %P e29872 %T COVID-19 Vaccine Hesitancy and Acceptance Among Individuals With Cancer, Autoimmune Diseases, or Other Serious Comorbid Conditions: Cross-sectional, Internet-Based Survey %A Tsai,Richard %A Hervey,John %A Hoffman,Kathleen %A Wood,Jessica %A Johnson,Jennifer %A Deighton,Dana %A Clermont,Donald %A Loew,Brian %A Goldberg,Stuart L %+ Inspire, 3101 Wilson Boulevard, Suite 220, Arlington, VA, 22201, United States, 1 800 945 0381, richard@inspire.com %K COVID-19 %K vaccine %K hesitancy %K cancer %K autoimmune diseases %K vaccination %K comorbidities %K SARS-CoV-2 %K survey %K cross-sectional %K survey %K incidence %K safety %K vulnerable %K perception %K attitude %D 2022 %7 5.1.2022 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34709184 %R 10.2196/29872 %U https://publichealth.jmir.org/2022/1/e29872 %U https://doi.org/10.2196/29872 %U http://www.ncbi.nlm.nih.gov/pubmed/34709184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 24 %N 1 %P e31752 %T Facilitators and Barriers to the Adoption of Telemedicine During the First Year of COVID-19: Systematic Review %A Kruse,Clemens %A Heinemann,Katharine %+ School of Health Administration, Texas State University, Encino Hall, Room 250, 601 University Dr, San Marcos, TX, 78666, United States, 1 5122454462, scottkruse@txstate.edu %K telemedicine %K pandemic %K technology acceptance %K COVID-19 %K digital health %K telehealth %K health policy %K health care %D 2022 %7 4.1.2022 %9 Review %J J Med Internet Res %G English %X Background: The virulent and unpredictable nature of COVID-19 combined with a change in reimbursement mechanisms both forced and enabled the rapid adoption of telemedicine around the world. Thus, it is important to now assess the effects of this rapid adoption and to determine whether the barriers to such adoption are the same today as they were under prepandemic conditions. Objective: The objective of this systematic literature review was to examine the research literature published during the COVID-19 pandemic to identify facilitators, barriers, and associated medical outcomes as a result of adopting telemedicine, and to determine if changes have occurred in the industry during this time. Methods: The systematic review was performed in accordance with the Kruse protocol and the results are reported in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. We analyzed 46 research articles from five continents published during the first year of the COVID-19 pandemic that were retrieved from searches in four research databases: PubMed (MEDLINE), CINAHL, Science Direct, and Web of Science. Results: Reviewers identified 25 facilitator themes and observations, 12 barrier themes and observations, and 14 results (compared to a control group) themes and observations. Overall, 22% of the articles analyzed reported strong satisfaction or satisfaction (zero reported a decline in satisfaction), 27% reported an improvement in administrative or efficiency results (as compared with a control group), 14% reported no statistically significant difference from the control group, and 40% and 10% reported an improvement or no statistically significant difference in medical outcomes using the telemedicine modality over the control group, respectively. Conclusions: The pandemic encouraged rapid adoption of telemedicine, which also encouraged practices to adopt the modality regardless of the challenges identified in previous research. Several barriers remain for health policymakers to address; however, health care administrators can feel confident in the modality as the evidence largely shows that it is safe, effective, and widely accepted. %M 34854815 %R 10.2196/31752 %U https://www.jmir.org/2022/1/e31752 %U https://doi.org/10.2196/31752 %U http://www.ncbi.nlm.nih.gov/pubmed/34854815 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 6 %N 1 %P e32564 %T A Telemedicine-Guided Self-Collection Approach for PCR-Based SARS-CoV-2 Testing: Comparative Study %A Würstle,Silvia %A Erber,Johanna %A Hanselmann,Michael %A Hoffmann,Dieter %A Werfel,Stanislas %A Hering,Svenja %A Weidlich,Simon %A Schneider,Jochen %A Franke,Ralf %A Maier,Michael %A Henkel,Andreas G %A Schmid,Roland M %A Protzer,Ulrike %A Laxy,Michael %A Spinner,Christoph D %+ Department of Internal Medicine II, School of Medicine, University Hospital rechts der Isar, Technical University of Munich, Ismaninger Str 22, Munich, 81675, Germany, 49 8941404375, Christoph.Spinner@mri.tum.de %K self-sampling %K telemedicine %K test strategy effectiveness %K simulation model %K SARS-CoV-2 %K COVID-19 %D 2022 %7 4.1.2022 %9 Original Paper %J JMIR Form Res %G English %X Background: Large-scale, polymerase chain reaction (PCR)-based SARS-CoV-2 testing is expensive, resource intensive, and time consuming. A self-collection approach is a probable alternative; however, its feasibility, cost, and ability to prevent infections need to be evaluated. Objective: This study aims to compare an innovative self-collection approach with a regular SARS-CoV-2 testing strategy in a large European industrial manufacturing site. Methods: The feasibility of a telemedicine-guided PCR-based self-collection approach was assessed for 150 employees (intervention group) and compared with a regular SARS-CoV-2 testing approach used for 143 employees (control group). Acceptance, ergonomics, and efficacy were evaluated using a software application. A simulation model was implemented to evaluate the effectiveness. An interactive R shiny app was created to enable customized simulations. Results: The test results were successfully communicated to and interpreted without uncertainty by 76% (114/150) and 76.9% (110/143) of the participants in the intervention and control groups, respectively (P=.96). The ratings for acceptability, ergonomics, and efficacy among intervention group participants were noninferior when compared to those among control group participants (acceptability: 71.6% vs 37.6%; ergonomics: 88.1% vs 74.5%; efficacy: 86.4% vs 77.5%). The self-collection approach was found to be less time consuming (23 min vs 38 min; P<.001). The simulation model indicated that both testing approaches reduce the risk of infection, and the self-collection approach tends to be slightly less effective owing to its lower sensitivity. Conclusions: The self-collection approach for SARS-CoV-2 diagnosis was found to be technically feasible and well rated in terms of acceptance, ergonomics, and efficacy. The simulation model facilitates the evaluation of test effectiveness; nonetheless, considering context specificity, appropriate adaptation by companies is required. %M 34803022 %R 10.2196/32564 %U https://formative.jmir.org/2022/1/e32564 %U https://doi.org/10.2196/32564 %U http://www.ncbi.nlm.nih.gov/pubmed/34803022 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e32846 %T Patterns of SARS-CoV-2 Testing Preferences in a National Cohort in the United States: Latent Class Analysis of a Discrete Choice Experiment %A Zimba,Rebecca %A Romo,Matthew L %A Kulkarni,Sarah G %A Berry,Amanda %A You,William %A Mirzayi,Chloe %A Westmoreland,Drew A %A Parcesepe,Angela M %A Waldron,Levi %A Rane,Madhura S %A Kochhar,Shivani %A Robertson,McKaylee M %A Maroko,Andrew R %A Grov,Christian %A Nash,Denis %+ Institute for Implementation Science in Population Health, CUNY Graduate School of Public Health & Health Policy, 55 W 125th St, 6th Floor, New York, NY, 10027, United States, 1 646 364 9618, rebecca.zimba@sph.cuny.edu %K SARS-CoV-2 %K testing %K discrete choice experiment %K latent class analysis %K COVID-19 %K pattern %K trend %K preference %K cohort %K United States %K discrete choice %K diagnostic %K transmission %K vaccine %K uptake %K public health %D 2021 %7 30.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34793320 %R 10.2196/32846 %U https://publichealth.jmir.org/2021/12/e32846 %U https://doi.org/10.2196/32846 %U http://www.ncbi.nlm.nih.gov/pubmed/34793320 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e27266 %T Risk Factors Associated with a Dengue Fever Outbreak in Islamabad, Pakistan: Case-Control Study %A Mehmood,Amjad %A Khalid Khan,Fawad %A Chaudhry,Ambreen %A Hussain,Zakir %A Laghari,Mumtaz Ali %A Shah,Ijaz %A Baig,Zeeshan Iqbal %A Baig,Mirza Amir %A Khader,Yousef %A Ikram,Aamer %+ Field Epidemiology and Laboratory Training Program, Park Road, Chak Shehzad, Islamabad, 44000, Pakistan, 92 519255302, ambr.chaudhry@gmail.com %K dengue fever %K DENV-2 %K outbreak investigation %K Islamabad %K Pakistan %K outbreak %K epidemiology %K disease surveillance %K surveillance %K vector %D 2021 %7 30.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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℃ 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. %M 34967753 %R 10.2196/27266 %U https://publichealth.jmir.org/2021/12/e27266 %U https://doi.org/10.2196/27266 %U http://www.ncbi.nlm.nih.gov/pubmed/34967753 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e31671 %T Temporal Variations and Spatial Disparities in Public Sentiment Toward COVID-19 and Preventive Practices in the United States: Infodemiology Study of Tweets %A Kahanek,Alexander %A Yu,Xinchen %A Hong,Lingzi %A Cleveland,Ana %A Philbrick,Jodi %+ College of Information, University of North Texas, E292, 3940 N Elm St, Denton, TX, 76203, United States, 1 9192607578, lingzi.hong@unt.edu %K COVID-19 %K preventive practices %K temporal variations %K spatial disparities %K Twitter %K public sentiment %K socioeconomic factors %D 2021 %7 30.12.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the COVID-19 pandemic, US public health authorities and county, state, and federal governments recommended or ordered certain preventative practices, such as wearing masks, to reduce the spread of the disease. However, individuals had divergent reactions to these preventive practices. Objective: The purpose of this study was to understand the variations in public sentiment toward COVID-19 and the recommended or ordered preventive practices from the temporal and spatial perspectives, as well as how the variations in public sentiment are related to geographical and socioeconomic factors. Methods: The authors leveraged machine learning methods to investigate public sentiment polarity in COVID-19–related tweets from January 21, 2020 to June 12, 2020. The study measured the temporal variations and spatial disparities in public sentiment toward both general COVID-19 topics and preventive practices in the United States. Results: In the temporal analysis, we found a 4-stage pattern from high negative sentiment in the initial stage to decreasing and low negative sentiment in the second and third stages, to the rebound and increase in negative sentiment in the last stage. We also identified that public sentiment to preventive practices was significantly different in urban and rural areas, while poverty rate and unemployment rate were positively associated with negative sentiment to COVID-19 issues. Conclusions: The differences between public sentiment toward COVID-19 and the preventive practices imply that actions need to be taken to manage the initial and rebound stages in future pandemics. The urban and rural differences should be considered in terms of the communication strategies and decision making during a pandemic. This research also presents a framework to investigate time-sensitive public sentiment at the county and state levels, which could guide local and state governments and regional communities in making decisions and developing policies in crises. %M 35013722 %R 10.2196/31671 %U https://infodemiology.jmir.org/2021/1/e31671 %U https://doi.org/10.2196/31671 %U http://www.ncbi.nlm.nih.gov/pubmed/35013722 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e31540 %T Infoveillance of the Croatian Online Media During the COVID-19 Pandemic: One-Year Longitudinal Study Using Natural Language Processing %A Beliga,Slobodan %A Martinčić-Ipšić,Sanda %A Matešić,Mihaela %A Petrijevčanin Vuksanović,Irena %A Meštrović,Ana %+ Department of Informatics, University of Rijeka, Radmile Matejčić 2, Rijeka, 51000, Croatia, 385 51584726, sbeliga@inf.uniri.hr %K COVID-19 %K pandemic %K online media %K news coverage %K infoveillance %K infodemic %K infodemiology %K natural language processing %K name entity recognition %K longitudinal study %D 2021 %7 24.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Online media play an important role in public health emergencies and serve as essential communication platforms. Infoveillance of online media during the COVID-19 pandemic is an important step toward gaining a better understanding of crisis communication. Objective: The goal of this study was to perform a longitudinal analysis of the COVID-19–related content on online media based on natural language processing. Methods: We collected a data set of news articles published by Croatian online media during the first 13 months of the pandemic. First, we tested the correlations between the number of articles and the number of new daily COVID-19 cases. Second, we analyzed the content by extracting the most frequent terms and applied the Jaccard similarity coefficient. Third, we compared the occurrence of the pandemic-related terms during the two waves of the pandemic. Finally, we applied named entity recognition to extract the most frequent entities and tracked the dynamics of changes during the observation period. Results: The results showed no significant correlation between the number of articles and the number of new daily COVID-19 cases. Furthermore, there were high overlaps in the terminology used in all articles published during the pandemic with a slight shift in the pandemic-related terms between the first and the second waves. Finally, the findings indicate that the most influential entities have lower overlaps for the identified people and higher overlaps for locations and institutions. Conclusions: Our study shows that online media have a prompt response to the pandemic with a large number of COVID-19–related articles. There was a high overlap in the frequently used terms across the first 13 months, which may indicate the narrow focus of reporting in certain periods. However, the pandemic-related terminology is well-covered. %M 34739388 %R 10.2196/31540 %U https://publichealth.jmir.org/2021/12/e31540 %U https://doi.org/10.2196/31540 %U http://www.ncbi.nlm.nih.gov/pubmed/34739388 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e27339 %T COVID-19–Related Rumor Content, Transmission, and Clarification Strategies in China: Descriptive Study %A Ning,Peishan %A Cheng,Peixia %A Li,Jie %A Zheng,Ming %A Schwebel,David C %A Yang,Yang %A Lu,Peng %A Mengdi,Li %A Zhang,Zhuo %A Hu,Guoqing %+ Department of Epidemiology and Health Statistics, Hunan Provincial Key Laboratory of Clinical Epidemiology, Xiangya School of Public Health, Central South University, 110 Xiangya Road, Changsha, 410078, China, 86 731 84805414, huguoqing009@gmail.com %K COVID-19 %K rumor %K strategy %K China %K social media %D 2021 %7 23.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the permeation of social media throughout society, rumors spread faster than ever before, which significantly complicates government responses to public health emergencies such as the COVID-19 pandemic. Objective: We aimed to examine the characteristics and propagation of rumors during the early months of the COVID-19 pandemic in China and evaluated the effectiveness of health authorities’ release of correction announcements. Methods: We retrieved rumors widely circulating on social media in China during the early stages of the COVID-19 pandemic and assessed the effectiveness of official government clarifications and popular science articles refuting those rumors. Results: We show that the number of rumors related to the COVID-19 pandemic fluctuated widely in China between December 1, 2019 and April 15, 2020. Rumors mainly occurred in 3 provinces: Hubei, Zhejiang, and Guangxi. Personal social media accounts constituted the major source of media reports of the 4 most widely distributed rumors (the novel coronavirus can be prevented with “Shuanghuanglian”: 7648/10,664, 71.7%; the novel coronavirus is the SARS coronavirus: 14,696/15,902, 92.4%; medical supplies intended for assisting Hubei were detained by the local government: 3911/3943, 99.2%; asymptomatically infected persons were regarded as diagnosed COVID-19 patients with symptoms in official counts: 322/323, 99.7%). The number of rumors circulating was positively associated with the severity of the COVID-19 epidemic (ρ=0.88, 95% CI 0.81-0.93). The release of correction articles was associated with a substantial decrease in the proportion of rumor reports compared to accurate reports. The proportions of negative sentiments appearing among comments by citizens in response to media articles disseminating rumors and disseminating correct information differ insignificantly (both correct reports: χ12=0.315, P=.58; both rumors: χ12=0.025, P=.88; first rumor and last correct report: χ12=1.287, P=.26; first correct report and last rumor: χ12=0.033, P=.86). Conclusions: Our results highlight the importance and urgency of monitoring and correcting false or misleading reports on websites and personal social media accounts. The circulation of rumors can influence public health, and government bodies should establish guidelines to monitor and mitigate the negative impact of such rumors. %M 34806992 %R 10.2196/27339 %U https://www.jmir.org/2021/12/e27339 %U https://doi.org/10.2196/27339 %U http://www.ncbi.nlm.nih.gov/pubmed/34806992 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e34218 %T Tracking Private WhatsApp Discourse About COVID-19 in Singapore: Longitudinal Infodemiology Study %A Tan,Edina YQ %A Wee,Russell RE %A Saw,Young Ern %A Heng,Kylie JQ %A Chin,Joseph WE %A Tong,Eddie MW %A Liu,Jean CJ %+ Division of Social Sciences, Yale-NUS College, 28 College Ave West, Singapore, 138527, Singapore, 65 66013694, jeanliu@yale-nus.edu.sg %K social media %K WhatsApp %K infodemiology %K misinformation %K COVID-19 %K tracking %K surveillance %K app %K longitudinal %K Singapore %K characteristic %K usage %K pattern %K well-being %K communication %K risk %D 2021 %7 23.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Worldwide, social media traffic increased following the onset of the COVID-19 pandemic. Although the spread of COVID-19 content has been described for several social media platforms (eg, Twitter and Facebook), little is known about how such content is spread via private messaging platforms, such as WhatsApp (WhatsApp LLC). Objective: In this study, we documented (1) how WhatsApp is used to transmit COVID-19 content, (2) the characteristics of WhatsApp users based on their usage patterns, and (3) how usage patterns link to COVID-19 concerns. Methods: We used the experience sampling method to track day-to-day WhatsApp usage during the COVID-19 pandemic. For 1 week, participants reported each day the extent to which they had received, forwarded, or discussed COVID-19 content. The final data set comprised 924 data points, which were collected from 151 participants. Results: During the weeklong monitoring process, most participants (143/151, 94.7%) reported at least 1 COVID-19–related use of WhatsApp. When a taxonomy was generated based on usage patterns, around 1 in 10 participants (21/151, 13.9%) were found to have received and shared a high volume of forwarded COVID-19 content, akin to super-spreaders identified on other social media platforms. Finally, those who engaged with more COVID-19 content in their personal chats were more likely to report having COVID-19–related thoughts throughout the day. Conclusions: Our findings provide a rare window into discourse on private messaging platforms. Such data can be used to inform risk communication strategies during the pandemic. Trial Registration: ClinicalTrials.gov NCT04367363; https://clinicaltrials.gov/ct2/show/NCT04367363 %M 34881720 %R 10.2196/34218 %U https://www.jmir.org/2021/12/e34218 %U https://doi.org/10.2196/34218 %U http://www.ncbi.nlm.nih.gov/pubmed/34881720 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e30106 %T Availability and Suitability of Digital Health Tools in Africa for Pandemic Control: Scoping Review and Cluster Analysis %A Silenou,Bernard C %A Nyirenda,John L Z %A Zaghloul,Ahmed %A Lange,Berit %A Doerrbecker,Juliane %A Schenkel,Karl %A Krause,Gérard %+ Department of Epidemiology, Helmholtz Centre for Infection Research, Inhoffenstraße 7, Braunschweig, 38124, Germany, 49 5316181 3100, Gerard.Krause@helmholtz-hzi.de %K mobile applications %K mHealth %K epidemiological surveillance %K communicable diseases %K outbreak response %K health information management %K public health %K review %K transmission network %D 2021 %7 23.12.2021 %9 Review %J JMIR Public Health Surveill %G English %X Background: Gaining oversight into the rapidly growing number of mobile health tools for surveillance or outbreak management in Africa has become a challenge. Objective: The aim of this study is to map the functional portfolio of mobile health tools used for surveillance or outbreak management of communicable diseases in Africa. Methods: We conducted a scoping review by combining data from a systematic review of the literature and a telephone survey of experts. We applied the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines by searching for articles published between January 2010 and December 2020. In addition, we used the respondent-driven sampling method and conducted a telephone survey from October 2019 to February 2020 among representatives from national public health institutes from all African countries. We combined the findings and used a hierarchical clustering method to group the tools based on their functionalities (attributes). Results: We identified 30 tools from 1914 publications and 45 responses from 52% (28/54) of African countries. Approximately 13% of the tools (4/30; Surveillance Outbreak Response Management and Analysis System, Go.Data, CommCare, and District Health Information Software 2) covered 93% (14/15) of the identified attributes. Of the 30 tools, 17 (59%) tools managed health event data, 20 (67%) managed case-based data, and 28 (97%) offered a dashboard. Clustering identified 2 exceptional attributes for outbreak management, namely contact follow-up (offered by 8/30, 27%, of the tools) and transmission network visualization (offered by Surveillance Outbreak Response Management and Analysis System and Go.Data). Conclusions: There is a large range of tools in use; however, most of them do not offer a comprehensive set of attributes, resulting in the need for public health workers having to use multiple tools in parallel. Only 13% (4/30) of the tools cover most of the attributes, including those most relevant for response to the COVID-19 pandemic, such as laboratory interface, contact follow-up, and transmission network visualization. %M 34941551 %R 10.2196/30106 %U https://publichealth.jmir.org/2021/12/e30106 %U https://doi.org/10.2196/30106 %U http://www.ncbi.nlm.nih.gov/pubmed/34941551 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e30424 %T COVID-19 Vaccine–Related Attitudes and Beliefs in Canada: National Cross-sectional Survey and Cluster Analysis %A Benham,Jamie L %A Atabati,Omid %A Oxoby,Robert J %A Mourali,Mehdi %A Shaffer,Blake %A Sheikh,Hasan %A Boucher,Jean-Christophe %A Constantinescu,Cora %A Parsons Leigh,Jeanna %A Ivers,Noah M %A Ratzan,Scott C %A Fullerton,Madison M %A Tang,Theresa %A Manns,Braden J %A Marshall,Deborah A %A Hu,Jia %A Lang,Raynell %+ Department of Medicine, University of Calgary, 1820 Richmond Road SW, Calgary, AB, T2T5C7, Canada, 1 4039558987, jlbenham@ucalgary.ca %K coronavirus %K COVID-19 %K public health %K marketing %K behavior %K risk reduction %K attitudes %K compliance %K vaccine %K hesitancy %K risk %K belief %K communication %K cross-sectional %K Canada %K gender %K education %K income %K race %K ethnicity %D 2021 %7 23.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34779784 %R 10.2196/30424 %U https://publichealth.jmir.org/2021/12/e30424 %U https://doi.org/10.2196/30424 %U http://www.ncbi.nlm.nih.gov/pubmed/34779784 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e34178 %T Predicting New Daily COVID-19 Cases and Deaths Using Search Engine Query Data in South Korea From 2020 to 2021: Infodemiology Study %A Husnayain,Atina %A Shim,Eunha %A Fuad,Anis %A Su,Emily Chia-Yu %+ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 172-1 Keelung Rd, Sec 2, Taipei, 106, Taiwan, 886 266382736 ext 1515, emilysu@tmu.edu.tw %K prediction %K internet search %K COVID-19 %K South Korea %K infodemiology %D 2021 %7 22.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the ongoing COVID-19 pandemic situation, accurate predictions could greatly help in the health resource management for future waves. However, as a new entity, COVID-19’s disease dynamics seemed difficult to predict. External factors, such as internet search data, need to be included in the models to increase their accuracy. However, it remains unclear whether incorporating online search volumes into models leads to better predictive performances for long-term prediction. Objective: The aim of this study was to analyze whether search engine query data are important variables that should be included in the models predicting new daily COVID-19 cases and deaths in short- and long-term periods. Methods: We used country-level case-related data, NAVER search volumes, and mobility data obtained from Google and Apple for the period of January 20, 2020, to July 31, 2021, in South Korea. Data were aggregated into four subsets: 3, 6, 12, and 18 months after the first case was reported. The first 80% of the data in all subsets were used as the training set, and the remaining data served as the test set. Generalized linear models (GLMs) with normal, Poisson, and negative binomial distribution were developed, along with linear regression (LR) models with lasso, adaptive lasso, and elastic net regularization. Root mean square error values were defined as a loss function and were used to assess the performance of the models. All analyses and visualizations were conducted in SAS Studio, which is part of the SAS OnDemand for Academics. Results: GLMs with different types of distribution functions may have been beneficial in predicting new daily COVID-19 cases and deaths in the early stages of the outbreak. Over longer periods, as the distribution of cases and deaths became more normally distributed, LR models with regularization may have outperformed the GLMs. This study also found that models performed better when predicting new daily deaths compared to new daily cases. In addition, an evaluation of feature effects in the models showed that NAVER search volumes were useful variables in predicting new daily COVID-19 cases, particularly in the first 6 months of the outbreak. Searches related to logistical needs, particularly for “thermometer” and “mask strap,” showed higher feature effects in that period. For longer prediction periods, NAVER search volumes were still found to constitute an important variable, although with a lower feature effect. This finding suggests that search term use should be considered to maintain the predictive performance of models. Conclusions: NAVER search volumes were important variables in short- and long-term prediction, with higher feature effects for predicting new daily COVID-19 cases in the first 6 months of the outbreak. Similar results were also found for death predictions. %M 34762064 %R 10.2196/34178 %U https://www.jmir.org/2021/12/e34178 %U https://doi.org/10.2196/34178 %U http://www.ncbi.nlm.nih.gov/pubmed/34762064 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e26644 %T Understanding Health Communication Through Google Trends and News Coverage for COVID-19: Multinational Study in Eight Countries %A Ming,Wai-kit %A Huang,Fengqiu %A Chen,Qiuyi %A Liang,Beiting %A Jiao,Aoao %A Liu,Taoran %A Wu,Huailiang %A Akinwunmi,Babatunde %A Li,Jia %A Liu,Guan %A Zhang,Casper J P %A Huang,Jian %A Liu,Qian %+ School of Journalism and Communication, National Media Experimental Teaching Demonstration Center, Jinan University, 601 Huangpu Dadao West, Guangzhou, 510632, China, 86 13302292599, tsusanliu@jnu.edu.cn %K COVID-19 %K Google Trends %K search peaks %K news coverage %K public concerns %D 2021 %7 21.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Due to the COVID-19 pandemic, health information related to COVID-19 has spread across news media worldwide. Google is among the most used internet search engines, and the Google Trends tool can reflect how the public seeks COVID-19–related health information during the pandemic. Objective: The aim of this study was to understand health communication through Google Trends and news coverage and to explore their relationship with prevention and control of COVID-19 at the early epidemic stage. Methods: To achieve the study objectives, we analyzed the public’s information-seeking behaviors on Google and news media coverage on COVID-19. We collected data on COVID-19 news coverage and Google search queries from eight countries (ie, the United States, the United Kingdom, Canada, Singapore, Ireland, Australia, South Africa, and New Zealand) between January 1 and April 29, 2020. We depicted the characteristics of the COVID-19 news coverage trends over time, as well as the search query trends for the topics of COVID-19–related “diseases,” “treatments and medical resources,” “symptoms and signs,” and “public measures.” The search query trends provided the relative search volume (RSV) as an indicator to represent the popularity of a specific search term in a specific geographic area over time. Also, time-lag correlation analysis was used to further explore the relationship between search terms trends and the number of new daily cases, as well as the relationship between search terms trends and news coverage. Results: Across all search trends in eight countries, almost all search peaks appeared between March and April 2020, and declined in April 2020. Regarding COVID-19–related “diseases,” in most countries, the RSV of the term “coronavirus” increased earlier than that of “covid-19”; however, around April 2020, the search volume of the term “covid-19” surpassed that of “coronavirus.” Regarding the topic “treatments and medical resources,” the most and least searched terms were “mask” and “ventilator,” respectively. Regarding the topic “symptoms and signs,” “fever” and “cough” were the most searched terms. The RSV for the term “lockdown” was significantly higher than that for “social distancing” under the topic “public health measures.” In addition, when combining search trends with news coverage, there were three main patterns: (1) the pattern for Singapore, (2) the pattern for the United States, and (3) the pattern for the other countries. In the time-lag correlation analysis between the RSV for the topic “treatments and medical resources” and the number of new daily cases, the RSV for all countries except Singapore was positively correlated with new daily cases, with a maximum correlation of 0.8 for the United States. In addition, in the time-lag correlation analysis between the overall RSV for the topic “diseases” and the number of daily news items, the overall RSV was positively correlated with the number of daily news items, the maximum correlation coefficient was more than 0.8, and the search behavior occurred 0 to 17 days earlier than the news coverage. Conclusions: Our findings revealed public interest in masks, disease control, and public measures, and revealed the potential value of Google Trends in the face of the emergence of new infectious diseases. Also, Google Trends combined with news media can achieve more efficient health communication. Therefore, both news media and Google Trends can contribute to the early prevention and control of epidemics. %M 34591781 %R 10.2196/26644 %U https://publichealth.jmir.org/2021/12/e26644 %U https://doi.org/10.2196/26644 %U http://www.ncbi.nlm.nih.gov/pubmed/34591781 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e32427 %T The Plebeian Algorithm: A Democratic Approach to Censorship and Moderation %A Fedoruk,Benjamin %A Nelson,Harrison %A Frost,Russell %A Fucile Ladouceur,Kai %+ Faculty of Science, University of Ontario, Institute of Technology, 2000 Simcoe St N, Oshawa, ON, L1G 0C5, Canada, 1 905 721 8668, benjamin.fedoruk@ontariotechu.net %K infodemiology %K misinformation %K algorithm %K social media %K plebeian %K natural language processing %K sentiment analysis %K sentiment %K trust %K decision-making %K COVID-19 %D 2021 %7 21.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The infodemic created by the COVID-19 pandemic has created several societal issues, including a rise in distrust between the public and health experts, and even a refusal of some to accept vaccination; some sources suggest that 1 in 4 Americans will refuse the vaccine. This social concern can be traced to the level of digitization today, particularly in the form of social media. Objective: The goal of the research is to determine an optimal social media algorithm, one which is able to reduce the number of cases of misinformation and which also ensures that certain individual freedoms (eg, the freedom of expression) are maintained. After performing the analysis described herein, an algorithm was abstracted. The discovery of a set of abstract aspects of an optimal social media algorithm was the purpose of the study. Methods: As social media was the most significant contributing factor to the spread of misinformation, the team decided to examine infodemiology across various text-based platforms (Twitter, 4chan, Reddit, Parler, Facebook, and YouTube). This was done by using sentiment analysis to compare general posts with key terms flagged as misinformation (all of which concern COVID-19) to determine their verity. In gathering the data sets, both application programming interfaces (installed using Python’s pip) and pre-existing data compiled by standard scientific third parties were used. Results: The sentiment can be described using bimodal distributions for each platform, with a positive and negative peak, as well as a skewness. It was found that in some cases, misinforming posts can have up to 92.5% more negative sentiment skew compared to accurate posts. Conclusions: From this, the novel Plebeian Algorithm is proposed, which uses sentiment analysis and post popularity as metrics to flag a post as misinformation. This algorithm diverges from that of the status quo, as the Plebeian Algorithm uses a democratic process to detect and remove misinformation. A method was constructed in which content deemed as misinformation to be removed from the platform is determined by a randomly selected jury of anonymous users. This not only prevents these types of infodemics but also guarantees a more democratic way of using social media that is beneficial for repairing social trust and encouraging the public’s evidence-informed decision-making. %M 34854812 %R 10.2196/32427 %U https://formative.jmir.org/2021/12/e32427 %U https://doi.org/10.2196/32427 %U http://www.ncbi.nlm.nih.gov/pubmed/34854812 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28416 %T Predictors to Use Mobile Apps for Monitoring COVID-19 Symptoms and Contact Tracing: Survey Among Dutch Citizens %A Jansen-Kosterink,Stephanie %A Hurmuz,Marian %A den Ouden,Marjolein %A van Velsen,Lex %+ eHealth Department, Roessingh Research and Development, Roessinghsbleekweg 33b, Enschede, 7522 AH, Netherlands, 31 88 0875 777, s.jansen@rrd.nl %K COVID-19 %K eHealth %K mHealth %K contact tracing %K symptom management %K intention to use %D 2021 %7 20.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: eHealth apps have been recognized as a valuable tool to reduce COVID-19’s effective reproduction number. The factors that determine the acceptance of COVID-19 apps remain unknown. The exception here is privacy. Objective: The aim of this article was to identify antecedents of acceptance of (1) a mobile app for COVID-19 symptom recognition and monitoring and (2) a mobile app for contact tracing, both by means of an online survey among Dutch citizens. Methods: Next to the demographics, the online survey contained questions focusing on perceived health, fear of COVID-19, and intention to use. We used snowball sampling via posts on social media and personal connections. To identify antecedents of the model for acceptance of the 2 mobile apps, we conducted multiple linear regression analyses. Results: In total, 238 Dutch adults completed the survey; 59.2% (n=141) of the responders were female and the average age was 45.6 years (SD 17.4 years). For the symptom app, the final model included the predictors age, attitude toward technology, and fear of COVID-19. The model had an r2 of 0.141. The final model for the tracing app included the same predictors and had an r2 of 0.156. The main reason to use both mobile apps was to control the spread of the COVID-19 virus. Concerns about privacy was mentioned as the main reason to not use the mobile apps. Conclusions: Age, attitude toward technology, and fear of COVID-19 are important predictors of the acceptance of COVID-19 mobile apps for symptom recognition and monitoring and for contact tracing. These predictors should be taken into account during the development and implementation of these mobile apps to secure acceptance. %M 34818210 %R 10.2196/28416 %U https://formative.jmir.org/2021/12/e28416 %U https://doi.org/10.2196/28416 %U http://www.ncbi.nlm.nih.gov/pubmed/34818210 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 4 %P e31503 %T COVID-19 Outcomes and Genomic Characterization of SARS-CoV-2 Isolated From Veterans in New England States: Retrospective Analysis %A Lee,Megan %A Sallah,Ya Haddy %A Petrone,Mary %A Ringer,Matthew %A Cosentino,Danielle %A Vogels,Chantal B F %A Fauver,Joseph R %A Alpert,Tara D %A Grubaugh,Nathan D %A Gupta,Shaili %+ VA Connecticut Healthcare System, 950 Campbell Ave, Bldg 1, Floor 5, Dept of Medicine, Mailstop 111a, West Haven, CT, 06516, United States, 1 203 932 5711 ext 4412, shaili.gupta@yale.edu %K infectious disease %K COVID-19 %K epidemiology %K veteran %K outcome %K sequencing %K genetics %K virus %K United States %K impact %K testing %K severity %K mortality %K cohort %D 2021 %7 17.12.2021 %9 Original Paper %J JMIRx Med %G English %X Background: Clinical and virologic characteristics of COVID-19 infections in veterans in New England have not been described. The average US veteran is a male older than the general US population. SARS-CoV-2 infection is known to cause poorer outcomes among men and older adults, making the veteran population an especially vulnerable group for COVID-19. Objective: This study aims to evaluate clinical and virologic factors impacting COVID-19 outcomes. Methods: This retrospective chart review included 476 veterans in six New England states with confirmed SARS-CoV-2 infection between April and September 2020. Whole genome sequencing was performed on SARS-CoV-2 RNA isolated from these veterans, and the correlation of genomic data to clinical outcomes was evaluated. Clinical and demographic variables were collected by manual chart review and were correlated to the end points of peak disease severity (based on oxygenation requirements), hospitalization, and mortality using multivariate regression analyses. Results: Of 476 veterans, 274 had complete and accessible charts. Of the 274 veterans, 92.7% (n=254) were men and 83.2% (n=228) were White, and the mean age was 63 years. In the multivariate regression, significant predictors of hospitalization (C statistic 0.75) were age (odds ratio [OR] 1.05, 95% CI 1.03-1.08) and non-White race (OR 2.39, 95% CI 1.13-5.01). Peak severity (C statistic 0.70) also varied by age (OR 1.07, 95% CI 1.03-1.11) and O2 requirement on admission (OR 45.7, 95% CI 18.79-111). Mortality (C statistic 0.87) was predicted by age (OR 1.06, 95% CI 1.01-1.11), dementia (OR 3.44, 95% CI 1.07-11.1), and O2 requirement on admission (OR 6.74, 95% CI 1.74-26.1). Most (291/299, 97.3%) of our samples were dominated by the spike protein D614G substitution and were from SARS-CoV-2 B.1 lineage or one of 37 different B.1 sublineages, with none representing more than 8.7% (26/299) of the cases. Conclusions: In a cohort of veterans from the six New England states with a mean age of 63 years and a high comorbidity burden, age was the largest predictor of hospitalization, peak disease severity, and mortality. Non-White veterans were more likely to be hospitalized, and patients who required oxygen on admission were more likely to have severe disease and higher rates of mortality. Multiple SARS-CoV-2 lineages were distributed in patients in New England early in the COVID-19 era, mostly related to viruses from New York State with D614G mutation. %M 35014989 %R 10.2196/31503 %U https://med.jmirx.org/2021/4/e31503 %U https://doi.org/10.2196/31503 %U http://www.ncbi.nlm.nih.gov/pubmed/35014989 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e27521 %T 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 %A Mbiine,Ronald %A Nakanwagi,Cephas %A Lekuya,Herve Monka %A Aine,Joan %A Hakim,Kawesi %A Nabunya,Lilian %A Tomusange,Henry %+ Makerere University College of Health Sciences, Mulago Hill Road, Kampala, 7072, Uganda, 256 774338585, mbiineron@gmail.com %K mHealth %K risk score for Covid-19 %K Africa %K mobile health %K digital health %K pandemic %K COVID-19 %K COVID %K screening tool %K healthcare workers %K transmission %K warning system %D 2021 %7 17.12.2021 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 34793321 %R 10.2196/27521 %U https://formative.jmir.org/2021/12/e27521 %U https://doi.org/10.2196/27521 %U http://www.ncbi.nlm.nih.gov/pubmed/34793321 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e34286 %T EpiHacks, a Process for Technologists and Health Experts to Cocreate Optimal Solutions for Disease Prevention and Control: User-Centered Design Approach %A Divi,Nomita %A Smolinski,Mark %+ Ending Pandemics, 870 Market Street, Suite 528, San Francisco, CA, 94102, United States, 1 6173591733, nomita@endingpandemics.org %K epidemiology %K public health %K diagnostic %K tool %K disease surveillance %K technology solution %K innovative approaches to disease surveillance %K One Health %K surveillance %K hack %K innovation %K expert %K solution %K prevention %K control %D 2021 %7 15.12.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34807832 %R 10.2196/34286 %U https://www.jmir.org/2021/12/e34286 %U https://doi.org/10.2196/34286 %U http://www.ncbi.nlm.nih.gov/pubmed/34807832 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e33739 %T COVID-19 Vaccine Perceptions, Intentions, and Uptake Among Young Adults in the United States: Prospective College-Based Cohort Study %A Gurley,Stephen %A Bennett,Brady %A Sullivan,Patrick Sean %A Kiley,Maryellen %A Linde,Jamie %A Szczerbacki,David %A Guest,Jodie %+ School of Medicine, Emory University, 100 Woodruff Circle, Atlanta, GA, 30322, United States, 1 404 727 0520, sgurley@emory.edu %K COVID-19 %K vaccine %K hesitancy %K college %K higher education %K race %K perception %K intention %K uptake %K prospective %K cohort %K demographic %K minority %K young adult %D 2021 %7 15.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34847054 %R 10.2196/33739 %U https://publichealth.jmir.org/2021/12/e33739 %U https://doi.org/10.2196/33739 %U http://www.ncbi.nlm.nih.gov/pubmed/34847054 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e33364 %T Digitally Disconnected: Qualitative Study of Patient Perspectives on the Digital Divide and Potential Solutions %A Alkureishi,Maria Alcocer %A Choo,Zi-Yi %A Rahman,Ali %A Ho,Kimberly %A Benning-Shorb,Jonah %A Lenti,Gena %A Velázquez Sánchez,Itzel %A Zhu,Mengqi %A Shah,Sachin D %A Lee,Wei Wei %+ Department of Pediatrics, University of Chicago, 5841 S Maryland Avenue, MC 6082 Room C124, Chicago, IL, 60637, United States, 1 773 834 8927, malkureishi@peds.bsd.uchicago.edu %K telemedicine %K digital divide %K patient experience %K qualitative study %D 2021 %7 15.12.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: As telemedicine utilization increased during the COVID-19 pandemic, divergent usage patterns for video and audio-only telephone visits emerged. Older, low-income, minority, and non-English speaking Medicaid patients are at highest risk of experiencing technology access and digital literacy barriers. This raises concern for disparities in health care access and widening of the “digital divide,” the separation of those with technological access and knowledge and those without. While studies demonstrate correlation between racial and socioeconomic demographics and technological access and ability, individual patients’ perspectives of the divide and its impacts remain unclear. Objective: We aimed to interview patients to understand their perspectives on (1) the definition, causes, and impact of the digital divide; (2) whose responsibility it is to address this divide, and (3) potential solutions to mitigate the digital divide. Methods: Between December 2020 and March 2021, we conducted 54 semistructured telephone interviews with adult patients and parents of pediatric patients who had virtual visits (phone, video, or both) between March and September 2020 at the University of Chicago Medical Center (UCMC) primary care clinics. A grounded theory approach was used to analyze interview data. Results: Patients were keenly aware of the digital divide and described impacts beyond health care, including employment, education, community and social contexts, and personal economic stability. Patients described that individuals, government, libraries, schools, health care organizations, and even private businesses all shared the responsibility to address the divide. Proposed solutions to address the divide included conducting community technology needs assessments and improving technology access, literacy training, and resource awareness. Recognizing that some individuals will never cross the divide, patients also emphasized continued support of low-tech communication methods and health care delivery to prevent widening of the digital divide. Furthermore, patients viewed technology access and literacy as drivers of the social determinants of health (SDOH), profoundly influencing how SDOH function to worsen or improve health disparities. Conclusions: Patient perspectives provide valuable insight into the digital divide and can inform solutions to mitigate health and resulting societal inequities. Future work is needed to understand the digital needs of disconnected individuals and communities. As clinical care and delivery continue to integrate telehealth, studies are needed to explore whether having a video or audio-only phone visit results in different patient outcomes and utilization. Advocacy efforts to disseminate public and private resources can also expand device and broadband internet access, improve technology literacy, and increase funding to support both high- and low-tech forms of health care delivery for the disconnected. %M 34705664 %R 10.2196/33364 %U https://humanfactors.jmir.org/2021/4/e33364 %U https://doi.org/10.2196/33364 %U http://www.ncbi.nlm.nih.gov/pubmed/34705664 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e33617 %T Utility of Facebook’s Social Connectedness Index in Modeling COVID-19 Spread: Exponential Random Graph Modeling Study %A Prusaczyk,Beth %A Pietka,Kathryn %A Landman,Joshua M %A Luke,Douglas A %+ Center for Population Health Informatics, Institute for Informatics, Washington University School of Medicine in St. Louis, 660 S. Euclid Avenue, Saint Louis, MO, 63110, United States, 1 314 330 0537, beth.prusaczyk@wustl.edu %K COVID-19 %K social media %K social networks %K network analysis %K public health %K utility %K Facebook %K connection %K modeling %K spread %K United States %K belief %D 2021 %7 15.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 (the disease caused by the SARS-CoV-2 virus) pandemic has underscored the need for additional data, tools, and methods that can be used to combat emerging and existing public health concerns. Since March 2020, there has been substantial interest in using social media data to both understand and intervene in the pandemic. Researchers from many disciplines have recently found a relationship between COVID-19 and a new data set from Facebook called the Social Connectedness Index (SCI). Objective: Building off this work, we seek to use the SCI to examine how social similarity of Missouri counties could explain similarities of COVID-19 cases over time. Additionally, we aim to add to the body of literature on the utility of the SCI by using a novel modeling technique. Methods: In September 2020, we conducted this cross-sectional study using publicly available data to test the association between the SCI and COVID-19 spread in Missouri using exponential random graph models, which model relational data, and the outcome variable must be binary, representing the presence or absence of a relationship. In our model, this was the presence or absence of a highly correlated COVID-19 case count trajectory between two given counties in Missouri. Covariates included each county’s total population, percent rurality, and distance between each county pair. Results: We found that all covariates were significantly associated with two counties having highly correlated COVID-19 case count trajectories. As the log of a county’s total population increased, the odds of two counties having highly correlated COVID-19 case count trajectories increased by 66% (odds ratio [OR] 1.66, 95% CI 1.43-1.92). As the percent of a county classified as rural increased, the odds of two counties having highly correlated COVID-19 case count trajectories increased by 1% (OR 1.01, 95% CI 1.00-1.01). As the distance (in miles) between two counties increased, the odds of two counties having highly correlated COVID-19 case count trajectories decreased by 43% (OR 0.57, 95% CI 0.43-0.77). Lastly, as the log of the SCI between two Missouri counties increased, the odds of those two counties having highly correlated COVID-19 case count trajectories significantly increased by 17% (OR 1.17, 95% CI 1.09-1.26). Conclusions: These results could suggest that two counties with a greater likelihood of sharing Facebook friendships means residents of those counties have a higher likelihood of sharing similar belief systems, in particular as they relate to COVID-19 and public health practices. Another possibility is that the SCI is picking up travel or movement data among county residents. This suggests the SCI is capturing a unique phenomenon relevant to COVID-19 and that it may be worth adding to other COVID-19 models. Additional research is needed to better understand what the SCI is capturing practically and what it means for public health policies and prevention practices. %M 34797775 %R 10.2196/33617 %U https://publichealth.jmir.org/2021/12/e33617 %U https://doi.org/10.2196/33617 %U http://www.ncbi.nlm.nih.gov/pubmed/34797775 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e32203 %T Presenting Characteristics, Comorbidities, and Outcomes Among Patients With COVID-19 Hospitalized in Pakistan: Retrospective Observational Study %A Akhtar,Hashaam %A Khalid,Sundas %A Rahman,Fazal ur %A Umar,Muhammad %A Ali,Sabahat %A Afridi,Maham %A Hassan,Faheem %A Saleh Khader,Yousef %A Akhtar,Nasim %A Khan,Muhammad Mujeeb %A Ikram,Aamer %+ Yusra Institute of Pharmaceutical Sciences, Zaraj Housing Society, Opposite DHA Phase 2 Gate III, Main G T Road, Islamabad, 44000, Pakistan, 92 3215272489, hashaamakhtar@gmail.com %K COVID-19 %K indicators %K symptoms %K risk factors %K comorbidities %K severity %K Pakistan %D 2021 %7 14.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34710053 %R 10.2196/32203 %U https://publichealth.jmir.org/2021/12/e32203 %U https://doi.org/10.2196/32203 %U http://www.ncbi.nlm.nih.gov/pubmed/34710053 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 4 %P e29234 %T Usability of an At-Home Anterior Nares SARS-CoV-2 RT-PCR Sample Collection Kit: Human Factors Feasibility Study %A Strong,Laura E %A Middendorf,Irene %A Turner,Michelle %A Edwards V,David K %A Sama,Varun %A Mou,Joshua %A Adams,K Colleen %+ Exact Sciences Corporation, 5505 Endeavor Lane, Madison, WI, 53719, United States, 1 6088006531, cadams@exactsciences.com %K COVID-19 testing %K at-home collection kit %K SARS-CoV-2 %K feasibility studies %K self-collection %K usability study %K COVID-19 %D 2021 %7 14.12.2021 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 34609947 %R 10.2196/29234 %U https://humanfactors.jmir.org/2021/4/e29234 %U https://doi.org/10.2196/29234 %U http://www.ncbi.nlm.nih.gov/pubmed/34609947 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e29086 %T Patients’ Perspectives on Qualitative Olfactory Dysfunction: Thematic Analysis of Social Media Posts %A Parker,Jane K %A Kelly,Christine E %A Smith,Barry C %A Kirkwood,Aidan F %A Hopkins,Claire %A Gane,Simon %+ Royal National Ear, Nose and Throat and Eastman Dental Hospitals, 47-49 Huntley Street, London, WC1E 6DG, United Kingdom, 44 7789655222, simongane@nhs.net %K olfactory dysfunction %K parosmia %K phantosmia %K olfactory perseveration %K trigger foods %K mental health %K COVID-19 %K patients’ perspective %K thematic analysis %K social media %K perspective %K smell %K nose %K symptom %K concern %K support %D 2021 %7 14.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The impact of qualitative olfactory disorders is underestimated. Parosmia, the distorted perception of familiar odors, and phantosmia, the experience of odors in the absence of a stimulus, can arise following postinfectious anosmia, and the incidences of both have increased substantially since the outbreak of COVID-19. Objective: The aims of this study are to explore the symptoms and sequalae of postinfectious olfactory dysfunction syndrome using unstructured and unsolicited threads from social media, and to articulate the perspectives and concerns of patients affected by these debilitating olfactory disorders. Methods: A thematic analysis and content analysis of posts in the AbScent Parosmia and Phantosmia Support group on Facebook was conducted between June and December 2020. Results: In this paper, we identify a novel symptom, olfactory perseveration, which is a triggered, identifiable, and usually unpleasant olfactory percept that persists in the absence of an ongoing stimulus. We also observe fluctuations in the intensity and duration of symptoms of parosmia, phantosmia, and olfactory perseveration. In addition, we identify a group of the most common items (coffee, meat, onion, and toothpaste) that trigger distortions; however, people have difficulty describing these distortions, using words associated with disgust and revulsion. The emotional aspect of living with qualitative olfactory dysfunction was evident and highlighted the detrimental impact on mental health. Conclusions: Qualitative and unsolicited data acquired from social media has provided useful insights into the patient experience of parosmia and phantosmia, which can inform rehabilitation strategies and ongoing research into understanding the molecular triggers associated with parosmic distortions and research into patient benefit. %M 34904953 %R 10.2196/29086 %U https://formative.jmir.org/2021/12/e29086 %U https://doi.org/10.2196/29086 %U http://www.ncbi.nlm.nih.gov/pubmed/34904953 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e33746 %T Multiplex Droplet Digital Polymerase Chain Reaction Assay for Rapid Molecular Detection of Pathogens in Patients With Sepsis: Protocol for an Assay Development Study %A Badran,Samir %A Chen,Ming %A Coia,John E %+ Research Unit in Clinical Microbiology, Department of Clinical Diagnostics, Hospital South West Jutland, University Hospital of Southern Denmark, Finensensgade 35, Esbjerg, 6700, Denmark, 45 20996334, Samir.Badran2@rsyd.dk %K sepsis %K ddPCR %K clinical microbiology %K molecular diagnostics %K infectious diseases %D 2021 %7 13.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 34898460 %R 10.2196/33746 %U https://www.researchprotocols.org/2021/12/e33746 %U https://doi.org/10.2196/33746 %U http://www.ncbi.nlm.nih.gov/pubmed/34898460 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e32165 %T An Alternative to the Light Touch Digital Health Remote Study: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study %A Goodday,Sarah M %A Karlin,Emma %A Alfarano,Alexandria %A Brooks,Alexa %A Chapman,Carol %A Desille,Rachelle %A Rangwala,Shazia %A Karlin,Daniel R %A Emami,Hoora %A Woods,Nancy Fugate %A Boch,Adrien %A Foschini,Luca %A Wildman,Mackenzie %A Cormack,Francesca %A Taptiklis,Nick %A Pratap,Abhishek %A Ghassemi,Marzyeh %A Goldenberg,Anna %A Nagaraj,Sujay %A Walsh,Elaine %A , %A Friend,Stephen %+ 4YouandMe, 2901 Third Ave Suite 330, Seattle, WA, 98121, United States, 1 2069288254, sarah@4youandme.org %K stress %K wearable %K digital health %K frontline %K COVID-19 %K health care worker %K alternative %K design %K app %K assessment %K sensor %K engagement %K support %K knowledge %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Several app-based studies share similar characteristics of a light touch approach that recruit, enroll, and onboard via a smartphone app and attempt to minimize burden through low-friction active study tasks while emphasizing the collection of passive data with minimal human contact. However, engagement is a common challenge across these studies, reporting low retention and adherence. Objective: This study aims to describe an alternative to a light touch digital health study that involved a participant-centric design including high friction app-based assessments, semicontinuous passive data from wearable sensors, and a digital engagement strategy centered on providing knowledge and support to participants. Methods: The Stress and Recovery in Frontline COVID-19 Health Care Workers Study included US frontline health care workers followed between May and November 2020. The study comprised 3 main components: (1) active and passive assessments of stress and symptoms from a smartphone app, (2) objective measured assessments of acute stress from wearable sensors, and (3) a participant codriven engagement strategy that centered on providing knowledge and support to participants. The daily participant time commitment was an average of 10 to 15 minutes. Retention and adherence are described both quantitatively and qualitatively. Results: A total of 365 participants enrolled and started the study, and 81.0% (n=297) of them completed the study for a total study duration of 4 months. Average wearable sensor use was 90.6% days of total study duration. App-based daily, weekly, and every other week surveys were completed on average 69.18%, 68.37%, and 72.86% of the time, respectively. Conclusions: This study found evidence for the feasibility and acceptability of a participant-centric digital health study approach that involved building trust with participants and providing support through regular phone check-ins. In addition to high retention and adherence, the collection of large volumes of objective measured data alongside contextual self-reported subjective data was able to be collected, which is often missing from light touch digital health studies. Trial Registration: ClinicalTrials.gov NCT04713111; https://clinicaltrials.gov/ct2/show/NCT04713111 %M 34726607 %R 10.2196/32165 %U https://formative.jmir.org/2021/12/e32165 %U https://doi.org/10.2196/32165 %U http://www.ncbi.nlm.nih.gov/pubmed/34726607 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31358 %T Nursing Perspectives on the Impacts of COVID-19: Social Media Content Analysis %A Koren,Ainat %A Alam,Mohammad Arif Ul %A Koneru,Sravani %A DeVito,Alexa %A Abdallah,Lisa %A Liu,Benyuan %+ Solomont School of Nursing, University of Massachusetts Lowell, 113 Wilder Street, Suite 200, Health and Social Science Building, Lowell, MA, 01854-3058, United States, 1 9789344429, Ainat_Koren@uml.edu %K mental health %K information retrieval %K coronavirus %K COVID-19 %K nursing %K nurses %K health care workers %K pandemic %K impact %K social media analytics %D 2021 %7 10.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Nurses are at the forefront of the COVID-19 pandemic. During the pandemic, nurses have faced an elevated risk of exposure and have experienced the hazards related to a novel virus. While being heralded as lifesaving heroes on the front lines of the pandemic, nurses have experienced more physical, mental, and psychosocial problems as a consequence of the COVID-19 outbreak. Social media discussions by nursing professionals participating in publicly formed Facebook groups constitute a valuable resource that offers longitudinal insights. Objective: This study aimed to explore how COVID-19 impacted nurses through capturing public sentiments expressed by nurses on a social media discussion platform and how these sentiments changed over time. Methods: We collected over 110,993 Facebook discussion posts and comments in an open COVID-19 group for nurses from March 2020 until the end of November 2020. Scraping of deidentified offline HTML tags on social media posts and comments was performed. Using subject-matter expert opinions and social media analytics (ie, topic modeling, information retrieval, and sentiment analysis), we performed a human-in-a-loop analysis of nursing professionals’ key perspectives to identify trends of the COVID-19 impact among at-risk nursing communities. We further investigated the key insights of the trends of the nursing professionals’ perspectives by detecting temporal changes of comments related to emotional effects, feelings of frustration, impacts of isolation, shortage of safety equipment, and frequency of safety equipment uses. Anonymous quotes were highlighted to add context to the data. Results: We determined that COVID-19 impacted nurses’ physical, mental, and psychosocial health as expressed in the form of emotional distress, anger, anxiety, frustration, loneliness, and isolation. Major topics discussed by nurses were related to work during a pandemic, misinformation spread by the media, improper personal protective equipment (PPE), PPE side effects, the effects of testing positive for COVID-19, and lost days of work related to illness. Conclusions: Public Facebook nursing groups are venues for nurses to express their experiences, opinions, and concerns and can offer researchers an important insight into understanding the COVID-19 impact on health care workers. %M 34623957 %R 10.2196/31358 %U https://formative.jmir.org/2021/12/e31358 %U https://doi.org/10.2196/31358 %U http://www.ncbi.nlm.nih.gov/pubmed/34623957 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e34381 %T An eHealth Intervention for Promoting COVID-19 Knowledge and Protective Behaviors and Reducing Pandemic Distress Among Sexual and Gender Minorities: Protocol for a Randomized Controlled Trial (#SafeHandsSafeHearts) %A Newman,Peter A %A Chakrapani,Venkatesan %A Williams,Charmaine %A Massaquoi,Notisha %A Tepjan,Suchon %A Roungprakhon,Surachet %A Akkakanjanasupar,Pakorn %A Logie,Carmen %A Rawat,Shruta %+ Factor-Inwentash Faculty of Social Work, University of Toronto, 246 Bloor Street West, Toronto, ON, M5S 1V4, Canada, 1 416 946 8611, p.newman@utoronto.ca %K COVID-19 %K eHealth %K RCT %K protective behaviors %K psychological distress %K LGBT+ %K India %K Thailand %D 2021 %7 10.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Existing data on COVID-19 disparities among vulnerable populations portend excess risk for lesbian, gay, bisexual, transgender (LGBT) and other persons outside of heteronormative and cisgender identities (ie, LGBT+). Owing to adverse social determinants of health, including pervasive HIV and sexual stigma, harassment, violence, barriers in access to health care, and existing health and mental health disparities, sexual and gender minorities in India and Thailand are at disproportionate risk for SARS-CoV-2 infection and severe disease. Despite global health disparities among LGBT+ populations, there is a lack of coordinated, community-engaged interventions to address the expected excess burden of COVID-19 and public health–recommended protective measures. Objective: We will implement a randomized controlled trial (RCT) to evaluate the effectiveness of a brief, peer-delivered eHealth intervention to increase COVID-19 knowledge and public health–recommended protective behaviors, and reduce psychological distress among LGBT+ people residing in Bangkok, Thailand, and Mumbai, India. Subsequent to the RCT, we will conduct exit interviews with purposively sampled subgroups, including those with no intervention effect. Methods: SafeHandsSafeHearts is a 2-site, parallel waitlist-controlled RCT to test the efficacy of a 3-session, peer counselor–delivered eHealth intervention based on motivational interviewing and psychoeducation. The study methods, online infrastructure, and content were pilot-tested with LGBT+ individuals in Toronto, Canada, before adaptation and rollout in the other contexts. The primary outcomes are COVID-19 knowledge (index based on US Centers for Disease Control and Prevention [CDC] items), protective behaviors (index based on World Health Organization and US CDC guidelines), depression (Patient Health Questionnaire-2), and anxiety (Generalized Anxiety Disorder-2). Secondary outcomes include loneliness, COVID-19 stress, and intended care-seeking. We will enroll 310 participants in each city aged 18 years and older. One-third of the participants will be cisgender gay, bisexual, and other men who have sex with men; one-third will be cisgender lesbian, bisexual, and other women who have sex with women; and one-third will be transfeminine, transmasculine, and gender nonbinary people. Participants will be equally stratified in the immediate intervention and waitlist control groups. Participants are mainly recruited from online social media accounts of community-based partner organizations. They can access the intervention on a computer, tablet, or mobile phone. SafeHandsSafeHearts involves 3 sessions delivered weekly over 3 successive weeks. Exit interviews will be conducted online with 3 subgroups (n=12 per group, n=36 in each city) of purposively selected participants to be informed by RCT outcomes and focal populations of concern. Results: The RCT was funded in 2020. The trials started recruitment as of August 1, 2021, and all RCT data collection will likely be completed by January 31, 2022. Conclusions: The SafeHandsSafeHearts RCT will provide evidence about the effectiveness of a brief, peer-delivered eHealth intervention developed for LGBT+ populations amid the COVID-19 pandemic. If the intervention proves effective, it will provide a basis for future scale-up in India and Thailand, and other low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT04870723; https://clinicaltrials.gov/ct2/show/NCT04870723 International Registered Report Identifier (IRRID): DERR1-10.2196/34381 %M 34726610 %R 10.2196/34381 %U https://www.researchprotocols.org/2021/12/e34381 %U https://doi.org/10.2196/34381 %U http://www.ncbi.nlm.nih.gov/pubmed/34726610 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e31645 %T The Pandemic, Infodemic, and People’s Resilience in India: Viewpoint %A Syed Abdul,Shabbir %A Ramaswamy,Meghna %A Fernandez-Luque,Luis %A John,Oommen %A Pitti,Thejkiran %A Parashar,Babita %+ Graduate Institute of Biomedical Informatics, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei, Taiwan, 886 02 2736 1661 ext 1514, drshabbir@tmu.edu.tw %K pandemic %K COVID-19 %K India %K digital health %K infodemics %K Sustainable Development Goals %K SDGs %D 2021 %7 8.12.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has caused widespread fear and stress. The pandemic has affected everyone, everywhere, and created systemic inequities, leaving no one behind. In India alone, more than 34,094,373 confirmed COVID-19 cases and 452,454 related deaths have been reported as of October 19, 2021. Around May 2021, the daily number of new COVID-19 cases crossed the 400,000 mark, seriously hampering the health care system. Despite the devastating situation, the public response was seen through their efforts to come forward with innovative ideas for potential ways to combat the pandemic, for instance, dealing with the shortage of oxygen cylinders and hospital bed availability. With increasing COVID-19 vaccination rates since September 2021, along with the diminishing number of daily new cases, the country is conducting preventive and preparatory measures for the third wave. In this article, we propose the pivotal role of public participation and digital solutions to re-establish our society and describe how Sustainable Development Goals (SDGs) can support eHealth initiatives and mitigate infodemics to tackle a postpandemic situation. This viewpoint reflects that the COVID-19 pandemic has featured a need to bring together research findings across disciplines, build greater coherence within the field, and be a driving force for multi-sectoral, cross-disciplinary collaboration. The article also highlights the various needs to develop digital solutions that can be applied to pandemic situations and be reprocessed to focus on other SDGs. Promoting the use of digital health care solutions to implement preventive measures can be enhanced by public empowerment and engagement. Wearable technologies can be efficiently used for remote monitoring or home-based care for patients with chronic conditions. Furthermore, the development and implementation of informational tools can aid the improvement of well-being and dissolve panic-ridden behaviors contributing toward infodemics. Thus, a call to action for an observatory of digital health initiatives on COVID-19 is required to share the main conclusions and lessons learned in terms of resilience, crisis mitigation, and preparedness. %M 34787574 %R 10.2196/31645 %U https://publichealth.jmir.org/2021/12/e31645 %U https://doi.org/10.2196/31645 %U http://www.ncbi.nlm.nih.gov/pubmed/34787574 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e33330 %T Health Care Providers’ Trusted Sources for Information About COVID-19 Vaccines: Mixed Methods Study %A Brauer,Eden %A Choi,Kristen %A Chang,John %A Luo,Yi %A Lewin,Bruno %A Munoz-Plaza,Corrine %A Bronstein,David %A Bruxvoort,Katia %+ School of Nursing, University of California, Los Angeles, 700 Tiverton Ave, Los Angeles, CA, United States, 1 3107947493, krchoi@ucla.edu %K health information %K trust %K health care provider %K COVID-19 %K vaccine %K mixed method %K communication %D 2021 %7 8.12.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Information and opinions shared by health care providers can affect patient vaccination decisions, but little is known about who health care providers themselves trust for information in the context of new COVID-19 vaccines. Objective: The purpose of this study is to investigate which sources of information about COVID-19 vaccines are trusted by health care providers and how they communicate this information to patients. Methods: This mixed methods study involved a one-time, web-based survey of health care providers and qualitative interviews with a subset of survey respondents. Health care providers (physicians, advanced practice providers, pharmacists, nurses) were recruited from an integrated health system in Southern California using voluntary response sampling, with follow-up interviews with providers who either accepted or declined a COVID-19 vaccine. The outcome was the type of information sources that respondents reported trusting for information about COVID-19 vaccines. Bivariate tests were used to compare trusted information sources by provider type; thematic analysis was used to explore perspectives about vaccine information and communicating with patients about vaccines. Results: The survey was completed by 2948 providers, of whom 91% (n=2683) responded that they had received ≥1 dose of a COVID-19 vaccine. The most frequently trusted source of COVID-19 vaccine information was government agencies (n=2513, 84.2%); the least frequently trusted source was social media (n=691, 9.5%). More physicians trusted government agencies (n=1226, 93%) than nurses (n=927, 78%) or pharmacists (n=203, 78%; P<.001), and more physicians trusted their employer (n=1115, 84%) than advanced practice providers (n=95, 67%) and nurses (n=759, 64%; P=.002). Qualitative themes (n=32 participants) about trusted sources of COVID-19 vaccine information were identified: processing new COVID-19 information in a health care work context likened to a “war zone” during the pandemic and communicating information to patients. Some providers were hesitant to recommend vaccines to pregnant people and groups they perceived to be at low risk for COVID-19. Conclusions: Physicians have stronger trust in government sources and their employers for information about COVID-19 vaccines compared with nurses, pharmacists, and advanced practice providers. Strategies such as role modeling, tailored messaging, or talking points with standard language may help providers to communicate accurate COVID-19 vaccine information to patients, and these strategies may also be used with providers with lower levels of trust in reputable information sources. %M 34926995 %R 10.2196/33330 %U https://infodemiology.jmir.org/2021/1/e33330 %U https://doi.org/10.2196/33330 %U http://www.ncbi.nlm.nih.gov/pubmed/34926995 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e32587 %T Investigating the Use of Digital Health Technology to Monitor COVID-19 and Its Effects: Protocol for an Observational Study (Covid Collab Study) %A Stewart,Callum %A Ranjan,Yatharth %A Conde,Pauline %A Rashid,Zulqarnain %A Sankesara,Heet %A Bai,Xi %A Dobson,Richard J B %A Folarin,Amos A %+ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 20 7848 0924, amos.folarin@kcl.ac.uk %K mobile health %K COVID-19 %K digital health %K smartphone %K wearable devices %K mental health %K wearable %K data %K crowdsourced %K monitoring %K surveillance %K observational %K feasibility %K infectious disease %K recovery %K mobile phone %D 2021 %7 8.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The ubiquity of mobile phones and increasing use of wearable fitness trackers offer a wide-ranging window into people’s health and well-being. There are clear advantages in using remote monitoring technologies to gain an insight into health, particularly under the shadow of the COVID-19 pandemic. Objective: Covid Collab is a crowdsourced study that was set up to investigate the feasibility of identifying, monitoring, and understanding the stratification of SARS-CoV-2 infection and recovery through remote monitoring technologies. Additionally, we will assess the impacts of the COVID-19 pandemic and associated social measures on people’s behavior, physical health, and mental well-being. Methods: Participants will remotely enroll in the study through the Mass Science app to donate historic and prospective mobile phone data, fitness tracking wearable data, and regular COVID-19–related and mental health–related survey data. The data collection period will cover a continuous period (ie, both before and after any reported infections), so that comparisons to a participant’s own baseline can be made. We plan to carry out analyses in several areas, which will cover symptomatology; risk factors; the machine learning–based classification of illness; and trajectories of recovery, mental well-being, and activity. Results: As of June 2021, there are over 17,000 participants—largely from the United Kingdom—and enrollment is ongoing. Conclusions: This paper introduces a crowdsourced study that will include remotely enrolled participants to record mobile health data throughout the COVID-19 pandemic. The data collected may help researchers investigate a variety of areas, including COVID-19 progression; mental well-being during the pandemic; and the adherence of remote, digitally enrolled participants. International Registered Report Identifier (IRRID): DERR1-10.2196/32587 %M 34784292 %R 10.2196/32587 %U https://www.researchprotocols.org/2021/12/e32587 %U https://doi.org/10.2196/32587 %U http://www.ncbi.nlm.nih.gov/pubmed/34784292 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e33296 %T The Standardization of Hospital-Acquired Infection Rates Using Prediction Models in Iran: Observational Study of National Nosocomial Infection Registry Data %A Izadi,Neda %A Etemad,Koorosh %A Mehrabi,Yadollah %A Eshrati,Babak %A Hashemi Nazari,Seyed Saeed %+ Prevention of Cardiovascular Disease Research Center, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Velenjak, 2th Floor, Tehran, Iran, 98 09125779300, saeedh_1999@yahoo.com %K hospital-acquired infections %K standardized infection ratio %K prediction model %K Iran %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34879002 %R 10.2196/33296 %U https://publichealth.jmir.org/2021/12/e33296 %U https://doi.org/10.2196/33296 %U http://www.ncbi.nlm.nih.gov/pubmed/34879002 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e31961 %T Analyzing Citizens’ and Health Care Professionals’ Searches for Smell/Taste Disorders and Coronavirus in Finland During the COVID-19 Pandemic: Infodemiological Approach Using Database Logs %A Mukka,Milla %A Pesälä,Samuli %A Hammer,Charlotte %A Mustonen,Pekka %A Jormanainen,Vesa %A Pelttari,Hanna %A Kaila,Minna %A Helve,Otto %+ University of Helsinki, Temppelikatu 17 A 5, Helsinki, 00100, Finland, 358 0504397177, milla.mukka@helsinki.fi %K COVID-19 %K SARS-CoV-2 %K smell disorders %K taste disorders %K information-seeking behavior %K health personnel %K statistical models %K medical informatics %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has prevailed over a year, and log and register data on coronavirus have been utilized to establish models for detecting the pandemic. However, many sources contain unreliable health information on COVID-19 and its symptoms, and platforms cannot characterize the users performing searches. Prior studies have assessed symptom searches from general search engines (Google/Google Trends). Little is known about how modeling log data on smell/taste disorders and coronavirus from the dedicated internet databases used by citizens and health care professionals (HCPs) could enhance disease surveillance. Our material and method provide a novel approach to analyze web-based information seeking to detect infectious disease outbreaks. Objective: The aim of this study was (1) to assess whether citizens’ and professionals’ searches for smell/taste disorders and coronavirus relate to epidemiological data on COVID-19 cases, and (2) to test our negative binomial regression modeling (ie, whether the inclusion of the case count could improve the model). Methods: We collected weekly log data on searches related to COVID-19 (smell/taste disorders, coronavirus) between December 30, 2019, and November 30, 2020 (49 weeks). Two major medical internet databases in Finland were used: Health Library (HL), a free portal aimed at citizens, and Physician’s Database (PD), a database widely used among HCPs. Log data from databases were combined with register data on the numbers of COVID-19 cases reported in the Finnish National Infectious Diseases Register. We used negative binomial regression modeling to assess whether the case numbers could explain some of the dynamics of searches when plotting database logs. Results: We found that coronavirus searches drastically increased in HL (0 to 744,113) and PD (4 to 5375) prior to the first wave of COVID-19 cases between December 2019 and March 2020. Searches for smell disorders in HL doubled from the end of December 2019 to the end of March 2020 (2148 to 4195), and searches for taste disorders in HL increased from mid-May to the end of November (0 to 1980). Case numbers were significantly associated with smell disorders (P<.001) and taste disorders (P<.001) in HL, and with coronavirus searches (P<.001) in PD. We could not identify any other associations between case numbers and searches in either database. Conclusions: Novel infodemiological approaches could be used in analyzing database logs. Modeling log data from web-based sources was seen to improve the model only occasionally. However, search behaviors among citizens and professionals could be used as a supplementary source of information for infectious disease surveillance. Further research is needed to apply statistical models to log data of the dedicated medical databases. %M 34727525 %R 10.2196/31961 %U https://publichealth.jmir.org/2021/12/e31961 %U https://doi.org/10.2196/31961 %U http://www.ncbi.nlm.nih.gov/pubmed/34727525 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31791 %T Impact of the COVID-19 Pandemic on a Physician Group’s WhatsApp Chat: Qualitative Content Analysis %A Abdel-Razig,Sawsan %A Anglade,Pascale %A Ibrahim,Halah %+ Cleveland Clinic Abu Dhabi, PO box 112412, Abu Dhabi, United Arab Emirates, 971 25019999 ext 48460, razigs@clevelandclinicabudhabi.ae %K WhatsApp %K social media %K physician %K pandemic %K COVID-19 %K qualitative %K communication %K misinformation %K information-seeking behavior %K information seeking %K information sharing %K content analysis %K community %D 2021 %7 7.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social media has emerged as an effective means of information sharing and community building among health professionals. The utility of these platforms is likely heightened during times of health system crises and global uncertainty. Studies have demonstrated that physicians’ social media platforms serve to bridge the gap of information between on-the-ground experiences of health care workers and emerging knowledge. Objective: The primary aim of this study was to characterize the use of a physician WhatsApp (WhatsApp LLC) group chat during the early months of the COVID-19 pandemic. Methods: Through the lens of the social network theory, we performed a qualitative content analysis of the posts of a women physician WhatsApp group located in the United Arab Emirates between February 1, 2020, and May 31, 2020, that is, during the initial surge of COVID-19 cases. Results: There were 6101 posts during the study period, which reflected a 2.6-fold increase in platform use when compared with platform use in the year prior. A total of 8 themes and 9 subthemes were described. The top 3 uses of the platform were requests for information (posts: 2818/6101, 46.2%), member support and promotion (posts: 988/6101, 16.2%), and information sharing (posts: 896/6101, 14.7%). A substantial proportion of posts were related to COVID-19 (2653/6101, 43.5%), with the most popular theme being requests for logistical (nonmedical) information. Among posts containing COVID-19–related medical information, it was notable that two-thirds (571/868, 65.8%) of these posts were from public mass media or unverified sources. Conclusions: Health crises can potentiate the use of social media platforms among physicians. This reflects physicians’ tendency to turn to these platforms for information sharing and community building purposes. However, important questions remain regarding the accuracy and credibility of the information shared. Our findings suggest that the training of physicians in social media practices and information dissemination may be needed. %M 34784291 %R 10.2196/31791 %U https://formative.jmir.org/2021/12/e31791 %U https://doi.org/10.2196/31791 %U http://www.ncbi.nlm.nih.gov/pubmed/34784291 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e30004 %T Using Venn Diagrams to Evaluate Digital Contact Tracing: Panel Survey Analysis %A Daniore,Paola %A Nittas,Vasileios %A Moser,André %A Höglinger,Marc %A von Wyl,Viktor %+ Institute for Implementation Science in Healthcare, University of Zurich, Universitätstrasse 84, Zurich, 8006, Switzerland, 41 446346380, viktor.vonwyl@uzh.ch %K digital contact tracing %K exposure notification %K COVID-19 %K SARS-CoV-2 %K contact tracing %K digital health %K tracing apps %K mHealth %K mobile apps %K key performance indicators %K Venn diagram approach %D 2021 %7 6.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Mitigation of the spread of infection relies on targeted approaches aimed at preventing nonhousehold interactions. Contact tracing in the form of digital proximity tracing apps has been widely adopted in multiple countries due to its perceived added benefits of tracing speed and breadth in comparison to traditional manual contact tracing. Assessments of user responses to exposure notifications through a guided approach can provide insights into the effect of digital proximity tracing app use on managing the spread of SARS-CoV-2. Objective: The aim of this study was to demonstrate the use of Venn diagrams to investigate the contributions of digital proximity tracing app exposure notifications and subsequent mitigative actions in curbing the spread of SARS-CoV-2 in Switzerland. Methods: We assessed data from 4 survey waves (December 2020 to March 2021) from a nationwide panel study (COVID-19 Social Monitor) of Swiss residents who were (1) nonusers of the SwissCovid app, (2) users of the SwissCovid app, or (3) users of the SwissCovid app who received exposure notifications. A Venn diagram approach was applied to describe the overlap or nonoverlap of these subpopulations and to assess digital proximity tracing app use and its associated key performance indicators, including actions taken to prevent SARS-CoV-2 transmission. Results: We included 12,525 assessments from 2403 participants, of whom 50.9% (1222/2403) reported not using the SwissCovid digital proximity tracing app, 49.1% (1181/2403) reported using the SwissCovid digital proximity tracing app and 2.5% (29/1181) of the digital proximity tracing app users reported having received an exposure notification. Most digital proximity tracing app users (75.9%, 22/29) revealed taking at least one recommended action after receiving an exposure notification, such as seeking SARS-CoV-2 testing (17/29, 58.6%) or calling a federal information hotline (7/29, 24.1%). An assessment of key indicators of mitigative actions through a Venn diagram approach reveals that 30% of digital proximity tracing app users (95% CI 11.9%-54.3%) also tested positive for SARS-CoV-2 after having received exposure notifications, which is more than 3 times that of digital proximity tracing app users who did not receive exposure notifications (8%, 95% CI 5%-11.9%). Conclusions: Responses in the form of mitigative actions taken by 3 out of 4 individuals who received exposure notifications reveal a possible contribution of digital proximity tracing apps in mitigating the spread of SARS-CoV-2. The application of a Venn diagram approach demonstrates its value as a foundation for researchers and health authorities to assess population-level digital proximity tracing app effectiveness by providing an intuitive approach for calculating key performance indicators. %M 34874890 %R 10.2196/30004 %U https://publichealth.jmir.org/2021/12/e30004 %U https://doi.org/10.2196/30004 %U http://www.ncbi.nlm.nih.gov/pubmed/34874890 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e33495 %T Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training: Protocol for the Development and Rapid-Response Deployment %A Fung,Kenneth %A Liu,Jenny JW %A Vahabi,Mandana %A Li,Alan Tai-Wai %A Zurowski,Mateusz %A Wong,Josephine Pui-Hing %+ Department of Psychiatry, Faculty of Medicine, University of Toronto, 399 Bathurst Street, Toronto, ON, M5T 2S8, Canada, 1 (416) 603 5349, ken.fung@uhn.ca %K COVID %K COVID-19 %K coronavirus %K pandemic %K resilience %K acceptance commitment therapy %K group empowerment %D 2021 %7 6.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: During a global pandemic, it is critical to rapidly deploy a psychological intervention to support the mental health and resilience of highly affected individuals and communities. Objective: This is the rationale behind the development and implementation of the Pandemic Acceptance and Commitment to Empowerment Response (PACER) Training, an online, blended, skills building intervention to increase the resilience and well-being of participants while promoting their individual and collective empowerment and capacity building. Methods: Based on acceptance and commitment therapy (ACT) and social justice–based group empowerment psychoeducation (GEP), we developed the Acceptance and Commitment to Empowerment (ACE) model to enhance psychological resilience and collective empowerment. The PACER program consists of 6 online, interactive, self-guided modules complemented by 6 weekly, 90-minute, videoconference, facilitator-led, group sessions. Results: As of August 2021, a total of 325 participants had enrolled in the PACER program. Participants include frontline health care providers and Chinese-Canadian community members. Conclusions: The PACER program is an innovative intervention program with the potential for increasing resilience and empowerment while reducing mental distress during the pandemic. International Registered Report Identifier (IRRID): DERR1-10.2196/33495 %M 34726602 %R 10.2196/33495 %U https://www.researchprotocols.org/2021/12/e33495 %U https://doi.org/10.2196/33495 %U http://www.ncbi.nlm.nih.gov/pubmed/34726602 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e31271 %T Re-examining COVID-19 Self-Reported Symptom Tracking Programs in the United States: Updated Framework Synthesis %A Janvrin,Miranda Lynn %A Korona-Bailey,Jessica %A Koehlmoos,Tracey Pérez %+ The Henry M Jackson Foundation for the Advancement of Military Medicine, 6720B Rockledge Dr, Suite 100, Bethesda, MD, 20817, United States, 1 6035403059, miranda.janvrin@gmail.com %K COVID-19 %K coronavirus %K framework analysis %K information resources %K monitoring %K patient-reported outcome measures %K self-reported %K surveillance %K symptom tracking %K synthesis %K digital health %D 2021 %7 6.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Early in the pandemic, in 2020, Koehlmoos et al completed a framework synthesis of currently available self-reported symptom tracking programs for COVID-19. This framework described relevant programs, partners and affiliates, funding, responses, platform, and intended audience, among other considerations. Objective: This study seeks to update the existing framework with the aim of identifying developments in the landscape and highlighting how programs have adapted to changes in pandemic response. Methods: Our team developed a framework to collate information on current COVID-19 self-reported symptom tracking programs using the “best-fit” framework synthesis approach. All programs from the previous study were included to document changes. New programs were discovered using a Google search for target keywords. The time frame for the search for programs ranged from March 1, 2021, to May 6, 2021. Results: We screened 33 programs, of which 8 were included in our final framework synthesis. We identified multiple common data elements, including demographic information such as race, age, gender, and affiliation (all were associated with universities, medical schools, or schools of public health). Dissimilarities included questions regarding vaccination status, vaccine hesitancy, adherence to social distancing, COVID-19 testing, and mental health. Conclusions: At this time, the future of self-reported symptom tracking for COVID-19 is unclear. Some sources have speculated that COVID-19 may become a yearly occurrence much like the flu, and if so, the data that these programs generate is still valuable. However, it is unclear whether the public will maintain the same level of interest in reporting their symptoms on a regular basis if the prevalence of COVID-19 becomes more common. %M 34792469 %R 10.2196/31271 %U https://formative.jmir.org/2021/12/e31271 %U https://doi.org/10.2196/31271 %U http://www.ncbi.nlm.nih.gov/pubmed/34792469 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 12 %P e29127 %T Content and Dynamics of Websites Shared Over Vaccine-Related Tweets in COVID-19 Conversations: Computational Analysis %A Cruickshank,Iain %A Ginossar,Tamar %A Sulskis,Jason %A Zheleva,Elena %A Berger-Wolf,Tanya %+ Center for Computational Analysis of Social and Organizational Systems, Carnegie Mellon University, 5000 Forbes Ave, Pittsburgh, PA, 15201, United States, 1 7192371515, icruicks@andrew.cmu.edu %K COVID-19 %K agenda setting %K antivaccination %K cross-platform %K data mining of social media %K misinformation %K social media %K Twitter %K vaccinations %K vaccine hesitancy %D 2021 %7 3.12.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The onset of the COVID-19 pandemic and the consequent “infodemic” increased concerns about Twitter’s role in advancing antivaccination messages, even before a vaccine became available to the public. New computational methods allow for analysis of cross-platform use by tracking links to websites shared over Twitter, which, in turn, can uncover some of the content and dynamics of information sources and agenda-setting processes. Such understanding can advance theory and efforts to reduce misinformation. Objective: Informed by agenda-setting theory, this study aimed to identify the content and temporal patterns of websites shared in vaccine-related tweets posted to COVID-19 conversations on Twitter between February and June 2020. Methods: We used triangulation of data analysis methods. Data mining consisted of the screening of around 5 million tweets posted to COVID-19 conversations to identify tweets that related to vaccination and including links to websites shared within these tweets. We further analyzed the content the 20 most-shared external websites using a mixed methods approach. Results: Of 841,896 vaccination-related tweets identified, 185,994 (22.1%) contained links to specific websites. A wide range of websites were shared, with the 20 most-tweeted websites constituting 14.5% (27,060/185,994) of the shared websites and typically being shared for only 2 to 3 days. Traditional media constituted the majority of these 20 websites, along with other social media and governmental sources. We identified markers of inauthentic propagation for some of these links. Conclusions: The topic of vaccination was prevalent in tweets about COVID-19 early in the pandemic. Sharing websites was a common communication strategy, and its “bursty” pattern and inauthentic propagation strategies pose challenges for health promotion efforts. Future studies should consider cross-platform use in dissemination of health information and in counteracting misinformation. %M 34665760 %R 10.2196/29127 %U https://www.jmir.org/2021/12/e29127 %U https://doi.org/10.2196/29127 %U http://www.ncbi.nlm.nih.gov/pubmed/34665760 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e33455 %T Learning From a Massive Open Online COVID-19 Vaccination Training Experience: Survey Study %A Goldin,Shoshanna %A Kong,So Yeon Joyce %A Tokar,Anna %A Utunen,Heini %A Ndiaye,Ngouille %A Bahl,Jhilmil %A Appuhamy,Ranil %A Moen,Ann %+ Influenza Preparedness and Response, Organisation Mondiale de la Santé, 20 Avenue Appia, Genève, CH-1211, Switzerland, 41 795165651, goldins@who.int %K COVID-19 %K vaccination %K training %K massive open online course %K pandemic %K vaccine %K education %K online education %K preparation %K evaluation %K user experience %K challenge %K impact %K knowledge %K interest %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34794116 %R 10.2196/33455 %U https://publichealth.jmir.org/2021/12/e33455 %U https://doi.org/10.2196/33455 %U http://www.ncbi.nlm.nih.gov/pubmed/34794116 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e32814 %T Factors Driving the Popularity and Virality of COVID-19 Vaccine Discourse on Twitter: Text Mining and Data Visualization Study %A Zhang,Jueman %A Wang,Yi %A Shi,Molu %A Wang,Xiuli %+ School of New Media, Peking University, 5 Yiheyuan Road, Haidian District, Beijing, 100871, China, 86 10 6276 6689, xiuli.wang@pku.edu.cn %K COVID-19 %K vaccine %K topic modeling %K LDA %K valence %K share %K viral %K Twitter %K social media %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 vaccination is considered a critical prevention measure to help end the pandemic. Social media platforms such as Twitter have played an important role in the public discussion about COVID-19 vaccines. Objective: The aim of this study was to investigate message-level drivers of the popularity and virality of tweets about COVID-19 vaccines using machine-based text-mining techniques. We further aimed to examine the topic communities of the most liked and most retweeted tweets using network analysis and visualization. Methods: We collected US-based English-language public tweets about COVID-19 vaccines from January 1, 2020, to April 30, 2021 (N=501,531). Topic modeling and sentiment analysis were used to identify latent topics and valence, which together with autoextracted information about media presence, linguistic features, and account verification were used in regression models to predict likes and retweets. Among the 2500 most liked tweets and 2500 most retweeted tweets, network analysis and visualization were used to detect topic communities and present the relationship between the topics and the tweets. Results: Topic modeling yielded 12 topics. The regression analyses showed that 8 topics positively predicted likes and 7 topics positively predicted retweets, among which the topic of vaccine development and people’s views and that of vaccine efficacy and rollout had relatively larger effects. Network analysis and visualization revealed that the 2500 most liked and most retweeted retweets clustered around the topics of vaccine access, vaccine efficacy and rollout, vaccine development and people’s views, and vaccination status. The overall valence of the tweets was positive. Positive valence increased likes, but valence did not affect retweets. Media (photo, video, gif) presence and account verification increased likes and retweets. Linguistic features had mixed effects on likes and retweets. Conclusions: This study suggests the public interest in and demand for information about vaccine development and people’s views, and about vaccine efficacy and rollout. These topics, along with the use of media and verified accounts, have enhanced the popularity and virality of tweets. These topics could be addressed in vaccine campaigns to help the diffusion of content on Twitter. %M 34665761 %R 10.2196/32814 %U https://publichealth.jmir.org/2021/12/e32814 %U https://doi.org/10.2196/32814 %U http://www.ncbi.nlm.nih.gov/pubmed/34665761 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 2 %P e33433 %T From the Cochrane Library: Interventions for Impetigo %A Oganesyan,Ani %A Sivesind,Torunn %A Dellavalle,Robert %+ Department of Dermatology, University of Colorado Anschutz Medical Campus, 13001 E 17th Place, Aurora, CO, 80045, United States, 1 818 441 6860, ani.oganesyan@cuanschutz.edu %K impetigo %K pustular lesions %K Staphylococcus aureus %K Streptococcus pyogenes %K dermatology %K skin infection %D 2021 %7 3.12.2021 %9 Research Letter %J JMIR Dermatol %G English %X %M 39478281 %R 10.2196/33433 %U https://derma.jmir.org/2021/2/e33433 %U https://doi.org/10.2196/33433 %U http://www.ncbi.nlm.nih.gov/pubmed/39478281 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28239 %T Pandemic Information Dissemination and Its Associations With the Symptoms of Mental Distress During the COVID-19 Pandemic: Cross-sectional Study %A Amundsen,Ole Myklebust %A Hoffart,Asle %A Johnson,Sverre Urnes %A Ebrahimi,Omid V %+ Department of Clinical Psychology, University of Bergen, Årstadveien 17, Bergen, 5009, Norway, 47 45209507, oleamundsen@me.com %K information sources %K COVID-19 %K avoidance %K psychopathology %D 2021 %7 3.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The 2020-2021 COVID-19 pandemic has added to the mental health strain on individuals and groups across the world in a variety of ways. Viral mitigation protocols and viral spread affect people on all continents every day, but at widely different degrees. To understand more about the mental health consequences of the pandemic, it is important to investigate whether or how people gather pandemic-related information and how obtaining this information differentially affects individuals. Objective: This study aimed to investigate whether and to what extent higher levels of COVID-19–related media consumption across information sources are associated with the symptoms of anxiety, health anxiety, and depression, and whether and to what extent using social media and online interactive platforms versus traditional media platforms is associated with the symptoms of anxiety, health anxiety, and depression. Additionally, we aimed to investigate whether and to what extent avoidance of COVID-19–related information is associated with the aforementioned symptoms. Methods: In a cross-sectional preregistered survey, 4936 participants responded between June 22 and July 13, 2020. Eligible participants were adults currently residing in Norway and were thus subjected to identical viral mitigation protocols. This sample was representative of the Norwegian population after utilizing an iterative raking algorithm to conduct poststratification. As 2 subgroups (transgender and intersex individuals) were too small to be analyzed, the final sample for descriptive statistics and regressions included 4921 participants. Multiple regressions were used to investigate associations between the symptoms of psychopathology and COVID-19–related information dissemination. Part correlations were calculated as measures of the effect size for each predictor variable. Due to the large anticipated sample size, the preregistered criterion for significance was set at P<.01. Results: The symptoms of anxiety and health anxiety were significantly associated with obtaining information from newspapers (P<.001), social media (P<.001), and the broader categories of online interactive (P<.001) and traditional media (P<.001). The symptoms of depression were significantly associated with obtaining information from newspapers (P=.003), social media (P=.009), and the broader category of online interactive media (P<.001). Additionally, avoidance of COVID-19–related information showed a significant association in all 3 domains of psychopathological symptoms (anxiety and depression, P<.001; health anxiety, P=.007). Conclusions: This study found significant associations between the symptoms of psychopathology and the use of media for obtaining information related to the COVID-19 pandemic. Significant findings for obtaining information through newspapers, social media, and online interactive media were seen across all 3 measures of psychopathology. Avoidance of COVID-19–related information and associations with the symptoms of psychopathology emerged as core findings, with generally higher effect sizes compared with information attainment. Trial Registration: ClinicalTrials.gov NCT04442360; https://clinicaltrials.gov/ct2/show/NCT04442360 %M 34678750 %R 10.2196/28239 %U https://formative.jmir.org/2021/12/e28239 %U https://doi.org/10.2196/28239 %U http://www.ncbi.nlm.nih.gov/pubmed/34678750 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 12 %P e31574 %T Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER): Protocol for a Multisite Longitudinal Cohort Study %A Edwards,Laura J %A Fowlkes,Ashley L %A Wesley,Meredith G %A Kuntz,Jennifer L %A Odean,Marilyn J %A Caban-Martinez,Alberto J %A Dunnigan,Kayan %A Phillips,Andrew L %A Grant,Lauren %A Herring,Meghan K %A Groom,Holly C %A Respet,Karley %A Beitel,Shawn %A Zunie,Tnelda %A Hegmann,Kurt T %A Kumar,Archana %A Joseph,Gregory %A Poe,Brandon %A Louzado-Feliciano,Paola %A Smith,Michael E %A Thiese,Matthew S %A Schaefer-Solle,Natasha %A Yoo,Young M %A Silvera,Carlos A %A Mayo Lamberte,Julie %A Mak,Josephine %A McDonald,L Clifford %A Stuckey,Matthew J %A Kutty,Preeta %A Arvay,Melissa L %A Yoon,Sarang K %A Tyner,Harmony L %A Burgess,Jefferey L %A Hunt,Danielle Rentz %A Meece,Jennifer %A Gaglani,Manjusha %A Naleway,Allison L %A Thompson,Mark G %+ Centers for Disease Control and Prevention, 1600 Clifton Rd. NE, Mailstop H24-7, Atlanta, GA, 30333, United States, 1 404 822 1999, ahl4@cdc.gov %K COVID-19 %K SARS-CoV-2 %K incidence %K vaccine effectiveness %K cohort study %K health care personnel %K first responder %K essential and frontline workers %D 2021 %7 3.12.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Workers critical to emergency response and continuity of essential services during the COVID-19 pandemic are at a disproportionally high risk of SARS-CoV-2 infection. Prospective cohort studies are needed for enhancing the understanding of the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, identifying risk factors, assessing clinical outcomes, and determining the effectiveness of vaccination. Objective: The Research on the Epidemiology of SARS-CoV-2 in Essential Response Personnel (RECOVER) prospective cohort study was designed to estimate the incidence of symptomatic and asymptomatic SARS-CoV-2 infections, examine the risk factors for infection and clinical spectrum of illness, and assess the effectiveness of vaccination among essential workers. Methods: The RECOVER multisite network was initiated in August 2020 and aims to enroll 3000 health care personnel (HCP), first responders, and other essential and frontline workers (EFWs) at 6 US locations. Data on participant demographics, medical history, and vaccination history are collected at baseline and throughout the study. Active surveillance for the symptoms of COVID-19–like illness (CLI), access of medical care, and symptom duration is performed by text messages, emails, and direct participant or medical record reports. Participants self-collect a mid-turbinate nasal swab weekly, regardless of symptoms, and 2 additional respiratory specimens at the onset of CLI. Blood is collected upon enrollment, every 3 months, approximately 28 days after a reverse transcription polymerase chain reaction (RT-PCR)–confirmed SARS-CoV-2 infection, and 14 to 28 days after a dose of any COVID-19 vaccine. From February 2021, household members of RT-PCR–confirmed participants are self-collecting mid-turbinate nasal swabs daily for 10 days. Results: The study observation period began in August 2020 and is expected to continue through spring 2022. There are 2623 actively enrolled RECOVER participants, including 280 participants who have been found to be positive for SARS-CoV-2 by RT-PCR. Enrollment is ongoing at 3 of the 6 study sites. Conclusions: Data collected through the cohort are expected to provide important public health information for essential workers at high risk for occupational exposure to SARS-CoV-2 and allow early evaluation of COVID-19 vaccine effectiveness. International Registered Report Identifier (IRRID): DERR1-10.2196/31574 %M 34662287 %R 10.2196/31574 %U https://www.researchprotocols.org/2021/12/e31574 %U https://doi.org/10.2196/31574 %U http://www.ncbi.nlm.nih.gov/pubmed/34662287 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e30702 %T Depression, Anxiety, and Daily Activity Among Adolescents Before and During the COVID-19 Pandemic: Cross-sectional Survey Study %A Jolliff,Anna %A Zhao,Qianqian %A Eickhoff,Jens %A Moreno,Megan %+ Department of Pediatrics, School of Medicine and Public Health, University of Wisconsin - Madison, 2870 University Avenue, Suite 200, Madison, WI, 53705, United States, 1 5035539361, ajolliff@wisc.edu %K COVID-19 %K pandemic %K adolescent %K depression %K anxiety %K socioeconomic status %K survey %K mental health %D 2021 %7 2.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has resulted in significant changes to adolescents’ daily lives and, potentially, to their mental health. The pandemic has also disproportionately affected historically marginalized and at-risk communities, including people of color, socioeconomically disadvantaged people, people identifying as female, and youth. Objective: This study aimed to understand differences in depression and anxiety among 2 groups of adolescents in the United States before and during the COVID-19 pandemic, and to examine demographic and daily activity variables associated with depression and anxiety. Methods: Online surveys were distributed in 2019 and 2020. Demographic questions were asked at the time of enrollment, and included participants’ age, gender, race and ethnicity, and socioeconomic status (SES). The 8-item Patient Health Questionnaire was used to assess symptoms of depression, and the 7-item Generalized Anxiety Disorder scale was used to assess symptoms of anxiety. A total of 4 pandemic-specific daily activity questions were asked only of the pandemic group. Analyses of covariance compared depression and anxiety between prepandemic and pandemic groups. Demographic and lifestyle variables were included as covariates. Results: The sample comprised a total of 234 adolescents, with 100 participants in the prepandemic group and 134 participants in the pandemic group. Within the pandemic group, 94% (n=126) of adolescents reported being out of school due to the pandemic, and another 85.8% (n=115) and 57.1% (n=76) were prevented from extracurricular activities and exercise, respectively. Higher depression was seen in the pandemic group, with a least-squares adjusted mean of 7.62 (SD 1.36) compared to 6.28 (SD 1.42) in the prepandemic group, although the difference was not significant (P=.08). There was no significant difference in anxiety scores between the 2 groups (least-squares adjusted means 5.52, SD 1.30 vs 5.01, SD 1.36; P=.48). Within the pandemic group, lower SES was predictive of anxiety, such that those in the pandemic group of lower SES were more anxious than their higher-SES peers (least-squares adjusted means 11.17, SD 2.34 vs 8.66, SD 2.16; P=.02). Within the pandemic group, being out of work or school and not partaking in extracurricular activities or exercise due to the pandemic were not associated with higher depression or anxiety scores. Conclusions: In this study, neither being in the pandemic group nor experiencing changes in daily activity due to the pandemic was associated with higher depression or anxiety. However, we found that adolescents from lower SES backgrounds experienced significantly more anxiety during the pandemic than their more privileged peers. Both instrumental and mental health interventions for low-income adolescents are imperative. %M 34609316 %R 10.2196/30702 %U https://formative.jmir.org/2021/12/e30702 %U https://doi.org/10.2196/30702 %U http://www.ncbi.nlm.nih.gov/pubmed/34609316 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 12 %P e30648 %T Predicting COVID-19 Transmission to Inform the Management of Mass Events: Model-Based Approach %A Donnat,Claire %A Bunbury,Freddy %A Kreindler,Jack %A Liu,David %A Filippidis,Filippos T %A Esko,Tonu %A El-Osta,Austen %A Harris,Matthew %+ Department of Statistics, University of Chicago, 5747 South Ellis Avenue, Chicago, IL, 60637, United States, 1 773 702 9890, cdonnat@uchicago.edu %K COVID-19 %K transmission dynamics %K live event management %K Monte Carlo simulation %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34583317 %R 10.2196/30648 %U https://publichealth.jmir.org/2021/12/e30648 %U https://doi.org/10.2196/30648 %U http://www.ncbi.nlm.nih.gov/pubmed/34583317 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 12 %P e28734 %T Transitioning From In-Person to Remote Clinical Research on Depression and Traumatic Brain Injury During the COVID-19 Pandemic: Study Modifications and Preliminary Feasibility From a Randomized Controlled Pilot Study %A Fisher,Lauren B %A Tuchman,Sylvie %A Curreri,Andrew J %A Markgraf,Maggie %A Nyer,Maren B %A Cassano,Paolo %A Iverson,Grant L %A Fava,Maurizio %A Zafonte,Ross D %A Pedrelli,Paola %+ Department of Psychiatry, Massachusetts General Hospital, 1 Bowdoin Square, 6th Floor, Boston, MA, 02114, United States, 1 617 643 0877, fisher.lauren@mgh.harvard.edu %K COVID-19 %K telemental health %K clinical trial %K traumatic brain injury %K depression %K cognitive behavioral therapy %D 2021 %7 1.12.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Telehealth has provided many researchers, especially those conducting psychosocial research, with the tools necessary to transition from in-person to remote clinical trials during the COVID-19 pandemic. A growing body of research supports the effectiveness of telemental health for a variety of psychiatric conditions, but few studies have examined telemental health for individuals with comorbid medical diagnoses. Furthermore, little is known about the remote implementation of clinical trials examining telemental health interventions. Objective: This paper outlines the procedural modifications used to facilitate conversion of an in-person randomized controlled trial of cognitive behavioral therapy (CBT) for depression in individuals with traumatic brain injury (TBI; CBT-TBI) to a telemental health study administered remotely. Methods: Given the nature of remote implementation and specific challenges experienced by individuals with TBI, considerations related to treatment delivery, remote consent, data management, neuropsychological assessment, safety monitoring, and delivery of supportive material have been discussed. Feasibility, acceptability, and safety were evaluated by examining attendance and participant responses on self-report measures of treatment satisfaction and suicidal behavior. Results: High rates of treatment attendance, assessment completion, study retention, and satisfaction with the intervention and modality were reported by participants who completed at least one telemental health CBT-TBI session. Conclusions: Study modifications are necessary when conducting a study remotely, and special attention should be paid to comorbidities and population-specific challenges (eg, cognitive impairment). Preliminary data support the feasibility, acceptability, and safety of remotely conducting a randomized controlled trial of CBT-TBI. Trial Registration: ClinicalTrials.gov NCT03307070; https://clinicaltrials.gov/ct2/show/NCT03307070 %M 34662285 %R 10.2196/28734 %U https://formative.jmir.org/2021/12/e28734 %U https://doi.org/10.2196/28734 %U http://www.ncbi.nlm.nih.gov/pubmed/34662285 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e31510 %T Global Research on Coronaviruses: Metadata-Based Analysis for Public Health Policies %A Warin,Thierry %+ HEC Montréal, 3000, chemin de la Côte-Sainte-Catherine, Montréal, QC, H3T 2A7, Canada, 1 5146082106, thierry.warin@hec.ca %K COVID-19 %K SARS-CoV-2 %K natural language processing %K coronavirus %K unstructured data %K data science %K health 4.0 %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Within the context of the COVID-19 pandemic, this paper suggests a data science strategy for analyzing global research on coronaviruses. The application of reproducible research principles founded on text-as-data information, open science, the dissemination of scientific data, and easy access to scientific production may aid public health in the fight against the virus. Objective: The primary goal of this paper was to use global research on coronaviruses to identify critical elements that can help inform public health policy decisions. We present a data science framework to assist policy makers in implementing cutting-edge data science techniques for the purpose of developing evidence-based public health policies. Methods: We used the EpiBibR (epidemiology-based bibliography for R) package to gain access to coronavirus research documents worldwide (N=121,231) and their associated metadata. To analyze these data, we first employed a theoretical framework to group the findings into three categories: conceptual, intellectual, and social. Second, we mapped the results of our analysis in these three dimensions using machine learning techniques (ie, natural language processing) and social network analysis. Results: Our findings, firstly, were methodological in nature. They demonstrated the potential for the proposed data science framework to be applied to public health policies. Additionally, our findings indicated that the United States and China were the primary contributors to global coronavirus research during the study period. They also demonstrated that India and Europe were significant contributors, albeit in a secondary position. University collaborations in this domain were strong between the United States, Canada, and the United Kingdom, confirming the country-level findings. Conclusions: Our findings argue for a data-driven approach to public health policy, particularly when efficient and relevant research is required. Text mining techniques can assist policy makers in calculating evidence-based indices and informing their decision-making process regarding specific actions necessary for effective health responses. %M 34596570 %R 10.2196/31510 %U https://medinform.jmir.org/2021/11/e31510 %U https://doi.org/10.2196/31510 %U http://www.ncbi.nlm.nih.gov/pubmed/34596570 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e27626 %T Evaluation of the National Tuberculosis Surveillance System in Sana’a, Yemen, 2018: Observational Study %A Al kalali,Fadwa Salem Ahmed %A Mahyoub,Essam %A Al-Hammadi,Abdulbary %A Anam,Labiba %A Khader,Yousef %+ Yemen Field Epidemiology Training Program, Ministry of Public Health and Population, Mazda St, Al Hasaba, Sana’a, 12093, Yemen, 967 778005123, fadwa20102011@yahoo.com %K evaluation %K surveillance system %K tuberculosis %K Yemen %D 2021 %7 30.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Tuberculosis remains a public problem that is considered one of the top causes of morbidity and mortality worldwide. The National Tuberculosis Control Program in Yemen was established in 1970 and included in the national health policy under the leadership of the Ministry of Public Health and Population to monitor tuberculosis control. The surveillance system must be evaluated periodically to produce recommendations for improving performance and usefulness. Objective: This study aims to assess the usefulness and the performance of the tuberculosis surveillance system attributes and to identify the strengths and weaknesses of the system. Methods: A quantitative and qualitative evaluation of the national tuberculosis surveillance system was conducted using the Centers for Disease Control and Prevention’s updated guidelines. The study was carried out in 10 districts in Sana’a City. A total of 28 public health facilities providing tuberculosis services for the whole population in their assigned catchment areas were purposively selected. All participants were interviewed based on their involvement with key aspects of tuberculosis surveillance activities. Results: The tuberculosis surveillance system was found to have an average performance in usefulness (57/80, 71%), flexibility (30/40, 75%), acceptability (174/264, 66%), data quality (4/6, 67%), and positive predictive value (78/107, 73%), and poor performance in simplicity (863/1452, 59%) and stability (15%, 3/20). In addition, the system also had a good performance in sensitivity (78/81, 96%). Conclusions: The tuberculosis surveillance system was found to be useful. The flexibility, positive predictive value, and data quality were average. Stability and simplicity were poor. The sensitivity was good. The main weaknesses in the tuberculosis surveillance system include a lack of governmental financial support, a paper-based system, and a lack of regular staff training. Developing an electronic system, securing governmental finances, and training the staff on tuberculosis surveillance are strongly recommended to improve the system performance. %M 34851294 %R 10.2196/27626 %U https://publichealth.jmir.org/2021/11/e27626 %U https://doi.org/10.2196/27626 %U http://www.ncbi.nlm.nih.gov/pubmed/34851294 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e30529 %T Mild Adverse Events of Sputnik V Vaccine in Russia: Social Media Content Analysis of Telegram via Deep Learning %A Jarynowski,Andrzej %A Semenov,Alexander %A Kamiński,Mikołaj %A Belik,Vitaly %+ System Modeling Group, Institute for Veterinary Epidemiology and Biostatistics, Freie Universität Berlin, Königsweg 67, Berlin, 14163, Germany, 49 30 838 61129, vitaly.belik@fu-berlin.de %K adverse events %K Sputnik V %K Gam-COVID-Vac %K social media %K Telegram %K COVID-19 %K Sars-CoV-2 %K deep learning %K vaccine safety %D 2021 %7 29.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: There is a limited amount of data on the safety profile of the COVID-19 vector vaccine Gam-COVID-Vac (Sputnik V). Previous infodemiology studies showed that social media discourse could be analyzed to assess the most concerning adverse events (AE) caused by drugs. Objective: We aimed to investigate mild AEs of Sputnik V based on a participatory trial conducted on Telegram in the Russian language. We compared AEs extracted from Telegram with other limited databases on Sputnik V and other COVID-19 vaccines. We explored symptom co-occurrence patterns and determined how counts of administered doses, age, gender, and sequence of shots could confound the reporting of AEs. Methods: We collected a unique dataset consisting of 11,515 self-reported Sputnik V vaccine AEs posted on the Telegram group, and we utilized natural language processing methods to extract AEs. Specifically, we performed multilabel classifications using the deep neural language model Bidirectional Encoder Representations from Transformers (BERT) “DeepPavlov,” which was pretrained on a Russian language corpus and applied to the Telegram messages. The resulting area under the curve score was 0.991. We chose symptom classes that represented the following AEs: fever, pain, chills, fatigue, nausea/vomiting, headache, insomnia, lymph node enlargement, erythema, pruritus, swelling, and diarrhea. Results: Telegram users complained mostly about pain (5461/11,515, 47.43%), fever (5363/11,515, 46.57%), fatigue (3862/11,515, 33.54%), and headache (2855/11,515, 24.79%). Women reported more AEs than men (1.2-fold, P<.001). In addition, there were more AEs from the first dose than from the second dose (1.1-fold, P<.001), and the number of AEs decreased with age (β=.05 per year, P<.001). The results also showed that Sputnik V AEs were more similar to other vector vaccines (132 units) than with messenger RNA vaccines (241 units) according to the average Euclidean distance between the vectors of AE frequencies. Elderly Telegram users reported significantly more (5.6-fold on average) systemic AEs than their peers, according to the results of the phase 3 clinical trials published in The Lancet. However, the AEs reported in Telegram posts were consistent (Pearson correlation r=0.94, P=.02) with those reported in the Argentinian postmarketing AE registry. Conclusions: After the Sputnik V vaccination, Russian Telegram users reported mostly pain, fever, and fatigue. The Sputnik V AE profile was comparable with other vector COVID-19 vaccines. Discussion on social media could provide meaningful information about the AE profile of novel vaccines. %M 34662291 %R 10.2196/30529 %U https://www.jmir.org/2021/11/e30529 %U https://doi.org/10.2196/30529 %U http://www.ncbi.nlm.nih.gov/pubmed/34662291 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e33088 %T Assessing Values and Preferences Toward SARS-CoV-2 Self-testing Among the General Population and Their Representatives, Health Care Personnel, and Decision-Makers: Protocol for a Multicountry Mixed Methods Study %A Shilton,Sonjelle %A Ivanova Reipold,Elena %A Roca Álvarez,Albert %A Martínez-Pérez,Guillermo Z %+ FIND, the global alliance for diagnostics, Chemin des Mines 9, Geneva, 1202, Switzerland, 41 22 710 05 90, sonjelle.shilton@finddx.org %K COVID-19 %K SARS-CoV-2 %K diagnostic %K self-testing %K mixed methods %K testing %K protocol %K preference %K testing %K population %K health care worker %K decision-making %K accessibility %K transmission %K screening %D 2021 %7 26.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Accessible, safe, and client-centered SARS-CoV-2 testing services are an effective way to halt its transmission. Testing enables infected individuals to isolate or quarantine to prevent further transmission. In countries with limited health systems and laboratory capacity, it can be challenging to provide accessible and safe screening for COVID-19. Self-testing provides a convenient, private, and safe testing option; however, it also raises important concerns about lack of counseling and ensuring timely reporting of self-test results to national surveillance systems. Investigating community members’ views and perceptions regarding SARS-CoV-2 self-testing is crucial to inform the most effective and safe strategies for implementing said testing. Objective: We aimed to determine whether SARS-CoV-2 self-testing was useful to diagnose and prevent the spread of SARS-CoV-2 for populations in low-resource settings and under which circumstances it would be acceptable. Methods: This multisite, mixed methods, observational study will be conducted in 9 countries—Brazil, India, Indonesia, Kenya, Malawi, Nigeria, Peru, the Philippines, and South Africa—and will consists of 2 components: cross-sectional surveys and interviews (semistructured and group) among 4 respondent groupings: the general population, general population representatives, health care workers, and decision-makers. General population and health care worker survey responses will be analyzed separately from each other, using bivariate and multivariate inferential analysis and descriptive statistics. Semistructured interviews and group interviews will be audiorecorded, transcribed, and coded for thematic comparative analysis. Results: As of November 19, 2021, participant enrollment is ongoing; 4364 participants have been enrolled in the general population survey, and 2233 participants have been enrolled in the health care workers survey. In the qualitative inquiry, 298 participants have been enrolled. We plan to complete data collection by December 31, 2021 and publish results in 2022 via publications, presentations at conferences, and dissemination events specifically targeted at local decision-makers, civil society, and patient groups. Conclusions: The views and perceptions of local populations are crucial in the discussion of the safest strategies for implementing SARS-CoV-2 self-testing. We intend to identify sociocultural specificities that may hinder or accelerate the widespread utilization of SARS-CoV-2 self-testing. International Registered Report Identifier (IRRID): DERR1-10.2196/33088 %M 34726608 %R 10.2196/33088 %U https://www.researchprotocols.org/2021/11/e33088 %U https://doi.org/10.2196/33088 %U http://www.ncbi.nlm.nih.gov/pubmed/34726608 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e33231 %T Predictive Modeling of Vaccination Uptake in US Counties: A Machine Learning–Based Approach %A Cheong,Queena %A Au-yeung,Martin %A Quon,Stephanie %A Concepcion,Katsy %A Kong,Jude Dzevela %+ Africa-Canada Artificial Intelligence and Data Innovation Consortium, Department of Mathematics and Statistics, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 66093, jdkong@yorku.ca %K COVID-19 %K vaccine %K public health %K machine learning %K XGBoost %K SARS-CoV-2 %K sociodemographic factors %K United States %K sociodemographic %K prediction %K model %K uptake %D 2021 %7 25.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although the COVID-19 pandemic has left an unprecedented impact worldwide, countries such as the United States have reported the most substantial incidence of COVID-19 cases worldwide. Within the United States, various sociodemographic factors have played a role in the creation of regional disparities. Regional disparities have resulted in the unequal spread of disease between US counties, underscoring the need for efficient and accurate predictive modeling strategies to inform public health officials and reduce the burden on health care systems. Furthermore, despite the widespread accessibility of COVID-19 vaccines across the United States, vaccination rates have become stagnant, necessitating predictive modeling to identify important factors impacting vaccination uptake. Objective: This study aims to determine the association between sociodemographic factors and vaccine uptake across counties in the United States. Methods: Sociodemographic data on fully vaccinated and unvaccinated individuals were sourced from several online databases such as the US Centers for Disease Control and Prevention and the US Census Bureau COVID-19 Site. Machine learning analysis was performed using XGBoost and sociodemographic data. Results: Our model predicted COVID-19 vaccination uptake across US counties with 62% accuracy. In addition, it identified location, education, ethnicity, income, and household access to the internet as the most critical sociodemographic features in predicting vaccination uptake in US counties. Lastly, the model produced a choropleth demonstrating areas of low and high vaccination rates, which can be used by health care authorities in future pandemics to visualize and prioritize areas of low vaccination and design targeted vaccination campaigns. Conclusions: Our study reveals that sociodemographic characteristics are predictors of vaccine uptake rates across counties in the United States and, if leveraged appropriately, can assist policy makers and public health officials to understand vaccine uptake rates and craft policies to improve them. %M 34751650 %R 10.2196/33231 %U https://www.jmir.org/2021/11/e33231 %U https://doi.org/10.2196/33231 %U http://www.ncbi.nlm.nih.gov/pubmed/34751650 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e33003 %T Nationwide Deployment of a Serious Game Designed to Improve COVID-19 Infection Prevention Practices in Switzerland: Prospective Web-Based Study %A Suppan,Melanie %A Stuby,Loric %A Harbarth,Stephan %A Fehlmann,Christophe A %A Achab,Sophia %A Abbas,Mohamed %A Suppan,Laurent %+ Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care, and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 223723311, laurent.suppan@hcuge.ch %K COVID-19 %K serious game %K infection prevention %K SARS-CoV-2 %K prospective %K web-based %K deployment %K prevention %K gaming %K public health %K dissemination %K health information %K behavior %K survey %D 2021 %7 25.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X 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. %M 34635472 %R 10.2196/33003 %U https://games.jmir.org/2021/4/e33003 %U https://doi.org/10.2196/33003 %U http://www.ncbi.nlm.nih.gov/pubmed/34635472 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e27880 %T Electronic Monitoring Systems for Hand Hygiene: Systematic Review of Technology %A Wang,Chaofan %A Jiang,Weiwei %A Yang,Kangning %A Yu,Difeng %A Newn,Joshua %A Sarsenbayeva,Zhanna %A Goncalves,Jorge %A Kostakos,Vassilis %+ School of Computing and Information Systems, The University of Melbourne, 700 Swanston Street, Carlton, 3053, Australia, 61 390358966, chaofanw@student.unimelb.edu.au %K hand hygiene %K hand hygiene compliance %K hand hygiene quality %K electronic monitoring systems %K systematic review %K mobile phone %D 2021 %7 24.11.2021 %9 Review %J J Med Internet Res %G English %X 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. %M 34821565 %R 10.2196/27880 %U https://www.jmir.org/2021/11/e27880 %U https://doi.org/10.2196/27880 %U http://www.ncbi.nlm.nih.gov/pubmed/34821565 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e28146 %T How Identification With the Social Environment and With the Government Guide the Use of the Official COVID-19 Contact Tracing App: Three Quantitative Survey Studies %A Scholl,Annika %A Sassenberg,Kai %+ Social Processes Lab, Leibniz-Institut fuer Wissensmedien, Schleichstr 6, Tuebingen, 72076, Germany, 49 7071979 ext 257, a.scholl@iwm-tuebingen.de %K COVID-19 %K SARS-CoV-2 %K contact tracing app %K social identification %K technology acceptance %K pandemic %K outbreak %K health technology %D 2021 %7 24.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Official contact tracing apps have been implemented and recommended for use across nations to track and contain the spread of COVID-19. Such apps can be effective if people are willing to use them. Accordingly, many attempts are being made to motivate citizens to make use of the officially recommended apps. Objective: The aim of this research was to contribute to an understanding of the preconditions under which people are willing to use a COVID-19 contact tracing app (ie, their use intentions and use). To go beyond personal motives in favor of app use, it is important to take people’s social relationships into account, under the hypothesis that the more people identify with the beneficiaries of app use (ie, people living close by in their social environment) and with the source recommending the app (ie, members of the government), the more likely they will be to accept the officially recommended contact tracing app. Methods: Before, right after, and 5 months after the official contact tracing app was launched in Germany, a total of 1044 people participated in three separate surveys. Structural equation modeling was used to test the hypotheses, examining the same model in all studies at these critical points in time. Results: Across the three surveys, both identification with the beneficiaries (people living in their social environment) and with the source recommending the app (members of the government) predicted greater intention to use and use (installation) of the official contact tracing app. Trust in the source (members of the government) served as a mediator. Other types of identification (with people in Germany or people around the world) did not explain the observed results. The findings were highly consistent across the three surveys. Conclusions: Attempts to motivate people to use new health technology (or potentially new measures more generally) not only for their personal benefit but also for collective benefits should take the social context into account (ie, the social groups people belong to and identify with). The more important the beneficiaries and the sources of such measures are to people’s sense of the self, the more willing they will likely be to adhere to and support such measures. %M 34662289 %R 10.2196/28146 %U https://mhealth.jmir.org/2021/11/e28146 %U https://doi.org/10.2196/28146 %U http://www.ncbi.nlm.nih.gov/pubmed/34662289 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29970 %T Demographics Associated With Stress, Severe Mental Distress, and Anxiety Symptoms During the COVID-19 Pandemic in Japan: Nationwide Cross-sectional Web-Based Survey %A Midorikawa,Haruhiko %A Tachikawa,Hirokazu %A Taguchi,Takaya %A Shiratori,Yuki %A Takahashi,Asumi %A Takahashi,Sho %A Nemoto,Kiyotaka %A Arai,Tetsuaki %+ Department of Disaster and Community Psychiatry, University of Tsukuba, Igakukei Gakukeitou 873, 1-1-1 Tennoudai, Tsukuba, 305-8577, Japan, 81 29 853 3057, tachikawa@md.tsukuba.ac.jp %K COVID-19 %K mental health %K stress %K depression %K anxiety %K occupation %K public health %K demographic factors %K epidemiology %K occupational health %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With the spread of COVID-19, the deterioration of public mental health has become a major global and social problem. Objective: The purpose of this study was to elucidate the relationship between the 3 mental health problems associated with COVID-19, that is, perceived stress, severe mental distress, and anxiety symptoms, and the various demographic factors, including occupation. Methods: A nationwide web-based questionnaire survey was conducted in Japan from August 4 to 31, 2020. In addition to sociodemographic data, the degrees of perceived stress, severe mental distress, and anxiety symptoms associated with COVID-19 were measured. After performing a descriptive statistical analysis, factors related to stress, severe mental distress, and anxiety symptoms were analyzed using logistic regression analysis. Results: A total of 8203 respondents submitted survey responses, among whom 34.9% (2861/8203) felt intense stress associated with COVID-19, 17.1% (1403/8203) were depressed, and 13.5% (1110/8203) had severe anxiety symptoms. The logistic regression analysis showed that each of the 3 mental health problems were prevalent in females, nonbinary gender, people in their 50s, 60s and older, respondents who visited psychiatrists, and those currently in psychiatric care. Severe mental distress and anxiety symptoms were associated with the number of effective lifestyle coping strategies during the lockdown period. Severe mental distress was only prevalent in teenagers and respondents in their 20s, as students tended to develop stress and severe mental distress. With regard to occupation, working in nursing care and welfare, education and research, and medical and health sectors was associated with stress; however, working in these occupations was not associated with severe mental distress and anxiety symptoms. Unemployment was associated with severe mental distress and anxiety symptoms. All 3 mental health problems were prevalent in part-time workers and those working in entertainment and arts sectors. Conclusions: Gender, age, occupation, history of psychiatric visits, and stress coping mechanisms were associated with mental health during the COVID-19 pandemic, but their associations with stress, severe mental distress, and anxiety symptoms differed. In addition, the actual state of mental health varied according to the respondents’ occupation. It is necessary to consider the impact of the COVID-19 pandemic on mental health not only at the individual level but also at the occupational level. %M 34653018 %R 10.2196/29970 %U https://publichealth.jmir.org/2021/11/e29970 %U https://doi.org/10.2196/29970 %U http://www.ncbi.nlm.nih.gov/pubmed/34653018 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e29181 %T To Use or Not to Use a COVID-19 Contact Tracing App: Mixed Methods Survey in Wales %A Jones,Kerina %A Thompson,Rachel %+ Swansea University, Population Data Science, Swansea University Medical School, Singleton Park, Swansea, SA28PP, United Kingdom, 44 01792602764, k.h.jones@swansea.ac.uk %K COVID-19 %K survey %K Wales %K contact tracing %K app %K mHealth %K mobile apps %K digital health %K public health %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many countries remain in the grip of the COVID-19 global pandemic, with a considerable journey still ahead toward normalcy and free mobility. Contact tracing smartphone apps are among a raft of measures introduced to reduce spread of the virus, but their uptake depends on public choice. Objective: The objective of this study was to ascertain the views of citizens in Wales on their intended use of a COVID-19 contact tracing smartphone app, including self-proposed reasons for or against use and what could lead to a change of decision. Methods: We distributed an anonymous survey among 4000 HealthWise Wales participants in May 2020. We adopted a mixed methods approach: responses to closed questions were analyzed using descriptive and inferential statistics; open question responses were analyzed and grouped into categories. Results: A total of 976 (24.4%) people completed the survey. Smartphone usage was 91.5% overall, but this varied among age groups. In total, 97.1% were aware of contact tracing apps, but only 67.2% felt sufficiently informed. Furthermore, 55.7% intended to use an app, 23.3% refused, and 21.0% were unsure. The top reasons for app use were as follows: controlling the spread of the virus, mitigating risks for others and for oneself, and increasing freedoms. The top reasons against app use were as follows: mistrusting the government, concerns about data security and privacy, and doubts about efficacy. The top response for changing one’s mind about app use from being willing to being unwilling was that nothing would; that is, they felt that nothing would cause them to become unwilling to use a contact tracing app. This was also the top response for changing one’s mind from being unwilling to being willing to use contact tracing apps. Among those who were unsure of using contact tracing apps, the top response was the need for more information. Conclusions: Respondents demonstrated a keenness to help themselves, others, society, and the government to avoid contracting the virus and to control its spread. However, digital inclusion varied among age groups, precluding participation for some people. Nonetheless, unwillingness was significant, and considering the nature of the concerns raised and the perceived lack of information, policy and decision-makers need to do more to act openly, increase communication, and demonstrate trustworthiness if members of the public are to be confident in using an app. %M 34698645 %R 10.2196/29181 %U https://mhealth.jmir.org/2021/11/e29181 %U https://doi.org/10.2196/29181 %U http://www.ncbi.nlm.nih.gov/pubmed/34698645 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e33576 %T Digital SARS-CoV-2 Detection Among Hospital Employees: Participatory Surveillance Study %A Leal-Neto,Onicio %A Egger,Thomas %A Schlegel,Matthias %A Flury,Domenica %A Sumer,Johannes %A Albrich,Werner %A Babouee Flury,Baharak %A Kuster,Stefan %A Vernazza,Pietro %A Kahlert,Christian %A Kohler,Philipp %+ Department of Economics, University of Zurich, Schönberggasse 1, Zurich, 8001, Switzerland, 41 783242116, onicio@gmail.com %K digital epidemiology %K SARS-CoV-2 %K COVID-19 %K health care workers %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34727046 %R 10.2196/33576 %U https://publichealth.jmir.org/2021/11/e33576 %U https://doi.org/10.2196/33576 %U http://www.ncbi.nlm.nih.gov/pubmed/34727046 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e31908 %T Promoting Safe Sleep, Tobacco Cessation, and Breastfeeding to Rural Women During the COVID-19 Pandemic: Quasi-Experimental Study %A Ahlers-Schmidt,Carolyn R %A Schunn,Christy %A Hervey,Ashley M %A Torres,Maria %A Nelson,Jill Elizabeth V %+ Center for Research for Infant Birth and Survival, University of Kansas School of Medicine-Wichita, 3242 E. Murdock St., Suite 602, Wichita, KS, United States, 1 3169627923, cschmidt3@kumc.edu %K COVID-19 %K SIDS %K sudden infant death syndrome %K safe sleep %K tobacco cessation %K breastfeeding %K virtual education %D 2021 %7 22.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: Safe Sleep Community Baby Showers address strategies to prevent sleep-related infant deaths. Due to the COVID-19 pandemic, these events transitioned from in-person to virtual. Objective: This study describes outcomes of transitioning Safe Sleep Community Baby Showers to a virtual format and compares outcomes to previous in-person events. Methods: Participants from four rural Kansas counties were emailed the presurvey, provided educational materials (videos, livestream, or digital documents), and completed a postsurvey. Those who completed both surveys received a portable crib and wearable blanket. Within-group comparisons were assessed between pre- and postsurveys; between-group comparisons (virtual vs in-person) were assessed by postsurveys. Results: Based on data from 145 in-person and 74 virtual participants, virtual participants were more likely to be married (P<.001) and have private insurance (P<.001), and were less likely to report tobacco use (P<.001). Both event formats significantly increased knowledge and intentions regarding safe sleep and avoidance of secondhand smoke (all P≤.001). Breastfeeding intentions did not change. Differences were observed between in-person and virtual meetings regarding confidence in the ability to avoid secondhand smoke (in-person: 121/144, 84% vs virtual: 53/74, 72%; P=.03), intention to breastfeed ≥6 months (in-person: 79/128, 62% vs virtual: 52/66, 79%; P=.008), and confidence in the ability to breastfeed ≥6 months (in-person: 58/123, 47% vs virtual: 44/69, 64%; P=.02). Conclusions: Although both event formats demonstrated increased knowledge/intentions to follow safe sleep recommendations, virtual events may further marginalize groups who are at high risk for poor birth outcomes. Strategies to increase technology access, recruit priority populations, and ensure disparities are not exacerbated will be critical for the implementation of future virtual events. %M 34550075 %R 10.2196/31908 %U https://pediatrics.jmir.org/2021/4/e31908 %U https://doi.org/10.2196/31908 %U http://www.ncbi.nlm.nih.gov/pubmed/34550075 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e32285 %T Seroepidemiological Survey on the Impact of Smoking on SARS-CoV-2 Infection and COVID-19 Outcomes: Protocol for the Troina Study %A Polosa,Riccardo %A Tomaselli,Venera %A Ferrara,Pietro %A Romeo,Alba Corina %A Rust,Sonja %A Saitta,Daniela %A Caraci,Filippo %A Romano,Corrado %A Thangaraju,Murugesan %A Zuccarello,Pietro %A Rose,Jed %A Cantone,Giulio Giacomo %A Ferrante,Margherita %A Belsey,Jonathan %A Cibella,Fabio %A Interlandi,Elisa %A Ferri,Raffaele %+ Institute of Internal Medicine, Azienda Ospedaliera Universitaria “Policlinico - V. Emanuele”, Via S Sofia, 78, Catania, 95123, Italy, 39 0953781566, polosa@unict.it %K antibody persistence %K cotinine %K COVID-19 %K SARS-CoV-2 %K seroprevalence %K smoking impact %K smoking status %D 2021 %7 22.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: After the global spread of SARS-CoV-2, research has highlighted several aspects of the pandemic, focusing on clinical features and risk factors associated with infection and disease severity. However, emerging results on the role of smoking in SARS-CoV-2 infection susceptibility or COVID-19 outcomes are conflicting, and their robustness remains uncertain. Objective: In this context, this study aims at quantifying the proportion of SARS-CoV-2 antibody seroprevalence, studying the changes in antibody levels over time, and analyzing the association between the biochemically verified smoking status and SARS-CoV-2 infection. Methods: The research design involves a 6-month prospective cohort study with a serial sampling of the same individuals. Each participant will be surveyed about their demographics and COVID-19–related information, and blood sampling will be collected upon recruitment and at specified follow-up time points (ie, after 8 and 24 weeks). Blood samples will be screened for the presence of SARS-CoV-2–specific antibodies and serum cotinine, being the latter of the principal metabolite of nicotine, which will be used to assess participants’ smoking status. Results: The study is ongoing. It aims to find a higher antibody prevalence in individuals at high risk for viral exposure (ie, health care personnel) and to refine current estimates on the association between smoking status and SARS-CoV-2/COVID-19. Conclusions: The added value of this research is that the current smoking status of the population to be studied will be biochemically verified to avoid the bias associated with self-reported smoking status. As such, the results from this survey may provide an actionable metric to study the role of smoking in SARS-CoV-2 infection and COVID-19 outcomes, and therefore to implement the most appropriate public health measures to control the pandemic. Results may also serve as a reference for future clinical research, and the methodology could be exploited in public health sectors and policies. International Registered Report Identifier (IRRID): DERR1-10.2196/32285 %M 34678752 %R 10.2196/32285 %U https://www.researchprotocols.org/2021/11/e32285 %U https://doi.org/10.2196/32285 %U http://www.ncbi.nlm.nih.gov/pubmed/34678752 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e33509 %T Central COVID-19 Coordination Centers in Germany: Description, Economic Evaluation, and Systematic Review %A Schopow,Nikolas %A Osterhoff,Georg %A von Dercks,Nikolaus %A Girrbach,Felix %A Josten,Christoph %A Stehr,Sebastian %A Hepp,Pierre %+ Department for Orthopedics, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Liebigstr. 20, Leipzig, 04103, Germany, 49 341 9717849, schopow@medizin.uni-leipzig.de %K telemedical consultation %K patient allocation %K algorithm-based treatment %K telemedicine %K telehealth %K consultation %K allocation %K algorithm %K treatment %K COVID-19 %K coordination %K Germany %K economic %K review %K establishment %K management %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the COVID-19 pandemic, Central COVID-19 Coordination Centers (CCCCs) have been established at several hospitals across Germany with the intention to assist local health care professionals in efficiently referring patients with suspected or confirmed SARS-CoV-2 infection to regional hospitals and therefore to prevent the collapse of local health system structures. In addition, these centers coordinate interhospital transfers of patients with COVID-19 and provide or arrange specialized telemedical consultations. Objective: This study describes the establishment and management of a CCCC at a German university hospital. Methods: We performed economic analyses (cost, cost-effectiveness, use, and utility) according to the CHEERS (Consolidated Health Economic Evaluation Reporting Standards) criteria. Additionally, we conducted a systematic review to identify publications on similar institutions worldwide. The 2 months with the highest local incidence of COVID-19 cases (December 2020 and January 2021) were considered. Results: During this time, 17.3 requests per day were made to the CCCC regarding admission or transfer of patients with COVID-19. The majority of requests were made by emergency medical services (601/1068, 56.3%), patients with an average age of 71.8 (SD 17.2) years were involved, and for 737 of 1068 cases (69%), SARS-CoV-2 had already been detected by a positive polymerase chain reaction test. In 59.8% (639/1068) of the concerned patients, further treatment by a general practitioner or outpatient presentation in a hospital could be initiated after appropriate advice, 27.2% (291/1068) of patients were admitted to normal wards, and 12.9% (138/1068) were directly transmitted to an intensive care unit. The operating costs of the CCCC amounted to more than €52,000 (US $60,031) per month. Of the 334 patients with detected SARS-CoV-2 who were referred via EMS or outpatient physicians, 302 (90.4%) were triaged and announced in advance by the CCCC. No other published economic analysis of COVID-19 coordination or management institutions at hospitals could be found. Conclusions: Despite the high cost of the CCCC, we were able to show that it is a beneficial concept to both the providing hospital and the public health system. However, the most important benefits of the CCCC are that it prevents hospitals from being overrun by patients and that it avoids situations in which physicians must weigh one patient’s life against another’s. %M 34623955 %R 10.2196/33509 %U https://publichealth.jmir.org/2021/11/e33509 %U https://doi.org/10.2196/33509 %U http://www.ncbi.nlm.nih.gov/pubmed/34623955 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e30743 %T Implementation of an Anticoagulation Practice Guideline for COVID-19 via a Clinical Decision Support System in a Large Academic Health System and Its Evaluation: Observational Study %A Shah,Surbhi %A Switzer,Sean %A Shippee,Nathan D %A Wogensen,Pamela %A Kosednar,Kathryn %A Jones,Emma %A Pestka,Deborah L %A Badlani,Sameer %A Butler,Mary %A Wagner,Brittin %A White,Katie %A Rhein,Joshua %A Benson,Bradley %A Reding,Mark %A Usher,Michael %A Melton,Genevieve B %A Tignanelli,Christopher James %+ Department of Surgery, University of Minnesota, 420 Delaware St SE, MMC 195, Minneapolis, MN, 55455, United States, 1 6126261968, ctignane@umn.edu %K COVID-19 %K anticoagulation %K clinical practice guideline %K evidence-based practice %K clinical decision support %K implementation science %K RE-AIM %D 2021 %7 18.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Studies evaluating strategies for the rapid development, implementation, and evaluation of clinical decision support (CDS) systems supporting guidelines for diseases with a poor knowledge base, such as COVID-19, are limited. Objective: We developed an anticoagulation clinical practice guideline (CPG) for COVID-19, which was delivered and scaled via CDS across a 12-hospital Midwest health care system. This study represents a preplanned 6-month postimplementation evaluation guided by the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. Methods: The implementation outcomes evaluated were reach, adoption, implementation, and maintenance. To evaluate effectiveness, the association of CPG adherence on hospital admission with clinical outcomes was assessed via multivariable logistic regression and nearest neighbor propensity score matching. A time-to-event analysis was conducted. Sensitivity analyses were also conducted to evaluate the competing risk of death prior to intensive care unit (ICU) admission. The models were risk adjusted to account for age, gender, race/ethnicity, non-English speaking status, area deprivation index, month of admission, remdesivir treatment, tocilizumab treatment, steroid treatment, BMI, Elixhauser comorbidity index, oxygen saturation/fraction of inspired oxygen ratio, systolic blood pressure, respiratory rate, treating hospital, and source of admission. A preplanned subgroup analysis was also conducted in patients who had laboratory values (D-dimer, C-reactive protein, creatinine, and absolute neutrophil to absolute lymphocyte ratio) present. The primary effectiveness endpoint was the need for ICU admission within 48 hours of hospital admission. Results: A total of 2503 patients were included in this study. CDS reach approached 95% during implementation. Adherence achieved a peak of 72% during implementation. Variation was noted in adoption across sites and nursing units. Adoption was the highest at hospitals that were specifically transformed to only provide care to patients with COVID-19 (COVID-19 cohorted hospitals; 74%-82%) and the lowest in academic settings (47%-55%). CPG delivery via the CDS system was associated with improved adherence (odds ratio [OR] 1.43, 95% CI 1.2-1.7; P<.001). Adherence with the anticoagulation CPG was associated with a significant reduction in the need for ICU admission within 48 hours (OR 0.39, 95% CI 0.30-0.51; P<.001) on multivariable logistic regression analysis. Similar findings were noted following 1:1 propensity score matching for patients who received adherent versus nonadherent care (21.5% vs 34.3% incidence of ICU admission within 48 hours; log-rank test P<.001). Conclusions: Our institutional experience demonstrated that adherence with the institutional CPG delivered via the CDS system resulted in improved clinical outcomes for patients with COVID-19. CDS systems are an effective means to rapidly scale a CPG across a heterogeneous health care system. Further research is needed to investigate factors associated with adherence at low and high adopting sites and nursing units. %M 34550900 %R 10.2196/30743 %U https://medinform.jmir.org/2021/11/e30743 %U https://doi.org/10.2196/30743 %U http://www.ncbi.nlm.nih.gov/pubmed/34550900 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e32876 %T Machine Learning–Based Predictive Modeling of Anxiety and Depressive Symptoms During 8 Months of the COVID-19 Global Pandemic: Repeated Cross-sectional Survey Study %A Hueniken,Katrina %A Somé,Nibene Habib %A Abdelhack,Mohamed %A Taylor,Graham %A Elton Marshall,Tara %A Wickens,Christine M %A Hamilton,Hayley A %A Wells,Samantha %A Felsky,Daniel %+ Krembil Centre for Neuroinformatics, Centre for Addiction and Mental Health, 250 College St, 12th Floor, Toronto, ON, M5T 1R8, Canada, 1 (416) 535 8501 ext 33587, Daniel.Felsky@camh.ca %K mental health %K machine learning %K COVID-19 %K emotional distress %K emotion %K distress %K prediction %K model %K anxiety %K depression %K symptom %K cross-sectional %K survey %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 global pandemic has increased the burden of mental illness on Canadian adults. However, the complex combination of demographic, economic, and lifestyle factors and perceived health risks contributing to patterns of anxiety and depression has not been explored. Objective: The aim of this study is to harness flexible machine learning methods to identify constellations of factors related to symptoms of mental illness and to understand their changes over time during the COVID-19 pandemic. Methods: Cross-sectional samples of Canadian adults (aged ≥18 years) completed web-based surveys in 6 waves from May to December 2020 (N=6021), and quota sampling strategies were used to match the English-speaking Canadian population in age, gender, and region. The surveys measured anxiety and depression symptoms, sociodemographic characteristics, substance use, and perceived COVID-19 risks and worries. First, principal component analysis was used to condense highly comorbid anxiety and depression symptoms into a single data-driven measure of emotional distress. Second, eXtreme Gradient Boosting (XGBoost), a machine learning algorithm that can model nonlinear and interactive relationships, was used to regress this measure on all included explanatory variables. Variable importance and effects across time were explored using SHapley Additive exPlanations (SHAP). Results: Principal component analysis of responses to 9 anxiety and depression questions on an ordinal scale revealed a primary latent factor, termed “emotional distress,” that explained 76% of the variation in all 9 measures. Our XGBoost model explained a substantial proportion of variance in emotional distress (r2=0.39). The 3 most important items predicting elevated emotional distress were increased worries about finances (SHAP=0.17), worries about getting COVID-19 (SHAP=0.17), and younger age (SHAP=0.13). Hopefulness was associated with emotional distress and moderated the impacts of several other factors. Predicted emotional distress exhibited a nonlinear pattern over time, with the highest predicted symptoms in May and November and the lowest in June. Conclusions: Our results highlight factors that may exacerbate emotional distress during the current pandemic and possible future pandemics, including a role of hopefulness in moderating distressing effects of other factors. The pandemic disproportionately affected emotional distress among younger adults and those economically impacted. %M 34705663 %R 10.2196/32876 %U https://mental.jmir.org/2021/11/e32876 %U https://doi.org/10.2196/32876 %U http://www.ncbi.nlm.nih.gov/pubmed/34705663 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e30642 %T COVID-19 Vaccine Hesitancy on Social Media: Building a Public Twitter Data Set of Antivaccine Content, Vaccine Misinformation, and Conspiracies %A Muric,Goran %A Wu,Yusong %A Ferrara,Emilio %+ Information Sciences Institute, University of Southern California, 4676 Admiralty Way, Suite 1001, Marina del Rey, CA, 90292, United States, 1 213 740 2467, gmuric@isi.edu %K vaccine hesitancy %K COVID-19 vaccines %K dataset %K COVID-19 %K SARS-CoV-2 %K social media %K network analysis %K hesitancy %K vaccine %K Twitter %K misinformation %K conspiracy %K trust %K public health %K utilization %D 2021 %7 17.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: False claims about COVID-19 vaccines can undermine public trust in ongoing vaccination campaigns, posing a threat to global public health. Misinformation originating from various sources has been spreading on the web since the beginning of the COVID-19 pandemic. Antivaccine activists have also begun to use platforms such as Twitter to promote their views. To properly understand the phenomenon of vaccine hesitancy through the lens of social media, it is of great importance to gather the relevant data. Objective: In this paper, we describe a data set of Twitter posts and Twitter accounts that publicly exhibit a strong antivaccine stance. The data set is made available to the research community via our AvaxTweets data set GitHub repository. We characterize the collected accounts in terms of prominent hashtags, shared news sources, and most likely political leaning. Methods: We started the ongoing data collection on October 18, 2020, leveraging the Twitter streaming application programming interface (API) to follow a set of specific antivaccine-related keywords. Then, we collected the historical tweets of the set of accounts that engaged in spreading antivaccination narratives between October 2020 and December 2020, leveraging the Academic Track Twitter API. The political leaning of the accounts was estimated by measuring the political bias of the media outlets they shared. Results: We gathered two curated Twitter data collections and made them publicly available: (1) a streaming keyword–centered data collection with more than 1.8 million tweets, and (2) a historical account–level data collection with more than 135 million tweets. The accounts engaged in the antivaccination narratives lean to the right (conservative) direction of the political spectrum. The vaccine hesitancy is fueled by misinformation originating from websites with already questionable credibility. Conclusions: The vaccine-related misinformation on social media may exacerbate the levels of vaccine hesitancy, hampering progress toward vaccine-induced herd immunity, and could potentially increase the number of infections related to new COVID-19 variants. For these reasons, understanding vaccine hesitancy through the lens of social media is of paramount importance. Because data access is the first obstacle to attain this goal, we published a data set that can be used in studying antivaccine misinformation on social media and enable a better understanding of vaccine hesitancy. %M 34653016 %R 10.2196/30642 %U https://publichealth.jmir.org/2021/11/e30642 %U https://doi.org/10.2196/30642 %U http://www.ncbi.nlm.nih.gov/pubmed/34653016 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e28956 %T Designing Better Exposure Notification Apps: The Role of Persuasive Design %A Oyibo,Kiemute %A Morita,Plinio Pelegrini %+ School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 41372, plinio.morita@uwaterloo.ca %K contact tracing app %K exposure notification app %K COVID Alert %K COVID-19 %K persuasive technology %K behavior change %D 2021 %7 16.11.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Background: Digital contact tracing apps have been deployed worldwide to limit the spread of COVID-19 during this pandemic and to facilitate the lifting of public health restrictions. However, due to privacy-, trust-, and design-related issues, the apps are yet to be widely adopted. This calls for an intervention to enable a critical mass of users to adopt them. Objective: The aim of this paper is to provide guidelines to design contact tracing apps as persuasive technologies to make them more appealing and effective. Methods: We identified the limitations of the current contact tracing apps on the market using the Government of Canada’s official exposure notification app (COVID Alert) as a case study. Particularly, we identified three interfaces in the COVID Alert app where the design can be improved. The interfaces include the no exposure status interface, exposure interface, and diagnosis report interface. We propose persuasive technology design guidelines to make them more motivational and effective in eliciting the desired behavior change. Results: Apart from trust and privacy concerns, we identified the minimalist and nonmotivational design of exposure notification apps as the key design-related factors that contribute to the current low uptake. We proposed persuasive strategies such as self-monitoring of daily contacts and exposure time to make the no exposure and exposure interfaces visually appealing and motivational. Moreover, we proposed social learning, praise, and reward to increase the diagnosis report interface’s effectiveness. Conclusions: We demonstrated that exposure notification apps can be designed as persuasive technologies by incorporating key persuasive features, which have the potential to improve uptake, use, COVID-19 diagnosis reporting, and compliance with social distancing guidelines. %M 34783673 %R 10.2196/28956 %U https://publichealth.jmir.org/2021/11/e28956 %U https://doi.org/10.2196/28956 %U http://www.ncbi.nlm.nih.gov/pubmed/34783673 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e30968 %T Characterization of Unlinked Cases of COVID-19 and Implications for Contact Tracing Measures: Retrospective Analysis of Surveillance Data %A Chong,Ka Chun %A Jia,Katherine %A Lee,Shui Shan %A Hung,Chi Tim %A Wong,Ngai Sze %A Lai,Francisco Tsz Tsun %A Chau,Nancy %A Yam,Carrie Ho Kwan %A Chow,Tsz Yu %A Wei,Yuchen %A Guo,Zihao %A Yeoh,Eng Kiong %+ Centre for Health Systems and Policy Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Central Avenue, Hong Kong, Hong Kong, 852 22528716, yeoh_ek@cuhk.edu.hk %K COVID-19 %K contact tracing %K unlinked %K superspreading %K dispersion %K surveillance %K monitoring %K digital health %K testing %K transmission %K epidemiology %K outbreak %K spread %D 2021 %7 16.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Contact tracing and intensive testing programs are essential for controlling the spread of COVID-19. However, conventional contact tracing is resource intensive and may not result in the tracing of all cases due to recall bias and cases not knowing the identity of some close contacts. Few studies have reported the epidemiological features of cases not identified by contact tracing (“unlinked cases”) or described their potential roles in seeding community outbreaks. Objective: For this study, we characterized the role of unlinked cases in the epidemic by comparing their epidemiological profile with the linked cases; we also estimated their transmission potential across different settings. Methods: We obtained rapid surveillance data from the government, which contained the line listing of COVID-19 confirmed cases during the first three waves in Hong Kong. We compared the demographics, history of chronic illnesses, epidemiological characteristics, clinical characteristics, and outcomes of linked and unlinked cases. Transmission potentials in different settings were assessed by fitting a negative binomial distribution to the observed offspring distribution. Results: Time interval from illness onset to hospital admission was longer among unlinked cases than linked cases (median 5.00 days versus 3.78 days; P<.001), with a higher proportion of cases whose condition was critical or serious (13.0% versus 8.2%; P<.001). The proportion of unlinked cases was associated with an increase in the weekly number of local cases (P=.049). Cluster transmissions from the unlinked cases were most frequently identified in household settings, followed by eateries and workplaces, with the estimated probability of cluster transmissions being around 0.4 for households and 0.1-0.3 for the latter two settings. Conclusions: The unlinked cases were positively associated with time to hospital admission, severity of infection, and epidemic size—implying a need to design and implement digital tracing methods to complement current conventional testing and tracing. To minimize the risk of cluster transmissions from unlinked cases, digital tracing approaches should be effectively applied in high-risk socioeconomic settings, and risk assessments should be conducted to review and adjust the policies. %M 34591778 %R 10.2196/30968 %U https://publichealth.jmir.org/2021/11/e30968 %U https://doi.org/10.2196/30968 %U http://www.ncbi.nlm.nih.gov/pubmed/34591778 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e31337 %T Predicting COVID-19–Related Health Care Resource Utilization Across a Statewide Patient Population: Model Development Study %A Kasturi,Suranga N %A Park,Jeremy %A Wild,David %A Khan,Babar %A Haggstrom,David A %A Grannis,Shaun %+ Regenstrief Institute, 1101 W 10th St, Indianapolis, IN, 46202, United States, 1 (317) 274 9000, snkasthu@iu.edu %K COVID-19 %K machine learning %K population health %K health care utilization %K health disparities %K health information %K epidemiology %K public health %K digital health %K health data %K pandemic %K decision models %K health informatics %K healthcare resources %D 2021 %7 15.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has highlighted the inability of health systems to leverage existing system infrastructure in order to rapidly develop and apply broad analytical tools that could inform state- and national-level policymaking, as well as patient care delivery in hospital settings. The COVID-19 pandemic has also led to highlighted systemic disparities in health outcomes and access to care based on race or ethnicity, gender, income-level, and urban-rural divide. Although the United States seems to be recovering from the COVID-19 pandemic owing to widespread vaccination efforts and increased public awareness, there is an urgent need to address the aforementioned challenges. Objective: This study aims to inform the feasibility of leveraging broad, statewide datasets for population health–driven decision-making by developing robust analytical models that predict COVID-19–related health care resource utilization across patients served by Indiana’s statewide Health Information Exchange. Methods: We leveraged comprehensive datasets obtained from the Indiana Network for Patient Care to train decision forest-based models that can predict patient-level need of health care resource utilization. To assess these models for potential biases, we tested model performance against subpopulations stratified by age, race or ethnicity, gender, and residence (urban vs rural). Results: For model development, we identified a cohort of 96,026 patients from across 957 zip codes in Indiana, United States. We trained the decision models that predicted health care resource utilization by using approximately 100 of the most impactful features from a total of 1172 features created. Each model and stratified subpopulation under test reported precision scores >70%, accuracy and area under the receiver operating curve scores >80%, and sensitivity scores approximately >90%. We noted statistically significant variations in model performance across stratified subpopulations identified by age, race or ethnicity, gender, and residence (urban vs rural). Conclusions: This study presents the possibility of developing decision models capable of predicting patient-level health care resource utilization across a broad, statewide region with considerable predictive performance. However, our models present statistically significant variations in performance across stratified subpopulations of interest. Further efforts are necessary to identify root causes of these biases and to rectify them. %M 34581671 %R 10.2196/31337 %U https://www.jmir.org/2021/11/e31337 %U https://doi.org/10.2196/31337 %U http://www.ncbi.nlm.nih.gov/pubmed/34581671 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29504 %T Algorithm for Individual Prediction of COVID-19–Related Hospitalization Based on Symptoms: Development and Implementation Study %A Murtas,Rossella %A Morici,Nuccia %A Cogliati,Chiara %A Puoti,Massimo %A Omazzi,Barbara %A Bergamaschi,Walter %A Voza,Antonio %A Rovere Querini,Patrizia %A Stefanini,Giulio %A Manfredi,Maria Grazia %A Zocchi,Maria Teresa %A Mangiagalli,Andrea %A Brambilla,Carla Vittoria %A Bosio,Marco %A Corradin,Matteo %A Cortellaro,Francesca %A Trivelli,Marco %A Savonitto,Stefano %A Russo,Antonio Giampiero %+ Epidemiology Unit, Agency for the Protection of Health of the Metropolitan Area of Milan, Via Conca del Naviglio 45, Milan, 20123, Italy, 39 0285782111, agrusso@ats-milano.it %K COVID-19 %K severe outcome %K prediction %K monitoring system %K symptoms %K risk prediction %K risk %K algorithms %K prediction models %K pandemic %K digital data %K health records %D 2021 %7 15.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has placed a huge strain on the health care system globally. The metropolitan area of Milan, Italy, was one of the regions most impacted by the COVID-19 pandemic worldwide. Risk prediction models developed by combining administrative databases and basic clinical data are needed to stratify individual patient risk for public health purposes. Objective: This study aims to develop a stratification tool aimed at improving COVID-19 patient management and health care organization. Methods: A predictive algorithm was developed and applied to 36,834 patients with COVID-19 in Italy between March 8 and the October 9, 2020, in order to foresee their risk of hospitalization. Exposures considered were age, sex, comorbidities, and symptoms associated with COVID-19 (eg, vomiting, cough, fever, diarrhea, myalgia, asthenia, headache, anosmia, ageusia, and dyspnea). The outcome was hospitalizations and emergency department admissions for COVID-19. Discrimination and calibration of the model were also assessed. Results: The predictive model showed a good fit for predicting COVID-19 hospitalization (C-index 0.79) and a good overall prediction accuracy (Brier score 0.14). The model was well calibrated (intercept –0.0028, slope 0.9970). Based on these results, 118,804 patients diagnosed with COVID-19 from October 25 to December 11, 2020, were stratified into low, medium, and high risk for COVID-19 severity. Among the overall study population, 67,030 (56.42%) were classified as low-risk patients; 43,886 (36.94%), as medium-risk patients; and 7888 (6.64%), as high-risk patients. In all, 89.37% (106,179/118,804) of the overall study population was being assisted at home, 9% (10,695/118,804) was hospitalized, and 1.62% (1930/118,804) died. Among those assisted at home, most people (63,983/106,179, 60.26%) were classified as low risk, whereas only 3.63% (3858/106,179) were classified at high risk. According to ordinal logistic regression, the odds ratio (OR) of being hospitalized or dead was 5.0 (95% CI 4.6-5.4) among high-risk patients and 2.7 (95% CI 2.6-2.9) among medium-risk patients, as compared to low-risk patients. Conclusions: A simple monitoring system, based on primary care data sets linked to COVID-19 testing results, hospital admissions data, and death records may assist in the proper planning and allocation of patients and resources during the ongoing COVID-19 pandemic. %M 34543227 %R 10.2196/29504 %U https://publichealth.jmir.org/2021/11/e29504 %U https://doi.org/10.2196/29504 %U http://www.ncbi.nlm.nih.gov/pubmed/34543227 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e30462 %T The Influence of Normative Perceptions on the Uptake of the COVID-19 TraceTogether Digital Contact Tracing System: Cross-sectional Study %A Lee,Jeong Kyu %A Lin,Lavinia %A Kang,Hyunjin %+ Saw Swee Hock School of Public Health, National University of Singapore, Tahir Foundation Building, 12 Science Drive 2, 10-01, Singapore, 117549, Singapore, 65 66015838, lee.jeongkyu@gmail.com %K COVID-19 %K social norms %K TraceTogether %K Singapore %K contact tracing %K mobile app %K token %D 2021 %7 12.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In 2020, the Singapore government rolled out the TraceTogether program, a digital system to facilitate contact tracing efforts in response to the COVID-19 pandemic. This system is available as a smartphone app and Bluetooth-enabled token to help identify close contacts. As of February 1, 2021, more than 80% of the population has either downloaded the mobile app or received the token in Singapore. Despite the high adoption rate of the TraceTogether mobile app and token (ie, device), it is crucial to understand the role of social and normative perceptions in uptake and usage by the public, given the collective efforts for contact tracing. Objective: This study aimed to examine normative influences (descriptive and injunctive norms) on TraceTogether device use for contact tracing purposes, informed by the theory of normative social behavior, a theoretical framework to explain how perceived social norms are related to behaviors. Methods: From January to February 2021, cross-sectional data were collected by a local research company through emailing their panel members who were (1) Singapore citizens or permanent residents aged 21 years or above; (2) able to read English; and (3) internet users with access to a personal email account. The study sample (n=1137) was restricted to those who had either downloaded the TraceTogether mobile app or received the token. Results: Multivariate (linear and ordinal logistic) regression analyses were carried out to assess the relationships of the behavioral outcome variables (TraceTogether device usage and intention of TraceTogether device usage) with potential correlates, including perceived social norms, perceived community, and interpersonal communication. Multivariate regression analyses indicated that descriptive norms (unstandardized regression coefficient β=0.31, SE=0.05; P<.001) and injunctive norms (unstandardized regression coefficient β=0.16, SE=0.04; P<.001) were significantly positively associated with the intention to use the TraceTogether device. It was also found that descriptive norms were a significant correlate of TraceTogether device use frequency (adjusted odds ratio [aOR] 2.08, 95% CI 1.66-2.61; P<.001). Though not significantly related to TraceTogether device use frequency, injunctive norms moderated the relationship between descriptive norms and the outcome variable (aOR 1.12, 95% CI 1.03-1.21; P=.005). Conclusions: This study provides useful implications for the design of effective intervention strategies to promote the uptake and usage of digital methods for contact tracing in a multiethnic Asian population. Our findings highlight that influence from social networks plays an important role in developing normative perceptions in relation to TraceTogether device use for contact tracing. To promote the uptake of the TraceTogether device and other preventive behaviors for COVID-19, it would be useful to devise norm-based interventions that address these normative perceptions by presenting high prevalence and approval of important social referents, such as family and close friends. %M 34623956 %R 10.2196/30462 %U https://publichealth.jmir.org/2021/11/e30462 %U https://doi.org/10.2196/30462 %U http://www.ncbi.nlm.nih.gov/pubmed/34623956 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e32093 %T Mobile Apps Leveraged in the COVID-19 Pandemic in East and South-East Asia: Review and Content Analysis %A Lee,Bohee %A Ibrahim,Siti Aishah %A Zhang,Tiying %+ Centre for Population Health Sciences, Usher Institute, University of Edinburgh, Old Medical School, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 1316503034, bohee.lee@ed.ac.uk %K mobile apps %K applications %K eHealth %K mHealth %K mobile health %K digital health %K telemedicine %K telehealth %K COVID-19 %K coronavirus %K pandemic %K public health %K health policy %D 2021 %7 11.11.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic increased attention to digital tools to support governmental public health policies in East and South-East Asia. Mobile apps related to the COVID-19 pandemic continue to emerge and evolve with a wide variety of characteristics and functions. However, there is a paucity of studies evaluating such apps in this region, with most of the available studies conducted in the early days of the pandemic. Objective: This study aimed to examine free apps developed or supported by governments in the East and South-East Asian region and highlight their key characteristics and functions. We also sought to interpret how the release dates of these apps were related to the commencement dates of other COVID-19 public health policies. Methods: We systematically searched for apps in Apple App Store and Google Play Store and analyzed the contents of eligible apps. Mobile apps released or updated with COVID-19–related functions between March 1 and May 7, 2021, in Singapore, Taiwan, South Korea, China (mainland), Japan, Thailand, Hong Kong, Vietnam, Malaysia, Indonesia, and the Philippines were included. The CoronaNet Research Project database was also examined to determine the timeline of public health policy commencement dates in relation to the release dates of the included apps. We assessed each app’s official website, media reports, and literature through content analysis. Descriptive statistics were used to summarize relevant information gathered from the mobile apps using RStudio. Results: Of the 1943 mobile apps initially identified, 46 were eligible, with almost 70% of the apps being intended for the general public. Most apps were from Vietnam (n=9, 20%), followed by Malaysia, Singapore, and Thailand (n=6 each, 13%). Of note, most apps for quarantine monitoring (n=6, 13%) were mandatory for the target users or a population subset. The most common function was health monitoring (32/46, 70%), followed by raising public health awareness (19/46, 41%) through education and information dissemination. Other functions included monitoring quarantine (12/46, 26%), providing health resources (12/46, 26%). COVID-19 vaccination management functions began to appear in parallel with vaccine rollout (7/46, 15%). Regarding the timing of the introduction of mobile solutions, the majority of mobile apps emerged close to the commencement dates of other public health policies in the early stages of the pandemic between March and April 2020. Conclusions: In East and South-East Asia, most governments used mobile health apps as adjuncts to public health measures for tracking COVID-19 cases and delivering credible information. In addition, these apps have evolved by expanding their functions for COVID-19 vaccination. %M 34748515 %R 10.2196/32093 %U https://mhealth.jmir.org/2021/11/e32093 %U https://doi.org/10.2196/32093 %U http://www.ncbi.nlm.nih.gov/pubmed/34748515 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e30259 %T Longitudinal Neurocognitive and Pulmonological Profile of Long COVID-19: Protocol for the COVIMMUNE-Clin Study %A Widmann,Catherine N %A Wieberneit,Michelle %A Bieler,Luzie %A Bernsen,Sarah %A Gräfenkämper,Robin %A Brosseron,Frederic %A Schmeel,Carsten %A Tacik,Pawel %A Skowasch,Dirk %A Radbruch,Alexander %A Heneka,Michael T %+ Section Neuropsychology, Department of Neurodegenerative Diseases and Gerontopsychiatry, University of Bonn Medical Center, Venusberg-Campus-1, Building 80, Bonn, 53127, Germany, 49 228 287 13093, catherine.widmann@ukbonn.de %K SARS-CoV-2 %K COVID-19 %K postacute COVID-19 syndrome %K cognition %K neuropsychology %K lung %K magnetic resonance imaging %D 2021 %7 11.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: There is a dearth of information about “brain fog,” characterized by concentration, word-finding, or memory problems, which has been listed in the new World Health Organization provisional classification “U09.9 Post-COVID-19 Condition.” Moreover, the extent to which these symptoms may be associated with neurological, pulmonary, or psychiatric difficulties is unclear. Objective: This ongoing cohort study aims to carefully assess neurocognitive function in the context of the neurological, psychiatric, and pulmonary sequelae of SARS-CoV-2 infection among patients with asymptomatic/mild and severe cases of COVID-19 after remission, including actively recruited healthy controls. Methods: A total of 150 participants will be included in this pilot study. The cohort will comprise patients who tested positive for SARS-CoV-2 infection with either an asymptomatic course or a mild course defined as no symptoms except for olfactory and taste dysfunction (n=50), patients who tested positive for SARS-CoV-2 infection with a severe disease course (n=50), and a healthy control group (n=50) with similar age and sex distribution based on frequency matching. A comprehensive neuropsychological assessment will be performed comprising nuanced aspects of complex attention, including language, executive function, verbal and visual learning, and memory. Psychiatric, personality, social and lifestyle factors, sleep, and fatigue will be evaluated. Brain magnetic resonance imaging, neurological and physical assessment, and pulmonological and lung function examinations (including body plethysmography, diffusion capacity, clinical assessments, and questionnaires) will also be performed. Three visits are planned with comprehensive testing at the baseline and 12-month visits, along with brief neurological and neuropsychological examinations at the 6-month assessment. Blood-based biomarkers of neurodegeneration will be quantified at baseline and 12-month follow-up. Results: At the time of submission, the study had begun recruitment through telephone and in-person screenings. The first patient was enrolled in the study at the beginning of April 2021. Interim data analysis of baseline information is expected to be complete by December 2021 and study completion is expected at the end of December 2022. Preliminary group comparisons indicate worse word list learning, short- and long-delayed verbal recall, and verbal recognition in both patient cohorts compared with those of the healthy control group, adjusted for age and sex. Initial volumetric comparisons show smaller grey matter, frontal, and temporal brain volumes in both patient groups compared with those of healthy controls. These results are quite robust but are neither final nor placed in the needed context intended at study completion. Conclusions: To the best of our knowledge, this is the first study to include objective and comprehensive longitudinal analyses of neurocognitive sequelae of COVID-19 in an extreme group comparison stratified by disease severity with healthy controls actively recruited during the pandemic. Results from this study will contribute to the nascent literature on the prolonged effects of COVID-19 on neurocognitive performance via our coassessment of neuroradiological, neurological, pulmonary, psychiatric, and lifestyle factors. Trial Registration: International Clinical Trials Registry Platform DRKS00023806; https://trialsearch.who.int/Trial2.aspx?TrialID=DRKS00023806 International Registered Report Identifier (IRRID): DERR1-10.2196/30259 %M 34559059 %R 10.2196/30259 %U https://www.researchprotocols.org/2021/11/e30259 %U https://doi.org/10.2196/30259 %U http://www.ncbi.nlm.nih.gov/pubmed/34559059 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e32591 %T Exploring Online Health Reviews to Monitor COVID-19 Public Health Responses in Alabama State Department of Corrections: Case Example %A Valera,Pamela %A Carmona,David %A Malarkey,Sarah %A Sinangil,Noah %A Owens,Madelyn %A Lefebre,Asia %+ Department of Urban-Global Public Health, Rutgers School of Public Health, 1 Riverfront Plaza, 10th Floor, Newark, NJ, 07102, United States, 1 9739726555, pv181@sph.rutgers.edu %K Alabama %K correctional facilities %K COVID-19 %K online health reviews %K review %K monitoring %K public health %K policy %K response %K prison %K United States %K case study %K formative %K feasibility %K acceptability %K survey %D 2021 %7 10.11.2021 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 34609313 %R 10.2196/32591 %U https://formative.jmir.org/2021/11/e32591 %U https://doi.org/10.2196/32591 %U http://www.ncbi.nlm.nih.gov/pubmed/34609313 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e32936 %T The Impact of Public Health Events on COVID-19 Vaccine Hesitancy on Chinese Social Media: National Infoveillance Study %A Zhang,Zizheng %A Feng,Guanrui %A Xu,Jiahong %A Zhang,Yimin %A Li,Jinhui %A Huang,Jian %A Akinwunmi,Babatunde %A Zhang,Casper J P %A Ming,Wai-kit %+ Department of Infectious Diseases and Public Health, Jockey Club College of Veterinary Medicine and Life Sciences, City University of Hong Kong, To Yuen Building, 31 To Yuen Street, Hong Kong, China (Hong Kong), 852 34426956, wkming2@cityu.edu.hk %K COVID-19 %K vaccine %K hesitancy %K social media %K China %K sentiment analysis %K infoveillance %K public health %K surveillance %K Weibo %K data mining %K sentiment %K attitude %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The ongoing COVID-19 pandemic has brought unprecedented challenges to every country worldwide. A call for global vaccination for COVID-19 plays a pivotal role in the fight against this virus. With the development of COVID-19 vaccines, public willingness to get vaccinated has become an important public health concern, considering the vaccine hesitancy observed worldwide. Social media is powerful in monitoring public attitudes and assess the dissemination, which would provide valuable information for policy makers. Objective: This study aimed to investigate the responses of vaccine positivity on social media when major public events (major outbreaks) or major adverse events related to vaccination (COVID-19 or other similar vaccines) were reported. Methods: A total of 340,783 vaccine-related posts were captured with the poster’s information on Weibo, the largest social platform in China. After data cleaning, 156,223 posts were included in the subsequent analysis. Using pandas and SnowNLP Python libraries, posts were classified into 2 categories, positive and negative. After model training and sentiment analysis, the proportion of positive posts was computed to measure the public positivity toward the COVID-19 vaccine. Results: The positivity toward COVID-19 vaccines in China tends to fluctuate over time in the range of 45.7% to 77.0% and is intuitively correlated with public health events. In terms of gender, males were more positive (70.0% of the time) than females. In terms of region, when regional epidemics arose, not only the region with the epidemic and surrounding regions but also the whole country showed more positive attitudes to varying degrees. When the epidemic subsided temporarily, positivity decreased with varying degrees in each region. Conclusions: In China, public positivity toward COVID-19 vaccines fluctuates over time and a regional epidemic or news on social media may cause significant variations in willingness to accept a vaccine. Furthermore, public attitudes toward COVID-19 vaccination vary from gender and region. It is crucial for policy makers to adjust their policies through the use of positive incentives with prompt responses to pandemic-related news to promote vaccination acceptance. %M 34591782 %R 10.2196/32936 %U https://publichealth.jmir.org/2021/11/e32936 %U https://doi.org/10.2196/32936 %U http://www.ncbi.nlm.nih.gov/pubmed/34591782 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e31707 %T Multilevel Determinants of COVID-19 Vaccine Uptake Among South Asian Ethnic Minorities in Hong Kong: Cross-sectional Web-Based Survey %A Singh,Akansha %A Lai,Angel Hor Yan %A Wang,Jingxuan %A Asim,Saba %A Chan,Paul Shing-Fong %A Wang,Zixin %A Yeoh,Eng Kiong %+ Centre for Health Systems and Policy Research, JC School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, N.T., Hong Kong, 666888, China (Hong Kong), 852 22528740, wangzx@cuhk.edu.hk %K COVID-19 %K South Asian ethnic minorities %K COVID-19 vaccination %K uptake %K cultural and religious reasons for vaccine hesitancy %K perceptions %K information exposure on social media %K influence of peers %K socioecological model %K Hong Kong %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic continues to have a disproportionate effect on ethnic minorities. Across countries, greater vaccine hesitancy has been observed among ethnic minorities. After excluding foreign domestic helpers, South Asians make up the largest proportion of ethnic minorities in Hong Kong. It is necessary to plan for COVID-19 vaccination promotional strategies that cater to the unique needs of South Asians in Hong Kong. Objective: This study investigated the prevalence of COVID-19 vaccine uptake among a sample of South Asians in Hong Kong. We examined the effects of sociodemographic data and factors at individual level (perceptions), interpersonal level (information exposure on social media), and sociostructural level (cultural) based on the socioecological model. Methods: A cross-sectional web-based survey was conducted on May 1-31, 2021. Participants were South Asian people aged 18 years or older living in Hong Kong; able to comprehend English, Hindi, Nepali, or Urdu; and having access to a smartphone. Three community-based organizations providing services to South Asians in Hong Kong facilitated the data collection. The staff of the community-based organizations posted the study information in WhatsApp groups involving South Asian clients and invited them to participate in a web-based survey. Logistic regression models were fit for data analysis. Results: Among 245 participants, 81 (33.1%) had taken at least one dose of the COVID-19 vaccine (one dose, 62/245, 25.2%; and both doses, 19/245, 7.9%). After adjusting for significant background characteristics, cultural and religious reasons for COVID-19 vaccine hesitancy were associated with lower COVID-19 vaccine uptake (adjusted odds ratio [AOR] 0.83, 95% CI 0.71-0.97; P=.02). At the individual level, having more positive attitudes toward COVID-19 vaccination (AOR 1.31, 95% CI 1.10-1.55; P=.002), perceived support from significant others (AOR 1.29, 95% CI 1.03-1.60; P=.03), and perceived higher behavioral control to receive COVID-19 vaccination (AOR 2.63, 95% CI 1.65-4.19; P<.001) were associated with higher COVID-19 vaccine uptake, while a negative association was found between negative attitudes and the dependent variable (AOR 0.73, 95% CI 0.62-0.85; P<.001). Knowing more peers who had taken the COVID-19 vaccine was also associated with higher uptake (AOR 1.39, 95% CI 1.11-1.74; P=.01). At the interpersonal level, higher exposure to information about deaths and other serious conditions caused by COVID-19 vaccination was associated with lower uptake (AOR 0.54, 95% CI 0.33-0.86; P=.01). Conclusions: In this study, one-third (81/245) of our participants received at least one dose of the COVID-19 vaccine. Cultural or religious reasons, perceptions, information exposure on social media, and influence of peers were found to be the determinants of COVID-19 vaccine uptake among South Asians. Future programs should engage community groups, champions, and faith leaders, and develop culturally competent interventions. %M 34653014 %R 10.2196/31707 %U https://publichealth.jmir.org/2021/11/e31707 %U https://doi.org/10.2196/31707 %U http://www.ncbi.nlm.nih.gov/pubmed/34653014 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 11 %P e26424 %T Acceptance of an Informational Antituberculosis Chatbot Among Korean Adults: Mixed Methods Research %A Kim,Agnes Jihae %A Yang,Jisun %A Jang,Yihyun %A Baek,Joon Sang %+ Department of Human Environment and Design, Yonsei University, Samsung Hall, 7th Fl., Yonsei-ro 50, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2123 3137, joonsbaek@yonsei.ac.kr %K tuberculosis %K chatbot %K technology acceptance model %K mobile phone %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Tuberculosis (TB) is a highly infectious disease. Negative perceptions and insufficient knowledge have made its eradication difficult. Recently, mobile health care interventions, such as an anti-TB chatbot developed by the research team, have emerged in support of TB eradication programs. However, before the anti-TB chatbot is deployed, it is important to understand the factors that predict its acceptance by the population. Objective: This study aims to explore the acceptance of an anti-TB chatbot that provides information about the disease and its treatment to people vulnerable to TB in South Korea. Thus, we are investigating the factors that predict technology acceptance through qualitative research based on the interviews of patients with TB and homeless facility personnel. We are then verifying the extended Technology Acceptance Model (TAM) and predicting the factors associated with the acceptance of the chatbot. Methods: In study 1, we conducted interviews with potential chatbot users to extract the factors that predict user acceptance and constructed a conceptual framework based on the TAM. In total, 16 interviews with patients with TB and one focus group interview with 10 experts on TB were conducted. In study 2, we conducted surveys of potential chatbot users to validate the extended TAM. Survey participants were recruited among late-stage patients in TB facilities and members of web-based communities sharing TB information. A total of 123 responses were collected. Results: The results indicate that perceived ease of use and social influence were significantly predictive of perceived usefulness (P=.04 and P<.001, respectively). Perceived usefulness was predictive of the attitude toward the chatbot (P<.001), whereas perceived ease of use (P=.88) was not. Behavioral intention was positively predicted by attitude toward the chatbot and facilitating conditions (P<.001 and P=.03, respectively). The research model explained 55.4% of the variance in the use of anti-TB chatbots. The moderating effect of TB history was found in the relationship between attitude toward the chatbot and behavioral intention (P=.01) and between facilitating conditions and behavioral intention (P=.02). Conclusions: This study can be used to inform future design of anti-TB chatbots and highlight the importance of services and the environment that empower people to use the technology. %M 34751667 %R 10.2196/26424 %U https://mhealth.jmir.org/2021/11/e26424 %U https://doi.org/10.2196/26424 %U http://www.ncbi.nlm.nih.gov/pubmed/34751667 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29319 %T Association of Substance Use With Behavioral Adherence to Centers for Disease Control and Prevention Guidelines for COVID-19 Mitigation: Cross-sectional Web-Based Survey %A Monnig,Mollie A %A Treloar Padovano,Hayley %A Sokolovsky,Alexander W %A DeCost,Grace %A Aston,Elizabeth R %A Haass-Koffler,Carolina L %A Szapary,Claire %A Moyo,Patience %A Avila,Jaqueline C %A Tidey,Jennifer W %A Monti,Peter M %A Ahluwalia,Jasjit S %+ Department of Behavioral and Social Sciences, Brown University, Box G-S121-5, Providence, RI, 02912, United States, 1 4018633491, mollie_monnig@brown.edu %K SARS-CoV-2 %K novel coronavirus %K COVID-19 %K alcohol use %K alcohol drinking %K opioid use %K stimulant use %K nicotine %K smoking %K survey %K substance abuse %K addiction %K mental health %K pandemic %D 2021 %7 9.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34591780 %R 10.2196/29319 %U https://publichealth.jmir.org/2021/11/e29319 %U https://doi.org/10.2196/29319 %U http://www.ncbi.nlm.nih.gov/pubmed/34591780 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e30150 %T Social Media Sharing of Articles About Measles in a European Context: Text Analysis Study %A Wawrzuta,Dominik %A Jaworski,Mariusz %A Gotlib,Joanna %A Panczyk,Mariusz %+ Department of Education and Research in Health Sciences, Medical University of Warsaw, Żwirki i Wigury 81, Warsaw, 02-091, Poland, 48 22 57 20 490, dwawrzuta@wum.edu.pl %K measles %K Facebook %K Twitter %K Pinterest %K social media %K vaccine %K infodemiology %K public health %D 2021 %7 8.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the existence of an effective vaccine, measles still threatens the health and lives of many Europeans. Notably, during the COVID-19 pandemic, measles vaccine uptake declined; as a result, after the pandemic, European countries will have to increase vaccination rates to restore the extent of vaccination coverage among the population. Because information obtained from social media are one of the main causes of vaccine hesitancy, knowledge of the nature of information pertaining to measles that is shared on social media may help create educational campaigns. Objective: In this study, we aim to define the characteristics of European news about measles shared on social media platforms (ie, Facebook, Twitter, and Pinterest) from 2017 to 2019. Methods: We downloaded and translated (into English) 10,305 articles on measles published in European Union countries. Using latent Dirichlet allocation, we identified main topics and estimated the sentiments expressed in these articles. Furthermore, we used linear regression to determine factors related to the number of times a given article was shared on social media. Results: We found that, in most European social media posts, measles is only discussed in the context of local European events. Articles containing educational information and describing world outbreaks appeared less frequently. The most common emotions identified from the study’s news data set were fear and trust. Yet, it was found that readers were more likely to share information on educational topics and the situation in Germany, Ukraine, Italy, and Samoa. A high amount of anger, joy, and sadness expressed within the text was also associated with a higher number of shares. Conclusions: We identified which features of news articles were related to increased social media shares. We found that social media users prefer sharing educational news to sharing informational news. Appropriate emotional content can also increase the willingness of social media users to share an article. Effective media content that promotes measles vaccinations should contain educational or scientific information, as well as specific emotions (such as anger, joy, or sadness). Articles with this type of content may offer the best chance of disseminating vital messages to a broad social media audience. %M 34570715 %R 10.2196/30150 %U https://www.jmir.org/2021/11/e30150 %U https://doi.org/10.2196/30150 %U http://www.ncbi.nlm.nih.gov/pubmed/34570715 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 11 %P e31586 %T A Digital Human for Delivering a Remote Loneliness and Stress Intervention to At-Risk Younger and Older Adults During the COVID-19 Pandemic: Randomized Pilot Trial %A Loveys,Kate %A Sagar,Mark %A Pickering,Isabella %A Broadbent,Elizabeth %+ Department of Psychological Medicine, The University of Auckland, Building 507, Level 3, 22-30 Park Avenue, Grafton, Auckland, 1023, New Zealand, 64 9 923 0003, e.broadbent@auckland.ac.nz %K COVID-19 %K loneliness %K stress %K well-being %K eHealth %K digital human %K conversational agent %K older adults %K chronic illness %D 2021 %7 8.11.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Loneliness is a growing public health issue that has been exacerbated in vulnerable groups during the COVID-19 pandemic. Computer agents are capable of delivering psychological therapies through the internet; however, there is limited research on their acceptability to date. Objective: The objectives of this study were to evaluate (1) the feasibility and acceptability of a remote loneliness and stress intervention with digital human delivery to at-risk adults and (2) the feasibility of the study methods in preparation for a randomized controlled trial. Methods: A parallel randomized pilot trial with a mixed design was conducted. Participants were adults aged 18 to 69 years with an underlying medical condition or aged 70 years or older with a Mini-Mental State Examination score of >24 (ie, at greater risk of developing severe COVID-19). Participants took part from their place of residence (independent living retirement village, 20; community dwelling, 7; nursing home, 3). Participants were randomly allocated to the intervention or waitlist control group that received the intervention 1 week later. The intervention involved completing cognitive behavioral and positive psychology exercises with a digital human facilitator on a website for at least 15 minutes per day over 1 week. The exercises targeted loneliness, stress, and psychological well-being. Feasibility was evaluated using dropout rates and behavioral observation data. Acceptability was evaluated from behavioral engagement data, the Friendship Questionnaire (adapted), self-report items, and qualitative questions. Psychological measures were administered to evaluate the feasibility of the trial methods and included the UCLA Loneliness Scale, the 4-item Perceived Stress Scale, a 1-item COVID-19 distress measure, the Flourishing Scale, and the Scale of Positive and Negative Experiences. Results: The study recruited 30 participants (15 per group). Participants were 22 older adults and 8 younger adults with a health condition. Six participants dropped out of the study. Thus, the data of 24 participants were analyzed (intervention group, 12; waitlist group, 12). The digital human intervention and trial methods were generally found to be feasible and acceptable in younger and older adults living independently, based on intervention completion, and behavioral, qualitative, and some self-report data. The intervention and trial methods were less feasible to nursing home residents who required caregiver assistance. Acceptability could be improved with additional content, tailoring to the population, and changes to the digital human’s design. Conclusions: Digital humans are a promising and novel technological solution for providing at-risk adults with access to remote psychological support during the COVID-19 pandemic. Research should further examine design techniques to improve their acceptability in this application and investigate intervention effectiveness in a randomized controlled trial. Trial Registration: Australia New Zealand Clinical Trials Registry ACTRN12620000786998; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380113 %M 34596572 %R 10.2196/31586 %U https://mental.jmir.org/2021/11/e31586 %U https://doi.org/10.2196/31586 %U http://www.ncbi.nlm.nih.gov/pubmed/34596572 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e33022 %T Investigating Unhealthy Alcohol Use As an Independent Risk Factor for Increased COVID-19 Disease Severity: Observational Cross-sectional Study %A Bhalla,Sameer %A Sharma,Brihat %A Smith,Dale %A Boley,Randy %A McCluskey,Connor %A Ilyas,Yousaf %A Afshar,Majid %A Balk,Robert %A Karnik,Niranjan %A Keshavarzian,Ali %+ Center for Circadian Rhythm and Alcohol-Induced Tissue Injury, Rush University Medical Center, 1725 W Harrison St, Chicago, IL, United States, 1 (312) 942 5861, Ali_Keshavarzian@rush.edu %K unhealthy alcohol use %K COVID-19 %K SARS-CoV-2 %K acute respiratory distress syndrome %K substance misuse %K mechanical ventilation %K substance use %D 2021 %7 5.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34665758 %R 10.2196/33022 %U https://publichealth.jmir.org/2021/11/e33022 %U https://doi.org/10.2196/33022 %U http://www.ncbi.nlm.nih.gov/pubmed/34665758 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e29049 %T Clinical Characteristics of Children With COVID-19 in the United Arab Emirates: Cross-sectional Multicenter Study %A Ennab,Farah %A ElSaban,Mariam %A Khalaf,Eman %A Tabatabaei,Hanieh %A Khamis,Amar Hassan %A Devi,Bindu Radha %A Hanif,Kashif %A Elhassan,Hiba %A Saravanan,Ketharanathan %A Cremonesini,David %A Popatia,Rizwana %A Malik,Zainab %A Ho,Samuel B %A Abusamra,Rania %+ College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Al Razi St - Umm Hurair 2, Dubai Healthcare City, Dubai, United Arab Emirates, 971 563786236, rania.abdelkarim@mediclinic.ae %K pediatrics %K children %K COVID-19 %K SARS-CoV-2 %K United Arab Emirates %K viral shedding %K pandemic %K treatment %K outcomes %K clinical %K public heath %D 2021 %7 5.11.2021 %9 Original Paper %J JMIR Pediatr Parent %G English %X Background: COVID-19 has infected over 123 million people globally. The first confirmed case in the United Arab Emirates (UAE) was 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. %M 34643535 %R 10.2196/29049 %U https://pediatrics.jmir.org/2021/4/e29049 %U https://doi.org/10.2196/29049 %U http://www.ncbi.nlm.nih.gov/pubmed/34643535 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e29896 %T Psychosocial and Behavioral Effects of the COVID-19 Pandemic in the Indian Population: Protocol for a Cross-sectional Study %A Joshi,Megha %A Shah,Aangi %A Trivedi,Bhavi %A Trivedi,Jaahnavee %A Patel,Viral %A Parghi,Devam %A Thakkar,Manini %A Barot,Kanan %A Jadawala,Vivek %+ Department of Psychiatry, Shrimati Nathiba Hargovandas Lakhamichand Municipal Medical College, Gujarat University, Pritamrai cross road,, Ellisbridge, Paldi, Ahmedabad, 380006, India, 91 9909896196, joshimegha1@gmail.com %K COVID-19 %K mental health %K India %K lockdown %K isolation %K social isolation %K behavior %K psychology %K psychosocial effects %D 2021 %7 5.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the year 2020, the COVID-19 pandemic spread from China to the rest of the world, which prompted the world to implement a widespread mandated quarantine or social isolation. The impending uncertainty of the pandemic must have resulted in a variety of widespread mental health maladies. There has been documentation in the literature about a lot of these in small populations of the world but limited studies have been conducted in India, leading to limited evidence in the literature. Objective: The main objective of our study is to investigate the mental health effects that the COVID-19 pandemic has had on the general population in India both quantitatively and qualitatively. These results will help contribute to reducing the knowledge gap that is recognized in the literature, which is the result of the unprecedented and novel nature of the pandemic. Methods: We designed and validated our own questionnaire and used the method of circulating the questionnaire via WhatsApp (Facebook Inc). WhatsApp is a social media app that is very popularly used in India; hence, it turned out to be an effective medium for gathering pilot data. We analyzed the pilot data and used them to validate the questionnaire. This was done with the expertise of our mentor, Nilima Shah, MD (psychiatry). We gathered pilot data on 545 subjects and used the results to determine the changes that were needed for the questionnaire while simultaneously validating the questionnaire. Results: The study protocol was approved in September 2020 by the institutional review board at Vadilal Sarabhai General Hospital, Ahmedabad, Gujarat, India. Conclusions: The following preliminary assumptions can be made about the study based on the pilot data: the majority of the survey respondents were male (289/545, 53%), most of them were educated and employed as health care workers (199/545, 36.5%). The majority of the responders were self-employed (185/545, 33.9%), single (297/545, 54.5%), and stayed with their families (427/541, 79%) for the lockdown, which helped them psychologically. Findings that are specific to mental health have been elaborated upon in the manuscript. It is evident from the data collected in previous literature that the pandemic has had significant detrimental effects on the mental health of a vast proportion of the Indian population. International Registered Report Identifier (IRRID): DERR1-10.2196/29896 %M 34519652 %R 10.2196/29896 %U https://www.researchprotocols.org/2021/11/e29896 %U https://doi.org/10.2196/29896 %U http://www.ncbi.nlm.nih.gov/pubmed/34519652 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28344 %T COVID-19 Knowledge, Attitudes, and Practices Among People in Bangladesh: Telephone-Based Cross-sectional Survey %A Rabbani,Md Golam %A Akter,Orin %A Hasan,Md Zahid %A Samad,Nandeeta %A Mahmood,Shehrin Shaila %A Joarder,Taufique %+ Public Health Foundation, Bangladesh, 54 Inner Circular Road, Scaut Market, Naya Paltan, Dhaka, 1217, Bangladesh, 880 1732292488, rabbaniduihe@gmail.com %K COVID-19 %K knowledge %K attitude %K practice %K risk communication and community engagement %K social and behavior change communication %K Bangladesh %K COVID-19 %K risk %K pandemic %K risk communication %D 2021 %7 5.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The world has been grappling with the COVID-19 pandemic, a dire public health crisis, since December 2019. Preventive and control measures have been adopted to reduce the spread of COVID-19. To date, the public’s knowledge, attitudes, and practices regarding COVID-19 across Bangladesh have been poorly understood. Therefore, it is important to assess people’s knowledge, attitudes, and practices (KAP) toward the disease and suggest appropriate strategies to combat COVID-19 effectively. Objective: This study aimed to assess the KAP of Bangladeshi people toward COVID-19 and to identify their determinants. Methods: We conducted a country-wide cross-sectional telephonic survey from May 7 to 29, 2020. A purposive sampling method was applied, and adult Bangladeshi citizens who have mobile phones were approached to participate in the survey. Interviews were conducted based on verbal consent. Multiple logistic regression analyses and several tests were performed to identify the factors associated with KAP related to COVID-19. Results: A total of 492 of 576 Bangladeshi adults aged 18 years and above completed the interview, with a response rate of 85.4% (492/576). Of the 492 participants, 321 (65.2%) were male, and 304 (61.8%) lived in a rural area. Mean scores for knowledge, attitudes, and practices were 10.56 (SD 2.86), 1.24 (SD 0.83), and 3.17 (SD 1.5), respectively. Among the 492 respondents, 273 (55.5%) had poor knowledge, and 251 (49%) expressed a negative attitude; 192 out of 359 respondents (53.5%) had poor practices toward COVID-19. Mean scores of knowledge, attitudes, and practices differed significantly across various demographic and socioeconomic groups. Rural residents had lower mean scores of knowledge (mean 9.8, SD 3.1, P<.001) and adherence to appropriate practice measures (mean 4, SD 1.4, P<.001) compared to their urban counterparts. Positive and statistically strong correlations between knowledge and attitudes (r=0.21, P<.001), knowledge and practices (r=0.45, P<.001), and attitudes and practices (r=0.27, P<.001) were observed. Television (53.7%) was identified as the major source of knowledge regarding COVID-19. Almost three-quarters of the respondents (359/492, 73%) went outside the home during the lockdown period. Furthermore, the study found that good knowledge (odds ratio [OR] 3.13, 95% CI 2.03-4.83, and adjusted OR 2.33, 95% CI 1.16-4.68) and a positive attitude (OR 2.43, 95% CI 1.59-3.72, and adjusted OR 3.87, 95% CI 1.95-7.68) are significantly associated with better practice of COVID-19 health measures. Conclusions: Evidence-informed and context-specific risk communication and community engagement, and a social and behavior change communication strategy against COVID-19 should be developed in Bangladesh based on the findings of this study, targeting different socioeconomic groups. %M 34519660 %R 10.2196/28344 %U https://formative.jmir.org/2021/11/e28344 %U https://doi.org/10.2196/28344 %U http://www.ncbi.nlm.nih.gov/pubmed/34519660 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e26523 %T Novel Methods in the Surveillance of Influenza-Like Illness in Germany Using Data From a Symptom Assessment App (Ada): Observational Case Study %A Cawley,Caoimhe %A Bergey,François %A Mehl,Alicia %A Finckh,Ashlee %A Gilsdorf,Andreas %+ Ada Health GmbH, Karl-Liebknecht Strasse 1, Berlin, 10178, Germany, 49 17680765335, caoimhecawley@gmail.com %K ILI %K influenza %K syndromic surveillance %K participatory surveillance %K digital surveillance %K mobile phone %D 2021 %7 4.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Participatory epidemiology is an emerging field harnessing consumer data entries of symptoms. The free app Ada allows users to enter the symptoms they are experiencing and applies a probabilistic reasoning model to provide a list of possible causes for these symptoms. Objective: The objective of our study is to explore the potential contribution of Ada data to syndromic surveillance by comparing symptoms of influenza-like illness (ILI) entered by Ada users in Germany with data from a national population-based reporting system called GrippeWeb. Methods: We extracted data for all assessments performed by Ada users in Germany over 3 seasons (2017/18, 2018/19, and 2019/20) and identified those with ILI (report of fever with cough or sore throat). The weekly proportion of assessments in which ILI was reported was calculated (overall and stratified by age group), standardized for the German population, and compared with trends in ILI rates reported by GrippeWeb using time series graphs, scatterplots, and Pearson correlation coefficient. Results: In total, 2.1 million Ada assessments (for any symptoms) were included. Within seasons and across age groups, the Ada data broadly replicated trends in estimated weekly ILI rates when compared with GrippeWeb data (Pearson correlation—2017-18: r=0.86, 95% CI 0.76-0.92; P<.001; 2018-19: r=0.90, 95% CI 0.84-0.94; P<.001; 2019-20: r=0.64, 95% CI 0.44-0.78; P<.001). However, there were differences in the exact timing and nature of the epidemic curves between years. Conclusions: With careful interpretation, Ada data could contribute to identifying broad ILI trends in countries without existing population-based monitoring systems or to the syndromic surveillance of symptoms not covered by existing systems. %M 34734836 %R 10.2196/26523 %U https://publichealth.jmir.org/2021/11/e26523 %U https://doi.org/10.2196/26523 %U http://www.ncbi.nlm.nih.gov/pubmed/34734836 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 4 %P e30747 %T Changes in Self-Reported Web-Based Gambling Activity During the COVID-19 Pandemic: Cross-sectional Study %A Claesdotter-Knutsson,Emma %A Håkansson,Anders %+ Child and Adolescent Psychiatry, Department of Clinical Sciences, Lund University, Barav 1, Lund, 221 85, Sweden, 46 768871765, emma.claesdotter-knutsson@med.lu.se %K COVID-19 %K pandemic %K web-based gambling %K psychological distress %K gender %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Serious Games %G English %X Background: The COVID‑19 pandemic has affected not only somatic health with over 3.7 million deaths worldwide, but also has had a huge impact on psychological health, creating what amounts to a mental health crisis. The negative effect of the pandemic on traditional addictions is well described and concerning, and the same has been seen for gambling. Objective: This study explores self-reported web-based gambling behavior during the COVID‑19 pandemic in Sweden. We investigated overall changes, but also changes in specific web-based gambling types, and whether they are associated with certain risk factors or lifestyle changes. Methods: Our study is based on an anonymous web-based survey of web panel participants in Sweden (N=1501) designed to study a range of behavioral changes during the COVID‑19 pandemic. Increases in gambling were analyzed using logistic regression models against sociodemographic data and psychological distress. Results: The majority of the respondents who gambled reported no changes in their gambling habits during the COVID‑19 pandemic. We found significant associations with the problem gambling severity index (PGSI), the Kessler score (indicating psychological distress), employment status, changes in alcohol habits, and self-exclusion when looking at overall changes in gambling activity in the pandemic. In the subgroup that reported an increase in gambling activity, we found an association with both the PGSI and Kessler scores. The PGSI score was also an independent predictor for all specific web-based gambling (horses, sports, poker, and casino) whereas the Kessler score only had a significant impact on changes in casino gambling. In addition, male gender was an independent predictor for gambling on sports and casino gambling. Conclusions: The majority of respondents who gambled reported no changes in their gambling activity during the COVID‑19 pandemic. The group that reported an increase in overall gambling activity during the COVID-19 pandemic represent a group with gambling problems and psychological distress. The group that reported increased sports and casino gambling were often male, and this group seemed to experience more psychological distress. %M 34730540 %R 10.2196/30747 %U https://games.jmir.org/2021/4/e30747 %U https://doi.org/10.2196/30747 %U http://www.ncbi.nlm.nih.gov/pubmed/34730540 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 11 %P e29789 %T Examining the Utility of Social Media in COVID-19 Vaccination: Unsupervised Learning of 672,133 Twitter Posts %A Liew,Tau Ming %A Lee,Cia Sin %+ Department of Psychiatry, Singapore General Hospital, Outram Road, Singapore, 169608, Singapore, 65 62223322, liew.tau.ming@singhealth.com.sg %K social media %K COVID-19 %K vaccine hesitancy %K natural language processing %K machine learning %K infodemiology %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34583316 %R 10.2196/29789 %U https://publichealth.jmir.org/2021/11/e29789 %U https://doi.org/10.2196/29789 %U http://www.ncbi.nlm.nih.gov/pubmed/34583316 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e30293 %T Adapting a Mental Health Intervention for Adolescents During the COVID-19 Pandemic: Web-Based Synchronous Focus Group Study %A Calvo-Valderrama,Maria Gabriela %A Marroquín-Rivera,Arturo %A Burn,Erin %A Ospina-Pinillos,Laura %A Bird,Victoria %A Gómez-Restrepo,Carlos %+ Unit for Social and Community Psychiatry, Institute of Population Health Sciences, Queen Mary University of London, Cherry Tree Way, London, E13 8SP, United Kingdom, 44 20754043802340, v.j.bird@qmul.ac.uk %K pandemic %K COVID-19 %K online focus groups %K qualitative research %K technology %K adolescents %K public health %D 2021 %7 3.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Although focus groups are a valuable qualitative research tool, face-to-face meetings may be difficult to arrange and time consuming. This challenge has been further compounded by the global COVID-19 pandemic and the subsequent lockdown and physical distancing measures implemented, which caused exceptional challenges to human activities. Online focus groups (OFGs) are an example of an alternative strategy and require further study. At present, OFGs have mostly been studied and used in high-income countries, with little information relating to their implementation in low- and middle-income countries (LMICs). Objective: The aim of this study is to share our experiences of conducting OFGs through a web conferencing service and provide recommendations for future research. Methods: As part of a broader study, OFGs were developed with adults and adolescents in Colombia during the COVID-19 pandemic. Through a convenience sampling method, we invited eligible participants via email in two different cities of Colombia to participate in OFGs conducted via Microsoft Teams. Researcher notes and discussion were used to capture participant and facilitator experiences, as well as practical considerations. Results: Technical issues were encountered, but various measures were taken to minimize them, such as using a web conferencing service that was familiar to participants, sending written instructions, and performing a trial meeting prior to the OFG. Adolescent participants, unlike their adult counterparts, were fluent in using web conferencing platforms and did not encounter technical challenges. Conclusions: OFGs have great potential in research settings, especially during the current and any future public health emergencies. It is important to keep in mind that even with the advantages that they offer, technical issues (ie, internet speed and access to technology) are major obstacles in LMICs. Further research is required and should carefully consider the appropriateness of OFGs in different settings. %M 34637395 %R 10.2196/30293 %U https://formative.jmir.org/2021/11/e30293 %U https://doi.org/10.2196/30293 %U http://www.ncbi.nlm.nih.gov/pubmed/34637395 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e28929 %T A Case Study of an SMS Text Message Community Panel Survey and Its Potential for Use During the COVID-19 Pandemic %A Chan,Lilian %A El-Haddad,Nouhad %A Freeman,Becky %A O'Hara,Blythe J %A Woodland,Lisa %A Harris-Roxas,Ben %+ Prevention Research Collaboration, Sydney School of Public Health and Charles Perkins Centre, The University of Sydney, John Hopkins Drive, Camperdown, 2006, Australia, 61 286277554, lilian.chan@sydney.edu.au %K data collection %K mobile phone %K short message service %K tobacco %K COVID-19 %K survey %D 2021 %7 3.11.2021 %9 Viewpoint %J JMIR Form Res %G English %X During the COVID-19 pandemic many traditional methods of data collection, such as intercept surveys or focus groups, are not feasible. This paper proposes that establishing community panels through SMS text messages may be a useful method during the pandemic, by describing a case study of how an innovative SMS text message community panel was used for the “Shisha No Thanks” project to collect data from young adults of Arabic-speaking background about their attitudes on the harms of waterpipe smoking. Participants were asked to complete an initial recruitment survey, and then subsequently sent 1 survey question per week. The study recruited 133 participants to the SMS text message community panel and the mean response rate for each question was 73.0% (97.1/133) (range 76/133 [57.1%] to 112/133 [84.2%]). The SMS text message community panel approach is not suited for all populations, nor for all types of inquiry, particularly due to limitations of the type of responses that it allows and the required access to mobile devices. However, it is a rapid method for data collection, and therefore during the COVID-19 pandemic, it can provide service providers and policymakers with timely information to inform public health responses. In addition, this method negates the need for in-person interactions and allows for longitudinal data collection. It may be useful in supplementing other community needs assessment activities, and may be particularly relevant for people who are considered to be more difficult to reach, particularly young people, culturally and linguistically diverse communities, and other groups that might otherwise be missed by traditional methods. %M 34612824 %R 10.2196/28929 %U https://formative.jmir.org/2021/11/e28929 %U https://doi.org/10.2196/28929 %U http://www.ncbi.nlm.nih.gov/pubmed/34612824 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 11 %P e32726 %T Optimal Triage for COVID-19 Patients Under Limited Health Care Resources With a Parsimonious Machine Learning Prediction Model and Threshold Optimization Using Discrete-Event Simulation: Development Study %A Kim,Jeongmin %A Lim,Hakyung %A Ahn,Jae-Hyeon %A Lee,Kyoung Hwa %A Lee,Kwang Suk %A Koo,Kyo Chul %+ Department of Urology, Yonsei University College of Medicine, 211 Eonju-ro, Gangnam-gu, Seoul, 135-720, Republic of Korea, 82 01099480342, gckoo@yuhs.ac %K COVID-19 %K decision support techniques %K machine learning %K prediction %K triage %D 2021 %7 2.11.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic has placed an unprecedented burden on health care systems. Objective: We aimed to effectively triage COVID-19 patients within situations of limited data availability and explore optimal thresholds to minimize mortality rates while maintaining health care system capacity. Methods: A nationwide sample of 5601 patients confirmed with COVID-19 until April 2020 was retrospectively reviewed. Extreme gradient boosting (XGBoost) and logistic regression analysis were used to develop prediction models for the maximum clinical severity during hospitalization, classified according to the World Health Organization Ordinal Scale for Clinical Improvement (OSCI). The recursive feature elimination technique was used to evaluate the maintenance of model performance when clinical and laboratory variables were eliminated. Using populations based on hypothetical patient influx scenarios, discrete-event simulation was performed to find an optimal threshold within limited resource environments that minimizes mortality rates. Results: The cross-validated area under the receiver operating characteristic curve (AUROC) of the baseline XGBoost model that utilized all 37 variables was 0.965 for OSCI ≥6. Compared to the baseline model’s performance, the AUROC of the feature-eliminated model that utilized 17 variables was maintained at 0.963 with statistical insignificance. Optimal thresholds were found to minimize mortality rates in a hypothetical patient influx scenario. The benefit of utilizing an optimal triage threshold was clear, reducing mortality up to 18.1%, compared with the conventional Youden index. Conclusions: Our adaptive triage model and its threshold optimization capability revealed that COVID-19 management can be achieved via the cooperation of both the medical and health care management sectors for maximum treatment efficacy. The model is available online for clinical implementation. %M 34609319 %R 10.2196/32726 %U https://medinform.jmir.org/2021/11/e32726 %U https://doi.org/10.2196/32726 %U http://www.ncbi.nlm.nih.gov/pubmed/34609319 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 11 %P e26136 %T Conducting Health Literacy Research With Hard-to-Reach Regional Culturally and Linguistically Diverse Populations: Evaluation Study of Recruitment and Retention Methods Before and During COVID-19 %A Perrins,Genevieve %A Ferdous,Tabassum %A Hay,Dawn %A Harreveld,Bobby %A Reid-Searl,Kerry %+ Central Queensland Multicultural Association, CQUniversity Rockhampton North, Room 31, Building 41 Buzacott Circle, 554-700 Yaamba Road, Norman Gardens, Rockhampton, 4701, Australia, 61 423853809, evie.perrins@cqma.org.au %K health literacy %K cultural and linguistic diversity %K COVID-19 %K health care barriers %K hard-to-reach research participants %K regional Australia %K health literacy profiles %K literacy %D 2021 %7 2.11.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In health research, culturally and linguistically diverse (CALD) health care consumers are cited as hidden or hard to reach. This paper evaluates the approach used by researchers to attract and retain hard-to-reach CALD research participants for a study investigating health communication barriers between CALD health care users and health care professionals in regional Australia. As the study was taking place during the COVID-19 pandemic, subsequent restrictions emerged. Thus, recruitment and retention methods were adapted. This evaluation considered the effectiveness of recruitment and retention used throughout the pre-COVID and during-COVID periods. Objective: This evaluation sought to determine the effectiveness of recruitment and retention efforts of researchers during a study that targeted regional hard-to-reach CALD participants. Methods: Recruitment and retention methods were categorized into the following 5 phases: recruitment, preintervention data collection, intervention, postintervention data collection, and interviews. To compare the methods used by researchers, recruitment and retention rates were divided into pre-COVID and during-COVID periods. Thereafter, in-depth reflections of the methods employed within this study were made. Results: This paper provides results relating to participant recruitment and retainment over the course of 5 research phases that occurred before and during COVID. During the pre-COVID recruitment phase, 22 participants were recruited. Of these participants, 15 (68%) transitioned to the next phase and completed the initial data collection phase. By contrast, 18 participants completed the during-COVID recruitment phase, with 13 (72%) continuing to the next phase. The success rate of the intervention phase in the pre-COVID period was 93% (14/15), compared with 84.6% (11/13) in the during-COVID period. Lastly, 93% (13/14) of participants completed the postintervention data collection in the pre-COVID period, compared with 91% (10/11) in the during-COVID period. In total, 40 participants took part in the initial data collection phase, with 23 (58%) completing the 5 research phases. Owing to the small sample size, it was not determined if there was any statistical significance between the groups (pre- and during-COVID periods). Conclusions: The success of this program in recruiting and maintaining regional hard-to-reach CALD populations was preserved over the pre- and during-COVID periods. The pandemic required researchers to adjust study methods, thereby inadvertently contributing to the recruitment and retention success of the project. The maintenance of participants during this period was due to flexibility offered by researchers through adaptive methods, such as the use of cultural gatekeepers, increased visibility of CALD researchers, and use of digital platforms. The major findings of this evaluation are 2-fold. First, increased diversity in the research sample required a high level of flexibility from researchers, meaning that such projects may be more resource intensive. Second, community organizations presented a valuable opportunity to connect with potential hard-to-reach research participants. %M 34581673 %R 10.2196/26136 %U https://formative.jmir.org/2021/11/e26136 %U https://doi.org/10.2196/26136 %U http://www.ncbi.nlm.nih.gov/pubmed/34581673 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 11 %P e28105 %T Utility of a Telephone Triage Hotline in Response to the COVID-19 Pandemic: Longitudinal Observational Study %A Cher,Benjamin A Y %A Wilson,Eric A %A Pinsky,Alexa M %A Townshend,Ryan F %A Wolski,Ann V %A Broderick,Michael %A Milen,Allison M %A Lau,Audrey %A Singh,Amrit %A Cinti,Sandro K %A Engelke,Carl G %A Saha,Anjan K %+ Department of Anesthesiology, Columbia University Irving Medical Center, 622 West 168th Street, 10032, New York, NY, United States, 1 (703) 785 3087, aks9032@nyp.org %K triage %K telephone %K COVID-19 %K utility %K telemedicine %K telehealth %K patient information %K concern %K implementation %K innovation %K hospital %D 2021 %7 1.11.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the initial months of the COVID-19 pandemic, rapidly rising disease prevalence in the United States created a demand for patient-facing information exchanges that addressed questions and concerns about the disease. One approach to managing increased patient volumes during a pandemic involves the implementation of telephone-based triage systems. During a pandemic, telephone triage hotlines can be employed in innovative ways to conserve medical resources and offer useful population-level data about disease symptomatology and risk factor profiles. Objective: The aim of this study is to describe and evaluate the COVID-19 telephone triage hotline used by a large academic medical center in the midwestern United States. Methods: Michigan Medicine established a telephone hotline to triage inbound patient calls related to COVID-19. For calls received between March 24, 2020, and May 5, 2020, we described total call volume, data reported by callers including COVID-19 risk factors and symptomatology, and distribution of callers to triage algorithm endpoints. We also described symptomatology reported by callers who were directed to the institutional patient portal (online medical visit questionnaire). Results: A total of 3929 calls (average 91 calls per day) were received by the call center during the study period. The maximum total number of daily calls peaked at 211 on March 24, 2020. Call volumes were the highest from 6 AM to 11 AM and during evening hours. Callers were most often directed to the online patient portal (1654/3929, 42%), nursing hotlines (1338/3929, 34%), or employee health services (709/3929, 18%). Cough (126/370 of callers, 34%), shortness of breath (101/370, 27%), upper respiratory infection (28/111, 25%), and fever (89/370, 24%) were the most commonly reported symptoms. Immunocompromised state (23/370, 6%) and age >65 years (18/370, 5%) were the most commonly reported risk factors. Conclusions: The triage algorithm successfully diverted low-risk patients to suitable algorithm endpoints, while directing high-risk patients onward for immediate assessment. Data collected from hotline calls also enhanced knowledge of symptoms and risk factors that typified community members, demonstrating that pandemic hotlines can aid in the clinical characterization of novel diseases. %M 34559669 %R 10.2196/28105 %U https://www.jmir.org/2021/11/e28105 %U https://doi.org/10.2196/28105 %U http://www.ncbi.nlm.nih.gov/pubmed/34559669 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 11 %P e33653 %T A Novel Risk and Crisis Communication Platform to Bridge the Gap Between Policy Makers and the Public in the Context of the COVID-19 Crisis (PubliCo): Protocol for a Mixed Methods Study %A Spitale,Giovanni %A Merten,Sonja %A Jafflin,Kristen %A Schwind,Bettina %A Kaiser-Grolimund,Andrea %A Biller-Andorno,Nikola %+ Institute of Biomedical Ethics and History of Medicine, University of Zurich, Winterthurerstrasse 30, Zurich, 8006, Switzerland, 41 44 634 40 80, biller-andorno@ibme.uzh.ch %K disease outbreaks %K coronavirus %K COVID-19 surveys %K COVID-19 questionnaires %K qualitative methods %K health literacy %K policy making %K risk and crisis communication %K COVID-19 %D 2021 %7 1.11.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Since the end of 2019, COVID-19 has had a significant impact on people around the globe. As governments institute more restrictive measures, public adherence could decrease and discontent may grow. Providing high-quality information and countering fake news are important. However, we also need feedback loops so that government officials can refine preventive measures and communication strategies. Policy makers need information—preferably based on real-time data—on people’s cognitive, emotional, and behavioral reactions to public health messages and restrictive measures. PubliCo aims to foster effective and tailored risk and crisis communication as well as provide an assessment of the risks and benefits of prevention and control measures, since their effectiveness depends on public trust and cooperation. Objective: Our project aims to develop a tool that helps tackle the COVID-19 infodemic, with a focus on enabling a nuanced and in-depth understanding of public perception. The project adopts a transdisciplinary multistakeholder approach, including participatory citizen science. Methods: We aim to combine a literature and media review and analysis as well as empirical research using mixed methods, including an online survey and diary-based research, both of which are ongoing and continuously updated. Building on real-time data and continuous data collection, our research results will be highly adaptable to the evolving situation. Results: As of September 2021, two-thirds of the proposed tool is operational. The current development cycles are focusing on analytics, user experience, and interface refinement. We have collected a total of 473 responses through PubliCo Survey and 22 diaries through PubliCo Diaries. Conclusions: Pilot data show that PubliCo is a promising and efficient concept for bidirectional risk and crisis communication in the context of public health crises. Further data are needed to assess its function at a larger scale or in the context of an issue other than COVID-19. International Registered Report Identifier (IRRID): DERR1-10.2196/33653 %M 34612823 %R 10.2196/33653 %U https://www.researchprotocols.org/2021/11/e33653 %U https://doi.org/10.2196/33653 %U http://www.ncbi.nlm.nih.gov/pubmed/34612823 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e30449 %T Young Adults’ Responses to an African and US-Based COVID-19 Edutainment Miniseries: Real-Time Qualitative Analysis of Online Social Media Engagement %A Baker,Venetia %A Arnold,Georgia %A Piot,Sara %A Thwala,Lesedi %A Glynn,Judith %A Hargreaves,James %A Birdthistle,Isolde %+ Department of Population Health, Faculty of Epidemiology and Population Health, The London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 20 7636 8636, venetia.baker1@lshtm.ac.uk %K COVID-19 %K adolescents %K young people %K social media %K edutainment %D 2021 %7 29.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In April 2020, as cases of the novel COVID-19 spread across the globe, MTV Staying Alive Foundation created the educational entertainment miniseries MTV Shuga: Alone Together. In 70 short episodes released daily on YouTube, Alone Together aimed to disseminate timely and accurate information to increase young people’s knowledge, motivation, and actions to prevent COVID-19. Objective: We sought to identify Alone Together viewer’s perspectives on the global COVID-19 pandemic and national lockdowns by examining the words, conversations, experiences, and emotions expressed on social media in response to the Alone Together episodes. We also assessed how viewers used the series and its online community as a source of support during the global pandemic. Methods: A total of 3982 comments and 70 live chat conversations were extracted from YouTube between April and October 2020 and analyzed through a data-led inductive thematic approach. Aggregated demographic and geographical data were collected using YouTube Analytics. Results: The miniseries had a global reach across 5 continents, with a total of 7.7 million views across MTV Shuga platforms. The series had over 1 million views over 70 episodes on YouTube and an average of 5683 unique viewers per episode on YouTube. The dominant audience was adults under the age of 35 years and women. Across diverse countries such as Nigeria, Ghana, the United States, and the UK, viewers believed that COVID-19 was serious and expressed that it was socially responsible to follow public health measures. Storylines of the series about the impact of self-isolation on mental health, exposure to violence in lockdowns, and restricted employment opportunities due to the pandemic resonated with young viewers. Tuning in to the miniseries provided viewers with reliable information, entertainment, and an online community during an isolating, confusing, and worrying time. Conclusions: During the first wave of COVID-19, viewers from at least 53 countries connected on social media via the MTV miniseries. The analysis showed how digitally connected people under the age of 35 years, predominantly women, felt compelled to follow COVID-19 safety measures despite the pandemic’s impact on their social, educational, and financial needs. Viewers used social media to reach out to fellow viewers for advice, solace, support, and resources. Organizations, governments, and individuals have been forced to innovate during the pandemic to ensure people can access services safely and remotely. This analysis showed that women under 35 years of age were especially receptive to receiving support from online communities and media services. Peer influence and support online can be a powerful public health tool as people have a great capacity to influence each other and shape norms around public health. However, online services are not accessible to everyone, and COVID-19 has increased disparities between digitally connected and unconnected younger adults. %M 34596568 %R 10.2196/30449 %U https://formative.jmir.org/2021/10/e30449 %U https://doi.org/10.2196/30449 %U http://www.ncbi.nlm.nih.gov/pubmed/34596568 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31086 %T Pilot Evaluations of Two Bluetooth Contact Tracing Approaches on a University Campus: Mixed Methods Study %A Shelby,Tyler %A Caruthers,Tyler %A Kanner,Oren Y %A Schneider,Rebecca %A Lipnickas,Dana %A Grau,Lauretta E %A Manohar,Rajit %A Niccolai,Linda %+ Epidemiology of Microbial Diseases Department, Yale School of Public Health, Yale University, 60 College Street, New Haven, CT, United States, 1 6202284003, tyler.shelby@yale.edu %K mHealth %K digital contact tracing %K Bluetooth %K COVID-19 %K mixed methods %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Many have proposed the use of Bluetooth technology to help scale up contact tracing for COVID-19. However, much remains unknown about the accuracy of this technology in real-world settings, the attitudes of potential users, and the differences between delivery formats (mobile app vs carriable or wearable devices). Objective: We pilot tested 2 separate Bluetooth contact tracing technologies on a university campus to evaluate their sensitivity and specificity, and to learn from the experiences of the participants. Methods: We used a convergent mixed methods study design, and participants included graduate students and researchers working on a university campus during June and July 2020. We conducted separate 2-week pilot studies for each Bluetooth technology. The first was for a mobile phone app (“app pilot”), and the second was for a small electronic “tag” (“tag pilot”). Participants validated a list of Bluetooth-identified contacts daily and reported additional close contacts not identified by Bluetooth. We used these data to estimate sensitivity and specificity. Participants completed a postparticipation survey regarding appropriateness, usability, acceptability, and adherence, and provided additional feedback via free text. We used tests of proportions to evaluate differences in survey responses between participants from each pilot, paired t tests to measure differences between compatible survey questions, and qualitative analysis to evaluate the survey’s free-text responses. Results: Among 25 participants in the app pilot, 53 contact interactions were identified by Bluetooth and an additional 61 by self-report. Among 17 participants in the tag pilot, 171 contact interactions were identified by Bluetooth and an additional 4 by self-report. The tag had significantly higher sensitivity compared with the app (46/49, 94% vs 35/61, 57%; P<.001), as well as higher specificity (120/126, 95% vs 123/141, 87%; P=.02). Most participants felt that Bluetooth contact tracing was appropriate on campus (26/32, 81%), while significantly fewer participants felt that using other technologies, such as GPS or Wi-Fi, was appropriate (17/31, 55%; P=.02). Most participants preferred technology developed and managed by the university rather than a third party (27/32, 84%) and preferred not to have tracing apps on their personal phones (21/32, 66%), due to “concerns with privacy.” There were no significant differences in self-reported adherence rates across pilots. Conclusions: Convenient and carriable Bluetooth technology may improve tracing efficiency while alleviating privacy concerns by shifting data collection away from personal devices. With accuracy comparable to, and in this case, superior to, mobile phone apps, such approaches may be suitable for workplace or school settings with the ability to purchase and maintain physical devices. %M 34586078 %R 10.2196/31086 %U https://formative.jmir.org/2021/10/e31086 %U https://doi.org/10.2196/31086 %U http://www.ncbi.nlm.nih.gov/pubmed/34586078 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e20970 %T WhatsApp-Based Focus Groups Among Mexican-Origin Women in Zika Risk Area: Feasibility, Acceptability, and Data Quality %A Anderson,Elizabeth %A Koss,Mary %A Castro Luque,Ana Lucía %A Garcia,David %A Lopez,Elise %A Ernst,Kacey %+ Department of Health Promotion Sciences, University of Arizona, 1295 N Martin Ave, Tucson, AZ, 85721, United States, 1 5205050040, andersone@email.arizona.edu %K WhatsApp %K synchronous text-based focus groups %K Zika %K Mexican-origin Latinas %K social media %K mHealth %K focus groups %K smartphones %K mobile phone %D 2021 %7 28.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Despite unprecedented advances in worldwide access to the internet via smartphones, barriers to engaging hard-to-reach populations remain in many methods of health research. A potential avenue for conducting qualitative research is via participatory web-based media, including the free, popular social platform WhatsApp. However, despite the clear advantages of engaging with participants over a well-established web-based platform, logistical challenges remain. Objective: This study aims to report evidence on the feasibility and acceptability of WhatsApp as a method to conduct focus groups. Methods: A pilot focus group was conducted with Spanish-speaking women near the US–Mexico border. The content focus was knowledge and perceived risks for exposure to the Zika virus during pregnancy. Results: Evidence was obtained regarding WhatsApp as a low-cost, logistically feasible methodology that resulted in rich qualitative data from a population that is often reticent to engage in traditional research. A total of 5 participants participated in a focus group, of whom all 5 consistently contributed to the focus group chat in WhatsApp, which was conducted over 3 consecutive days. Conclusions: The findings are noteworthy at a time when face-to-face focus groups, the gold standard, are risky or precluded by safe COVID-19 guidelines. Other implications include more applications and evaluations of WhatsApp for delivering one-on-one or group health education interventions on sensitive topics. This paper outlines the key steps and considerations for the replication or adaptation of methods. %M 34709185 %R 10.2196/20970 %U https://formative.jmir.org/2021/10/e20970 %U https://doi.org/10.2196/20970 %U http://www.ncbi.nlm.nih.gov/pubmed/34709185 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e29820 %T Emotional Tone, Analytical Thinking, and Somatosensory Processes of a Sample of Italian Tweets During the First Phases of the COVID-19 Pandemic: Observational Study %A Monzani,Dario %A Vergani,Laura %A Pizzoli,Silvia Francesca Maria %A Marton,Giulia %A Pravettoni,Gabriella %+ Department of Oncology and Hemato-Oncology, University of Milan, Via Festa del Perdono 7, Milan, 20122, Italy, 39 029 4372099, laura.vergani@ieo.it %K internet %K mHealth %K infodemiology %K infoveillance %K pandemic %K public health %K COVID-19 %K Twitter %K psycholinguistic analysis %K trauma %D 2021 %7 27.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic is a traumatic individual and collective chronic experience, with tremendous consequences on mental and psychological health that can also be reflected in people’s use of words. Psycholinguistic analysis of tweets from Twitter allows obtaining information about people’s emotional expression, analytical thinking, and somatosensory processes, which are particularly important in traumatic events contexts. Objective: We aimed to analyze the influence of official Italian COVID-19 daily data (new cases, deaths, and hospital discharges) and the phase of managing the pandemic on how people expressed emotions and their analytical thinking and somatosensory processes in Italian tweets written during the first phases of the COVID-19 pandemic in Italy. Methods: We retrieved 1,697,490 Italian COVID-19–related tweets written from February 24, 2020 to June 14, 2020 and analyzed them using LIWC2015 to calculate 3 summary psycholinguistic variables: emotional tone, analytical thinking, and somatosensory processes. Official daily data about new COVID-19 cases, deaths, and hospital discharges were retrieved from the Italian Prime Minister's Office and Civil Protection Department GitHub page. We considered 3 phases of managing the COVID-19 pandemic in Italy. We performed 3 general models, 1 for each summary variable as the dependent variable and with daily data and phase of managing the pandemic as independent variables. Results: General linear models to assess differences in daily scores of emotional tone, analytical thinking, and somatosensory processes were significant (F6,104=21.53, P<.001, R2= .55; F5,105=9.20, P<.001, R2= .30; F6,104=6.15, P<.001, R2=.26, respectively). Conclusions: The COVID-19 pandemic affects how people express emotions, analytical thinking, and somatosensory processes in tweets. Our study contributes to the investigation of pandemic psychological consequences through psycholinguistic analysis of social media textual data. %M 34516386 %R 10.2196/29820 %U https://www.jmir.org/2021/10/e29820 %U https://doi.org/10.2196/29820 %U http://www.ncbi.nlm.nih.gov/pubmed/34516386 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 10 %P e27131 %T Stakeholders’ Perceptions of Benefits of and Barriers to Using Video-Observed Treatment for Monitoring Patients With Tuberculosis in Uganda: Exploratory Qualitative Study %A Sekandi,Juliet Nabbuye %A Kasiita,Vicent %A Onuoha,Nicole Amara %A Zalwango,Sarah %A Nakkonde,Damalie %A Kaawa-Mafigiri,David %A Turinawe,Julius %A Kakaire,Robert %A Davis-Olwell,Paula %A Atuyambe,Lynn %A Buregyeya,Esther %+ Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, 100 Foster Road, Athens, GA, 30602, United States, 1 17063387993, jsekandi@uga.edu %K tuberculosis %K adherence %K mHealth %K video directly observed therapy %K Uganda %K mobile phone %D 2021 %7 27.10.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Nonadherence to treatment remains a barrier to tuberculosis (TB) control. Directly observed therapy (DOT) is the standard for monitoring adherence to TB treatment worldwide, but its implementation is challenging, especially in resource-limited settings. DOT is labor-intensive and inconvenient to both patients and health care workers. Video DOT (VDOT) is a novel patient-centered alternative that uses mobile technology to observe patients taking medication remotely. However, the perceptions and acceptability of potential end users have not been evaluated in Africa. Objective: This study explores stakeholders’ acceptability of, as well as perceptions of potential benefits of and barriers to, using VDOT to inform a pilot study for monitoring patients with TB in urban Uganda. Methods: An exploratory, qualitative, cross-sectional study with an exit survey was conducted in Kampala, Uganda, from April to May 2018. We conducted 5 focus group discussions, each comprising 6 participants. Groups included patients with TB (n=2 groups; male and female), health care providers (n=1), caregivers (n=1), and community DOT volunteer workers (n=1). The questions that captured perceived benefits and barriers were guided by domains adopted from the Technology Acceptance Model. These included perceived usefulness, ease of use, and intent to use technology. Eligible participants were aged ≥18 years and provided written informed consent. For patients with TB, we included only those who had completed at least 2 months of treatment to minimize the likelihood of infection. A purposive sample of patients, caregivers, health care providers, and community DOT workers was recruited at 4 TB clinics in Kampala. Trained interviewers conducted unstructured interviews that were audio-recorded, transcribed, and analyzed using inductive content analysis to generate emerging themes. Results: The average age of participants was 34.5 (SD 10.7) years. VDOT was acceptable to most participants on a scale of 1 to 10. Of the participants, 70% (21/30) perceived it as highly acceptable, with scores ≥8, whereas 30% (9/30) scored between 5 and 7. Emergent themes on perceived benefits of VDOT were facilitation of easy adherence monitoring, timely follow-up on missed doses, patient-provider communication, and saving time and money because of minimal travel to meet in person. Perceived barriers included limited technology usability skills, inadequate cellular connectivity, internet access, availability of electricity, cost of the smartphone, and use of the internet. Some female patients raised concerns about the disruption of their domestic work routines to record videos. The impact of VDOT on privacy and confidentiality emerged as both a perceived benefit and barrier. Conclusions: VDOT was acceptable and perceived as beneficial by most study participants, despite potential technical and cost barriers. Mixed perceptions emerged about the impact of VDOT on privacy and confidentiality. Future efforts should focus on training users, ensuring adequate technical infrastructure, assuring privacy, and performing comparative cost analyses in the local context. %M 34704961 %R 10.2196/27131 %U https://mhealth.jmir.org/2021/10/e27131 %U https://doi.org/10.2196/27131 %U http://www.ncbi.nlm.nih.gov/pubmed/34704961 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32345 %T 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 %A Xiao,Jin %A Meyerowitz,Cyril %A Ragusa,Patricia %A Funkhouser,Kimberly %A Lischka,Tamara R %A Mendez Chagoya,Luis Alberto %A Al Jallad,Nisreen %A Wu,Tong Tong %A Fiscella,Kevin %A Ivie,Eden %A Strange,Michelle %A Collins,Jamie %A Kopycka-Kedzierawski,Dorota T %A , %+ Eastman Institute for Oral Health, University of Rochester Medical Center, 625 Elmwood Ave, Rochester, NY, 14620, United States, 1 585 275 0706, Dorota_KopyckaKedzierawski@URMC.Rochester.edu %K teledentistry %K mDentistry %K oral diseases %K virtual visit %K intraoral camera %K pandemic response %K COVID-19 %K mHealth %D 2021 %7 26.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 34597259 %R 10.2196/32345 %U https://www.researchprotocols.org/2021/10/e32345 %U https://doi.org/10.2196/32345 %U http://www.ncbi.nlm.nih.gov/pubmed/34597259 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e31101 %T Using Twitter Comments to Understand People’s Experiences of UK Health Care During the COVID-19 Pandemic: Thematic and Sentiment Analysis %A Ainley,Esther %A Witwicki,Cara %A Tallett,Amy %A Graham,Chris %+ Picker Institute Europe, Buxton Court, 3 West Way, Oxford, OX2 0JB, United Kingdom, 44 01865208168, esther.ainley@pickereurope.ac.uk %K patient experience %K COVID-19 %K remote health care %K phone consultation %K video consultation %K Twitter %K sentiment analysis %K social media %K digital health %K public health %K public opinion %D 2021 %7 25.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to changes in health service utilization patterns and a rapid rise in care being delivered remotely. However, there has been little published research examining patients’ experiences of accessing remote consultations since COVID-19. Such research is important as remote methods for delivering some care may be maintained in the future. Objective: The aim of this study was to use content from Twitter to understand discourse around health and care delivery in the United Kingdom as a result of COVID-19, focusing on Twitter users’ views on and attitudes toward care being delivered remotely. Methods: Tweets posted from the United Kingdom between January 2018 and October 2020 were extracted using the Twitter application programming interface. A total of 1408 tweets across three search terms were extracted into Excel; 161 tweets were removed following deduplication and 610 were identified as irrelevant to the research question. The remaining relevant tweets (N=637) were coded into categories using NVivo software, and assigned a positive, neutral, or negative sentiment. To examine views of remote care over time, the coded data were imported back into Excel so that each tweet was associated with both a theme and sentiment. Results: The volume of tweets on remote care delivery increased markedly following the COVID-19 outbreak. Five main themes were identified in the tweets: access to remote care (n=267), quality of remote care (n=130), anticipation of remote care (n=39), online booking and asynchronous communication (n=85), and publicizing changes to services or care delivery (n=160). Mixed public attitudes and experiences to the changes in service delivery were found. The proportion of positive tweets regarding access to, and quality of, remote care was higher in the immediate period following the COVID-19 outbreak (March-May 2020) when compared to the time before COVID-19 onset and the time when restrictions from the first lockdown eased (June-October 2020). Conclusions: Using Twitter data to address our research questions proved beneficial for providing rapid access to Twitter users’ attitudes to remote care delivery at a time when it would have been difficult to conduct primary research due to COVID-19. This approach allowed us to examine the discourse on remote care over a relatively long period and to explore shifting attitudes of Twitter users at a time of rapid changes in care delivery. The mixed attitudes toward remote care highlight the importance for patients to have a choice over the type of consultation that best suits their needs, and to ensure that the increased use of technology for delivering care does not become a barrier for some. The finding that overall sentiment about remote care was more positive in the early stages of the pandemic but has since declined emphasizes the need for a continued examination of people’s preference, particularly if remote appointments are likely to remain central to health care delivery. %M 34469327 %R 10.2196/31101 %U https://www.jmir.org/2021/10/e31101 %U https://doi.org/10.2196/31101 %U http://www.ncbi.nlm.nih.gov/pubmed/34469327 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e30613 %T Best Practices for the Implementation and Sustainment of Virtual Health Information System Training: Qualitative Study %A Jeyakumar,Tharshini %A Ambata-Villanueva,Sharon %A McClure,Sarah %A Henderson,Carolyn %A Wiljer,David %+ University Health Network, 190 Elizabeth Street, R. Fraser Elliot Building, RFE 3S-441, Toronto, ON, M5G 2C4, Canada, 1 14163404800, David.Wiljer@uhn.ca %K training %K health care providers %K educational technology %K patient care %K COVID-19 %K development %K practice %K best practice %K pedagogy %K teaching %K implementation %K medical education %K online education %K care delivery %K perception %K effectiveness %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: The COVID-19 pandemic has necessitated the adoption and implementation of digital technologies to help transform the educational ecosystem and the delivery of care. Objective: We sought to understand instructors’ and learners’ perceptions of the challenges and opportunities faced in implementing health information system virtual training amid the COVID-19 pandemic. Methods: Semistructured interviews were conducted with education specialists and health care staff who provided or had taken part in a virtual instructor-led training at a large Canadian academic health sciences center. Guided by the Technology Acceptance Model and the Community of Inquiry framework, we analyzed interview transcript themes deductively and inductively. Results: Of the 18 individuals participating in the study, 9 were education specialists, 5 were learners, 3 were program coordinators, and 1 was a senior manager at the Centre for Learning, Innovation, and Simulation. We found 3 predominant themes: adopting a learner-centered approach for a meaningful learning experience, embracing the advances in educational technologies to maximize the transfer of learning, and enhancing the virtual user experience. Conclusions: This study adds to the literature on designing and implementing virtual training in health care organizations by highlighting the importance of recognizing learners’ needs and maximizing the transfer of learning. Findings from this study can be used to help inform the design and development of training strategies to support learners across an organization during the current climate and to ensure changes are sustainable. %M 34449402 %R 10.2196/30613 %U https://mededu.jmir.org/2021/4/e30613 %U https://doi.org/10.2196/30613 %U http://www.ncbi.nlm.nih.gov/pubmed/34449402 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e25489 %T High Work-Related Stress and Anxiety as a Response to COVID-19 Among Health Care Workers in South Korea: Cross-sectional Online Survey Study %A Ahn,Myung Hee %A Shin,Yong-Wook %A Suh,Sooyeon %A Kim,Jeong Hye %A Kim,Hwa Jung %A Lee,Kyoung-Uk %A Chung,Seockhoon %+ Department of Psychiatry, Asan Medical Center, University of Ulsan College of Medicine, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea, 82 2 3010 3411, schung@amc.seoul.kr %K COVID-19 %K health personnel %K occupational stress %K anxiety %K depression %K stress %K mental health %K South Korea %K health care worker %K assessment %K intervention %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 outbreak had a severe impact on health care workers' psychological health. It is important to establish a process for psychological assessment and intervention for health care workers during epidemics. Objective: We investigated risk factors associated with psychological impacts for each health care worker group, to help optimize psychological interventions for health care workers in countries affected by the COVID-19 pandemic. Methods: Respondents (n=1787) from 2 hospitals in Korea completed a web-based survey during the period from April 14 to 30, 2020. The web-based survey collected demographic information, psychiatric history, and responses to the 9-item Stress and Anxiety to Viral Epidemics (SAVE-9), 9-item Patient Health Questionnaire (PHQ-9), and 7-item Generalized Anxiety Disorder-7 (GAD-7) scales. We performed logistic regression to assess contributing factors as predictor variables, using health care workers’ depression as outcome variables. Results: Among 1783 health care workers, nursing professionals had significantly higher levels of depression (PHQ-9 score: meannurse 5.5, SD 4.6; meanother 3.8, SD 4.2; P<.001), general anxiety (GAD-7 score: meannurse 4.0, SD 4.1; meanother 2.7, SD 3.6; P<.001), and virus-related anxiety symptoms (SAVE-9 score: meannurse 21.6, SD 5.9; meanother 18.6, SD 6.3; P<.001). Among nursing professionals, single workers reported more severe depressive symptoms than married workers (PHQ-9 score ≥10; meannurse 20.3%; meanother 14.1%; P=.02), and junior (<40 years) workers reported more anxiety about the viral epidemic (SAVE-9 anxiety score; meannurse 15.6, SD 4.1; meanother 14.7, SD 4.4; P=.002). Logistic regression revealed that hospital (adjusted odds ratio [OR] 1.45, 95% CI 1.06-1.99), nursing professionals (adjusted OR 1.37, 95% CI 1.02-1.98), single workers (adjusted OR 1.51, 95% CI 1.05-2.16), higher stress and anxiety to the viral infection (high SAVE-9 score, adjusted OR 1.20, 95% CI 1.17-1.24), and past psychiatric history (adjusted OR 3.26, 95% CI 2.15-4.96) were positively associated with depression. Conclusions: Psychological support and interventions should be considered for health care workers, especially nursing professionals, those who are single, and those with high SAVE-9 scores. %M 34478401 %R 10.2196/25489 %U https://publichealth.jmir.org/2021/10/e25489 %U https://doi.org/10.2196/25489 %U http://www.ncbi.nlm.nih.gov/pubmed/34478401 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e28088 %T Perceptions and Feelings of Brazilian Health Care Professionals Regarding the Effects of COVID-19: Cross-sectional Web-Based Survey %A Corrêa,Roberta Pires %A Castro,Helena Carla %A Quaresma,Bruna Maria Castro Salomão %A Stephens,Paulo Roberto Soares %A Araujo-Jorge,Tania Cremonini %A Ferreira,Roberto Rodrigues %+ Laboratory of Innovations in Therapies, Education and Bioproducts, Oswaldo Cruz Institute, Oswaldo Cruz Foundation (Fiocruz), Av Brasil, 4365, Rio de Janeiro, Brazil, 55 21 2562 1295, robertoferreira@ioc.fiocruz.br %K COVID-19 %K SARS-CoV-2 %K health professionals %K Brazil %K pandemic %K mental health %K health planning %D 2021 %7 22.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The importance of health professionals has been recognized in COVID-19 pandemic–affected countries, especially in those such as Brazil, which is one of the top 3 countries that have been affected in the world. However, the workers’ perception of the stress and the changes that the pandemic has caused in their lives vary according to the conditions offered by these affected countries, including salaries, individual protection equipment, and psychological support. Objective: The purpose of this study was to identify the perceptions of Brazilian health workers regarding the COVID-19 pandemic impact on their lives, including possible self-contamination and mental health. Methods: This cross-sectional web-based survey was conducted in Brazil by applying a 32-item questionnaire, including multiple-choice questions by using the Google Forms electronic assessment. This study was designed to capture spontaneous perceptions from health professionals. All questions were mandatory and divided into 2 blocks with different proposals: personal profile and COVID-19 pandemic impact. Results: We interviewed Brazilian health professionals from all 5 Brazilian regions (N=1376). Our study revealed that 1 in 5 (23%) complained about inadequate personal protective equipment, including face shields (234/1376, 17.0%), masks (206/1376, 14.9%), and laboratory coats (138/1376, 10.0%), whereas 1 in 4 health professionals did not have enough information to protect themselves from the coronavirus disease. These professionals had anxiety due to COVID-19 (604/1376, 43.9%), difficulties in sleep (593/1376, 43.1%), and concentrating on work (453/1376, 32.9%). Almost one-third experienced traumatic situations at work (385/1376, 28.0%), which may have led to negative feelings of fear of COVID-19 and sadness. Despite this situation, there was hope and empathy among their positive feelings. The survey also showed that 1 in 5 acquired COVID-19 with the most classic and minor symptoms, including headache (274/315, 87.0%), body pain (231/315, 73.3%), tiredness (228/315, 72.4%), and loss of taste and smell (208/315, 66.0%). Some of their negative feelings were higher than those of noninfected professionals (fear of COVID-19, 243/315, 77.1% vs 509/1061, 48.0%; impotence, 142/315, 45.1% vs 297/1061, 28.0%; and fault, 38/315, 12.1% vs 567/1061, 53.4%, respectively). Another worrying outcome was that 61.3% (193/315) reported acquiring an infection while working at a health facility and as expected, most of the respondents felt affected (344/1376, 25.0%) or very affected (619/1376, 45.0%) by the COVID-19. Conclusions: In Brazil, the health professionals were exposed to a stressful situation and to the risk of self-contamination—conditions that can spell future psychological problems for these workers. Our survey findings showed that the psychological support for this group should be included in the future health planning of Brazil and of other hugely affected countries to assure a good mental health condition for the medical teams in the near future. %M 34519656 %R 10.2196/28088 %U https://formative.jmir.org/2021/10/e28088 %U https://doi.org/10.2196/28088 %U http://www.ncbi.nlm.nih.gov/pubmed/34519656 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e29954 %T Implementation of the World Health Organization Global Antimicrobial Resistance Surveillance System in Uganda, 2015-2020: Mixed-Methods Study Using National Surveillance Data %A Nabadda,Susan %A Kakooza,Francis %A Kiggundu,Reuben %A Walwema,Richard %A Bazira,Joel %A Mayito,Jonathan %A Mugerwa,Ibrahimm %A Sekamatte,Musa %A Kambugu,Andrew %A Lamorde,Mohammed %A Kajumbula,Henry %A Mwebasa,Henry %+ Global Health Security Department, Infectious Diseases Institute, Makerere University College of Health Sciences, Hall Lane, Makerere University-Main Campus, Kampala, PO Box 22418, Uganda, 256 772437100, francis.kakooza1@gmail.com %K antimicrobial resistance %K surveillance %K microbiology %K laboratory %K Uganda %K implementation %K WHO %K collection %K analysis %K data %K antimicrobial %K progress %K bacteria %K feasibility %K resistance %K antibiotic %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Antimicrobial resistance (AMR) is an emerging public health crisis in Uganda. The World Health Organization (WHO) Global Action Plan recommends that countries should develop and implement National Action Plans for AMR. We describe the establishment of the national AMR program in Uganda and present the early microbial sensitivity results from the program. Objective: The aim of this study is to describe a national surveillance program that was developed to perform the systematic and continuous collection, analysis, and interpretation of AMR data. Methods: A systematic qualitative description of the process and progress made in the establishment of the national AMR program is provided, detailing the progress made from 2015 to 2020. This is followed by a report of the findings of the isolates that were collected from AMR surveillance sites. Identification and antimicrobial susceptibility testing (AST) of the bacterial isolates were performed using standard methods at both the surveillance sites and the reference laboratory. Results: Remarkable progress has been achieved in the establishment of the national AMR program, which is guided by the WHO Global Laboratory AMR Surveillance System (GLASS) in Uganda. A functional national coordinating center for AMR has been established with a supporting designated reference laboratory. WHONET software for AMR data management has been installed in the surveillance sites and laboratory staff trained on data quality assurance. Uganda has progressively submitted data to the WHO GLASS reporting system. Of the 19,216 isolates from WHO GLASS priority specimens collected from October 2015 to June 2020, 22.95% (n=4411) had community-acquired infections, 9.46% (n=1818) had hospital-acquired infections, and 68.57% (n=12,987) had infections of unknown origin. The highest proportion of the specimens was blood (12,398/19,216, 64.52%), followed by urine (5278/19,216, 27.47%) and stool (1266/19,216, 6.59%), whereas the lowest proportion was urogenital swabs (274/19,216, 1.4%). The mean age was 19.1 (SD 19.8 years), whereas the median age was 13 years (IQR 28). Approximately 49.13% (9440/19,216) of the participants were female and 50.51% (9706/19,216) were male. Participants with community-acquired infections were older (mean age 28, SD 18.6 years; median age 26, IQR 20.5 years) than those with hospital-acquired infections (mean age 17.3, SD 20.9 years; median age 8, IQR 26 years). All gram-negative (Escherichia coli, Klebsiella pneumoniae, and Neisseria gonorrhoeae) and gram-positive (Staphylococcus aureus and Enterococcus sp) bacteria with AST showed resistance to each of the tested antibiotics. Conclusions: Uganda is the first African country to implement a structured national AMR surveillance program in alignment with the WHO GLASS. The reported AST data indicate very high resistance to the recommended and prescribed antibiotics for treatment of infections. More effort is required regarding quality assurance of laboratory testing methodologies to ensure optimal adherence to WHO GLASS–recommended pathogen-antimicrobial combinations. The current AMR data will inform the development of treatment algorithms and clinical guidelines. %M 34673531 %R 10.2196/29954 %U https://publichealth.jmir.org/2021/10/e29954 %U https://doi.org/10.2196/29954 %U http://www.ncbi.nlm.nih.gov/pubmed/34673531 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e31125 %T Willingness to Receive COVID-19 Vaccination Among People Living With HIV and AIDS in China: Nationwide Cross-sectional Online Survey %A Huang,Xiaojie %A Yu,Maohe %A Fu,Gengfeng %A Lan,Guanghua %A Li,Linghua %A Yang,Jianzhou %A Qiao,Ying %A Zhao,Jin %A Qian,Han-Zhu %A Zhang,Xiangjun %A Liu,Xinchao %A Jin,Xia %A Chen,Guohong %A Jiang,Hui %A Tang,Weiming %A Wang,Zixin %A Xu,Junjie %+ Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, NT, Hong Kong, 666888, China, 852 22528740, wangzx@cuhk.edu.hk %K people living with HIV and AIDS %K COVID-19 vaccination %K willingness %K perceptions %K internet and social media influences %K interpersonal communication %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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 (β=.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. %M 34543223 %R 10.2196/31125 %U https://publichealth.jmir.org/2021/10/e31125 %U https://doi.org/10.2196/31125 %U http://www.ncbi.nlm.nih.gov/pubmed/34543223 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e28519 %T Hospital-Based Contact Tracing of Patients With COVID-19 and Health Care Workers During the COVID-19 Pandemic in Eastern India: Cross-sectional Study %A Sahoo,Durgesh Prasad %A Singh,Arvind Kumar %A Sahu,Dinesh Prasad %A Pradhan,Somen Kumar %A Patro,Binod Kumar %A Batmanabane,Gitanjali %A Mishra,Baijayantimala %A Behera,Bijayini %A Das,Ambarish %A Dora,G Susmita %A Anand,L %A Azhar,S M %A Nair,Jyolsna %A Panigrahi,Sasmita %A Akshaya,R %A Sahoo,Bimal Kumar %A Sahu,Subhakanta %A Sahoo,Suchismita %+ All India Institute of Medical Sciences, Bhubaneswar, Sijua, Patrapada, Bhubaneswar, Odisha, 751019, India, 91 6742476001, director@aiimsbhubaneswar.edu.in %K COVID-19 %K SARS-CoV-2 %K risk categorization %K health care personnel %K virus transmission %K contact tracing %K pandemic %K risk stratification %D 2021 %7 21.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The contact tracing and subsequent quarantining of health care workers (HCWs) are essential to minimizing the further transmission of SARS-CoV-2 infection and mitigating the shortage of HCWs during the COVID-19 pandemic situation. Objective: This study aimed to assess the yield of contact tracing for COVID-19 cases and the risk stratification of HCWs who are exposed to these cases. Methods: This was an analysis of routine data that were collected for the contact tracing of COVID-19 cases at the All India Institute of Medical Sciences, Bhubaneswar, in Odisha, India. Data from March 19 to August 31, 2020, were considered for this study. COVID-19 cases were admitted patients, outpatients, or HCWs in the hospital. HCWs who were exposed to COVID-19 cases were categorized, per the risk stratification guidelines, as high-risk contacts or low-risk contacts Results: During contact tracing, 3411 HCWs were identified as those who were exposed to 360 COVID-19 cases. Of these 360 cases, 269 (74.7%) were either admitted patients or outpatients, and 91 (25.3%) were HCWs. After the risk stratification of the 3411 HCWs, 890 (26.1%) were categorized as high-risk contacts, and 2521 (73.9%) were categorized as low-risk contacts. The COVID-19 test positivity rates of high-risk contacts and low-risk contacts were 3.8% (34/890) and 1.9% (48/2521), respectively. The average number of high-risk contacts was significantly higher when the COVID-19 case was an admitted patient (number of contacts: mean 6.6) rather than when the COVID-19 case was an HCW (number of contacts: mean 4.0) or outpatient (number of contacts: mean 0.2; P=.009). Similarly, the average number of high-risk contacts was higher when the COVID-19 case was admitted in a non–COVID-19 area (number of contacts: mean 15.8) rather than when such cases were admitted in a COVID-19 area (number of contacts: mean 0.27; P<.001). There was a significant decline in the mean number of high-risk contacts over the study period (P=.003). Conclusions: Contact tracing and risk stratification were effective and helped to reduce the number of HCWs requiring quarantine. There was also a decline in the number of high-risk contacts during the study period. This indicates the role of the implementation of hospital-based, COVID-19–related infection control strategies. The contact tracing and risk stratification approaches that were designed in this study can also be implemented in other health care settings. %M 34596569 %R 10.2196/28519 %U https://formative.jmir.org/2021/10/e28519 %U https://doi.org/10.2196/28519 %U http://www.ncbi.nlm.nih.gov/pubmed/34596569 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e28071 %T Psychological Impact of the COVID-19 Pandemic and Social Determinants on the Portuguese Population: Protocol for a Web-Based Cross-sectional Study %A Aguiar,A %A Pinto,M %A Duarte,R %+ EPIUnit, Instituto de Saúde Pública, Universidade do Porto, Rua das Taipas 135, Porto, 4050-600, Portugal, 351 222061820, ana.aguiar@ispup.up.pt %K COVID-19 %K public health %K mental health %K study protocol %K psychological impact %K anxiety %K depression %K grief %K behavior change %D 2021 %7 19.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 outbreak and consequent physical distance measures implemented worldwide have caused significant stress, anxiety, and mental health implications among the general population. Unemployment, working from home, and day-to-day changes may lead to a greater risk of poor mental health outcomes. Objective: This paper describes the protocol for a web-based cross-sectional study that aims to address the impact of the COVID-19 pandemic on mental health. Methods: Individuals from the general population aged 18 years or more and living in Portugal were included in this study. Data collection took place between November 10, 2020, and February 10, 2021. An exponential, nondiscriminative, snowball sampling method was applied to recruit participants. A web-based survey was developed and shared on social media platforms (eg, Facebook, Instagram, Twitter, LinkedIn, and WhatsApp groups) and through e-mail lists for recruitment of the seeds. Results: Data analysis will be performed in accordance with the different variables and outcomes of interest by using quantitative methods, qualitative methods, or mixed methods, as applicable. A total of 929 individuals had completed the web-based survey during the 3-month period; thus, our final sample comprised 929 participants. Results of the survey will be disseminated in national and international scientific journals in 2021-2022. Conclusions: We believe that the findings of this study will have broad implications for understanding the psychological impact of the COVID-19 pandemic on Portuguese residents, as well as aspects related to the informal economy. We also hope that the findings of this study are able to provide insights and guidelines for the Portuguese government to implement action. Finally, we expect this protocol to provide a roadmap for other countries and researchers that would like to implement a similar questionnaire considering the related conclusions. International Registered Report Identifier (IRRID): DERR1-10.2196/28071 %M 34516387 %R 10.2196/28071 %U https://www.researchprotocols.org/2021/10/e28071 %U https://doi.org/10.2196/28071 %U http://www.ncbi.nlm.nih.gov/pubmed/34516387 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 10 %P e32303 %T Harnessing the Electronic Health Record and Computerized Provider Order Entry Data for Resource Management During the COVID-19 Pandemic: Development of a Decision Tree %A Luu,Hung S %A Filkins,Laura M %A Park,Jason Y %A Rakheja,Dinesh %A Tweed,Jefferson %A Menzies,Christopher %A Wang,Vincent J %A Mittal,Vineeta %A Lehmann,Christoph U %A Sebert,Michael E %+ Department of Pathology, University of Texas Southwestern Medical Center, 1935 Medical District Drive, Dallas, TX, 75235, United States, 1 2144562168, hung.luu@childrens.com %K COVID-19 %K computerized provider order entry %K electronic health record %K resource utilization %K personal protective equipment %K SARS-CoV-2 testing %K clinical decision support %D 2021 %7 18.10.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic has resulted in shortages of diagnostic tests, personal protective equipment, hospital beds, and other critical resources. Objective: We sought to improve the management of scarce resources by leveraging electronic health record (EHR) functionality, computerized provider order entry, clinical decision support (CDS), and data analytics. Methods: Due to the complex eligibility criteria for COVID-19 tests and the EHR implementation–related challenges of ordering these tests, care providers have faced obstacles in selecting the appropriate test modality. As test choice is dependent upon specific patient criteria, we built a decision tree within the EHR to automate the test selection process by using a branching series of questions that linked clinical criteria to the appropriate SARS-CoV-2 test and triggered an EHR flag for patients who met our institutional persons under investigation criteria. Results: The percentage of tests that had to be canceled and reordered due to errors in selecting the correct testing modality was 3.8% (23/608) before CDS implementation and 1% (262/26,643) after CDS implementation (P<.001). Patients for whom multiple tests were ordered during a 24-hour period accounted for 0.8% (5/608) and 0.3% (76/26,643) of pre- and post-CDS implementation orders, respectively (P=.03). Nasopharyngeal molecular assay results were positive in 3.4% (826/24,170) of patients who were classified as asymptomatic and 10.9% (1421/13,074) of symptomatic patients (P<.001). Positive tests were more frequent among asymptomatic patients with a history of exposure to COVID-19 (36/283, 12.7%) than among asymptomatic patients without such a history (790/23,887, 3.3%; P<.001). Conclusions: The leveraging of EHRs and our CDS algorithm resulted in a decreased incidence of order entry errors and the appropriate flagging of persons under investigation. These interventions optimized reagent and personal protective equipment usage. Data regarding symptoms and COVID-19 exposure status that were collected by using the decision tree correlated with the likelihood of positive test results, suggesting that clinicians appropriately used the questions in the decision tree algorithm. %M 34546942 %R 10.2196/32303 %U https://medinform.jmir.org/2021/10/e32303 %U https://doi.org/10.2196/32303 %U http://www.ncbi.nlm.nih.gov/pubmed/34546942 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 4 %P e29392 %T Machine Learning–Based Prediction of COVID-19 Mortality With Limited Attributes to Expedite Patient Prognosis and Triage: Retrospective Observational Study %A Doyle,Riccardo %+ Stuart Ltd, 2 London Wall Place, Barbican, London, EC2Y 5AU, United Kingdom, 44 7380400958, r.doyle.edu@gmail.com %K COVID-19 %K coronavirus %K medical informatics %K machine learning %K artificial intelligence %K dimensionality reduction %K automation %K model development %K prediction %K hospital %K resource management %K mortality %K prognosis %K triage %K comorbidities %K public data %K epidemiology %K pre-existing conditions %D 2021 %7 15.10.2021 %9 Original Paper %J JMIRx Med %G English %X Background: The onset and development of the COVID-19 pandemic have placed pressure on hospital resources and staff worldwide. The integration of more streamlined predictive modeling in prognosis and triage–related decision-making can partly ease this pressure. Objective: The objective of this study is to assess the performance impact of dimensionality reduction on COVID-19 mortality prediction models, demonstrating the high impact of a limited number of features to limit the need for complex variable gathering before reaching meaningful risk labelling in clinical settings. Methods: Standard machine learning classifiers were employed to predict an outcome of either death or recovery using 25 patient-level variables, spanning symptoms, comorbidities, and demographic information, from a geographically diverse sample representing 17 countries. The effects of feature reduction on the data were tested by running classifiers on a high-quality data set of 212 patients with populated entries for all 25 available features. The full data set was compared to two reduced variations with 7 features and 1 feature, respectively, extracted using univariate mutual information and chi-square testing. Classifier performance on each data set was then assessed on the basis of accuracy, sensitivity, specificity, and received operating characteristic–derived area under the curve metrics to quantify benefit or loss from reduction. Results: The performance of the classifiers on the 212-patient sample resulted in strong mortality detection, with the highest performing model achieving specificity of 90.7% (95% CI 89.1%-92.3%) and sensitivity of 92.0% (95% CI 91.0%-92.9%). Dimensionality reduction provided strong benefits for performance. The baseline accuracy of a random forest classifier increased from 89.2% (95% CI 88.0%-90.4%) to 92.5% (95% CI 91.9%-93.0%) when training on 7 chi-square–extracted features and to 90.8% (95% CI 89.8%-91.7%) when training on 7 mutual information–extracted features. Reduction impact on a separate logistic classifier was mixed; however, when present, losses were marginal compared to the extent of feature reduction, altogether showing that reduction either improves performance or can reduce the variable-sourcing burden at hospital admission with little performance loss. Extreme feature reduction to a single most salient feature, often age, demonstrated large standalone explanatory power, with the best-performing model achieving an accuracy of 81.6% (95% CI 81.1%-82.1%); this demonstrates the relatively marginal improvement that additional variables bring to the tested models. Conclusions: Predictive statistical models have promising performance in early prediction of death among patients with COVID-19. Strong dimensionality reduction was shown to further improve baseline performance on selected classifiers and only marginally reduce it in others, highlighting the importance of feature reduction in future model construction and the feasibility of deprioritizing large, hard-to-source, and nonessential feature sets in real world settings. %M 34843609 %R 10.2196/29392 %U https://med.jmirx.org/2021/4/e29392 %U https://doi.org/10.2196/29392 %U http://www.ncbi.nlm.nih.gov/pubmed/34843609 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e31983 %T Change in Threads on Twitter Regarding Influenza, Vaccines, and Vaccination During the COVID-19 Pandemic: Artificial Intelligence–Based Infodemiology Study %A Benis,Arriel %A Chatsubi,Anat %A Levner,Eugene %A Ashkenazi,Shai %+ Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Golomb St. 52, Holon, 5810201, Israel, 972 35026892, arrielb@hit.ac.il %K influenza %K vaccines %K vaccination %K social media %K social networks %K health communication %K artificial intelligence %K machine learning %K text mining %K infodemiology %K COVID-19 %K SARS-CoV-2 %D 2021 %7 14.10.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: Discussions of health issues on social media are a crucial information source reflecting real-world responses regarding events and opinions. They are often important in public health care, since these are influencing pathways that affect vaccination decision-making by hesitant individuals. Artificial intelligence methodologies based on internet search engine queries have been suggested to detect disease outbreaks and population behavior. Among social media, Twitter is a common platform of choice to search and share opinions and (mis)information about health care issues, including vaccination and vaccines. Objective: Our primary objective was to support the design and implementation of future eHealth strategies and interventions on social media to increase the quality of targeted communication campaigns and therefore increase influenza vaccination rates. Our goal was to define an artificial intelligence–based approach to elucidate how threads in Twitter on influenza vaccination changed during the COVID-19 pandemic. Such findings may support adapted vaccination campaigns and could be generalized to other health-related mass communications. Methods: The study comprised the following 5 stages: (1) collecting tweets from Twitter related to influenza, vaccines, and vaccination in the United States; (2) data cleansing and storage using machine learning techniques; (3) identifying terms, hashtags, and topics related to influenza, vaccines, and vaccination; (4) building a dynamic folksonomy of the previously defined vocabulary (terms and topics) to support the understanding of its trends; and (5) labeling and evaluating the folksonomy. Results: We collected and analyzed 2,782,720 tweets of 420,617 unique users between December 30, 2019, and April 30, 2021. These tweets were in English, were from the United States, and included at least one of the following terms: “flu,” “influenza,” “vaccination,” “vaccine,” and “vaxx.” We noticed that the prevalence of the terms vaccine and vaccination increased over 2020, and that “flu” and “covid” occurrences were inversely correlated as “flu” disappeared over time from the tweets. By combining word embedding and clustering, we then identified a folksonomy built around the following 3 topics dominating the content of the collected tweets: “health and medicine (biological and clinical aspects),” “protection and responsibility,” and “politics.” By analyzing terms frequently appearing together, we noticed that the tweets were related mainly to COVID-19 pandemic events. Conclusions: This study focused initially on vaccination against influenza and moved to vaccination against COVID-19. Infoveillance supported by machine learning on Twitter and other social media about topics related to vaccines and vaccination against communicable diseases and their trends can lead to the design of personalized messages encouraging targeted subpopulations’ engagement in vaccination. A greater likelihood that a targeted population receives a personalized message is associated with higher response, engagement, and proactiveness of the target population for the vaccination process. %M 34693212 %R 10.2196/31983 %U https://infodemiology.jmir.org/2021/1/e31983 %U https://doi.org/10.2196/31983 %U http://www.ncbi.nlm.nih.gov/pubmed/34693212 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e32425 %T Intervening on Trust in Science to Reduce Belief in COVID-19 Misinformation and Increase COVID-19 Preventive Behavioral Intentions: Randomized Controlled Trial %A Agley,Jon %A Xiao,Yunyu %A Thompson,Esi E %A Chen,Xiwei %A Golzarri-Arroyo,Lilian %+ Prevention Insights, Department of Applied Health Science, School of Public Health Bloomington, Indiana University Bloomington, 809 E. 9th St., Bloomington, IN, 47404, United States, 1 812 855 3123, jagley@indiana.edu %K infodemic %K misinformation %K trust in science %K COVID-19 %K RCT %K randomized controlled trial %D 2021 %7 14.10.2021 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 34581678 %R 10.2196/32425 %U https://www.jmir.org/2021/10/e32425 %U https://doi.org/10.2196/32425 %U http://www.ncbi.nlm.nih.gov/pubmed/34581678 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e29984 %T Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year (the PUPPY Study): Protocol for a Longitudinal Mixed Methods Study %A Marshall,Emily Gard %A Breton,Mylaine %A Cossette,Benoit %A Isenor,Jennifer %A Mathews,Maria %A Ayn,Caitlyn %A Smithman,Mélanie Ann %A Stock,David %A Frymire,Eliot %A Edwards,Lynn %A Green,Michael %+ Primary Care Research Unit, Dalhousie Family Medicine, 1465 Brenton Street Suite 402, Halifax, NS, B3J 3T4, Canada, 1 902 473 4155, emily.marshall@dal.ca %K primary care %K health services research %K health policy %K mixed methods research %K COVID-19 %K protocol %K policy %K longitudinal %K coordination %K access %K impact %K virtual care %K virtual health %K Canada %D 2021 %7 13.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has significantly disrupted primary care in Canada, with many walk-in clinics and family practices initially closing or being perceived as inaccessible; pharmacies remaining open with restrictions on patient interactions; rapid uptake of virtual care; and reduced referrals for lab tests, diagnostics, and specialist care. Objective: The PUPPY Study (Problems in Coordinating and Accessing Primary Care for Attached and Unattached Patients Exacerbated During the COVID-19 Pandemic Year) seeks to understand the impact of the COVID-19 pandemic across the quadruple aims of primary care, with particular focus on the effects on patients without attachment to a regular provider and those with chronic health conditions. Methods: The PUPPY study builds on an existing research program exploring patients’ access and attachment to a primary care practice, pivoted to adapt to the emerging COVID-19 context. We intend to undertake a longitudinal mixed methods study to understand critical gaps in primary care access and coordination, as well as compare prepandemic and postpandemic data across 3 Canadian provinces (Quebec, Ontario, and Nova Scotia). Multiple data sources will be used such as a policy review; qualitative interviews with primary care policymakers, providers (ie, family physicians, nurse practitioners, and pharmacists), and patients (N=120); and medication prescriptions and health care billing data. Results: This study has received funding by the Canadian Institutes of Health Research COVID-19 Rapid Funding Opportunity Grant. Ethical approval to conduct this study was granted in Ontario (Queens Health Sciences & Affiliated Teaching Hospitals Research Ethics Board, file 6028052; Western University Health Sciences Research Ethics Board, project 116591; University of Toronto Health Sciences Research Ethics Board, protocol 40335) in November 2020, Québec (Centre intégré universitaire de santé et de services sociaux de l'Estrie, project 2020-3446) in December 2020, and Nova Scotia (Nova Scotia Health Research Ethics Board, file 1024979) in August 2020. Conclusions: To our knowledge, this is the first study of its kind to explore the effects of the COVID-19 pandemic on primary care systems, with particular focus on the issues of patient’s attachment and access to primary care. Through a multistakeholder, cross-jurisdictional approach, the findings of the PUPPY study will inform the strengthening of primary care during and beyond the COVID-19 pandemic, as well as have implications for future policy and practice. International Registered Report Identifier (IRRID): DERR1-10.2196/29984 %M 34559672 %R 10.2196/29984 %U https://www.researchprotocols.org/2021/10/e29984 %U https://doi.org/10.2196/29984 %U http://www.ncbi.nlm.nih.gov/pubmed/34559672 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 7 %N 4 %P e30652 %T e-Learning and Web-Based Tools for Psychosocial Interventions Addressing Neuropsychiatric Symptoms of Dementia During the COVID-19 Pandemic in Tokyo, Japan: Quasi-Experimental Study %A Nakanishi,Miharu %A Yamasaki,Syudo %A Endo,Kaori %A Niimura,Junko %A Ziylan,Canan %A Bakker,Ton J E M %A Granvik,Eva %A Nägga,Katarina %A Nishida,Atsushi %+ Department of Psychiatric Nursing, Tohoku University Graduate School of Medicine, 2-1 Seiryo-machi, Aoba-ku, Sendai-shi, 980-8575, Japan, 81 22 717 8179, mnakanishi-tky@umin.ac.jp %K dementia %K home care services %K implementation science %K nursing homes %K web-based tool %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Med Educ %G English %X Background: Concern has been raised that the COVID-19 pandemic and consequent social distancing measures may increase neuropsychiatric symptoms in people with dementia. Thus, we developed and delivered an e-learning training course to professional caregivers on using a web-based tool for psychosocial interventions for people with dementia. Objective: The aim of our study was to evaluate the feasibility and efficacy of an e-learning course in combination with a web-based tool in addressing neuropsychiatric symptoms of dementia. Methods: A quasi-experimental design was used in Tokyo, Japan. The e-learning course was delivered three times to professional caregivers between July and December 2020. Caregivers who completed the course assessed the level of neuropsychiatric symptoms in people with dementia using the total score from the Neuropsychiatric Inventory (NPI) via a web-based tool. The primary outcome measures were the number of caregivers who implemented follow-up NPI evaluations by March 2021 and the change in NPI scores from baseline to their most recent follow-up evaluations. As a control group, information was also obtained from professional caregivers who completed a face-to-face training course using the same web-based tool between July 2019 and March 2020. Results: A total of 268 caregivers completed the e-learning course in 2020. Of the 268 caregivers, 56 (20.9%) underwent follow-up evaluations with 63 persons with dementia. The average NPI score was significantly reduced from baseline (mean 20.4, SD 16.2) to the most recent follow-up evaluations (mean 14.3, SD 13.4). The effect size was assumed to be medium (Cohen drm [repeated measures]=0.40). The control group consisted of 252 caregivers who completed a face-to-face training course. Of the 252 caregivers, 114 (45.2%) underwent follow-up evaluations. Compared to the control group, caregivers who completed the e-learning course were significantly less likely to implement follow-up evaluations (χ21=52.0, P<.001). The change in NPI scores did not differ according to the type of training course (baseline-adjusted difference=–0.61, P=.69). Conclusions: The replacement of face-to-face training with e-learning may have provided professionals with an opportunity to participate in the dementia behavior analysis and support enhancement (DEMBASE) program who may not have participated in the program otherwise. Although the program showed equal efficacy in terms of the two training courses, the feasibility was suboptimal with lower implementation levels for those receiving e-learning training. Thus, further strategies should be developed to improve feasibility by providing motivational triggers for implementation and technical support for care professionals. Using online communities in the program should also be investigated. %M 34543224 %R 10.2196/30652 %U https://mededu.jmir.org/2021/4/e30652 %U https://doi.org/10.2196/30652 %U http://www.ncbi.nlm.nih.gov/pubmed/34543224 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e31161 %T Development and Actionability of the Dutch COVID-19 Dashboard: Descriptive Assessment and Expert Appraisal Study %A Bos,Véronique L L C %A Jansen,Tessa %A Klazinga,Niek S %A Kringos,Dionne S %+ Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, Meibergdreef 9, Amsterdam, 1105 AZ, Netherlands, 31 020 5661449, v.l.bos@amsterdamumc.nl %K COVID-19 %K dashboard %K performance intelligence %K Netherlands %K actionability %K communication %K government %K pandemic %K public health %D 2021 %7 12.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Web-based public reporting by means of dashboards has become an essential tool for governments worldwide to monitor COVID-19 information and communicate it to the public. The actionability of such dashboards is determined by their fitness for purpose—meeting a specific information need—and fitness for use—placing the right information into the right hands at the right time and in a manner that can be understood. Objective: The aim of this study was to identify specific areas where the actionability of the Dutch government’s COVID-19 dashboard could be improved, with the ultimate goal of enhancing public understanding of the pandemic. Methods: The study was conducted from February 2020 to April 2021. A mixed methods approach was carried out, using (1) a descriptive checklist over time to monitor changes made to the dashboard, (2) an actionability scoring of the dashboard to pinpoint areas for improvement, and (3) a reflection meeting with the dashboard development team to contextualize findings and discuss areas for improvement. Results: The dashboard predominantly showed epidemiological information on COVID-19. It had been developed and adapted by adding more in-depth indicators, more geographic disaggregation options, and new indicator themes. It also changed in target audience from policy makers to the general public; thus, a homepage was added with the most important information, using news-like items to explain the provided indicators and conducting research to enhance public understanding of the dashboard. However, disaggregation options such as sex, socioeconomic status, and ethnicity and indicators on dual-track health system management and social and economic impact that have proven to give important insights in other countries are missing from the Dutch COVID-19 dashboard, limiting its actionability. Conclusions: The Dutch COVID-19 dashboard developed over time its fitness for purpose and use in terms of providing epidemiological information to the general public as a target audience. However, to strengthen the Dutch health system’s ability to cope with upcoming phases of the COVID-19 pandemic or future public health emergencies, we advise (1) establishing timely indicators relating to health system capacity, (2) including relevant data disaggregation options (eg, sex, socioeconomic status), and (3) enabling interoperability between social, health, and economic data sources. %M 34543229 %R 10.2196/31161 %U https://publichealth.jmir.org/2021/10/e31161 %U https://doi.org/10.2196/31161 %U http://www.ncbi.nlm.nih.gov/pubmed/34543229 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e31400 %T International Changes in COVID-19 Clinical Trajectories Across 315 Hospitals and 6 Countries: Retrospective Cohort Study %A Weber,Griffin M %A Zhang,Harrison G %A L'Yi,Sehi %A Bonzel,Clara-Lea %A Hong,Chuan %A Avillach,Paul %A Gutiérrez-Sacristán,Alba %A Palmer,Nathan P %A Tan,Amelia Li Min %A Wang,Xuan %A Yuan,William %A Gehlenborg,Nils %A Alloni,Anna %A Amendola,Danilo F %A Bellasi,Antonio %A Bellazzi,Riccardo %A Beraghi,Michele %A Bucalo,Mauro %A Chiovato,Luca %A Cho,Kelly %A Dagliati,Arianna %A Estiri,Hossein %A Follett,Robert W %A García Barrio,Noelia %A Hanauer,David A %A Henderson,Darren W %A Ho,Yuk-Lam %A Holmes,John H %A Hutch,Meghan R %A Kavuluru,Ramakanth %A Kirchoff,Katie %A Klann,Jeffrey G %A Krishnamurthy,Ashok K %A Le,Trang T %A Liu,Molei %A Loh,Ne Hooi Will %A Lozano-Zahonero,Sara %A Luo,Yuan %A Maidlow,Sarah %A Makoudjou,Adeline %A Malovini,Alberto %A Martins,Marcelo Roberto %A Moal,Bertrand %A Morris,Michele %A Mowery,Danielle L %A Murphy,Shawn N %A Neuraz,Antoine %A Ngiam,Kee Yuan %A Okoshi,Marina P %A Omenn,Gilbert S %A Patel,Lav P %A Pedrera Jiménez,Miguel %A Prudente,Robson A %A Samayamuthu,Malarkodi Jebathilagam %A Sanz Vidorreta,Fernando J %A Schriver,Emily R %A Schubert,Petra %A Serrano Balazote,Pablo %A Tan,Byorn WL %A Tanni,Suzana E %A Tibollo,Valentina %A Visweswaran,Shyam %A Wagholikar,Kavishwar B %A Xia,Zongqi %A Zöller,Daniela %A , %A Kohane,Isaac S %A Cai,Tianxi %A South,Andrew M %A Brat,Gabriel A %+ Department of Biomedical Informatics, Harvard Medical School, 10 Shattuck St, Boston, MA, 02115, United States, 1 6175488520, tcai@hsph.harvard.edu %K SARS-CoV-2 %K electronic health records %K federated study %K retrospective cohort study %K meta-analysis %K COVID-19 %K severe COVID-19 %K laboratory trajectory %D 2021 %7 11.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many countries have experienced 2 predominant waves of COVID-19–related hospitalizations. Comparing the clinical trajectories of patients hospitalized in separate waves of the pandemic enables further understanding of the evolving epidemiology, pathophysiology, and health care dynamics of the COVID-19 pandemic. Objective: In this retrospective cohort study, we analyzed electronic health record (EHR) data from patients with SARS-CoV-2 infections hospitalized in participating health care systems representing 315 hospitals across 6 countries. We compared hospitalization rates, severe COVID-19 risk, and mean laboratory values between patients hospitalized during the first and second waves of the pandemic. Methods: Using a federated approach, each participating health care system extracted patient-level clinical data on their first and second wave cohorts and submitted aggregated data to the central site. Data quality control steps were adopted at the central site to correct for implausible values and harmonize units. Statistical analyses were performed by computing individual health care system effect sizes and synthesizing these using random effect meta-analyses to account for heterogeneity. We focused the laboratory analysis on C-reactive protein (CRP), ferritin, fibrinogen, procalcitonin, D-dimer, and creatinine based on their reported associations with severe COVID-19. Results: Data were available for 79,613 patients, of which 32,467 were hospitalized in the first wave and 47,146 in the second wave. The prevalence of male patients and patients aged 50 to 69 years decreased significantly between the first and second waves. Patients hospitalized in the second wave had a 9.9% reduction in the risk of severe COVID-19 compared to patients hospitalized in the first wave (95% CI 8.5%-11.3%). Demographic subgroup analyses indicated that patients aged 26 to 49 years and 50 to 69 years; male and female patients; and black patients had significantly lower risk for severe disease in the second wave than in the first wave. At admission, the mean values of CRP were significantly lower in the second wave than in the first wave. On the seventh hospital day, the mean values of CRP, ferritin, fibrinogen, and procalcitonin were significantly lower in the second wave than in the first wave. In general, countries exhibited variable changes in laboratory testing rates from the first to the second wave. At admission, there was a significantly higher testing rate for D-dimer in France, Germany, and Spain. Conclusions: Patients hospitalized in the second wave were at significantly lower risk for severe COVID-19. This corresponded to mean laboratory values in the second wave that were more likely to be in typical physiological ranges on the seventh hospital day compared to the first wave. Our federated approach demonstrated the feasibility and power of harmonizing heterogeneous EHR data from multiple international health care systems to rapidly conduct large-scale studies to characterize how COVID-19 clinical trajectories evolve. %M 34533459 %R 10.2196/31400 %U https://www.jmir.org/2021/10/e31400 %U https://doi.org/10.2196/31400 %U http://www.ncbi.nlm.nih.gov/pubmed/34533459 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e29379 %T Statin Use and COVID-19 Infectivity and Severity in South Korea: Two Population-Based Nationwide Cohort Studies %A Lee,Seung Won %A Kim,So Young %A Moon,Sung Yong %A Yoo,In Kyung %A Yoo,Eun-Gyong %A Eom,Gwang Hyeon %A Kim,Jae-Min %A Shin,Jae Il %A Jeong,Myung Ho %A Yang,Jee Myung %A Yon,Dong Keon %+ Department of Pediatrics, Seoul National University Hospital, Seoul National University College of Medicine, 103 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 6935 2476, yonkkang@gmail.com %K COVID-19 %K statin %K susceptibility %K severe clinical outcomes %K length of hospital stay %D 2021 %7 8.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Basic studies suggest that statins as add-on therapy may benefit patients with COVID-19; however, real-world evidence of such a beneficial association is lacking. Objective: We investigated differences in SARS-CoV-2 test positivity and clinical outcomes of COVID-19 (composite endpoint: admission to intensive care unit, invasive ventilation, or death) between statin users and nonusers. Methods: Two independent population-based cohorts were analyzed, and we investigated the differences in SARS-CoV-2 test positivity and severe clinical outcomes of COVID-19, such as admission to the intensive care unit, invasive ventilation, or death, between statin users and nonusers. One group comprised an unmatched cohort of 214,207 patients who underwent SARS-CoV-2 testing from the Global Research Collaboration Project (GRCP)-COVID cohort, and the other group comprised an unmatched cohort of 74,866 patients who underwent SARS-CoV-2 testing from the National Health Insurance Service (NHIS)-COVID cohort. Results: The GRCP-COVID cohort with propensity score matching had 29,701 statin users and 29,701 matched nonusers. The SARS-CoV-2 test positivity rate was not associated with statin use (statin users, 2.82% [837/29,701]; nonusers, 2.65% [787/29,701]; adjusted relative risk [aRR] 0.97; 95% CI 0.88-1.07). Among patients with confirmed COVID-19 in the GRCP-COVID cohort, 804 were statin users and 1573 were matched nonusers. Statin users were associated with a decreased likelihood of severe clinical outcomes (statin users, 3.98% [32/804]; nonusers, 5.40% [85/1573]; aRR 0.62; 95% CI 0.41-0.91) and length of hospital stay (statin users, 23.8 days; nonusers, 26.3 days; adjusted mean difference –2.87; 95% CI –5.68 to –0.93) than nonusers. The results of the NHIS-COVID cohort were similar to the primary results of the GRCP-COVID cohort. Conclusions: Our findings indicate that prior statin use is related to a decreased risk of worsening clinical outcomes of COVID-19 and length of hospital stay but not to that of SARS-CoV-2 infection. %M 34623311 %R 10.2196/29379 %U https://publichealth.jmir.org/2021/10/e29379 %U https://doi.org/10.2196/29379 %U http://www.ncbi.nlm.nih.gov/pubmed/34623311 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e27739 %T Prevalence of SARS-CoV-2 Infection in Children by Antibody Detection in Saliva: Protocol for a Prospective Longitudinal Study (Coro-Buddy) %A Pinilla,Yudi T %A Friessinger,Evelyn %A Griesbaum,Johanna Marie %A Berner,Lilith %A Heinzel,Constanze %A Elsner,Käthe %A Fendel,Rolf %A Held,Jana %A Kreidenweiss,Andrea %+ Institut für Tropenmedizin, Universitätsklinikum Tübingen, Wilhelmstraße 27, Tübingen, 72074, Germany, 49 7071 2985569, andrea.kreidenweiss@uni-tuebingen.de %K SARS-CoV-2 %K COVID-19 %K antibody %K saliva %K children %K epidemiology %D 2021 %7 8.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The world has been confronted with the COVID-19 pandemic for more than one year. Severe disease is more often found among elderly people, whereas most young children and adolescents show mild symptoms or even remain asymptomatic, so that infection might be undiagnosed. Therefore, only limited epidemiological data on SARS-CoV-2 infection in children and young adults are available. Objective: This study aims to determine the prevalence of SARS-CoV-2 antibodies in children from the city of Tübingen, Germany, and to measure the incidence of new cases over 12 months. Methods: SARS-CoV-2 antibodies will be measured in saliva as a surrogate for a previous SARS-CoV-2 infection. Children will be sampled at their preschools, primary schools, and secondary schools at three time points: July 2020, October to December 2020, and April to July 2021. An adult cohort will be sampled at the same time points (ie, adult comparator group). The saliva-based SARS-CoV-2–antibody enzyme-linked immunosorbent assay will be validated using blood and saliva samples from adults with confirmed previous SARS-CoV-2 infections (ie, adult validation group). Results: The first study participant was enrolled in July 2020, and recruitment and enrollment continued until July 2021. We have recruited and enrolled 1850 children, 560 adults for the comparator group, and 83 adults for the validation group. We have collected samples from the children and the adults for the comparator group at the three time points. We followed up with participants in the adult validation group every 2 months and, as of the writing of this paper, we were at time point 7. We will conduct data analysis after the data collection period. Conclusions: Infection rates in children are commonly underreported due to a lack of polymerase chain reaction testing. This study will report on the prevalence of SARS-CoV-2 infections in infants, school children, and adolescents as well as the incidence change over 12 months in the city of Tübingen, Germany. The saliva sampling approach for SARS-CoV-2–antibody measurement allows for a unique, representative, population-based sample collection process. Trial Registration: ClinicalTrials.gov NCT04581889; https://clinicaltrials.gov/ct2/show/NCT04581889 International Registered Report Identifier (IRRID): DERR1-10.2196/27739 %M 34533472 %R 10.2196/27739 %U https://www.researchprotocols.org/2021/10/e27739 %U https://doi.org/10.2196/27739 %U http://www.ncbi.nlm.nih.gov/pubmed/34533472 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e32559 %T Excess Mortality During the COVID-19 Pandemic in Jordan: Secondary Data Analysis %A Khader,Yousef %A Al Nsour,Mohannad %+ Department of Public Health, Faculty of Medicine, Jordan University of Science and Technology, Alramtha-Amman Street, Irbid, 22110, Jordan, 962 796802040, yskhader@just.edu.jo %K COVID-19 %K excess mortality %K pandemic %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: All-cause mortality and estimates of excess deaths are commonly used in different countries to estimate the burden of COVID-19 and assess its direct and indirect effects. Objective: This study aimed to analyze the excess mortality during the COVID-19 pandemic in Jordan in April-December 2020. Methods: Official data on deaths in Jordan for 2020 and previous years (2016-2019) were obtained from the Department of Civil Status. We contrasted mortality rates in 2020 with those in each year and the pooled period 2016-2020 using a standardized mortality ratio (SMR) measure. Expected deaths for 2020 were estimated by fitting the overdispersed Poisson generalized linear models to the monthly death counts for the period of 2016-2019. Results: Overall, a 21% increase in standardized mortality (SMR 1.21, 95% CI 1.19-1.22) occurred in April-December 2020 compared with the April-December months in the pooled period 2016-2019. The SMR was more pronounced for men than for women (SMR 1.26, 95% CI 1.24-1.29 vs SMR 1.12, 95% CI 1.10-1.14), and it was statistically significant for both genders (P<.05). Using overdispersed Poisson generalized linear models, the number of expected deaths in April-December 2020 was 12,845 (7957 for women and 4888 for men). The total number of excess deaths during this period was estimated at 4583 (95% CI 4451-4716), with higher excess deaths in men (3112, 95% CI 3003-3221) than in women (1503, 95% CI 1427-1579). Almost 83.66% of excess deaths were attributed to COVID-19 in the Ministry of Health database. The vast majority of excess deaths occurred in people aged 60 years or older. Conclusions: The reported COVID-19 death counts underestimated mortality attributable to COVID-19. Excess deaths could reflect the increased deaths secondary to the pandemic and its containment measures. The majority of excess deaths occurred among old age groups. It is, therefore, important to maintain essential services for the elderly during pandemics. %M 34617910 %R 10.2196/32559 %U https://publichealth.jmir.org/2021/10/e32559 %U https://doi.org/10.2196/32559 %U http://www.ncbi.nlm.nih.gov/pubmed/34617910 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 10 %P e29963 %T Attitudes About COVID-19 and Health (ATTACH): Online Survey and Mixed Methods Study %A Hood,Anna M %A Stotesbury,Hanne %A Murphy,Jennifer %A Kölbel,Melanie %A Slee,April %A Springall,Charlie %A Paradis,Matthew %A Corral-Frías,Nadia Saraí %A Reyes-Aguilar,Azalea %A Cuellar Barboza,Alfredo B %A Noser,Amy E %A Gomes,Stacey %A Mitchell,Monica %A Watkins,Sharon M %A Butsch Kovacic,Melinda %A Kirkham,Fenella J %A Crosby,Lori E %+ Developmental Neurosciences Unit and Biomedical Research Centre, University College London Great Ormond Street Institute of Child Health, 30 Guilford Street, London, WC1N 1EH, United Kingdom, 44 02079052744, a.hood@ucl.ac.uk %K COVID-19 %K mental health %K international %K mitigation strategies %K deprivation %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Behavioral mitigation strategies to slow the spread of COVID-19 have resulted in sweeping lifestyle changes, with short- and long-term psychological, well-being, and quality of life implications. The Attitudes About COVID-19 and Health (ATTACH) study focuses on understanding attitudes and beliefs while considering the impact on mental and physical health and the influence of broader demographic and geographic factors on attitudes, beliefs, and mental health burden. Objective: In this assessment of our first wave of data collection, we provide baseline cohort description of the ATTACH study participants in the United Kingdom, the United States, and Mexico. Additionally, we assess responses to daily poll questions related to COVID-19 and conduct a cross-sectional analysis of baseline assessments collected in the UK between June 26 and October 31, 2020. Methods: The ATTACH study uses smartphone app technology and online survey data collection. Participants completed poll questions related to COVID-19 2 times daily and a monthly survey assessing mental health, social isolation, physical health, and quality of life. Poll question responses were graphed using 95% Clopper–Pearson (exact) tests with 95% CIs. Pearson correlations, hierarchical linear regression analyses, and generalized linear models assessed relationships, predictors of self-reported outcomes, and group differences, respectively. Results: By October 31, 2020, 1405, 80, and 90 participants had consented to participate in the UK, United States, and Mexico, respectively. Descriptive data for the UK daily poll questions indicated that participants generally followed social distancing measures, but worry and negative impacts on families increased as the pandemic progressed. Although participants generally reported feeling that the reasons for current measures had been made clear, there was low trust that the government was doing everything in its power to meet public needs. In the UK, 1282 participants also completed a monthly survey (94.99% [1326/1396] White, 72.22% [1014/1404] female, and 20.12% [277/1377] key or essential workers); 18.88% (242/1282) of UK participants reported a preexisting mental health disorder, 31.36% (402/1282) reported a preexisting chronic medical illness, and 35.11% (493/1404) were aged over 65; 57.72% (740/1282) of participants reported being more sedentary since the pandemic began, and 41.89% (537/1282) reported reduced access to medical care. Those with poorer mental health outcomes lived in more deprived neighborhoods, in larger households (Ps<.05), had more preexisting mental health disorders and medical conditions, and were younger than 65 years (all Ps<.001). Conclusions: Communities who have been exposed to additional harm during the COVID-19 pandemic were experiencing worse mental outcomes. Factors including having a medical condition, or living in a deprived neighborhood or larger household were associated with heightened risk. Future longitudinal studies should investigate the link between COVID-19 exposure, mental health, and sociodemographic and residential characteristics. %M 34357877 %R 10.2196/29963 %U https://mental.jmir.org/2021/10/e29963 %U https://doi.org/10.2196/29963 %U http://www.ncbi.nlm.nih.gov/pubmed/34357877 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e28873 %T Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH): Protocol for a Prospective Observational Study %A Ranjan,Yatharth %A Althobiani,Malik %A Jacob,Joseph %A Orini,Michele %A Dobson,Richard JB %A Porter,Joanna %A Hurst,John %A Folarin,Amos A %+ Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, 16 De Crespigny Park, London, SE5 8AF, United Kingdom, 44 02078480924, amos.folarin@kcl.ac.uk %K mHealth %K COVID-19 %K mobile health %K remote monitoring %K wearables %K internet of things %K lung diseases %K respiratory health %K mental health %K cardiopulmonary diseases %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Chronic lung disorders like chronic obstructive pulmonary disease (COPD) and idiopathic pulmonary fibrosis (IPF) are characterized by exacerbations. They are unpleasant for patients and sometimes severe enough to cause hospital admission and death. Moreover, due to the COVID-19 pandemic, vulnerable populations with these disorders are at high risk, and their routine care cannot be done properly. Remote monitoring offers a low cost and safe solution for gaining visibility into the health of people in their daily lives, making it useful for vulnerable populations. Objective: The primary objective is to assess the feasibility and acceptability of remote monitoring using wearables and mobile phones in patients with pulmonary diseases. The secondary objective is to provide power calculations for future studies centered around understanding the number of exacerbations according to sample size and duration. Methods: Twenty participants will be recruited in each of three cohorts (COPD, IPF, and posthospitalization COVID). Data collection will be done remotely using the RADAR-Base (Remote Assessment of Disease And Relapse) mobile health (mHealth) platform for different devices, including Garmin wearable devices and smart spirometers, mobile app questionnaires, surveys, and finger pulse oximeters. Passive data include wearable-derived continuous heart rate, oxygen saturation, respiration rate, activity, and sleep. Active data include disease-specific patient-reported outcome measures, mental health questionnaires, and symptom tracking to track disease trajectory. Analyses will assess the feasibility of lung disorder remote monitoring (including data quality, data completeness, system usability, and system acceptability). We will attempt to explore disease trajectory, patient stratification, and identification of acute clinical events such as exacerbations. A key aspect is understanding the potential of real-time data collection. We will simulate an intervention to acquire responses at the time of the event to assess model performance for exacerbation identification. Results: The Remote Assessment of Lung Disease and Impact on Physical and Mental Health (RALPMH) study provides a unique opportunity to assess the use of remote monitoring in the evaluation of lung disorders. The study started in the middle of June 2021. The data collection apparatus, questionnaires, and wearable integrations were setup and tested by the clinical teams prior to the start of recruitment. While recruitment is ongoing, real-time exacerbation identification models are currently being constructed. The models will be pretrained daily on data of previous days, but the inference will be run in real time. Conclusions: The RALPMH study will provide a reference infrastructure for remote monitoring of lung diseases. It specifically involves information regarding the feasibility and acceptability of remote monitoring and the potential of real-time data collection and analysis in the context of chronic lung disorders. It will help plan and inform decisions in future studies in the area of respiratory health. Trial Registration: ISRCTN Registry ISRCTN16275601; https://www.isrctn.com/ISRCTN16275601 International Registered Report Identifier (IRRID): PRR1-10.2196/28873 %M 34319235 %R 10.2196/28873 %U https://www.researchprotocols.org/2021/10/e28873 %U https://doi.org/10.2196/28873 %U http://www.ncbi.nlm.nih.gov/pubmed/34319235 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e27301 %T Positioning Digital Tracing Applications in the Management of the COVID-19 Pandemic in France %A Albouy-Llaty,Marion %A Martin,Caroline %A Benamouzig,Daniel %A Bothorel,Eric %A Munier,Gilles %A Simonin,Catherine %A Guéant,Jean-Louis %A Rusch,Emmanuel %+ Faculty of Medicine and Pharmacy, University of Poitiers, 6 rue de la Milétrie, Poitiers, 86021, France, 33 0669660192, marion.albouy@univ-poitiers.fr %K COVID-19 pandemic %K digital contact tracing applications %K health inequalities %K Europe %K health promotion %D 2021 %7 7.10.2021 %9 Viewpoint %J J Med Internet Res %G English %X To combat the COVID-19 pandemic, many European countries have developed a public health strategy involving the use of digital contact tracing (DCT) applications to improve timely tracking and contact tracing of COVID-19 cases. France’s independent COVID-19 Control and Society Connection Council (CCL) was established by law in May 2020 to issue advice and recommendations on the national epidemic digital systems. In this paper, we present the recommendations by the CCL, with the objective to increase the uptake and utility of French DCT applications. As the country's most vulnerable population has been subjected to greater virus exposure, a stronger impact of the lockdown, and less access to preventive and health care services, the CCL is particularly aware of health inequalities. The French DCT app TousAntiCovid had been downloaded by 13.6 million users (ie, 20% of the French population) in March 2021. To promote the use of DCT apps, the CCL has recommended that communication about the app’s individual and collective objectives be increased. The CCL has also recommended the introduction of clear, simple, accessible, incentivizing, noncoercive information within the digital tools. In addition, the CCL has recommended improving public health policies to address the needs of the underprivileged. The CCL calls for promoting population empowerment with the use of digital tools, improving public health culture for decision-makers dealing with health determinants, taking social considerations into account, and incorporating community participation. %M 34313588 %R 10.2196/27301 %U https://www.jmir.org/2021/10/e27301 %U https://doi.org/10.2196/27301 %U http://www.ncbi.nlm.nih.gov/pubmed/34313588 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e26840 %T Adoption of Preventive Measures During the Very Early Phase of the COVID-19 Outbreak in China: National Cross-sectional Survey Study %A Lau,Joseph %A Yu,Yanqiu %A Xin,Meiqi %A She,Rui %A Luo,Sitong %A Li,Lijuan %A Wang,Suhua %A Ma,Le %A Tao,Fangbiao %A Zhang,Jianxin %A Zhao,Junfeng %A Hu,Dongsheng %A Li,Liping %A Zhang,Guohua %A Gu,Jing %A Lin,Danhua %A Wang,Hongmei %A Cai,Yong %A Wang,Zhaofen %A You,Hua %A Hu,Guoqing %A , %+ Centre for Health Behaviours Research, Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, 30-32 Ngan Shing Street, Sha Tin, New Territory, Hong Kong, Hong Kong, 852 22528727, jlau@cuhk.edu.hk %K COVID-19 %K health behavior %K prevention %K control %K cognition %K face mask %K hand hygiene %K interpersonal contacts %K China %K protection %K public health %K behavior %K infectious disease %K cross-sectional %K survey %D 2021 %7 7.10.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34479184 %R 10.2196/26840 %U https://publichealth.jmir.org/2021/10/e26840 %U https://doi.org/10.2196/26840 %U http://www.ncbi.nlm.nih.gov/pubmed/34479184 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e32216 %T Evaluation of Novel Concentrated Interdisciplinary Group Rehabilitation for Patients With Chronic Illnesses: Protocol for a Nonrandomized Clinical Intervention Study %A Kvale,Gerd %A Frisk,Bente %A Jürgensen,Marte %A Børtveit,Tore %A Ødegaard-Olsen,Øystein Theodor %A Wilhelmsen-Langeland,Ane %A Aarli,Bernt Bøgvald %A Sandnes,Kristina %A Rykken,Sidsel %A Haugstvedt,Anne %A Hystad,Sigurd William %A Søfteland,Eirik %+ Division of Psychiatry, Haukeland University Hospital, PO Box 1400, Bergen, 5021, Norway, 47 55975000, gerd.kvale@helse-bergen.no %K COVID-19 %K chronic illnesses %K concentrated rehabilitation %K low back pain %K post–COVID-19 symptoms %K post–COVID-19 syndrome %K long COVID %K fatigue %K type 2 diabetes %K anxiety %K depression %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: An aging population with a growing burden of chronic complex illnesses will seriously challenge the public health care system. Consequently, novel and efficacious treatment approaches are highly warranted. Based on our experiences with concentrated treatment formats for other health challenges, we developed a highly concentrated interdisciplinary group rehabilitation approach for chronic illnesses. Objective: We aim to explore the acceptability of the intervention and describe potential changes in functional impairment at follow-up. Methods: The cornerstones of the intervention are as follows: (1) prepare the patient for change prior to treatment, (2) focus on health promoting microchoices instead of symptoms, and (3) expect the patient to integrate the changes in everyday living with limited hands-on follow-up. The intervention will be delivered to patients with highly diverse primary symptoms, namely patients with low back pain, post–COVID-19 symptoms, anxiety and depression, and type 2 diabetes. Results: Recruitment started between August 2020 and January 2021 (according to the illness category). For initial 3-month results, recruitment is expected to be completed by the end of 2021. Conclusions: If successful, this study may have a substantial impact on the treatment of low back pain, post–COVID-19 symptoms, anxiety and depression, and type 2 diabetes, which together constitute a major socioeconomic cost. Further, the study may widen the evidence base for the use of the concentrated treatment format in a diverse group of medical conditions. International Registered Report Identifier (IRRID): DERR1-10.2196/32216 %M 34505838 %R 10.2196/32216 %U https://www.researchprotocols.org/2021/10/e32216 %U https://doi.org/10.2196/32216 %U http://www.ncbi.nlm.nih.gov/pubmed/34505838 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30757 %T The COVID-19 Study of Healthcare and Support Personnel (CHAMPS): Protocol for a Longitudinal Observational Study %A Kaufmann,Peter G %A Havens,Donna S %A Mensinger,Janell L %A Bradley,Patricia K %A Brom,Heather M %A Copel,Linda C %A Costello,Alexander %A D'Annunzio,Christine %A Dean Durning,Jennifer %A Maldonado,Linda %A Barrow McKenzie,Ann %A Smeltzer,Suzanne C %A Yost,Jennifer %A , %+ M. Louise Fitzapatrick College of Nursing, Villanova University, 800 Lancaster Ave, Villanova, PA, 19085, United States, 1 6105195972, peter.kaufmann@villanova.edu %K COVID-19 %K SARS-CoV-2 %K stress %K depression %K anxiety %K sleep %K social support %K resilience %K mental health %K physical health %D 2021 %7 7.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Early in the development of the COVID-19 pandemic, it was evident that health care workers, first responders, and other essential workers would face significant stress and workplace demands related to equipment shortages and rapidly growing infections in the general population. Although the effects of other sources of stress on health have been documented, the effects of these unique conditions of the COVID-19 pandemic on the long-term health and well-being of the health care workforce are not known. Objective: The COVID-19 Study of Healthcare and Support Personnel (CHAMPS) was designed to document early and longitudinal effects of the pandemic on the mental and physical health of essential workers engaged in health care. We will investigate mediators and moderators of these effects and evaluate the influence of exposure to stress, including morbidity and mortality, over time. We will also examine the effect of protective factors and resilience on health outcomes. Methods: The study cohort is a convenience sample recruited nationally through communities, professional organizations, networks, social media, and snowball sampling. Recruitment took place for 13 months to obtain an estimated sample of 2762 adults who provided self-reported information administered on the web through structured questionnaires about their work environment, mental and physical health, and psychosocial factors. Follow-up questionnaires will be administered after 6 months and annually thereafter to ascertain changes in health, well-being, and lifestyle. Participants who consented to be recontacted form the longitudinal cohort and the CHAMPS Registry may be contacted to ascertain their interest in ancillary studies for which they may be eligible. Results: The study was approved by the Institutional Review Board and launched in May 2020, with grants from Travere Therapeutics Inc, McKesson Corporation, anonymous donors, and internal funding from the M. Louise Fitzpatrick College of Nursing at Villanova University. Recruitment ended in June 2021 after enrolling 2762 participants, 1534 of whom agreed to participate in the longitudinal study and the registry as well as to be contacted about eligibility for future studies. Conclusions: The CHAMPS Study and Registry will enable the acquisition of detailed data on the effects of extended psychosocial and workplace stress on morbidity and mortality and serve as a platform for ancillary studies related to the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04370821; https://clinicaltrials.gov/ct2/show/NCT04370821 International Registered Report Identifier (IRRID): DERR1-10.2196/30757 %M 34582354 %R 10.2196/30757 %U https://www.researchprotocols.org/2021/10/e30757 %U https://doi.org/10.2196/30757 %U http://www.ncbi.nlm.nih.gov/pubmed/34582354 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 10 %P e32468 %T Effectiveness of Contact Tracing for Viral Disease Mitigation and Suppression: Evidence-Based Review %A Thomas Craig,Kelly Jean %A Rizvi,Rubina %A Willis,Van C %A Kassler,William J %A Jackson,Gretchen Purcell %+ Center for AI, Research, and Evaluation, IBM Watson Health, IBM Corporation, 75 Binney Street, Cambridge, MA, 02142, United States, 1 9702613366, kelly.jean.craig@ibm.com %K contact tracing %K non-pharmaceutical interventions %K pandemic %K epidemic %K viral disease %K COVID-19 %K isolation %K testing %K surveillance %K monitoring %K review %K intervention %K effectiveness %K mitigation %K transmission %K spread %K protection %K outcome %D 2021 %7 6.10.2021 %9 Review %J JMIR Public Health Surveill %G English %X 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. %M 34612841 %R 10.2196/32468 %U https://publichealth.jmir.org/2021/10/e32468 %U https://doi.org/10.2196/32468 %U http://www.ncbi.nlm.nih.gov/pubmed/34612841 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e27472 %T The Impact of the Online COVID-19 Infodemic on French Red Cross Actors’ Field Engagement and Protective Behaviors: Mixed Methods Study %A Heyerdahl,Leonardo W %A Lana,Benedetta %A Giles-Vernick,Tamara %+ Department of Global Health, Anthropology and Ecology of Disease Emergence Unit, Institut Pasteur, 25 rue du Docteur Roux, Paris, 75015, France, 33 0140613982, tamara.giles-vernick@pasteur.fr %K COVID-19 %K infodemics %K social listening %K epidemics %K medical anthropology %K nongovernmental organizations %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The COVID-19 pandemic has been widely described as an infodemic, an excess of rapidly circulating information in social and traditional media in which some information may be erroneous, contradictory, or inaccurate. One key theme cutting across many infodemic analyses is that it stymies users’ capacities to identify appropriate information and guidelines, encourages them to take inappropriate or even harmful actions, and should be managed through multiple transdisciplinary approaches. Yet, investigations demonstrating how the COVID-19 information ecosystem influences complex public decision making and behavior offline are relatively few. Objective: The aim of this study was to investigate whether information reported through the social media channel Twitter, linked articles and websites, and selected traditional media affected the risk perception, engagement in field activities, and protective behaviors of French Red Cross (FRC) volunteers and health workers in the Paris region of France from June to October 2020. Methods: We used a hybrid approach that blended online and offline data. We tracked daily Twitter discussions and selected traditional media in France for 7 months, qualitatively evaluating COVID-19 claims and debates about nonpharmaceutical protective measures. We conducted 24 semistructured interviews with FRC workers and volunteers. Results: Social and traditional media debates about viral risks and nonpharmaceutical interventions fanned anxieties among FRC volunteers and workers. Decisions to continue conducting FRC field activities and daily protective practices were also influenced by other factors unrelated to the infodemic: familial and social obligations, gender expectations, financial pressures, FRC rules and communications, state regulations, and relationships with coworkers. Some respondents developed strategies for “tuning out” social and traditional media. Conclusions: This study suggests that during the COVID-19 pandemic, the information ecosystem may be just one among multiple influences on one group’s offline perceptions and behavior. Measures to address users who have disengaged from online sources of health information and who rely on social relationships to obtain information are needed. Tuning out can potentially lead to less informed decision making, leading to worse health outcomes. %M 34661065 %R 10.2196/27472 %U https://infodemiology.jmir.org/2021/1/e27472 %U https://doi.org/10.2196/27472 %U http://www.ncbi.nlm.nih.gov/pubmed/34661065 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31273 %T Supporting Mental Health During the COVID-19 Pandemic Using a Digital Behavior Change Intervention: An Open-Label, Single-Arm, Pre-Post Intervention Study %A Summers,Charlotte %A Wu,Philip %A Taylor,Alisdair J G %+ DDM Health, Technology House, Science Park, University of Warwick, Coventry, CV4 7EZ, United Kingdom, 44 7969091134, charlotte@ddm.health %K stress %K mental health %K COVID-19 %K digital therapy %K mHealth %K support %K behavior %K intervention %K online intervention %K outcome %K wellbeing %K sleep %K activity %K nutrition %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is taking a toll on people’s mental health, particularly as people are advised to adhere to social distancing, self-isolation measures, and government-imposed national lockdowns. Digital health technologies have an important role to play in keeping people connected and in supporting their mental health and well-being. Even before the COVID-19 pandemic, mental health and social services were already strained. Objective: Our objective was to evaluate the 12-week outcomes of the digitally delivered Gro Health intervention, a holistic digital behavior change app designed for self-management of mental well-being, sleep, activity, and nutrition. Methods: The study used a quasi-experimental research design consisting of an open-label, single-arm, pre-post intervention engagement using a convenience sample. Adults who had joined the Gro Health app (intervention) and had a complete baseline dataset (ie, 7-item Generalized Anxiety Disorder scale, Perceived Stress Scale, and 9-item Patient Health Questionnaire) were followed up at 12 weeks (n=273), including 33 (12.1%) app users who reported a positive COVID-19 diagnosis during the study period. User engagement with the Gro Health platform was tracked by measuring total minutes of app engagement. Paired t tests were used to compare pre-post intervention scores. Linear regression analysis was performed to assess the relationship between minutes of active engagement with the Gro Health app and changes in scores across the different mental health measures. Results: Of the 347 study participants, 273 (78.67%) completed both the baseline and follow-up surveys. Changes in scores for anxiety, perceived stress, and depression were predicted by app engagement, with the strongest effect observed for changes in perceived stress score (F1,271=251.397; R2=0.479; P<.001). Conclusions: A digital behavior change platform that provides remote mental well-being support can be effective in managing depression, anxiety, and perceived stress during times of crisis such as the current COVID-19 pandemic. The outcomes of this study may also support the implementation of remote digital health apps supporting behavior change and providing support for low levels of mental health within the community. %M 34459740 %R 10.2196/31273 %U https://formative.jmir.org/2021/10/e31273 %U https://doi.org/10.2196/31273 %U http://www.ncbi.nlm.nih.gov/pubmed/34459740 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e30473 %T Sustaining a Multidisciplinary, Single-Institution, Postoperative Mobilization Clinical Practice Improvement Program Following Hepatopancreatobiliary Surgery During the COVID-19 Pandemic: Prospective Cohort Study %A Chan,Kai Siang %A Wang,Bei %A Tan,Yen Pin %A Chow,Jaclyn Jie Ling %A Ong,Ee Ling %A Junnarkar,Sameer P %A Low,Jee Keem %A Huey,Cheong Wei Terence %A Shelat,Vishal G %+ Department of General Surgery, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore, 65 63577807, vishal_g_shelat@ttsh.com.sg %K enhanced recovery after surgery %K early mobilization %K liver resection %K pancreas surgery %K quality improvement project %K pancreaticoduodenectomy %D 2021 %7 6.10.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The Enhanced Recovery After Surgery (ERAS) protocol has been recently extended to hepatopancreatobiliary (HPB) surgery, with excellent outcomes reported. Early mobilization is an essential facet of the ERAS protocol, but compliance has been reported to be poor. We recently reported our success in a 6-month clinical practice improvement program (CPIP) for early postoperative mobilization. During the COVID-19 pandemic, we experienced reduced staffing and resource availability, which can make CPIP sustainability difficult. Objective: We report outcomes at 1 year following the implementation of our CPIP to improve postoperative mobilization in patients undergoing major HPB surgery during the COVID-19 pandemic. Methods: We divided our study into 4 phases—phase 1: before CPIP implementation (January to April 2019); phase 2: CPIP implementation (May to September 2019); phase 3: post–CPIP implementation but prior to the COVID-19 pandemic (October 2019 to March 2020); and phase 4: post–CPIP implementation and during the pandemic (April 2020 to September 2020). Major HPB surgery was defined as any surgery on the liver, pancreas, and biliary system with a duration of >2 hours and with an anticipated blood loss of ≥500 ml. Study variables included length of hospital stay, distance ambulated on postoperative day (POD) 2, morbidity, balance measures (incidence of fall and accidental dislodgement of drains), and reasons for failure to achieve targets. Successful mobilization was defined as the ability to sit out of bed for >6 hours on POD 1 and ambulate ≥30 m on POD 2. The target mobilization rate was ≥75%. Results: A total of 114 patients underwent major HPB surgery from phases 2 to 4 of our study, with 33 (29.0%), 45 (39.5%), and 36 (31.6%) patients in phases 2, 3, and 4, respectively. No baseline patient demographic data were collected for phase 1 (pre–CPIP implementation). The majority of the patients were male (n=79, 69.3%) and underwent hepatic surgery (n=92, 80.7%). A total of 76 (66.7%) patients underwent ON-Q PainBuster insertion intraoperatively. The median mobilization rate was 22% for phase 1, 78% for phases 2 and 3 combined, and 79% for phase 4. The mean pain score was 2.7 (SD 1.0) on POD 1 and 1.8 (SD 1.5) on POD 2. The median length of hospitalization was 6 days (IQR 5-11.8). There were no falls or accidental dislodgement of drains. Six patients (5.3%) had pneumonia, and 21 (18.4%) patients failed to ambulate ≥30 m on POD 2 from phases 2 to 4. The most common reason for failure to achieve the ambulation target was pain (6/21, 28.6%) and lethargy or giddiness (5/21, 23.8%). Conclusions: This follow-up study demonstrates the sustainability of our CPIP in improving early postoperative mobilization rates following major HPB surgery 1 year after implementation, even during the COVID-19 pandemic. Further large-scale, multi-institutional prospective studies should be conducted to assess compliance and determine its sustainability. %M 34559668 %R 10.2196/30473 %U https://periop.jmir.org/2021/2/e30473 %U https://doi.org/10.2196/30473 %U http://www.ncbi.nlm.nih.gov/pubmed/34559668 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30444 %T Detection of Spatiotemporal Clusters of COVID-19–Associated Symptoms and Prevention Using a Participatory Surveillance App: Protocol for the @choum Study %A De Ridder,David %A Loizeau,Andrea Jutta %A Sandoval,José Luis %A Ehrler,Frédéric %A Perrier,Myriam %A Ritch,Albert %A Violot,Guillemette %A Santolini,Marc %A Greshake Tzovaras,Bastian %A Stringhini,Silvia %A Kaiser,Laurent %A Pradeau,Jean-François %A Joost,Stéphane %A Guessous,Idris %+ Division of Primary Care, Geneva University Hospitals, 4 Rue Gabrielle-Perret-Gentil, Geneva, 1205, Switzerland, 41 22 305 58 61, Idris.Guessous@hcuge.ch %K participatory surveillance %K infectious disease %K COVID-19 %K SARS-CoV-2 %K space-time clustering %K digital health %K mobile app %K mHealth %K epidemiology %K surveillance %K digital surveillance %K public health %D 2021 %7 6.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The early detection of clusters of infectious diseases such as the SARS-CoV-2–related COVID-19 disease can promote timely testing recommendation compliance and help to prevent disease outbreaks. Prior research revealed the potential of COVID-19 participatory syndromic surveillance systems to complement traditional surveillance systems. However, most existing systems did not integrate geographic information at a local scale, which could improve the management of the SARS-CoV-2 pandemic. Objective: The aim of this study is to detect active and emerging spatiotemporal clusters of COVID-19–associated symptoms, and to examine (a posteriori) the association between the clusters’ characteristics and sociodemographic and environmental determinants. Methods: This report presents the methodology and development of the @choum (English: “achoo”) study, evaluating an epidemiological digital surveillance tool to detect and prevent clusters of individuals (target sample size, N=5000), aged 18 years or above, with COVID-19–associated symptoms living and/or working in the canton of Geneva, Switzerland. The tool is a 5-minute survey integrated into a free and secure mobile app (CoronApp-HUG). Participants are enrolled through a comprehensive communication campaign conducted throughout the 12-month data collection phase. Participants register to the tool by providing electronic informed consent and nonsensitive information (gender, age, geographically masked addresses). Symptomatic participants can then report COVID-19–associated symptoms at their onset (eg, symptoms type, test date) by tapping on the @choum button. Those who have not yet been tested are offered the possibility to be informed on their cluster status (information returned by daily automated clustering analysis). At each participation step, participants are redirected to the official COVID-19 recommendations websites. Geospatial clustering analyses are performed using the modified space-time density-based spatial clustering of applications with noise (MST-DBSCAN) algorithm. Results: The study began on September 1, 2020, and will be completed on February 28, 2022. Multiple tests performed at various time points throughout the 5-month preparation phase have helped to improve the tool’s user experience and the accuracy of the clustering analyses. A 1-month pilot study performed among 38 pharmacists working in 7 Geneva-based pharmacies confirmed the proper functioning of the tool. Since the tool’s launch to the entire population of Geneva on February 11, 2021, data are being collected and clusters are being carefully monitored. The primary study outcomes are expected to be published in mid-2022. Conclusions: The @choum study evaluates an innovative participatory epidemiological digital surveillance tool to detect and prevent clusters of COVID-19–associated symptoms. @choum collects precise geographic information while protecting the user’s privacy by using geomasking methods. By providing an evidence base to inform citizens and local authorities on areas potentially facing a high COVID-19 burden, the tool supports the targeted allocation of public health resources and promotes testing. International Registered Report Identifier (IRRID): DERR1-10.2196/30444 %M 34449403 %R 10.2196/30444 %U https://www.researchprotocols.org/2021/10/e30444 %U https://doi.org/10.2196/30444 %U http://www.ncbi.nlm.nih.gov/pubmed/34449403 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30339 %T A Guided Internet-Based Problem-Solving Intervention Delivered Through Smartphones for Secondary School Pupils During the COVID-19 Pandemic in India: Protocol for a Pilot Randomized Controlled Trial %A Gonsalves,Pattie P %A Sharma,Rhea %A Hodgson,Eleanor %A Bhat,Bhargav %A Jambhale,Abhijeet %A Weiss,Helen A %A Fairburn,Christopher G %A Cavanagh,Kate %A Cuijpers,Pim %A Michelson,Daniel %A Patel,Vikram %+ Sangath, E-5, Lane 1, Westend Marg, Saiyad ul ajaib, Saket, New Delhi, 110030, India, 91 9899419704, pattie.gonsalves@sangath.in %K randomized controlled trial %K internet-based intervention %K smartphone %K adolescent %K schools %K mental health %K COVID-19 %K app %K protocol %K problem-solving %K intervention %K teenager %K young adult %K India %K feasibility %K effective %D 2021 %7 6.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: “POD Adventures” is a gamified mental health intervention delivered via a smartphone app and supported by counsellors for a target population of secondary school students in India. This paper describes the protocol for a pilot randomized controlled trial of a remotely delivered version of the intervention in the context of COVID-19 restrictions. Objective: Our objectives are to assess the feasibility of research procedures and intervention delivery and to generate preliminary estimates of the effectiveness of the intervention to inform the sample size calculation of a full-scale trial. Methods: We will conduct a parallel, 2-arm, individually randomized pilot controlled trial in 11 secondary schools in Goa, India. This pilot trial aims to recruit 70 participants with a felt need for psychological support. Participants will receive either the POD Adventures intervention delivered over 4 weeks or usual care comprising information about local mental health services and national helplines. Outcomes will be assessed at two timepoints: baseline and 6 weeks post randomization. Results: The first participant was enrolled on January 28, 2021, and 6-week assessment completed on April 4, 2021. Owing to a second wave of the COVID-19 pandemic in India, schools in Goa were closed on April 22, 2021. Trial participants are currently receiving the intervention or completing follow-up assessments. Conclusions: This pilot trial will help understand the feasibility of implementing and evaluating a remotely delivered digital mental health intervention in a low-resource setting. Our findings will be used to design future trials that can address difficulties of accessing psychosocial support in-person and support wider efforts to scale up evidence-based mental health interventions for young people. Trial Registration: ClinicalTrials.gov NCT04672486; https://clinicaltrials.gov/ct2/show/NCT04672486 International Registered Report Identifier (IRRID): DERR1-10.2196/30339 %M 34586075 %R 10.2196/30339 %U https://www.researchprotocols.org/2021/10/e30339 %U https://doi.org/10.2196/30339 %U http://www.ncbi.nlm.nih.gov/pubmed/34586075 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e26104 %T A Web-Based Intervention (Germ Defence) to Increase Handwashing During a Pandemic: Process Evaluations of a Randomized Controlled Trial and Public Dissemination %A Miller,Sascha %A Ainsworth,Ben %A Weal,Mark %A Smith,Peter %A Little,Paul %A Yardley,Lucy %A Morrison,Leanne %+ Center for Clinical and Community Applications of Health Psychology, Department of Psychology, University of Southampton, Building 44 Highfield Campus, Southampton, SO17 1BJ, United Kingdom, 44 02380595000, sm2t07@soton.ac.uk %K behavior %K infection %K prevention %K respiratory tract infection %K internet %K evaluation studies %K pandemic %K COVID-19 %K transmission %K virus %K influenza %K respiratory %K intervention %K digital intervention %K dissemination %D 2021 %7 5.10.2021 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 34519661 %R 10.2196/26104 %U https://www.jmir.org/2021/10/e26104 %U https://doi.org/10.2196/26104 %U http://www.ncbi.nlm.nih.gov/pubmed/34519661 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 10 %P e30083 %T An Early Warning Risk Prediction Tool (RECAP-V1) for Patients Diagnosed With COVID-19: Protocol for a Statistical Analysis Plan %A Fiorentino,Francesca %A Prociuk,Denys %A Espinosa Gonzalez,Ana Belen %A Neves,Ana Luisa %A Husain,Laiba %A Ramtale,Sonny Christian %A Mi,Emma %A Mi,Ella %A Macartney,Jack %A Anand,Sneha N %A Sherlock,Julian %A Saravanakumar,Kavitha %A Mayer,Erik %A de Lusignan,Simon %A Greenhalgh,Trisha %A Delaney,Brendan C %+ Department of Surgery and Cancer, Imperial College London, Queen Elizabeth the Queen Mother Building (10th Floor/1091), St Mary's Hospital, Praed Street, London, W2 1NY, United Kingdom, 44 2033123761, f.fiorentino@imperial.ac.uk %K COVID-19 %K modeling %K remote assessment %K risk score %K early warning %D 2021 %7 5.10.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Since the start of the COVID-19 pandemic, efforts have been made to develop early warning risk scores to help clinicians decide which patient is likely to deteriorate and require hospitalization. The RECAP (Remote COVID-19 Assessment in Primary Care) study investigates the predictive risk of hospitalization, deterioration, and death of patients with confirmed COVID-19, based on a set of parameters chosen through a Delphi process performed by clinicians. We aim to use rich data collected remotely through the use of electronic data templates integrated in the electronic health systems of several general practices across the United Kingdom to construct accurate predictive models. The models will be based on preexisting conditions and monitoring data of a patient’s clinical parameters (eg, blood oxygen saturation) to make reliable predictions as to the patient’s risk of hospital admission, deterioration, and death. Objective: This statistical analysis plan outlines the statistical methods to build the prediction model to be used in the prioritization of patients in the primary care setting. The statistical analysis plan for the RECAP study includes the development and validation of the RECAP-V1 prediction model as a primary outcome. This prediction model will be adapted as a three-category risk score split into red (high risk), amber (medium risk), and green (low risk) for any patient with suspected COVID-19. The model will predict the risk of deterioration and hospitalization. Methods: After the data have been collected, we will assess the degree of missingness and use a combination of traditional data imputation using multiple imputation by chained equations, as well as more novel machine-learning approaches to impute the missing data for the final analysis. For predictive model development, we will use multiple logistic regression analyses to construct the model. We aim to recruit a minimum of 1317 patients for model development and validation. We will then externally validate the model on an independent dataset of 1400 patients. The model will also be applied for multiple different datasets to assess both its performance in different patient groups and its applicability for different methods of data collection. Results: As of May 10, 2021, we have recruited 3732 patients. A further 2088 patients have been recruited through the National Health Service Clinical Assessment Service, and approximately 5000 patients have been recruited through the DoctalyHealth platform. Conclusions: The methodology for the development of the RECAP-V1 prediction model as well as the risk score will provide clinicians with a statistically robust tool to help prioritize COVID-19 patients. Trial Registration: ClinicalTrials.gov NCT04435041; https://clinicaltrials.gov/ct2/show/NCT04435041 International Registered Report Identifier (IRRID): DERR1-10.2196/30083 %M 34468322 %R 10.2196/30083 %U https://www.researchprotocols.org/2021/10/e30083 %U https://doi.org/10.2196/30083 %U http://www.ncbi.nlm.nih.gov/pubmed/34468322 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 10 %P e30697 %T The National COVID Cohort Collaborative: Analyses of Original and Computationally Derived Electronic Health Record Data %A Foraker,Randi %A Guo,Aixia %A Thomas,Jason %A Zamstein,Noa %A Payne,Philip RO %A Wilcox,Adam %A , %+ Division of General Medical Sciences, School of Medicine, Washington University in St. Louis, 600 S. Taylor Avenue, Suite 102, Campus Box 8102, St. Louis, MO, 63110, United States, 1 314 273 2211, randi.foraker@wustl.edu %K synthetic data %K protected health information %K COVID-19 %K electronic health records and systems %K data analysis %D 2021 %7 4.10.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Computationally derived (“synthetic”) data can enable the creation and analysis of clinical, laboratory, and diagnostic data as if they were the original electronic health record data. Synthetic data can support data sharing to answer critical research questions to address the COVID-19 pandemic. Objective: We aim to compare the results from analyses of synthetic data to those from original data and assess the strengths and limitations of leveraging computationally derived data for research purposes. Methods: We used the National COVID Cohort Collaborative’s instance of MDClone, a big data platform with data-synthesizing capabilities (MDClone Ltd). We downloaded electronic health record data from 34 National COVID Cohort Collaborative institutional partners and tested three use cases, including (1) exploring the distributions of key features of the COVID-19–positive cohort; (2) training and testing predictive models for assessing the risk of admission among these patients; and (3) determining geospatial and temporal COVID-19–related measures and outcomes, and constructing their epidemic curves. We compared the results from synthetic data to those from original data using traditional statistics, machine learning approaches, and temporal and spatial representations of the data. Results: For each use case, the results of the synthetic data analyses successfully mimicked those of the original data such that the distributions of the data were similar and the predictive models demonstrated comparable performance. Although the synthetic and original data yielded overall nearly the same results, there were exceptions that included an odds ratio on either side of the null in multivariable analyses (0.97 vs 1.01) and differences in the magnitude of epidemic curves constructed for zip codes with low population counts. Conclusions: This paper presents the results of each use case and outlines key considerations for the use of synthetic data, examining their role in collaborative research for faster insights. %M 34559671 %R 10.2196/30697 %U https://www.jmir.org/2021/10/e30697 %U https://doi.org/10.2196/30697 %U http://www.ncbi.nlm.nih.gov/pubmed/34559671 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 4 %P e27769 %T Delivery Outcomes During the COVID-19 Pandemic as Reported in a Pregnancy Mobile App: Retrospective Cohort Study %A Noddin,Katie %A Bradley,Dani %A Wolfberg,Adam %+ Ovia Health, 308 Congress St, Boston, MA, 02210, United States, 1 3392032545, katie@oviahealth.com %K digital health %K COVID-19 %K maternal health %K obstetrics %K COVID %K pandemic %K pregnant women %K birth %K hospital %K delivery %K women's health %K Cesarean sections %D 2021 %7 4.10.2021 %9 Short Paper %J JMIR Pediatr Parent %G English %X Background: The COVID-19 pandemic has presented obstacles for providers and patients in the maternal health care setting, causing changes to many pregnant women’s birth plans, as well as abrupt changes in hospital labor and delivery policies and procedures. Few data exist on the effects of the COVID-19 pandemic on the maternal health care landscape at the national level in the United States. Objective: The aim of this study is to assess the incidence of key obstetrics outcomes (preterm delivery, Cesarean sections, and home births) and length of hospital stay during the COVID-19 pandemic as compared to the 6 months prior. Methods: We conducted a retrospective cohort study of women aged 18-44 years in the United States who delivered between October 1, 2019, and September 30, 2020, had singleton deliveries, and completed a birth report in the Ovia Pregnancy mobile app. Women were assigned to the prepandemic cohort if they delivered between October 2019 and March 2020, and the pandemic cohort if they delivered between April and September 2020. Gestational age at delivery, delivery method, delivery facility type, and length of hospital stay were compared. Results: A total of 304,023 birth reports were collected, with 152,832 (50.26%) in the prepandemic cohort and 151,191 (49.73%) in the pandemic cohort. Compared to the prepandemic cohort, principal findings indicate a 5.67% decrease in preterm delivery rates in the pandemic cohort (P<.001; odds ratio [OR] 0.94, 95% CI 0.91-0.96), a 30.0% increase in home birth rates (P<.001; OR 1.3, 95% CI 1.23-1.4), and a 7.81% decrease in the average hospital length of stay postdelivery (mean 2.48 days, SD 1.35). There were no overall changes in Cesarean section rates between cohorts, but differences were observed between age, race, and ethnicity subgroups. Conclusions: Results suggest a need for continuous monitoring of maternal health trends as the COVID-19 pandemic progresses and underline the important role of digital data collection, particularly during the pandemic. %M 34509975 %R 10.2196/27769 %U https://pediatrics.jmir.org/2021/4/e27769 %U https://doi.org/10.2196/27769 %U http://www.ncbi.nlm.nih.gov/pubmed/34509975 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e32353 %T Use of a Guided Imagery Mobile App (See Me Serene) to Reduce COVID-19–Related Stress: Pilot Feasibility Study %A Gordon,Judith S %A Sbarra,David %A Armin,Julie %A Pace,Thaddeus W W %A Gniady,Chris %A Barraza,Yessenya %+ College of Nursing, University of Arizona, 1305 North Martin Avenue, Tucson, AZ, 85721, United States, 1 5206264970, judithg@email.arizona.edu %K COVID-19 %K stress %K anxiety %K isolation %K intervention %K guided imagery %K mobile app %D 2021 %7 4.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The SARS-CoV-2 pandemic has led to concerns about mental health resulting from regional and national lockdowns, social isolation, job loss, and concern about disease exposure. Objective: We describe results of the pilot feasibility study of the See Me Serene mHealth app. The app provides users with immersive, vivid, nature experiences to reduce stress and anxiety related to COVID-19 and other isolation. The goals of the study were to develop the See Me Serene app and test the feasibility and acceptability of study procedures, and explore the potential impact of the app on stress and anxiety. Methods: We developed and tested the See Me Serene app and our study procedures for feasibility, and gathered preliminary data with a goal of 100 participants. The research was conducted in 2 phases: (1) development and internal testing of the app; and (2) feasibility and pilot testing with participants recruited online through earned media (eg, news stories), presentations at a university campus, and social media (eg, online sharing of earned media and presentations). The feasibility study employed a mixed methods, within-subjects, pre-/posttest design. At baseline and 30-day follow-up, we assessed stress-related variables via validated self-report measures and saliva samples for determination of cortisol concentrations. Results: We met or surpassed all our feasibility benchmarks for recruitment (101 participants recruited), retention (91% [90/99] of 30-day assessment completed), and data collection (99 participants completed all baseline data; 85% [84/99] of salivary cortisol samples returned). Participants adhered to the intervention. On average, participants listened to 48.2 audio files over 30 days or approximately 1.6 audio files per day. Participants were satisfied with the app, with 87% (78/90) rating the app as helpful in dealing with stress and anxiety. The app showed the potential to reduce stress, anxiety, loneliness, and worry. We did not find significant differences (P=.41) in cortisol levels over time. Our findings suggest that future research is warranted to test the efficacy of the See Me Serene app with a representative, diverse sample. Conclusions: There is a need for evidence-based and easily disseminable stress-reduction interventions. See Me Serene is a feasible intervention and has the potential to reduce stress related to COVID-19 and other forms of social isolation. More research on See Me Serene is warranted. %M 34546941 %R 10.2196/32353 %U https://formative.jmir.org/2021/10/e32353 %U https://doi.org/10.2196/32353 %U http://www.ncbi.nlm.nih.gov/pubmed/34546941 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e31722 %T Practical and Emotional Problems Reported by Users of a Self-guided Digital Problem-solving Intervention During the COVID-19 Pandemic: Content Analysis %A Hentati,Amira %A Forsell,Erik %A Ljótsson,Brjánn %A Kraepelien,Martin %+ Centre for Psychiatry Research, Department of Clinical Neuroscience, Karolinska Institutet & Stockholm Health Care Services, Region Stockholm, Norra Stationsgatan 69, Stockholm, 11364, Sweden, 46 704411425, amira.hentati@ki.se %K digital intervention %K COVID-19 %K problem-solving %K self-guided intervention %K content analysis %K public health %K mental health %K depression %K anxiety %K pandemic %D 2021 %7 4.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: To better direct assessments and interventions toward the general population during both the ongoing COVID-19 pandemic and future crises with societal restrictions, data on the types of practical and emotional problems that people are experiencing are needed. Objective: The aim of this study was to examine the types of practical and emotional problems that the general population is experiencing during the COVID-19 pandemic and to construct an empirically derived inventory based on the findings. Methods: A total of 396 participants, recruited among members of the general public in Sweden who were experiencing practical and/or emotional problems during the pandemic, accessed a self-guided digital problem-solving intervention for a period of 1 week to report and solve the problems they experienced. Prior to accessing the intervention, the participants completed a short self-assessment regarding symptoms of depression and anxiety. Content analysis was used to account for the types of problems participants reported. A set of items for an inventory was later proposed based on the problem categories derived from the analysis. Results: A majority of participants had clinically relevant symptoms of either depression or anxiety. The problems reported were categorized as 13 distinct types of problems. The most common problem was difficulty managing daily activities. Based on the categories, a 13-item inventory was proposed. Conclusions: The 13 types of problems, and the proposed inventory, could be valuable when composing assessments and interventions for the general population during the ongoing pandemic or similar crises with societal restrictions. The most common problem was of a practical nature, indicating the importance of including examples of such problems within assessments and interventions. Trial Registration: ClinicalTrials.gov NCT04677270; https://clinicaltrials.gov/ct2/show/NCT04677270 %M 34559670 %R 10.2196/31722 %U https://formative.jmir.org/2021/10/e31722 %U https://doi.org/10.2196/31722 %U http://www.ncbi.nlm.nih.gov/pubmed/34559670 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e27358 %T A Novel Mobile App (“CareFit”) to Support Informal Caregivers to Undertake Regular Physical Activity From Home During and Beyond COVID-19 Restrictions: Co-design and Prototype Development Study %A Egan,Kieren J %A Hodgson,William %A Dunlop,Mark D %A Imperatore,Gennaro %A Kirk,Alison %A Maguire,Roma %+ Department of Computer and Information Science, University of Strathclyde, Livingstone Tower, 26 Richmond Street, Glasgow, G1 1XH, United Kingdom, 44 0141 548 3138, kieren.egan@strath.ac.uk %K physical activity %K Android %K COVID-19 %K intervention %K co-design %K exercise %K app %K development %K support %K caregiver %D 2021 %7 1.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Informal caregivers, or carers (unpaid family members and friends), are instrumental to millions worldwide for the ongoing delivery of health and well-being needs. The risk of crisis points (eg, hospitalizations) for caregivers increases with the absence of physical activity. The COVID-19 pandemic is highly likely to have increased the risk of crisis points for caregivers by increasing the amount of time spent indoors due to shielding and lockdown restrictions. Thus, accessible evidence-based tools to facilitate physical activity for caregivers indoors are urgently needed. Objective: The aim of this study was to co-design and develop a novel mobile app to educate and support carers in the undertaking of regular physical activity at home during and beyond COVID-19 restrictions via integration of the transtheoretical model of behavior change and UK physical activity guidelines. Methods: We co-designed a mobile app, “CareFit,” by directly involving caregivers, health care professionals, and social care professionals in the requirements, capturing, and evaluation phases of three Agile Scrum design and development sprints. Seven participants representing multistakeholder views took part in three co-design sessions, each of which was followed by a development sprint. Requirements for CareFit were grounded in a combination of behavioral change science and UK government guidelines for physical activity. Results: Participants identified different barriers and enablers to physical activity, such as a lack of time, recognition of existing activities, and concerns regarding safely undertaking physical activity. Requirements analysis highlighted the importance of simplicity in design and a need to anchor development around the everyday needs of caregivers (eg, easy-to-use video instructions). Our final prototype app integrated guidance for undertaking physical activity at home through educational, physical activity, and communication components. Conclusions: Integrating government guidelines with models of behavioral change into a mobile app to support the physical activity of carers is novel. We found that integrating core physical activity guidelines into a co-designed smartphone app with functionality such as a weekly planner and educational material for users is feasible. This work holds promise to fill the gap of effective physical activity solutions for caregivers both during and beyond the COVID-19 pandemic. Further work is now needed to explore the feasibility, acceptability, and usability of the approach in real-world settings. %M 34406969 %R 10.2196/27358 %U https://formative.jmir.org/2021/10/e27358 %U https://doi.org/10.2196/27358 %U http://www.ncbi.nlm.nih.gov/pubmed/34406969 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 10 %P e26980 %T Knowledge, Attitudes, and Practices Regarding COVID-19 Among Health Care Workers in Public Health Facilities in Eastern Ethiopia: Cross-sectional Survey Study %A Farah,Alinoor Mohamed %A Nour,Tahir Yousuf %A Obsiye,Muse %A Aden,Mowlid Akil %A Ali,Omar Moeline %A Hussein,Muktar Arab %A Budul,Abdullahi Bedel %A Omer,Muktar %A Getnet,Fentabil %+ Department of Public Health Nutrition, School of Public Health, College of Medicine and Health Sciences, Jigjiga University, CoMHS Building, 2nd Floor, Jigjiga, 1020, Ethiopia, 251 911053913, alinuriana@yahoo.com %K COVID-19 %K knowledge %K attitude %K practice %K health care workers %K Eastern Ethiopia %D 2021 %7 1.10.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: On March 13, 2020, Ethiopia reported the first confirmed case of COVID-19 in Addis Ababa. COVID-19 is likely to overwhelm an already-fragile health care delivery system and reduce the availability of essential health services. This analysis of data from the Somali Region of Eastern Ethiopia on health care workers’ (HCWs) knowledge, attitudes, and practices regarding the prevention and control of COVID-19 may be used in planning health education programs about the emerging viral disease. Objective: This study aimed to investigate the knowledge, attitudes, and practices of HCWs regarding COVID-19 infection. Methods: This cross-sectional study was conducted among HCWs in three public health facilities in the Somali Region, Eastern Ethiopia. A self-administered questionnaire was shared with all HCWs working at the public health facilities. A total of 15 knowledge questions were scored as 1 or 0 for correct or incorrect responses, respectively. A total of 14 practice questions were scored on a 3-point scale from 1 (“always”) to 3 (“never”). A total of six attitude questions were rated on a 5-point Likert scale, in a negative dimension, as follows: 1 (“strongly agree”), 2 (“agree”), 3 (“neutral”), 4 (“disagree”), and 5 (“strongly disagree”). Mean scores were calculated and used as a cut point to dichotomize the outcome variables (>13.7 indicated good knowledge, <18.8 indicated good practices, and ≤10.5 indicated favorable attitudes). We used t tests and analyses of variance (ie, F tests) to analyze the mean score differences of knowledge, attitudes, and practices between the independent variables. Spearman correlation was used to assess the relationship between mean knowledge and attitude scores. Results: Of the 686 HCWs approached, a total of 434 HCWs responded (63.3% response rate). The mean age of the participants was 27.6 (SD 5.3) years, and the majority of the participants were male (293/434, 67.5%). The mean knowledge score was 13.7 (SD 2.6), and 73.3% (318/434) of participants had sufficient knowledge. The mean attitude score was 10.5 (SD 4.1), and 54.8% (238/434) of the participants had a good attitude toward COVID-19. The mean practice score was 18.8 (SD 5.8), and 61.5% (267/434) of the participants practiced precautionary measures to prevent COVID-19. There was a negative correlation between knowledge and attitude scores (r=–0.295, P<.001) and between knowledge and practice scores (r=–0.298, P<.001). Conclusions: The overall levels of knowledge and practice were relatively better than the attitude level. This highlights the need to implement strategies that enhance the positive attitudes and safe practices of the HCWs for better containment of the pandemic and supporting of essential health care services. %M 34477559 %R 10.2196/26980 %U https://formative.jmir.org/2021/10/e26980 %U https://doi.org/10.2196/26980 %U http://www.ncbi.nlm.nih.gov/pubmed/34477559 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e31122 %T Columbia Open Health Data for COVID-19 Research: Database Analysis %A Lee,Junghwan %A Kim,Jae Hyun %A Liu,Cong %A Hripcsak,George %A Natarajan,Karthik %A Ta,Casey %A Weng,Chunhua %+ Columbia University, Ph-20, 622 W 168 ST, New York, NY, United States, 1 212 304 7907, cw2384@cumc.columbia.edu %K COVID-19 %K open data %K electronic health record %K data science %K research %K data %K access %K database %K symptom %K cohort %K prevalence %D 2021 %7 30.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has threatened the health of tens of millions of people all over the world. Massive research efforts have been made in response to the COVID-19 pandemic. Utilization of clinical data can accelerate these research efforts to combat the pandemic since important characteristics of the patients are often found by examining the clinical data. Publicly accessible clinical data on COVID-19, however, remain limited despite the immediate need. Objective: To provide shareable clinical data to catalyze COVID-19 research, we present Columbia Open Health Data for COVID-19 Research (COHD-COVID), a publicly accessible database providing clinical concept prevalence, clinical concept co-occurrence, and clinical symptom prevalence for hospitalized patients with COVID-19. COHD-COVID also provides data on hospitalized patients with influenza and general hospitalized patients as comparator cohorts. Methods: The data used in COHD-COVID were obtained from NewYork-Presbyterian/Columbia University Irving Medical Center’s electronic health records database. Condition, drug, and procedure concepts were obtained from the visits of identified patients from the cohorts. Rare concepts were excluded, and the true concept counts were perturbed using Poisson randomization to protect patient privacy. Concept prevalence, concept prevalence ratio, concept co-occurrence, and symptom prevalence were calculated using the obtained concepts. Results: Concept prevalence and concept prevalence ratio analyses showed the clinical characteristics of the COVID-19 cohorts, confirming the well-known characteristics of COVID-19 (eg, acute lower respiratory tract infection and cough). The concepts related to the well-known characteristics of COVID-19 recorded high prevalence and high prevalence ratio in the COVID-19 cohort compared to the hospitalized influenza cohort and general hospitalized cohort. Concept co-occurrence analyses showed potential associations between specific concepts. In case of acute lower respiratory tract infection in the COVID-19 cohort, a high co-occurrence ratio was obtained with COVID-19–related concepts and commonly used drugs (eg, disease due to coronavirus and acetaminophen). Symptom prevalence analysis indicated symptom-level characteristics of the cohorts and confirmed that well-known symptoms of COVID-19 (eg, fever, cough, and dyspnea) showed higher prevalence than the hospitalized influenza cohort and the general hospitalized cohort. Conclusions: We present COHD-COVID, a publicly accessible database providing useful clinical data for hospitalized patients with COVID-19, hospitalized patients with influenza, and general hospitalized patients. We expect COHD-COVID to provide researchers and clinicians quantitative measures of COVID-19–related clinical features to better understand and combat the pandemic. %M 34543225 %R 10.2196/31122 %U https://www.jmir.org/2021/9/e31122 %U https://doi.org/10.2196/31122 %U http://www.ncbi.nlm.nih.gov/pubmed/34543225 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e29544 %T Uncovering Clinical Risk Factors and Predicting Severe COVID-19 Cases Using UK Biobank Data: Machine Learning Approach %A Wong,Kenneth Chi-Yin %A Xiang,Yong %A Yin,Liangying %A So,Hon-Cheong %+ School of Biomedical Sciences, The Chinese University of Hong Kong, RM 520A, Lo Kwee Seong Biomedical Sciences Buildiing, Chinese University of Hong Kong, Hong Kong, China, 86 39439255, hcso@cuhk.edu.hk %K prediction %K COVID-19 %K risk factors %K machine learning %K pandemic %K biobank %K public health %K prediction models %K medical informatics %D 2021 %7 30.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 is a major public health concern. Given the extent of the pandemic, it is urgent to identify risk factors associated with disease severity. More accurate prediction of those at risk of developing severe infections is of high clinical importance. Objective: Based on the UK Biobank (UKBB), we aimed to build machine learning models to predict the risk of developing severe or fatal infections, and uncover major risk factors involved. Methods: We first restricted the analysis to infected individuals (n=7846), then performed analysis at a population level, considering those with no known infection as controls (ncontrols=465,728). Hospitalization was used as a proxy for severity. A total of 97 clinical variables (collected prior to the COVID-19 outbreak) covering demographic variables, comorbidities, blood measurements (eg, hematological/liver/renal function/metabolic parameters), anthropometric measures, and other risk factors (eg, smoking/drinking) were included as predictors. We also constructed a simplified (lite) prediction model using 27 covariates that can be more easily obtained (demographic and comorbidity data). XGboost (gradient-boosted trees) was used for prediction and predictive performance was assessed by cross-validation. Variable importance was quantified by Shapley values (ShapVal), permutation importance (PermImp), and accuracy gain. Shapley dependency and interaction plots were used to evaluate the pattern of relationships between risk factors and outcomes. Results: A total of 2386 severe and 477 fatal cases were identified. For analyses within infected individuals (n=7846), our prediction model achieved area under the receiving-operating characteristic curve (AUC–ROC) of 0.723 (95% CI 0.711-0.736) and 0.814 (95% CI 0.791-0.838) for severe and fatal infections, respectively. The top 5 contributing factors (sorted by ShapVal) for severity were age, number of drugs taken (cnt_tx), cystatin C (reflecting renal function), waist-to-hip ratio (WHR), and Townsend deprivation index (TDI). For mortality, the top features were age, testosterone, cnt_tx, waist circumference (WC), and red cell distribution width. For analyses involving the whole UKBB population, AUCs for severity and fatality were 0.696 (95% CI 0.684-0.708) and 0.825 (95% CI 0.802-0.848), respectively. The same top 5 risk factors were identified for both outcomes, namely, age, cnt_tx, WC, WHR, and TDI. Apart from the above, age, cystatin C, TDI, and cnt_tx were among the top 10 across all 4 analyses. Other diseases top ranked by ShapVal or PermImp were type 2 diabetes mellitus (T2DM), coronary artery disease, atrial fibrillation, and dementia, among others. For the “lite” models, predictive performances were broadly similar, with estimated AUCs of 0.716, 0.818, 0.696, and 0.830, respectively. The top ranked variables were similar to above, including age, cnt_tx, WC, sex (male), and T2DM. Conclusions: We identified numerous baseline clinical risk factors for severe/fatal infection by XGboost. For example, age, central obesity, impaired renal function, multiple comorbidities, and cardiometabolic abnormalities may predispose to poorer outcomes. The prediction models may be useful at a population level to identify those susceptible to developing severe/fatal infections, facilitating targeted prevention strategies. A risk-prediction tool is also available online. Further replications in independent cohorts are required to verify our findings. %M 34591027 %R 10.2196/29544 %U https://publichealth.jmir.org/2021/9/e29544 %U https://doi.org/10.2196/29544 %U http://www.ncbi.nlm.nih.gov/pubmed/34591027 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 2 %P e27166 %T The Psychological Experience of Frontline Perioperative Health Care Staff in Responding to COVID-19: Qualitative Study %A Withiel,Toni %A Barson,Elizabeth %A Ng,Irene %A Segal,Reny %A Williams,Daryl Lindsay Goulding %A Krieser,Roni Benjamin %A Lee,Keat %A Mezzavia,Paul Mario %A Sindoni,Teresa %A Chen,Yinwei %A Fisher,Caroline Anne %+ Department of Allied Health, Royal Melbourne Hospital, 300 Grattan St, Parkville, 3010, Australia, 61 411729045, toni.withiel@mh.org.au %K COVID-19 %K perioperative %K mental health %K qualitative %K grief %K psychology %K health care worker %K experience %K hospital %K trauma %K thematic analysis %K interview %D 2021 %7 29.9.2021 %9 Original Paper %J JMIR Perioper Med %G English %X Background: The rapid spread of the novel coronavirus (COVID-19) has presented immeasurable challenges to health care workers who remain at the frontline of the pandemic. A rapidly evolving body of literature has quantitatively demonstrated significant psychological impacts of the pandemic on health care workers. However, little is known about the lived experience of the pandemic for frontline medical staff. Objective: This study aimed to explore the qualitative experience of perioperative staff from a large trauma hospital in Melbourne, Australia. Methods: Inductive thematic analysis using a critical realist approach was used to analyze data from 9 semistructured interviews. Results: Four key themes were identified. Hospital preparedness related to the perceived readiness of the hospital to respond to the pandemic and encompassed key subthemes around communication of policy changes, team leadership, and resource availability. Perceptions of readiness contributed to the perceived psychological impacts of the pandemic, which were highly varied and ranged from anger to anxiety. A number of coping strategies were identified in response to psychological impacts which incorporated both internal and external coping mechanisms. Finally, adaptation with time reflected change and growth over time, and encompassed all other themes. Conclusions: While frontline staff and hospitals have rapidly marshalled a response to managing the virus, relatively less consideration was seen regarding staff mental health in our study. Findings highlight the vulnerability of health care workers in response to the pandemic and reinforce the need for a coordinated approach to managing mental health. %M 34346887 %R 10.2196/27166 %U https://periop.jmir.org/2021/2/e27166 %U https://doi.org/10.2196/27166 %U http://www.ncbi.nlm.nih.gov/pubmed/34346887 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e24554 %T Predicting Norovirus in the United States Using Google Trends: Infodemiology Study %A Yuan,Kai %A Huang,Guangrui %A Wang,Lepeng %A Wang,Ting %A Liu,Wenbin %A Jiang,Haixu %A Yang,Albert C %+ Digital Medicine Center, National Yang Ming Chiao Tung University, 155 Li-Nong Street, Section 2, Peitou District, Taipei, Republic of China, 886 28267995, accyang@gmail.com %K norovirus %K Google Trends %K correlation %K outbreak %K predictors %D 2021 %7 29.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Norovirus is a contagious disease. The transmission of norovirus spreads quickly and easily in various ways. Because effective methods to prevent or treat norovirus have not been discovered, it is important to rapidly recognize and report norovirus outbreaks in the early phase. Internet search has been a useful method for people to access information immediately. With the precise record of internet search trends, internet search has been a useful tool to manifest infectious disease outbreaks. Objective: In this study, we tried to discover the correlation between internet search terms and norovirus infection. Methods: The internet search trend data of norovirus were obtained from Google Trends. We used cross-correlation analysis to discover the temporal correlation between norovirus and other terms. We also used multiple linear regression with the stepwise method to recognize the most important predictors of internet search trends and norovirus. In addition, we evaluated the temporal correlation between actual norovirus cases and internet search terms in New York, California, and the United States as a whole. Results: Some Google search terms such as gastroenteritis, watery diarrhea, and stomach bug coincided with norovirus Google Trends. Some Google search terms such as contagious, travel, and party presented earlier than norovirus Google Trends. Some Google search terms such as dehydration, bar, and coronavirus presented several months later than norovirus Google Trends. We found that fever, gastroenteritis, poison, cruise, wedding, and watery diarrhea were important factors correlated with norovirus Google Trends. In actual norovirus cases from New York, California, and the United States as a whole, some Google search terms presented with, earlier, or later than actual norovirus cases. Conclusions: Our study provides novel strategy-based internet search evidence regarding the epidemiology of norovirus. %M 34586079 %R 10.2196/24554 %U https://www.jmir.org/2021/9/e24554 %U https://doi.org/10.2196/24554 %U http://www.ncbi.nlm.nih.gov/pubmed/34586079 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e27741 %T Emotional Analysis of Twitter Posts During the First Phase of the COVID-19 Pandemic in Greece: Infoveillance Study %A Geronikolou,Styliani %A Drosatos,George %A Chrousos,George %+ Biomedical Research Foundation of the Academy of Athens, Soranou Ephessiou 4, Athens, 11527, Greece, 30 2106597403, sgeronik@gmail.com %K emotional analysis %K COVID-19 %K Twitter %K Greece %K infodemics %K emotional contagion %K epidemiology %K pandemic %K mental health %D 2021 %7 29.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The effectiveness of public health measures depends upon a community’s compliance as well as on its positive or negative emotions. Objective: The purpose of this study was to perform an analysis of the expressed emotions in English tweets by Greek Twitter users during the first phase of the COVID-19 pandemic in Greece. Methods: The period of this study was from January 25, 2020 to June 30, 2020. Data collection was performed by using appropriate search words with the filter-streaming application programming interface of Twitter. The emotional analysis of the tweets that satisfied the inclusion criteria was achieved using a deep learning approach that performs better by utilizing recurrent neural networks on sequences of characters. Emotional epidemiology tools such as the 6 basic emotions, that is, joy, sadness, disgust, fear, surprise, and anger based on the Paul Ekman classification were adopted. Results: The most frequent emotion that was detected in the tweets was “surprise” at the emerging contagion, while the imposed isolation resulted mostly in “anger” (odds ratio 2.108, 95% CI 0.986-4.506). Although the Greeks felt rather safe during the first phase of the COVID-19 pandemic, their positive and negative emotions reflected a masked “flight or fight” or “fear versus anger” response to the contagion. Conclusions: The findings of our study show that emotional analysis emerges as a valid tool for epidemiology evaluations, design, and public health strategy and surveillance. %M 34469328 %R 10.2196/27741 %U https://formative.jmir.org/2021/9/e27741 %U https://doi.org/10.2196/27741 %U http://www.ncbi.nlm.nih.gov/pubmed/34469328 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e29413 %T Tracking Self-reported Symptoms and Medical Conditions on Social Media During the COVID-19 Pandemic: Infodemiological Study %A Ding,Qinglan %A Massey,Daisy %A Huang,Chenxi %A Grady,Connor B %A Lu,Yuan %A Cohen,Alina %A Matzner,Pini %A Mahajan,Shiwani %A Caraballo,César %A Kumar,Navin %A Xue,Yuchen %A Dreyer,Rachel %A Roy,Brita %A Krumholz,Harlan M %+ Center for Outcomes Research and Evaluation, Yale New Haven Hospital, 1 Church Street, Suite 200, New Haven, CT, 06510, United States, 1 203 764 5885, harlan.krumholz@yale.edu %K health conditions %K symptoms %K mental health %K social media %K infoveillance %K public health surveillance %K COVID-19 %K pandemic %K natural language processing %D 2021 %7 28.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Harnessing health-related data posted on social media in real time can offer insights into how the pandemic impacts the mental health and general well-being of individuals and populations over time. Objective: This study aimed to obtain information on symptoms and medical conditions self-reported by non-Twitter social media users during the COVID-19 pandemic, to determine how discussion of these symptoms and medical conditions changed over time, and to identify correlations between frequency of the top 5 commonly mentioned symptoms post and daily COVID-19 statistics (new cases, new deaths, new active cases, and new recovered cases) in the United States. Methods: We used natural language processing (NLP) algorithms to identify symptom- and medical condition–related topics being discussed on social media between June 14 and December 13, 2020. The sample posts were geotagged by NetBase, a third-party data provider. We calculated the positive predictive value and sensitivity to validate the classification of posts. We also assessed the frequency of health-related discussions on social media over time during the study period, and used Pearson correlation coefficients to identify statistically significant correlations between the frequency of the 5 most commonly mentioned symptoms and fluctuation of daily US COVID-19 statistics. Results: Within a total of 9,807,813 posts (nearly 70% were sourced from the United States), we identified a discussion of 120 symptom-related topics and 1542 medical condition–related topics. Our classification of the health-related posts had a positive predictive value of over 80% and an average classification rate of 92% sensitivity. The 5 most commonly mentioned symptoms on social media during the study period were anxiety (in 201,303 posts or 12.2% of the total posts mentioning symptoms), generalized pain (189,673, 11.5%), weight loss (95,793, 5.8%), fatigue (91,252, 5.5%), and coughing (86,235, 5.2%). The 5 most discussed medical conditions were COVID-19 (in 5,420,276 posts or 66.4% of the total posts mentioning medical conditions), unspecified infectious disease (469,356, 5.8%), influenza (270,166, 3.3%), unspecified disorders of the central nervous system (253,407, 3.1%), and depression (151,752, 1.9%). Changes in posts in the frequency of anxiety, generalized pain, and weight loss were significant but negatively correlated with daily new COVID-19 cases in the United States (r=-0.49, r=-0.46, and r=-0.39, respectively; P<.05). Posts on the frequency of anxiety, generalized pain, weight loss, fatigue, and the changes in fatigue positively and significantly correlated with daily changes in both new deaths and new active cases in the United States (r ranged=0.39-0.48; P<.05). Conclusions: COVID-19 and symptoms of anxiety were the 2 most commonly discussed health-related topics on social media from June 14 to December 13, 2020. Real-time monitoring of social media posts on symptoms and medical conditions may help assess the population’s mental health status and enhance public health surveillance for infectious disease. %M 34517338 %R 10.2196/29413 %U https://publichealth.jmir.org/2021/9/e29413 %U https://doi.org/10.2196/29413 %U http://www.ncbi.nlm.nih.gov/pubmed/34517338 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e20131 %T The Use of Telemonitoring in Managing the COVID-19 Pandemic: Pilot Implementation Study %A McKinstry,Brian %A Alexander,Helen %A Maxwell,Gabriela %A Blaikie,Lesley %A Patel,Sameer %A Guthrie,Bruce %A , %+ Centre for Informatics, Usher Institute, The University of Edinburgh, 17 Burnside Park, Edinburgh, EH165AG, United Kingdom, 44 07803268660, brian.mckinstry@ed.ac.uk %K telemonitoring %K eHealth %K COVID-19 %K primary care %D 2021 %7 27.9.2021 %9 Viewpoint %J JMIR Form Res %G English %X Background: Most people with COVID-19 self-manage at home. However, the condition can deteriorate quickly, and some people may develop serious hypoxia with relatively few symptoms. Early identification of deterioration allows effective management with oxygen and steroids. Telemonitoring of symptoms and physiological signs may facilitate this. Objective: The aim of this study was to design, implement, and evaluate a telemonitoring system for people with COVID-19 who are self-managing at home and are considered at significant risk of deterioration. Methods: A multidisciplinary team developed a telemonitoring protocol using a commercial platform to record symptoms, pulse oximetry, and temperature. If symptoms or physiological measures breached targets, patients were alerted and asked to phone for an ambulance (red alert) or for advice (amber alert). Patients attending COVID-19 assessment centers, who were considered fit for discharge but at risk of deterioration, were shown how to use a pulse oximeter and the monitoring system, which they were to use twice daily for 2 weeks. Patients could interact with the system via app, SMS, or touch-tone phone. Written guidance on alerts was also provided. Following consent, patient data on telemonitoring usage and alerts were linked to data on the use of service resources. Subsequently, patients who had either used or not used the telemonitoring service, including those who had not followed advice to seek help, agreed to brief telephone interviews to explore their views on, and how they had interacted with, the telemonitoring system. Interviews were recorded and analyzed thematically. Professionals involved in the implementation were sent an online questionnaire asking them about their perceptions of the service. Results: We investigated the first 116 patients who used the service. Of these patients, 71 (61.2%) submitted data and the remainder (n=45, 38.8%) chose to self-monitor without electronic support. Of the 71 patients who submitted data, 35 (49%) received 152 alerts during their 2-week observation. A total of 67 red alerts were for oxygen saturation (SpO2) levels of ≤93%, and 15 red alerts were because patients recorded severe breathlessness. Out of 71 patients, 14 (20%) were admitted to hospital for an average stay of 3.6 (SD 4.5) days. Of the 45 who used written guidance alone, 7 (16%) were admitted to hospital for an average stay of 4.0 (SD 4.2) days and 1 (2%) died. Some patients who were advised to seek help did not do so, some because parameters improved on retesting and others because they felt no worse than before. All patients found self-monitoring to be reassuring. Of the 11 professionals who used the system, most found it to be useful and easy to use. Of these 11 professionals, 5 (45%) considered the system “very safe,” 3 (27%) thought it “could be safer,” and 3 (27%) wished to have more experience with it before deciding. In total, 2 (18%) felt that SpO2 trigger thresholds were too high. Conclusions: Supported self-monitoring of patients with COVID-19 at home is reassuring to patients, is acceptable to clinicians, and can detect important signs of deterioration. Worryingly, some patients, because they felt well, occasionally ignored important signs of deterioration. It is important, therefore, to emphasize the importance of the early investigation and treatment of asymptomatic hypoxia at the time when patients are initiated and in the warning messages that are sent to patients. %M 34449404 %R 10.2196/20131 %U https://formative.jmir.org/2021/9/e20131 %U https://doi.org/10.2196/20131 %U http://www.ncbi.nlm.nih.gov/pubmed/34449404 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e32663 %T Exploring the Well-being of Health Care Workers During the COVID-19 Pandemic: Protocol for a Prospective Longitudinal Study %A Liu,Jenny J W %A Nazarov,Anthony %A Plouffe,Rachel A %A Forchuk,Callista A %A Deda,Erisa %A Gargala,Dominic %A Le,Tri %A Bourret-Gheysen,Jesse %A Soares,Vanessa %A Nouri,Maede S %A Hosseiny,Fardous %A Smith,Patrick %A Roth,Maya %A MacDougall,Arlene G %A Marlborough,Michelle %A Jetly,Rakesh %A Heber,Alexandra %A Albuquerque,Joy %A Lanius,Ruth %A Balderson,Ken %A Dupuis,Gabrielle %A Mehta,Viraj %A Richardson,J Don %+ MacDonald Franklin Operational Stress Injury Research Centre, Lawson Health Research Institute, St. Joseph's Health Care London, Parkwood Institute Research, Mental Health Building RM F4-367, 550 Wellington Road, London, ON, N6C 0A7, Canada, 1 519 685 4292 ext 48211, jenny.liu@sjhc.london.on.ca %K COVID-19 %K health care worker %K pandemic %K mental health %K wellbeing %K survey %K design %K longitudinal %K prospective %K protocol %K challenge %K impact %K distress %K perception %D 2021 %7 27.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care workers (HCWs) have experienced several stressors associated with the COVID-19 pandemic. Structural stressors, including extended work hours, redeployment, and changes in organizational mandates, often intersect with interpersonal and personal stressors, such as caring for those with COVID-19 infections; worrying about infection of self, family, and loved ones; working despite shortages of personal protective equipment; and encountering various difficult moral-ethical dilemmas. Objective: The paper describes the protocol for a longitudinal study seeking to capture the unique experiences, challenges, and changes faced by HCWs during the COVID-19 pandemic. The study seeks to explore the impact of COVID-19 on the mental well-being of HCWs with a particular focus on moral distress, perceptions of and satisfaction with delivery of care, and how changes in work structure are tolerated among HCWs providing clinical services. Methods: A prospective longitudinal design is employed to assess HCWs’ experiences across domains of mental health (depression, anxiety, posttraumatic stress, and well-being), moral distress and moral reasoning, work-related changes and telehealth, organizational responses to COVID-19 concerns, and experiences with COVID-19 infections to self and to others. We recruited HCWs from across Canada through convenience snowball sampling to participate in either a short-form or long-form web-based survey at baseline. Respondents to the baseline survey are invited to complete a follow-up survey every 3 months, for a total of 18 months. Results: A total of 1926 participants completed baseline surveys between June 26 and December 31, 2020, and 1859 participants provided their emails to contact them to participate in follow-up surveys. As of July 2021, data collection is ongoing, with participants nearing the 6- or 9-month follow-up periods depending on their initial time of self-enrollment. Conclusions: This protocol describes a study that will provide unique insights into the immediate and longitudinal impact of the COVID-19 pandemic on the dimensions of mental health, moral distress, health care delivery, and workplace environment of HCWs. The feasibility and acceptability of implementing a short-form and long-form survey on participant engagement and data retention will also be discussed. International Registered Report Identifier (IRRID): DERR1-10.2196/32663 %M 34477557 %R 10.2196/32663 %U https://www.researchprotocols.org/2021/9/e32663 %U https://doi.org/10.2196/32663 %U http://www.ncbi.nlm.nih.gov/pubmed/34477557 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e31236 %T Participatory Surveillance of COVID-19 in Lesotho via Weekly Calls: Protocol for Cell Phone Data Collection %A Greenleaf,Abigail R %A Mwima,Gerald %A Lethoko,Molibeli %A Conkling,Martha %A Keefer,George %A Chang,Christiana %A McLeod,Natasha %A Maruyama,Haruka %A Chen,Qixuan %A Farley,Shannon M %A Low,Andrea %+ ICAP at Columbia University, Mailman School of Public Health, Columbia University, 60 Haven Avenue, New York, NY, United States, 1 2123050398, arg2177@cumc.columbia.edu %K COVID-19 %K cell phones %K mHealth %K Africa south of the Sahara %K surveillance %D 2021 %7 27.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The increase in cell phone ownership in low- and middle-income countries (LMIC) has created an opportunity for low-cost, rapid data collection by calling participants on their cell phones. Cell phones can be mobilized for a myriad of data collection purposes, including surveillance. In LMIC, cell phone–based surveillance has been used to track Ebola, measles, acute flaccid paralysis, and diarrheal disease, as well as noncommunicable diseases. Phone-based surveillance in LMIC is a particularly pertinent, burgeoning approach in the context of the COVID-19 pandemic. Participatory surveillance via cell phone could allow governments to assess burden of disease and complements existing surveillance systems. Objective: We describe the protocol for the LeCellPHIA (Lesotho Cell Phone PHIA) project, a cell phone surveillance system that collects weekly population-based data on influenza-like illness (ILI) in Lesotho by calling a representative sample of a recent face-to-face survey. Methods: We established a phone-based surveillance system to collect ILI symptoms from approximately 1700 participants who had participated in a recent face-to-face survey in Lesotho, the Population-based HIV Impact Assessment (PHIA) Survey. Of the 15,267 PHIA participants who were over 18 years old, 11,975 (78.44%) consented to future research and provided a valid phone number. We followed the PHIA sample design and included 342 primary sampling units from 10 districts. We randomly selected 5 households from each primary sampling unit that had an eligible participant and sampled 1 person per household. We oversampled the elderly, as they are more likely to be affected by COVID-19. A 3-day Zoom training was conducted in June 2020 to train LeCellPHIA interviewers. Results: The surveillance system launched July 1, 2020, beginning with a 2-week enrollment period followed by weekly calls that will continue until September 30, 2022. Of the 11,975 phone numbers that were in the sample frame, 3020 were sampled, and 1778 were enrolled. Conclusions: The surveillance system will track COVID-19 in a resource-limited setting. The novel approach of a weekly cell phone–based surveillance system can be used to track other health outcomes, and this protocol provides information about how to implement such a system. International Registered Report Identifier (IRRID): DERR1-10.2196/31236 %M 34351866 %R 10.2196/31236 %U https://www.researchprotocols.org/2021/9/e31236 %U https://doi.org/10.2196/31236 %U http://www.ncbi.nlm.nih.gov/pubmed/34351866 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e32685 %T Comparing Public Sentiment Toward COVID-19 Vaccines Across Canadian Cities: Analysis of Comments on Reddit %A Yan,Cathy %A Law,Melanie %A Nguyen,Stephanie %A Cheung,Janelle %A Kong,Jude %+ Department of Mathematics & Statistics, York University, Ross 533N, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 416 736 2100 ext 66093, jdkong@yorku.ca %K COVID-19 %K public sentiment %K social media %K Reddit %K Canada %K communication %K sentiment %K opinion %K emotion %K concern %K pandemic %K vaccine %K hesitancy %D 2021 %7 24.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media enables the rapid consumption of news related to COVID-19 and serves as a platform for discussions. Its richness in text-based data in the form of posts and comments allows researchers to identify popular topics and assess public sentiment. Nonetheless, the vast majority of topic extraction and sentiment analysis based on social media is performed on the platform or country level and does not account for local culture and policies. Objective: The aim of this study is to use location-based subreddits on Reddit to study city-level variations in sentiments toward vaccine-related topics. Methods: Comments on posts providing regular updates on COVID-19 statistics in the Vancouver (r/vancouver, n=49,291), Toronto (r/toronto, n=20,764), and Calgary (r/calgary, n=21,277) subreddits between July 13, 2020, and June 14, 2021, were extracted. Latent Dirichlet allocation was used to identify frequently discussed topics. Sentiment (joy, sadness, fear, and anger) scores were assigned to comments through random forest regression. Results: The number of comments on the 250 posts from the Vancouver subreddit positively correlated with the number of new daily COVID-19 cases in British Columbia (R=0.51, 95% CI for slope 0.18-0.29; P<.001). From the comments, 13 topics were identified. Two were related to vaccines, 1 regarding vaccine uptake and the other about vaccine supply. The levels of discussion for both topics were linked to the total number of vaccines administered (Granger test for causality, P<.001). Comments pertaining to either topic displayed higher scores for joy than for other topics (P<.001). Calgary and Toronto also discussed vaccine uptake. Sentiment scores for this topic differed across the 3 cities (P<.001). Conclusions: Our work demonstrates that data from city-specific subreddits can be used to better understand concerns and sentiments around COVID-19 vaccines at the local level. This can potentially lead to more targeted and publicly acceptable policies based on content on social media. %M 34519654 %R 10.2196/32685 %U https://www.jmir.org/2021/9/e32685 %U https://doi.org/10.2196/32685 %U http://www.ncbi.nlm.nih.gov/pubmed/34519654 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e31278 %T The Influence of Social Distancing Behaviors and Psychosocial Factors on Physical Activity During the COVID-19 Pandemic: Cross-sectional Survey Study %A Cross,Troy J %A Isautier,Jennifer M J %A Morris,Sarah J %A Johnson,Bruce D %A Wheatley-Guy,Courtney M %A Taylor,Bryan J %+ Sydney School of Health Sciences, Faculty of Medicine and Health, The University of Sydney, Camperdown Campus, Camperdown, 2006, Australia, 61 2 9351 2222, troy.cross@sydney.edu.au %K physical activity %K COVID-19 %K mental health %K social distancing %K public health %K pandemic %K physical health %K exercise %D 2021 %7 24.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has arguably facilitated a shift toward increased sedentariness and reduced physical activity. Moreover, there is mounting evidence that mental health has also declined during the pandemic. However, it remains unknown to what extent social distancing (SD) behaviors and mental health have affected the physical activity levels of the general population. Objective: The purpose of this study was to determine the influence of SD behaviors and prevailing mental health on the odds of being physically active during the early COVID-19 pandemic response. Methods: A total of 4819 adults (2474/4819, 51.3%, female) from the US population with a median age of 46 (IQR 35-59) completed an online survey during the early pandemic response (April-June 2020). The survey included questions on adherence to 11 SD behaviors, and validated questionnaires which assessed self-reported physical activity, depression, anxiety, and mental well-being. Respondents were categorized into 2 physical activity groups: inactive (0-599 metabolic equivalent of task [MET]-minutes/week) and active (≥600 MET-minutes/week). A logistic generalized additive model (GAM) was used to determine which SD factors and mental health outcomes were associated with physical activity level. Results: The GAM analysis revealed that wearing a facemask in public (odds ratio [OR] 1.46, 95% CI 1.14-1.79; P=.003), limiting the use of public transport (OR 1.47, 95% CI 1.19-1.83; P=.001), and restricting travel outside the house (OR 1.56, 95% CI 1.19-2.05; P=.002) were SD behaviors associated with higher odds of being more physically active. Conversely, avoiding physical activity outside the house was associated with higher odds of being inactive (OR 0.52, 95% CI 0.46-0.63; P<.001). Leaving the house more frequently, and a higher mental well-being were associated with increasing odds of being physically active (P<.001). Engaging with a moderate number of SD behaviors (3-7 total) was positively associated with physical activity, whereas a very high SD vigilance (ie, engaging with ≥10 total behaviors) decreased the odds of being active during the early pandemic response. Conclusions: Based on the findings of our study, we suggest that future public health messaging of SD guidelines should include (1) a clear portrayal of the benefits of regular exercise on mental health; and (2) a specific focus on how to be physically active outdoors in a COVID-safe manner. %M 34509976 %R 10.2196/31278 %U https://publichealth.jmir.org/2021/9/e31278 %U https://doi.org/10.2196/31278 %U http://www.ncbi.nlm.nih.gov/pubmed/34509976 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28002 %T “Skip the Small Talk” Virtual Event Intended to Promote Social Connection During a Global Pandemic: Online Survey Study %A Mote,Jasmine %A Gill,Kathryn %A Fulford,Daniel %+ Department of Occupational Therapy, Tufts University, 574 Boston Ave, Medford, MA, 02155, United States, 1 617 627 3781, jasmine.mote@tufts.edu %K COVID-19 %K depression %K digital group %K loneliness %K social connection %K virtual social interaction %K community %K mental health %K connection %K virtual health %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social distancing measures meant to prevent the spread of COVID-19 in the past year have exacerbated loneliness and depression in the United States. While virtual tools exist to improve social connections, there have been limited attempts to assess community-based, virtual methods to promote new social connections. Objective: In this proof-of-concept study, we examined the extent to which Skip the Small Talk (STST)—a business dedicated to hosting events to facilitate structured, vulnerable conversations between strangers—helped reduce loneliness in a virtual format in the early months of the 2020 COVID-19 pandemic. We predicted that participants who attended STST virtual events would show a reduction in loneliness, improvement in positive affect, and reduction in negative affect after attending an event. We were also interested in exploring the role of depression symptoms on these results as well as the types of goals participants accomplished by attending STST events. Methods: Adult participants who registered for an STST virtual event between March 25 and June 30, 2020, completed a survey before attending the event (pre-event survey; N=64) and a separate survey after attending the event (postevent survey; n=25). Participants reported on their depression symptoms, loneliness, and positive and negative affect. Additionally, participants reported the goals they wished to accomplish as well as those they actually accomplished by attending the STST event. Results: The four most cited goals that participants hoped to accomplish before attending the STST event included the following: “to make new friends,” “to have deeper/better conversations with other people,” “to feel less lonely,” and “to practice social skills.” A total of 34% (20/58) of participants who completed the pre-event survey reported depression symptoms that indicated a high risk of a major depressive episode in the preceding 2 weeks. Of the 25 participants who completed the pre- and postevent surveys, participants reported a significant reduction in loneliness (P=.03, Cohen d=0.48) and negative affect (P<.001, Cohen d=1.52) after attending the STST event compared to before the event. Additionally, depressive symptoms were significantly positively correlated with change in negative affect (P=.03), suggesting that the higher the depression score was prior to attending the STST event, the higher the reduction in negative affect was following the event. Finally, 100% of the participants who wished to reduce their loneliness (11/11) or feel less socially anxious (5/5) prior to attending the STST event reported that they accomplished those goals after the event. Conclusions: Our preliminary assessment suggests that the virtual format of STST was helpful for reducing loneliness and negative affect for participants, including those experiencing depression symptoms, during the COVID-19 pandemic. While encouraging, additional research is necessary to demonstrate whether STST has benefits when compared to other social events and interventions and whether such benefits persist beyond the events themselves. %M 34468326 %R 10.2196/28002 %U https://formative.jmir.org/2021/9/e28002 %U https://doi.org/10.2196/28002 %U http://www.ncbi.nlm.nih.gov/pubmed/34468326 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e25615 %T Pretesting a Poster on Recommended Stress Management During the COVID-19 Pandemic in Indonesia: Qualitative Study %A Wati,Risa Laras %A Ulfa,Annisa Sayyidatul %A Kevaladandra,Zulfa %A Shalihat,Shelly %A Syahadatina,Bella %A Pratomo,Hadi %+ Department of Health Education & Behavioral Sciences, Faculty of Public Health, Universitas Indonesia, Jl. Margonda Raya, Pondok Cina, Kecamatan Beji, Depok, 16424, Indonesia, 62 8161841277, hadi.pratomo@ui.ac.id %K pretesting %K media %K stress %K COVID-19 %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 Peritraumatic Distress Index (CPDI) is a self-report questionnaire developed to evaluate the frequency of anxiety and depression symptoms among individuals during the COVID-19 pandemic. A recent study in China showed high CPDI scores among individuals in the 18-30 years age group and those over 60 years. During the COVID-19 outbreak, people were expected to maintain their mental health conditions, especially stress levels. Therefore, many national governments actively published health promotion media in an effort to educate the public. One such media developed by the Ministry of Health, Republic of Indonesia, was a poster titled “Hindari Stres dan Tetap Optimis dengan Melakukan Aktivitas Sehari-hari dan Tetap Menjaga Jarak.” Objective: The aim of this study is to conduct a test on a stress management recommendation poster developed by the Ministry of Health, Republic of Indonesia, in response to the COVID-19 outbreak by using pretesting communication theory. Methods: In-depth interviews were conducted among 8 key informants and 1 graphic design expert. Results: Pretesting can identify the strengths and weaknesses of media. The large amount of text and the lack of illustrations made the poster less attractive to readers. Moreover, there was a discrepancy between the title and contents of the poster. The poster was not able to persuade the informants to change their behavior in the near future. Conclusions: The poster was understood and accepted by the informants, but there was still much to be improved considering the poster was a product of the Ministry of Health, Republic of Indonesia. %M 34254944 %R 10.2196/25615 %U https://formative.jmir.org/2021/9/e25615 %U https://doi.org/10.2196/25615 %U http://www.ncbi.nlm.nih.gov/pubmed/34254944 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e29429 %T Implementation of Telehealth Services at the US Department of Veterans Affairs During the COVID-19 Pandemic: Mixed Methods Study %A Der-Martirosian,Claudia %A Wyte-Lake,Tamar %A Balut,Michelle %A Chu,Karen %A Heyworth,Leonie %A Leung,Lucinda %A Ziaeian,Boback %A Tubbesing,Sarah %A Mullur,Rashmi %A Dobalian,Aram %+ Veterans Emergency Management Evaluation Center, US Department of Veterans Affairs, 16111 Plummer St MS-152, North Hills, CA, 91343, United States, 1 818 891 7711 ext 36124, claudia.der-martirosian@va.gov %K telehealth %K telemedicine %K veterans %K US Department of Veterans Affairs %K primary care %K cardiology %K home-based primary care %K COVID-19 %D 2021 %7 23.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: At the onset of the COVID-19 pandemic, there was a rapid increase in the use of telehealth services at the US Department of Veterans Affairs (VA), which was accelerated by state and local policies mandating stay-at-home orders and restricting nonurgent in-person appointments. Even though the VA was an early adopter of telehealth in the late 1990s, the vast majority of VA outpatient care continued to be face-to-face visits through February 2020. Objective: We compared telehealth service use at a VA Medical Center, Greater Los Angeles across 3 clinics (primary care [PC], cardiology, and home-based primary care [HBPC]) 12 months before and 12 months after the onset of COVID-19 (March 2020). Methods: We used a parallel mixed methods approach including simultaneous quantitative and qualitative approaches. The distribution of monthly outpatient and telehealth visits, as well as telephone and VA Video Connect encounters were examined for each clinic. Semistructured telephone interviews were conducted with 34 staff involved in telehealth services within PC, cardiology, and HBPC during COVID-19. All audiotaped interviews were transcribed and analyzed by identifying key themes. Results: Prior to COVID-19, telehealth use was minimal at all 3 clinics, but at the onset of COVID-19, telehealth use increased substantially at all 3 clinics. Telephone was the main modality of patient choice. Compared with PC and cardiology, video-based care had the greatest increase in HBPC. Several important barriers (multiple steps for videoconferencing, creation of new scheduling grids, and limited access to the internet and internet-connected devices) and facilitators (flexibility in using different video-capable platforms, technical support for patients, identification of staff telehealth champions, and development of workflows to help incorporate telehealth into treatment plans) were noted. Conclusions: Technological issues must be addressed at the forefront of telehealth evolution to achieve access for all patient populations with different socioeconomic backgrounds, living situations and locations, and health conditions. The unprecedented expansion of telehealth during COVID-19 provides opportunities to create lasting telehealth solutions to improve access to care beyond the pandemic. %M 34477554 %R 10.2196/29429 %U https://formative.jmir.org/2021/9/e29429 %U https://doi.org/10.2196/29429 %U http://www.ncbi.nlm.nih.gov/pubmed/34477554 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30274 %T Severe Fatigue in Long COVID: Web-Based Quantitative Follow-up Study in Members of Online Long COVID Support Groups %A Van Herck,Maarten %A Goërtz,Yvonne M J %A Houben-Wilke,Sarah %A Machado,Felipe V C %A Meys,Roy %A Delbressine,Jeannet M %A Vaes,Anouk W %A Burtin,Chris %A Posthuma,Rein %A Franssen,Frits M E %A Hajian,Bita %A Vijlbrief,Herman %A Spies,Yvonne %A van 't Hul,Alex J %A Janssen,Daisy J A %A Spruit,Martijn A %+ REVAL Rehabilitation Research Center, BIOMED Research Institute, Faculty of Rehabilitation Sciences, Hasselt University, Agoralaan gebouw A, Diepenbeek, 3590, Belgium, 32 494758248, maarten.vanherck@uhasselt.be %K COVID-19 %K SARS-CoV-2 %K long COVID %K post-COVID-19 syndrome %K post-acute sequelae of COVID-19 %K fatigue %K post-viral fatigue %K pandemic %K online health %K mental health %K online support %D 2021 %7 21.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Fatigue is the most commonly reported symptom in patients with persistent complaints following COVID-19 (ie, long COVID). Longitudinal studies examining the intensity of fatigue and differentiating between physical and mental fatigue are lacking. Objective: The objectives of this study were to (1) assess the severity of fatigue over time in members of online long COVID peer support groups, and (2) assess whether members of these groups experienced mental fatigue, physical fatigue, or both. Methods: A 2-wave web-based follow-up study was conducted in members of online long COVID peer support groups with a confirmed diagnosis approximately 3 and 6 months after the onset of infectious symptoms. Demographics, COVID-19 diagnosis, received health care (from medical professionals or allied health care professionals), fatigue (Checklist Individual Strength–subscale subjective fatigue [CIS-Fatigue]; 8-56 points), and physical and mental fatigue (self-constructed questions; 3-21 points) were assessed. Higher scores indicated more severe fatigue. A CIS-Fatigue score ≥36 points was used to qualify patients as having severe fatigue. Results: A total of 239 patients with polymerase chain reaction/computed tomography–confirmed COVID-19 completed the survey 10 weeks (SD 2) and 23 weeks (SD 2) after onset of infectious symptoms, respectively (T1 and T2). Of these 239 patients, 198 (82.8%) were women; 142 (59.4%) had no self-reported pre-existing comorbidities; 208 (87%) self-reported being in good health before contracting COVID-19; and 62 (25.9%) were hospitalized during acute infection. The median age was 50 years (IQR 39-56). The vast majority of patients had severe fatigue at T1 and T2 (n=204, 85.4%, and n=188, 78.7%, respectively). No significant differences were found in the prevalence of normal, mild, and severe fatigue between T1 and T2 (P=.12). The median CIS-Fatigue score was 48 points (IQR 42-53) at T1, and it decreased from T1 to T2 (median change: –2 points, IQR –7 to 3; P<.001). At T1, a median physical fatigue score of 19 points (IQR 16-20) and a median mental fatigue score of 15 points (IQR 10-17) were reported; these scores were lower at T2 for physical but not for mental fatigue (median change for physical fatigue –1 point, IQR –3 to 0, P<.001; median change for mental fatigue 0 points, IQR –3 to 3, P=.52). At the time of completing the follow-up survey, 194/239 (81.2%) and 164/239 (68.6%) of all patients had received care from at least one medical professional and one allied health care professional, respectively. Conclusions: Fatigue in members of online long COVID support groups with a confirmed COVID-19 diagnosis decreases from 10 to 23 weeks after onset of symptoms. Despite this, severe fatigue remains highly prevalent. Both physical and mental fatigue are present. It remains unclear whether and to what extent fatigue will resolve spontaneously in the longer term. Trial Registration: Netherlands Trial Register NTR8705; https://www.trialregister.nl/trial/8705. %M 34494964 %R 10.2196/30274 %U https://www.jmir.org/2021/9/e30274 %U https://doi.org/10.2196/30274 %U http://www.ncbi.nlm.nih.gov/pubmed/34494964 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e28005 %T Clinical, Laboratory, and Imaging Features of COVID-19 in a Cohort of Patients: Cross-Sectional Comparative Study %A Qaisieh,Rami %A Al-Tamimi,Mohammad %A El-Hammuri,Naser %A Shalabi,Marwan %A Kilani,Muna M %A Taha,Hana %A Al-Muhtaseb,Abdallah %A Alfarrajin,Ibrahim %A Abu Shaqra,Marwan %A Hamdan,Almothana %+ Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Damascus Highway, Zarqa, Jordan, 962 5 3903333, mohammad.altamimi@hu.edu.jo %K COVID-19 %K gender %K clinical %K laboratory %K imaging %K SARS-CoV2 %K Jordan %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34081600 %R 10.2196/28005 %U https://publichealth.jmir.org/2021/9/e28005 %U https://doi.org/10.2196/28005 %U http://www.ncbi.nlm.nih.gov/pubmed/34081600 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e27283 %T Chloe for COVID-19: Evolution of an Intelligent Conversational Agent to Address Infodemic Management Needs During the COVID-19 Pandemic %A Siedlikowski,Sophia %A Noël,Louis-Philippe %A Moynihan,Stephanie Anne %A Robin,Marc %+ Dialogue Health Technologies Inc, 390 Rue Notre-Dame Ouest #200, Montreal, QC, H2Y 1T9, Canada, 1 613 806 0671, marc.robin@dialogue.co %K chatbot %K COVID-19 %K conversational agents %K public health %K artificial intelligence %K infodemic %K infodemiology %K misinformation %K digital health %K virtual care %D 2021 %7 21.9.2021 %9 Viewpoint %J J Med Internet Res %G English %X There is an unprecedented demand for infodemic management due to rapidly evolving information about the novel COVID-19 pandemic. This viewpoint paper details the evolution of a Canadian digital information tool, Chloe for COVID-19, based on incremental leveraging of artificial intelligence techniques. By providing an accessible summary of Chloe’s development, we show how proactive cooperation between health, technology, and corporate sectors can lead to a rapidly scalable, safe, and secure virtual chatbot to assist public health efforts in keeping Canadians informed. We then highlight Chloe’s strengths, the challenges we faced during the development process, and future directions for the role of chatbots in infodemic management. The information presented here may guide future collaborative efforts in health technology in order to enhance access to accurate and timely health information to the public. %M 34375299 %R 10.2196/27283 %U https://www.jmir.org/2021/9/e27283 %U https://doi.org/10.2196/27283 %U http://www.ncbi.nlm.nih.gov/pubmed/34375299 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30280 %T Delivering Mental Health Care Virtually During the COVID-19 Pandemic: Qualitative Evaluation of Provider Experiences in a Scaled Context %A Budhwani,Suman %A Fujioka,Jamie Keiko %A Chu,Cherry %A Baranek,Hayley %A Pus,Laura %A Wasserman,Lori %A Vigod,Simone %A Martin,Danielle %A Agarwal,Payal %A Mukerji,Geetha %+ Women's College Hospital Institute for Health System Solutions & Virtual Care, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 (416) 323 6400, suman.budhwani@wchospital.ca %K virtual care %K mental health %K quality of care %K implementation %K COVID-19 %K digital health %K pandemic %K ambulatory care %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Virtual care delivery within mental health has increased rapidly during the COVID-19 pandemic. Understanding facilitators and challenges to adoption and perceptions of the quality of virtual care when delivered at scale can inform service planning postpandemic. Objective: We sought to understand consistent facilitators and persistent challenges to adoption of virtual care and perceived impact on quality of care in an initial pilot phase prior to the pandemic and then during scaled use during the pandemic in the mental health department of an ambulatory care hospital. Methods: This study took place at Women’s College Hospital, an academic ambulatory hospital located in Toronto, Canada. We utilized a multimethods approach to collect quantitative data through aggregate utilization data of phone, video, and in-person visits prior to and during COVID-19 lockdown measures and through a provider experience survey administered to mental health providers (n=30). Qualitative data were collected through open-ended questions on provider experience surveys, focus groups (n=4) with mental health providers, and interviews with clinical administrative and implementation hospital staff (n=3). Results: Utilization data demonstrated slower uptake of video visits at launch and prior to COVID-19 lockdown measures in Ontario (pre-March 2020) and subsequent increased uptake of phone and video visits during COVID-19 lockdown measures (post-March 2020). Mental health providers and clinic staff highlighted barriers and facilitators to adoption of virtual care at the operational, behavioral, cultural, and system/policy levels such as required changes in workflows and scheduling, increased provider effort, provider and staff acceptance, and billing codes for physician providers. Much of the described provider experiences focused on perceived impact on quality of mental health care delivery, including perceptions on providing appropriate and patient-centered care, virtual care effectiveness, and equitable access to care for patients. Conclusions: Continued efforts to enhance suggested facilitators, reduce persistent challenges, and address provider concerns about care quality based on these findings can enable a hybrid model of patient-centered and appropriate care to emerge in the future, with options for in-person, video, and phone visits being used to meet patient and clinical needs as required. %M 34406967 %R 10.2196/30280 %U https://formative.jmir.org/2021/9/e30280 %U https://doi.org/10.2196/30280 %U http://www.ncbi.nlm.nih.gov/pubmed/34406967 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e30422 %T Trends in Stress Throughout Pregnancy and Postpartum Period During the COVID-19 Pandemic: Longitudinal Study Using Ecological Momentary Assessment and Data From the Postpartum Mothers Mobile Study %A Omowale,Serwaa S %A Casas,Andrea %A Lai,Yu-Hsuan %A Sanders,Sarah A %A Hill,Ashley V %A Wallace,Meredith L %A Rathbun,Stephen L %A Gary-Webb,Tiffany L %A Burke,Lora E %A Davis,Esa M %A Mendez,Dara D %+ Department of Epidemiology, Graduate School of Public Health, University of Pittsburgh, 130 De Soto Street, Pittsburgh, PA, 15261, United States, 1 4126243001, ddm11@pitt.edu %K COVID-19 %K ecological momentary assessment %K health status disparities %K pandemics %K postpartum %K pregnancy %K psychological stress %D 2021 %7 21.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Stress is associated with adverse birth and postpartum health outcomes. Few studies have longitudinally explored racial differences in maternal stress in a birthing population in the United States during the ongoing COVID-19 pandemic. Objective: This study aimed to do the following: (1) assess changes in reported stress before, during, and after initial emergency declarations (eg, stay-at-home orders) were in place due to the COVID-19 pandemic, and (2) assess Black-White differences in reported stress in a pregnant and postpartum population from Southwestern Pennsylvania. Methods: We leveraged data from the ongoing Postpartum Mothers Mobile Study (PMOMS), which surveys participants in real time throughout the pregnancy and postpartum periods via ecological momentary assessment (EMA) and smartphone technology. We analyzed data from a subset of PMOMS participants (n=85) who were either Black or White, and who submitted EMA responses regarding stress between November 1, 2019, and August 31, 2020, the time frame of this study. We divided data into four phases based on significant events during the COVID-19 pandemic: “pre” phase (baseline), “early” phase (first case of COVID-19 reported in United States), “during” phase (stay-at-home orders), and “post” phase (stay-at-home orders eased). We assessed mean stress levels at each phase using linear mixed-effects models and post hoc contrasts based on the models. Results: Overall mean stress (0=not at all to 4=a lot) during the pre phase was 0.8 for Black and White participants (range for Black participants: 0-3.9; range for White participants: 0-2.8). There was an increase of 0.3 points (t5649=5.2, P<.001) in the during phase as compared with the pre phase, and an increase of 0.2 points (t5649=3.1, P=.002) in the post phase compared with the pre phase (n=85). No difference was found between Black and White participants in the change in mean stress from the pre phase to the during phase (overall change predicted for the regression coefficient=–0.02, P=.87). There was a significant difference between Black and White participants in the change in mean stress from the during phase to the post phase (overall change predicted for the regression coefficient=0.4, P<.001). Conclusions: There was an overall increase in mean stress levels in this subset of pregnant and postpartum participants during the same time as the emergency declarations/stay-at-home orders in the United States. Compared to baseline, mean stress levels remained elevated when stay-at-home orders eased. We found no significant difference in the mean stress levels by race. Given that stress is associated with adverse birth outcomes and postpartum health, stress induced by the ongoing COVID-19 pandemic may have adverse implications for birthing populations in the United States. International Registered Report Identifier (IRRID): RR2-10.2196/13569 %M 34328420 %R 10.2196/30422 %U https://mental.jmir.org/2021/9/e30422 %U https://doi.org/10.2196/30422 %U http://www.ncbi.nlm.nih.gov/pubmed/34328420 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e30460 %T Determinants of Shielding Behavior During the COVID-19 Pandemic and Associations With Well-being Among National Health Service Patients: Longitudinal Observational Study %A Bachtiger,Patrik %A Adamson,Alexander %A Maclean,William A %A Kelshiker,Mihir A %A Quint,Jennifer K %A Peters,Nicholas S %+ National Heart and Lung Institute, Imperial College London, Hammersmith Hospital, Du Cane Road, London, W12 0HS, United Kingdom, 44 020 7589 5111, n.peters@imperial.ac.uk %K COVID-19 %K shielding %K well-being %K personal health record %K determinant %K behavior %K protection %K longitudinal %K observational %K health policy %K mental health %K epidemiology %K public health %D 2021 %7 20.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34298499 %R 10.2196/30460 %U https://publichealth.jmir.org/2021/9/e30460 %U https://doi.org/10.2196/30460 %U http://www.ncbi.nlm.nih.gov/pubmed/34298499 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30161 %T Information Retrieval in an Infodemic: The Case of COVID-19 Publications %A Teodoro,Douglas %A Ferdowsi,Sohrab %A Borissov,Nikolay %A Kashani,Elham %A Vicente Alvarez,David %A Copara,Jenny %A Gouareb,Racha %A Naderi,Nona %A Amini,Poorya %+ Department of Radiology and Medical Informatics, University of Geneva, Campus Biotech G6-N3 - Chemin des Mines 9, Geneva, 1202, Switzerland, 41 022 379 0225, douglas.teodoro@unige.ch %K information retrieval %K multistage retrieval %K neural search %K deep learning %K COVID-19 %K coronavirus %K infodemic %K infodemiology %K literature %K online information %D 2021 %7 17.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 global health crisis has led to an exponential surge in published scientific literature. In an attempt to tackle the pandemic, extremely large COVID-19–related corpora are being created, sometimes with inaccurate information, which is no longer at scale of human analyses. Objective: In the context of searching for scientific evidence in the deluge of COVID-19–related literature, we present an information retrieval methodology for effective identification of relevant sources to answer biomedical queries posed using natural language. Methods: Our multistage retrieval methodology combines probabilistic weighting models and reranking algorithms based on deep neural architectures to boost the ranking of relevant documents. Similarity of COVID-19 queries is compared to documents, and a series of postprocessing methods is applied to the initial ranking list to improve the match between the query and the biomedical information source and boost the position of relevant documents. Results: The methodology was evaluated in the context of the TREC-COVID challenge, achieving competitive results with the top-ranking teams participating in the competition. Particularly, the combination of bag-of-words and deep neural language models significantly outperformed an Okapi Best Match 25–based baseline, retrieving on average, 83% of relevant documents in the top 20. Conclusions: These results indicate that multistage retrieval supported by deep learning could enhance identification of literature for COVID-19–related questions posed using natural language. %M 34375298 %R 10.2196/30161 %U https://www.jmir.org/2021/9/e30161 %U https://doi.org/10.2196/30161 %U http://www.ncbi.nlm.nih.gov/pubmed/34375298 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29085 %T Public Adoption of and Trust in the NHS COVID-19 Contact Tracing App in the United Kingdom: Quantitative Online Survey Study %A Dowthwaite,Liz %A Fischer,Joel %A Perez Vallejos,Elvira %A Portillo,Virginia %A Nichele,Elena %A Goulden,Murray %A McAuley,Derek %+ Horizon Digital Economy Research, University of Nottingham, Innovation Park, Triumph Road, Nottingham, NG7 2TU, United Kingdom, 44 07943583035, liz.dowthwaite@gmail.com %K trust %K technology adoption %K COVID-19 %K digital contact tracing %K coronavirus %K vulnerable populations %K attitudes %K SARS-CoV-2 %K digital proximity tracing %K compliance %D 2021 %7 17.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital contact tracing is employed to monitor and manage the spread of COVID-19. However, to be effective the system must be adopted by a substantial proportion of the population. Studies of mostly hypothetical contact tracing apps show generally high acceptance, but little is known about the drivers and barriers to adoption of deployed systems. Objective: The aim of this study was to investigate adoption of and attitudes toward the NHS (National Health Service) COVID-19 smartphone app, the digital contact tracing solution in the United Kingdom. Methods: An online survey based on the extended Technology Acceptance Model with the added factor of trust was carried out with a representative sample of the UK population. Statistical analysis showed adoption rates, attitudes toward and trust in the app, and compliance with self-isolation advice and highlighted differences for vulnerable populations (ie, older adults aged 65 years and over and members of Black, Asian, and minority ethnic [BAME] communities). Results: A total of 1001 participants took part in the study. Around half of the participants who had heard of the NHS COVID-19 mobile phone app (490/963, 50.9%; 95% CI 47.8%-54.0%) had downloaded and kept the app, but more than one-third (345/963, 35.8%; 95% CI 32.8%-38.8%) either did not intend to download it or had deleted it. Significantly more BAME respondents than White respondents had deleted the app (16/115, 13.9%; 95% CI 11.8%-16.0%, vs 65/876, 7.4%; 95% CI 5.8%-9.0%), and significantly more older adults 65 years and over than those under 65 years did not intend to download it (44/127, 34.6%; 95% CI 31.7%-37.5%, vs 220/874, 25.2%; 95% CI 22.5%-27.9%). Broadly, one of the reasons for uptake was to help the NHS and other people, especially among older adults, although significantly fewer BAME participants agreed that they did so to help the NHS. Reported compliance with received notifications to self-isolate was high but was significantly lower than reported intended compliance without received notifications. Only one-fifth (136/699, 19.5%; 95% CI 17.0%-22.0%) of participants understood that the decision to send self-isolation notifications was automated by the app. There were a range of significantly more negative views among BAME participants, including lower trust in the NHS, while older adults were often significantly more positive. Respondents without the app reported significantly lower trust and more negative views toward the app and were less likely to report that they understood how the app works. Conclusions: While compliance on the part of the approximately 50% of participants who had the app was fairly high, there were issues surrounding trust and understanding that hindered adoption and, therefore, the effectiveness of digital contact tracing, particularly among BAME communities. This study highlights that more needs to be done to improve adoption among groups who are more vulnerable to the effects of the virus in order to enhance uptake and acceptance of contact tracing apps. %M 34406960 %R 10.2196/29085 %U https://www.jmir.org/2021/9/e29085 %U https://doi.org/10.2196/29085 %U http://www.ncbi.nlm.nih.gov/pubmed/34406960 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e31930 %T Morocco's National Response to the COVID-19 Pandemic: Public Health Challenges and Lessons Learned %A Barkia,Abdelaziz %A Laamrani,Hammou %A Belalia,Abdelmounaim %A Benmamoun,Abderrahman %A Khader,Yousef %+ Department of Public Health, Jordan University of Science and technology, Alramtha-Amman street, Irbid, 22110, Jordan, 962 796802040, yskhader@just.edu.jo %K COVID-19 %K public health %K challenges %K prevention %K control %K infectious disease %D 2021 %7 17.9.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X This report aimed to provide an overview of the epidemiological situation of COVID-19 in Morocco and to review the actions carried out as part of the national response to this pandemic. The methodology adopted was based on literature review, interviews with officials and actors in the field, and remote discussion workshops with a multidisciplinary and multisectoral working group. Morocco took advantage of the capacities already strengthened within the framework of the application of the provisions of the International Health Regulations (IHR) of 2005. A SWOT analysis made it possible to note that an unprecedented political commitment enabled all the necessary means to face the pandemic and carry out all the response activities, including a campaign of relentless communication. Nevertheless, and despite the efforts made, the shortage of human resources, especially those qualified in intensive care and resuscitation, has been the main drawback to be addressed. The main lesson learned is a need to further strengthen national capacities to prepare for and respond to possible public health emergencies and to embark on a process overhaul of the health system, including research into innovative tools to ensure the continuity of the various disease prevention and control activities. In addition, response to a health crisis is not only the responsibility of the health sector but also intersectoral collaboration is needed to guarantee an optimal coordinated fight. Community-oriented approaches in public health have to be strengthened through more participation and involvement of nongovernmental organizations (NGOs) and civil society in operational and strategic planning. %M 34388104 %R 10.2196/31930 %U https://publichealth.jmir.org/2021/9/e31930 %U https://doi.org/10.2196/31930 %U http://www.ncbi.nlm.nih.gov/pubmed/34388104 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 9 %P e27670 %T Social Media Monitoring of the COVID-19 Pandemic and Influenza Epidemic With Adaptation for Informal Language in Arabic Twitter Data: Qualitative Study %A Alsudias,Lama %A Rayson,Paul %+ Information Technology Department, College of Computer and Information Sciences, King Saud University, Prince Turki Bin Abdulaziz Al Awwal Road, Riyadh, 12371, Saudi Arabia, 966 118051044, lalsudias@ksu.edu.sa %K Arabic %K COVID-19 %K infectious disease %K influenza %K infodemiology %K infoveillance %K social listening %K informal language %K multilabel classification %K natural language processing %K named entity recognition %K Twitter %D 2021 %7 17.9.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Twitter is a real-time messaging platform widely used by people and organizations to share information on many topics. Systematic monitoring of social media posts (infodemiology or infoveillance) could be useful to detect misinformation outbreaks as well as to reduce reporting lag time and to provide an independent complementary source of data compared with traditional surveillance approaches. However, such an analysis is currently not possible in the Arabic-speaking world owing to a lack of basic building blocks for research and dialectal variation. Objective: We collected around 4000 Arabic tweets related to COVID-19 and influenza. We cleaned and labeled the tweets relative to the Arabic Infectious Diseases Ontology, which includes nonstandard terminology, as well as 11 core concepts and 21 relations. The aim of this study was to analyze Arabic tweets to estimate their usefulness for health surveillance, understand the impact of the informal terms in the analysis, show the effect of deep learning methods in the classification process, and identify the locations where the infection is spreading. Methods: We applied the following multilabel classification techniques: binary relevance, classifier chains, label power set, adapted algorithm (multilabel adapted k-nearest neighbors [MLKNN]), support vector machine with naive Bayes features (NBSVM), bidirectional encoder representations from transformers (BERT), and AraBERT (transformer-based model for Arabic language understanding) to identify tweets appearing to be from infected individuals. We also used named entity recognition to predict the place names mentioned in the tweets. Results: We achieved an F1 score of up to 88% in the influenza case study and 94% in the COVID-19 one. Adapting for nonstandard terminology and informal language helped to improve accuracy by as much as 15%, with an average improvement of 8%. Deep learning methods achieved an F1 score of up to 94% during the classifying process. Our geolocation detection algorithm had an average accuracy of 54% for predicting the location of users according to tweet content. Conclusions: This study identified two Arabic social media data sets for monitoring tweets related to influenza and COVID-19. It demonstrated the importance of including informal terms, which are regularly used by social media users, in the analysis. It also proved that BERT achieves good results when used with new terms in COVID-19 tweets. Finally, the tweet content may contain useful information to determine the location of disease spread. %M 34346892 %R 10.2196/27670 %U https://medinform.jmir.org/2021/9/e27670 %U https://doi.org/10.2196/27670 %U http://www.ncbi.nlm.nih.gov/pubmed/34346892 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30504 %T An App-Based Surveillance System for Undergraduate Students’ Mental Health During the COVID-19 Pandemic: Protocol for a Prospective Cohort Study %A Brogly,Chris %A Bauer,Michael A %A Lizotte,Daniel J %A Press,MacLean L %A MacDougall,Arlene %A Speechley,Mark %A Huner,Erin %A Mitchell,Marc %A Anderson,Kelly K %A Pila,Eva %+ School of Kinesiology, Faculty of Health Sciences, Western University, 1151 Richmond Street, London, ON, N6A 3K7, Canada, 1 519 661 2111, epila@uwo.ca %K undergraduate %K mental health %K smartphone %K app %K COVID-19 %K postsecondary institutions %K mobile apps %K mHealth %K mobile health %D 2021 %7 17.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic is a public health emergency that poses challenges to the mental health of approximately 1.4 million university students in Canada. Preliminary evidence has shown that the COVID-19 pandemic had a detrimental impact on undergraduate student mental health and well-being; however, existing data are predominantly limited to cross-sectional survey-based studies. Owing to the evolving nature of the pandemic, longer-term prospective surveillance efforts are needed to better anticipate risk and protective factors during a pandemic. Objective: The overarching aim of this study is to use a mobile (primarily smartphone-based) surveillance system to identify risk and protective factors for undergraduate students’ mental health. Factors will be identified from weekly self-report data (eg, affect and living accommodation) and device sensor data (eg, physical activity and device usage) to prospectively predict self-reported mental health and service utilization. Methods: Undergraduate students at Western University (London, Ontario, Canada), will be recruited via email to complete an internet-based baseline questionnaire with the option to participate in the study on a weekly basis, using the Student Pandemic Experience (SPE) mobile app for Android/iOS. The app collects sensor samples (eg, GPS coordinates and steps) and self-reported weekly mental health and wellness surveys. Student participants can opt in to link their mobile data with campus-based administrative data capturing health service utilization. Risk and protective factors that predict mental health outcomes are expected to be estimated from (1) cross-sectional associations among students’ characteristics (eg, demographics) and key psychosocial factors (eg, affect, stress, and social connection), and behaviors (eg, physical activity and device usage) and (2) longitudinal associations between psychosocial and behavioral factors and campus-based health service utilization. Results: Data collection began November 9, 2020, and will be ongoing through to at least October 31, 2021. Retention from the baseline survey (N=427) to app sign-up was 74% (315/427), with 175-215 (55%-68%) app participants actively responding to weekly surveys. From November 9, 2020, to August 8, 2021, a total of 4851 responses to the app surveys and 25,985 sensor samples (consisting of up to 68 individual data items each; eg, GPS coordinates and steps) were collected from the 315 participants who signed up for the app. Conclusions: The results of this real-world longitudinal cohort study of undergraduate students’ mental health based on questionnaires and mobile sensor metrics is expected to show psychosocial and behavioral patterns associated with both positive and negative mental health–related states during pandemic conditions at a relatively large, public, and residential Canadian university campus. The results can be used to support decision-makers and students during the ongoing COVID-19 pandemic and similar future events. For comparable settings, new interventions (digital or otherwise) might be designed using these findings as an evidence base. International Registered Report Identifier (IRRID): DERR1-10.2196/30504 %M 34516391 %R 10.2196/30504 %U https://www.researchprotocols.org/2021/9/e30504 %U https://doi.org/10.2196/30504 %U http://www.ncbi.nlm.nih.gov/pubmed/34516391 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e30010 %T Assessing COVID-19 Vaccine Uptake and Effectiveness Through the North West London Vaccination Program: Retrospective Cohort Study %A Glampson,Ben %A Brittain,James %A Kaura,Amit %A Mulla,Abdulrahim %A Mercuri,Luca %A Brett,Stephen J %A Aylin,Paul %A Sandall,Tessa %A Goodman,Ian %A Redhead,Julian %A Saravanakumar,Kavitha %A Mayer,Erik K %+ Department of Surgery and Cancer, Imperial College London, 10th Floor QEQM building, St Mary's Hospital Campus, Praed Street, London, W2 1NY, United Kingdom, 44 2078082076, e.mayer@imperial.ac.uk %K health informatics %K real-word evidence %K COVID-19 %K medical informatics %K vaccine %K vaccination %D 2021 %7 17.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: On March 11, 2020, the World Health Organization declared SARS-CoV-2, causing COVID-19, as a pandemic. The UK mass vaccination program commenced on December 8, 2020, vaccinating groups of the population deemed to be most vulnerable to severe COVID-19 infection. Objective: This study aims to assess the early vaccine administration coverage and outcome data across an integrated care system in North West London, leveraging a unique population-level care data set. Vaccine effectiveness of a single dose of the Oxford/AstraZeneca and Pfizer/BioNTech vaccines were compared. Methods: A retrospective cohort study identified 2,183,939 individuals eligible for COVID-19 vaccination between December 8, 2020, and February 24, 2021, within a primary, secondary, and community care integrated care data set. These data were used to assess vaccination hesitancy across ethnicity, gender, and socioeconomic deprivation measures (Pearson product-moment correlations); investigate COVID-19 transmission related to vaccination hubs; and assess the early effectiveness of COVID-19 vaccination (after a single dose) using time-to-event analyses with multivariable Cox regression analysis to investigate if vaccination independently predicted positive SARS-CoV-2 in those vaccinated compared to those unvaccinated. Results: In this study, 5.88% (24,332/413,919) of individuals declined and did not receive a vaccination. Black or Black British individuals had the highest rate of declining a vaccine at 16.14% (4337/26,870). There was a strong negative association between socioeconomic deprivation and rate of declining vaccination (r=–0.94; P=.002) with 13.5% (1980/14,571) of individuals declining vaccination in the most deprived areas compared to 0.98% (869/9609) in the least. In the first 6 days after vaccination, 344 of 389,587 (0.09%) individuals tested positive for SARS-CoV-2. The rate increased to 0.13% (525/389,243) between days 7 and 13, before then gradually falling week on week. At 28 days post vaccination, there was a 74% (hazard ratio 0.26, 95% CI 0.19-0.35) and 78% (hazard ratio 0.22, 95% CI 0.18-0.27) reduction in risk of testing positive for SARS-CoV-2 for individuals that received the Oxford/AstraZeneca and Pfizer/BioNTech vaccines, respectively, when compared with unvaccinated individuals. A very low proportion of hospital admissions were seen in vaccinated individuals who tested positive for SARS-CoV-2 (288/389,587, 0.07% of all patients vaccinated) providing evidence for vaccination effectiveness after a single dose. Conclusions: There was no definitive evidence to suggest COVID-19 was transmitted as a result of vaccination hubs during the vaccine administration rollout in North West London, and the risk of contracting COVID-19 or becoming hospitalized after vaccination has been demonstrated to be low in the vaccinated population. This study provides further evidence that a single dose of either the Pfizer/BioNTech vaccine or the Oxford/AstraZeneca vaccine is effective at reducing the risk of testing positive for COVID-19 up to 60 days across all age groups, ethnic groups, and risk categories in an urban UK population. %M 34265740 %R 10.2196/30010 %U https://publichealth.jmir.org/2021/9/e30010 %U https://doi.org/10.2196/30010 %U http://www.ncbi.nlm.nih.gov/pubmed/34265740 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e31052 %T Associations Between the Perceived Severity of the COVID-19 Pandemic, Cyberchondria, Depression, Anxiety, Stress, and Lockdown Experience: Cross-sectional Survey Study %A Han,Lei %A Zhan,Yanru %A Li,Weizi %A Xu,Yuqing %A Xu,Yan %A Zhao,Jinzhe %+ Faculty of Psychology, Beijing Normal University, 19 Xinjiekouwai Street Haidian District, Beijing, 100875, China, 86 19800356013, sszbjz@163.com %K COVID-19 %K cyberchondria %K depression %K anxiety %K stress %K ABC theory of emotions %K lockdown experience %K perceived severity %K cross-sectional %K online health information %D 2021 %7 16.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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 (β=0.36, t=8.51, P<.001), anxiety (β=0.41, t=9.84, P<.001), and stress (β=0.46, t=11.45, P<.001), which were mediated by cyberchondria (β=0.36, t=8.59, P<.001). The direct effects of perceived severity of the COVID-19 pandemic on anxiety (β=0.07, t=2.01, P=.045) and stress (β=0.09, t=2.75, P=.006) and the indirect effects of cyberchondria on depression (β=0.10, t=2.59, P=.009) and anxiety (β=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. %M 34478402 %R 10.2196/31052 %U https://publichealth.jmir.org/2021/9/e31052 %U https://doi.org/10.2196/31052 %U http://www.ncbi.nlm.nih.gov/pubmed/34478402 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e30819 %T Early Detection of Symptom Exacerbation in Patients With SARS-CoV-2 Infection Using the Fitbit Charge 3 (DEXTERITY): Pilot Evaluation %A Yamagami,Kan %A Nomura,Akihiro %A Kometani,Mitsuhiro %A Shimojima,Masaya %A Sakata,Kenji %A Usui,Soichiro %A Furukawa,Kenji %A Takamura,Masayuki %A Okajima,Masaki %A Watanabe,Kazuyoshi %A Yoneda,Takashi %+ Department of Cardiovascular Medicine, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takaramachi, Kanazawa, Japan, 81 076 265 2000, anomura@med.kanazawa-u.ac.jp %K COVID-19 %K silent hypoxia %K wearable device %K Fitbit %K estimated oxygen variation %K detection %K infectious disease %K pilot study %K symptom %K outpatient %K oxygen %K sleep %K wearable %D 2021 %7 16.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Some patients with COVID-19 experienced sudden death due to rapid symptom deterioration. Thus, it is important to predict COVID-19 symptom exacerbation at an early stage prior to increasing severity in patients. Patients with COVID-19 could experience a unique “silent hypoxia” at an early stage of the infection when they are apparently asymptomatic, but with rather low SpO2 (oxygen saturation) levels. In order to continuously monitor SpO2 in daily life, a high-performance wearable device, such as the Apple Watch or Fitbit, has become commercially available to monitor several biometric data including steps, resting heart rate (RHR), physical activity, sleep quality, and estimated oxygen variation (EOV). Objective: This study aimed to test whether EOV measured by the wearable device Fitbit can predict COVID-19 symptom exacerbation. Methods: We recruited patients with COVID-19 from August to November 2020. Patients were asked to wear the Fitbit for 30 days, and biometric data including EOV and RHR were extracted. EOV is a relative physiological measure that reflects users’ SpO2 levels during sleep. We defined a high EOV signal as a patient’s oxygen level exhibiting a significant dip and recovery within the index period, and a high RHR signal as daily RHR exceeding 5 beats per day compared with the minimum RHR of each patient in the study period. We defined successful prediction as the appearance of those signals within 2 days before the onset of the primary outcome. The primary outcome was the composite of deaths of all causes, use of extracorporeal membrane oxygenation, use of mechanical ventilation, oxygenation, and exacerbation of COVID-19 symptoms, irrespective of readmission. We also assessed each outcome individually as secondary outcomes. We made weekly phone calls to discharged patients to check on their symptoms. Results: We enrolled 23 patients with COVID-19 diagnosed by a positive SARS-CoV-2 polymerase chain reaction test. The patients had a mean age of 50.9 (SD 20) years, and 70% (n=16) were female. Each patient wore the Fitbit for 30 days. COVID-19 symptom exacerbation occurred in 6 (26%) patients. We were successful in predicting exacerbation using EOV signals in 4 out of 5 cases (sensitivity=80%, specificity=90%), whereas the sensitivity and specificity of high RHR signals were 50% and 80%, respectively, both lower than those of high EOV signals. Coincidental obstructive sleep apnea syndrome confirmed by polysomnography was detected in 1 patient via consistently high EOV signals. Conclusions: This pilot study successfully detected early COVID-19 symptom exacerbation by measuring EOV, which may help to identify the early signs of COVID-19 exacerbation. Trial Registration: University Hospital Medical Information Network Clinical Trials Registry UMIN000041421; https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000047290 %M 34516390 %R 10.2196/30819 %U https://formative.jmir.org/2021/9/e30819 %U https://doi.org/10.2196/30819 %U http://www.ncbi.nlm.nih.gov/pubmed/34516390 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e30833 %T Shift in Social Media App Usage During COVID-19 Lockdown and Clinical Anxiety Symptoms: Machine Learning–Based Ecological Momentary Assessment Study %A Ryu,Jihan %A Sükei,Emese %A Norbury,Agnes %A H Liu,Shelley %A Campaña-Montes,Juan José %A Baca-Garcia,Enrique %A Artés,Antonio %A Perez-Rodriguez,M Mercedes %+ Department of Psychiatry, Icahn School of Medicine at Mount Sinai, Icahn (East) Bldg, 4th Floor, L4-53, 1425 Madison Ave, New York, NY, 10029, United States, 1 241 9775, mercedes.perez@mssm.edu %K anxiety disorder %K COVID-19 %K social media %K public health %K digital phenotype %K ecological momentary assessment %K smartphone %K machine learning %K hidden Markov model %D 2021 %7 15.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Anxiety symptoms during public health crises are associated with adverse psychiatric outcomes and impaired health decision-making. The interaction between real-time social media use patterns and clinical anxiety during infectious disease outbreaks is underexplored. Objective: We aimed to evaluate the usage pattern of 2 types of social media apps (communication and social networking) among patients in outpatient psychiatric treatment during the COVID-19 surge and lockdown in Madrid, Spain and their short-term anxiety symptoms (7-item General Anxiety Disorder scale) at clinical follow-up. Methods: The individual-level shifts in median social media usage behavior from February 1 through May 3, 2020 were summarized using repeated measures analysis of variance that accounted for the fixed effects of the lockdown (prelockdown versus postlockdown), group (clinical anxiety group versus nonclinical anxiety group), the interaction of lockdown and group, and random effects of users. A machine learning–based approach that combined a hidden Markov model and logistic regression was applied to predict clinical anxiety (n=44) and nonclinical anxiety (n=51), based on longitudinal time-series data that comprised communication and social networking app usage (in seconds) as well as anxiety-associated clinical survey variables, including the presence of an essential worker in the household, worries about life instability, changes in social interaction frequency during the lockdown, cohabitation status, and health status. Results: Individual-level analysis of daily social media usage showed that the increase in communication app usage from prelockdown to lockdown period was significantly smaller in the clinical anxiety group than that in the nonclinical anxiety group (F1,72=3.84, P=.05). The machine learning model achieved a mean accuracy of 62.30% (SD 16%) and area under the receiver operating curve 0.70 (SD 0.19) in 10-fold cross-validation in identifying the clinical anxiety group. Conclusions: Patients who reported severe anxiety symptoms were less active in communication apps after the mandated lockdown and more engaged in social networking apps in the overall period, which suggested that there was a different pattern of digital social behavior for adapting to the crisis. Predictive modeling using digital biomarkers—passive-sensing of shifts in category-based social media app usage during the lockdown—can identify individuals at risk for psychiatric sequelae. %M 34524091 %R 10.2196/30833 %U https://mental.jmir.org/2021/9/e30833 %U https://doi.org/10.2196/30833 %U http://www.ncbi.nlm.nih.gov/pubmed/34524091 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29622 %T Characterization and Identification of Variations in Types of Primary Care Visits Before and During the COVID-19 Pandemic in Catalonia: Big Data Analysis Study %A Lopez Segui,Francesc %A Hernandez Guillamet,Guillem %A Pifarré Arolas,Héctor %A Marin-Gomez,Francesc X %A Ruiz Comellas,Anna %A Ramirez Morros,Anna Maria %A Adroher Mas,Cristina %A Vidal-Alaball,Josep %+ Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Pica d'Estats 36, Sant Fruitós de Bages, Spain, 34 93 693 0040, jvidal.cc.ics@gencat.cat %K COVID-19 %K primary care %K diagnose variations %K big data %K ICD10 %K health system %K big data %K primary care %K healthcare system %D 2021 %7 14.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has turned the care model of health systems around the world upside down, causing the abrupt cancellation of face-to-face visits and redirection of the model toward telemedicine. Digital transformation boosts information systems—the more robust they are, the easier it is to monitor the health care system in a highly complex state and allow for more agile and reliable analysis. Objective: The purpose of this study was to analyze diagnoses from primary care visits and distinguish between those that had higher and lower variations, relative to the 2019 and 2020 periods (roughly before and during COVID-19), to identify clinical profiles that may have been most impaired from the least-used diagnostic codes for visits during the pandemic. Methods: We used a database from the Primary Care Services Information Technologies Information System of Catalonia. We analyzed the register of visits (n=2,824,185) and their International Classification of Diseases (ICD-10) diagnostic codes (n=3,921,974; mean 1.38 per visit), as approximations of the reasons for consultations, at 3 different grouping levels. The data were represented by a term frequency matrix and analyzed recursively in different partitions aggregated according to date. Results: The increase in non–face-to-face visits (+267%) did not counterbalance the decrease in face-to-face visits (–47%), with an overall reduction in the total number of visits of 1.36%, despite the notable increase in nursing visits (10.54%). The largest increases in 2020 were visits with diagnoses related to COVID-19 (ICD-10 codes Z20-Z29: 2.540%), along with codes related to economic and housing problems (ICD-10 codes Z55-Z65: 44.40%). Visits with most of the other diagnostic codes decreased in 2020 relative to those in 2019. The largest reductions were chronic pathologies such as arterial hypertension (ICD-10 codes I10-I16: –32.73%) or diabetes (ICD-10 codes E08-E13: –21.13%), but also obesity (E65-E68: –48.58%) and bodily injuries (ICD-10 code T14: –33.70%). Visits with mental health–related diagnostic codes decreased, but the decrease was less than the average decrease. There was a decrease in consultations—for children, adolescents, and adults—for respiratory infections (ICD-10 codes J00-J06: –40.96%). The results show large year-on-year variations (in absolute terms, an average of 12%), which is representative of the strong shock to the health system. Conclusions: The disruption in the primary care model in Catalonia has led to an explosive increase in the number of non–face-to-face visits. There has been a reduction in the number of visits for diagnoses related to chronic pathologies, respiratory infections, obesity, and bodily injuries. Instead, visits for diagnoses related to socioeconomic and housing problems have increased, which emphasizes the importance of social determinants of health in the context of this pandemic. Big data analytics with routine care data yield findings that are consistent with those derived from intuition in everyday clinical practice and can help inform decision making by health planners in order to use the next few years to focus on the least-treated diseases during the COVID-19 pandemic. %M 34313600 %R 10.2196/29622 %U https://www.jmir.org/2021/9/e29622 %U https://doi.org/10.2196/29622 %U http://www.ncbi.nlm.nih.gov/pubmed/34313600 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29136 %T Overview of Technologies Implemented During the First Wave of the COVID-19 Pandemic: Scoping Review %A Abd-Alrazaq,Alaa %A Hassan,Asmaa %A Abuelezz,Israa %A Ahmed,Arfan %A Alzubaidi,Mahmood Saleh %A Shah,Uzair %A Alhuwail,Dari %A Giannicchi,Anna %A Househ,Mowafa %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, P.O. Box 5825, Doha Al Luqta St, Ar-Rayyan, Doha, Qatar, 974 55708549, mhouseh@hbku.edu.qa %K technologies %K digital tools %K COVID-19 %K novel coronavirus %K scoping review %K digital health %K telemedicine %D 2021 %7 14.9.2021 %9 Review %J J Med Internet Res %G English %X Background: Technologies have been extensively implemented to provide health care services for all types of clinical conditions during the COVID-19 pandemic. While several reviews have been conducted regarding technologies used during the COVID-19 pandemic, they were limited by focusing either on a specific technology (or features) or proposed rather than implemented technologies. Objective: This review aims to provide an overview of technologies, as reported in the literature, implemented during the first wave of the COVID-19 pandemic. Methods: We conducted a scoping review using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) Extension for Scoping Reviews. Studies were retrieved by searching 8 electronic databases, checking the reference lists of included studies and relevant reviews (backward reference list checking), and checking studies that cited included studies (forward reference list checking). The search terms were chosen based on the target intervention (ie, technologies) and the target disease (ie, COVID-19). We included English publications that focused on technologies or digital tools implemented during the COVID-19 pandemic to provide health-related services regardless of target health condition, user, or setting. Two reviewers independently assessed the eligibility of studies and extracted data from eligible papers. We used a narrative approach to synthesize extracted data. Results: Of 7374 retrieved papers, 126 were deemed eligible. Telemedicine was the most common type of technology (107/126, 84.9%) implemented in the first wave of the COVID-19 pandemic, and the most common mode of telemedicine was synchronous (100/108, 92.6%). The most common purpose of the technologies was providing consultation (75/126, 59.5%), followed by following up with patients (45/126, 35.7%), and monitoring their health status (22/126, 17.4%). Zoom (22/126, 17.5%) and WhatsApp (12/126, 9.5%) were the most commonly used videoconferencing and social media platforms, respectively. Both health care professionals and health consumers were the most common target users (103/126, 81.7%). The health condition most frequently targeted was COVID-19 (38/126, 30.2%), followed by any physical health conditions (21/126, 16.7%), and mental health conditions (13/126, 10.3%). Technologies were web-based in 84.1% of the studies (106/126). Technologies could be used through 11 modes, and the most common were mobile apps (86/126, 68.3%), desktop apps (73/126, 57.9%), telephone calls (49/126, 38.9%), and websites (45/126, 35.7%). Conclusions: Technologies played a crucial role in mitigating the challenges faced during the COVID-19 pandemic. We did not find papers describing the implementation of other technologies (eg, contact-tracing apps, drones, blockchain) during the first wave. Furthermore, technologies in this review were used for other purposes (eg, drugs and vaccines discovery, social distancing, and immunity passport). Future research on studies on these technologies and purposes is recommended, and further reviews are required to investigate technologies implemented in subsequent waves of the pandemic. %M 34406962 %R 10.2196/29136 %U https://www.jmir.org/2021/9/e29136 %U https://doi.org/10.2196/29136 %U http://www.ncbi.nlm.nih.gov/pubmed/34406962 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e25636 %T Characterization of Vaccine Tweets During the Early Stage of the COVID-19 Outbreak in the United States: Topic Modeling Analysis %A Jiang,Li Crystal %A Chu,Tsz Hang %A Sun,Mengru %+ Department of Media and Communication, City University of Hong Kong, M5082, Run Run Shaw Creative Media Centre, 18 Tat Hong Avenue, Kowloon, Hong Kong, China (Hong Kong), 852 034429332, crystal.jiang@cityu.edu.hk %K topic modeling %K social media %K infoveillance %K vaccine %K coronavirus %K COVID-19 %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: During the early stages of the COVID-19 pandemic, developing safe and effective coronavirus vaccines was considered critical to arresting the spread of the disease. News and social media discussions have extensively covered the issue of coronavirus vaccines, with a mixture of vaccine advocacies, concerns, and oppositions. Objective: This study aimed to uncover the emerging themes in Twitter users’ perceptions and attitudes toward vaccines during the early stages of the COVID-19 outbreak. Methods: This study employed topic modeling to analyze tweets related to coronavirus vaccines at the start of the COVID-19 outbreak in the United States (February 21 to March 20, 2020). We created a predefined query (eg, “COVID” AND “vaccine”) to extract the tweet text and metadata (number of followers of the Twitter account and engagement metrics based on likes, comments, and retweeting) from the Meltwater database. After preprocessing the data, we tested Latent Dirichlet Allocation models to identify topics associated with these tweets. The model specifying 20 topics provided the best overall coherence, and each topic was interpreted based on its top associated terms. Results: In total, we analyzed 100,209 tweets containing keywords related to coronavirus and vaccines. The 20 topics were further collapsed based on shared similarities, thereby generating 7 major themes. Our analysis characterized 26.3% (26,234/100,209) of the tweets as News Related to Coronavirus and Vaccine Development, 25.4% (25,425/100,209) as General Discussion and Seeking of Information on Coronavirus, 12.9% (12,882/100,209) as Financial Concerns, 12.7% (12,696/100,209) as Venting Negative Emotions, 9.9% (9908/100,209) as Prayers and Calls for Positivity, 8.1% (8155/100,209) as Efficacy of Vaccine and Treatment, and 4.9% (4909/100,209) as Conspiracies about Coronavirus and Its Vaccines. Different themes demonstrated some changes over time, mostly in close association with news or events related to vaccine developments. Twitter users who discussed conspiracy theories, the efficacy of vaccines and treatments, and financial concerns had more followers than those focused on other vaccine themes. The engagement level—the extent to which a tweet being retweeted, quoted, liked, or replied by other users—was similar among different themes, but tweets venting negative emotions yielded the lowest engagement. Conclusions: This study enriches our understanding of public concerns over new vaccines or vaccine development at early stages of the outbreak, bearing implications for influencing vaccine attitudes and guiding public health efforts to cope with infectious disease outbreaks in the future. This study concluded that public concerns centered on general policy issues related to coronavirus vaccines and that the discussions were considerably mixed with political views when vaccines were not made available. Only a small proportion of tweets focused on conspiracy theories, but these tweets demonstrated high engagement levels and were often contributed by Twitter users with more influence. %M 34604707 %R 10.2196/25636 %U https://infodemiology.jmir.org/2021/1/e25636 %U https://doi.org/10.2196/25636 %U http://www.ncbi.nlm.nih.gov/pubmed/34604707 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 3 %P e28989 %T A Sociodemographic Profile of Mask Use During the COVID-19 Outbreak Among Young and Elderly Individuals in Brazil: Online Survey Study %A Vancini,Rodrigo L %A Camargo-Neto,Luiz %A Andrade,Marilia S %A de Lira,Claudio A %A dos Santos,Rafaela G %A Nikolaidis,Pantelis T %A Knechtle,Beat %A Piacezzi,Luiz HV %A Teixeira-Lopes,Maria CB %A Assayag-Batista,Ruth E %A Pinto-Okuno,Meiry F %A Vancini-Campanharo,Cássia R %+ Institute of Primary Care, University of Zurich, Pestalozzistrasse 24, Zürich, 8091, Switzerland, 41 44 255 98 55, beat.knechtle@hispeed.ch %K aging %K older adults %K COVID-19 %K pandemic %K sociodemographic profile %K face mask %K social media %K online media %K adolescents %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Aging %G English %X 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. %M 34253508 %R 10.2196/28989 %U https://aging.jmir.org/2021/3/e28989 %U https://doi.org/10.2196/28989 %U http://www.ncbi.nlm.nih.gov/pubmed/34253508 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e28028 %T Semisupervised Deep Learning Techniques for Predicting Acute Respiratory Distress Syndrome From Time-Series Clinical Data: Model Development and Validation Study %A Lam,Carson %A Tso,Chak Foon %A Green-Saxena,Abigail %A Pellegrini,Emily %A Iqbal,Zohora %A Evans,Daniel %A Hoffman,Jana %A Calvert,Jacob %A Mao,Qingqing %A Das,Ritankar %+ Dascena, Inc, Suite B, Private Mailbox 65148, 12333 Sowden Rd, Houston, TX, 77080, United States, 1 7149326188, clam@dascena.com %K acute respiratory distress syndrome %K COVID-19 %K semisupervised learning %K deep learning %K machine learning %K algorithm %K prediction %K decision support %D 2021 %7 14.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: A high number of patients who are hospitalized with COVID-19 develop acute respiratory distress syndrome (ARDS). Objective: In response to the need for clinical decision support tools to help manage the next pandemic during the early stages (ie, when limited labeled data are present), we developed machine learning algorithms that use semisupervised learning (SSL) techniques to predict ARDS development in general and COVID-19 populations based on limited labeled data. Methods: SSL techniques were applied to 29,127 encounters with patients who were admitted to 7 US hospitals from May 1, 2019, to May 1, 2021. A recurrent neural network that used a time series of electronic health record data was applied to data that were collected when a patient’s peripheral oxygen saturation level fell below the normal range (<97%) to predict the subsequent development of ARDS during the remaining duration of patients’ hospital stay. Model performance was assessed with the area under the receiver operating characteristic curve and area under the precision recall curve of an external hold-out test set. Results: For the whole data set, the median time between the first peripheral oxygen saturation measurement of <97% and subsequent respiratory failure was 21 hours. The area under the receiver operating characteristic curve for predicting subsequent ARDS development was 0.73 when the model was trained on a labeled data set of 6930 patients, 0.78 when the model was trained on the labeled data set that had been augmented with the unlabeled data set of 16,173 patients by using SSL techniques, and 0.84 when the model was trained on the entire training set of 23,103 labeled patients. Conclusions: In the context of using time-series inpatient data and a careful model training design, unlabeled data can be used to improve the performance of machine learning models when labeled data for predicting ARDS development are scarce or expensive. %M 34398784 %R 10.2196/28028 %U https://formative.jmir.org/2021/9/e28028 %U https://doi.org/10.2196/28028 %U http://www.ncbi.nlm.nih.gov/pubmed/34398784 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e31295 %T Factors Associated With Longitudinal Psychological and Physiological Stress in Health Care Workers During the COVID-19 Pandemic: Observational Study Using Apple Watch Data %A Hirten,Robert P %A Danieletto,Matteo %A Tomalin,Lewis %A Choi,Katie Hyewon %A Zweig,Micol %A Golden,Eddye %A Kaur,Sparshdeep %A Helmus,Drew %A Biello,Anthony %A Pyzik,Renata %A Calcagno,Claudia %A Freeman,Robert %A Sands,Bruce E %A Charney,Dennis %A Bottinger,Erwin P %A Murrough,James W %A Keefer,Laurie %A Suarez-Farinas,Mayte %A Nadkarni,Girish N %A Fayad,Zahi A %+ The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1 Gustave L Levy Place, New York, NY, 10029, United States, 1 212 241 0150, robert.hirten@mountsinai.org %K wearable device %K COVID-19 %K stress %K heart rate variability %K psychological %K psychology %K physiology %K mental health %K health care worker %K observational %K app %K heart rate %K nervous system %K resilience %K emotion %K support %K quality of life %D 2021 %7 13.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has resulted in a high degree of psychological distress among health care workers (HCWs). There is a need to characterize which HCWs are at an increased risk of developing psychological effects from the pandemic. Given the differences in the response of individuals to stress, an analysis of both the perceived and physiological consequences of stressors can provide a comprehensive evaluation of its impact. Objective: This study aimed to determine characteristics associated with longitudinal perceived stress in HCWs and to assess whether changes in heart rate variability (HRV), a marker of autonomic nervous system function, are associated with features protective against longitudinal stress. Methods: HCWs across 7 hospitals in New York City, NY, were prospectively followed in an ongoing observational digital study using the custom Warrior Watch Study app. Participants wore an Apple Watch for the duration of the study to measure HRV throughout the follow-up period. Surveys measuring perceived stress, resilience, emotional support, quality of life, and optimism were collected at baseline and longitudinally. Results: A total of 361 participants (mean age 36.8, SD 10.1 years; female: n=246, 69.3%) were enrolled. Multivariate analysis found New York City’s COVID-19 case count to be associated with increased longitudinal stress (P=.008). Baseline emotional support, quality of life, and resilience were associated with decreased longitudinal stress (P<.001). A significant reduction in stress during the 4-week period after COVID-19 diagnosis was observed in the highest tertial of emotional support (P=.03) and resilience (P=.006). Participants in the highest tertial of baseline emotional support and resilience had a significantly different circadian pattern of longitudinally collected HRV compared to subjects in the low or medium tertial. Conclusions: High resilience, emotional support, and quality of life place HCWs at reduced risk of longitudinal perceived stress and have a distinct physiological stress profile. Our findings support the use of these characteristics to identify HCWs at risk of the psychological and physiological stress effects of the pandemic. %M 34379602 %R 10.2196/31295 %U https://www.jmir.org/2021/9/e31295 %U https://doi.org/10.2196/31295 %U http://www.ncbi.nlm.nih.gov/pubmed/34379602 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e24624 %T Domestic Violence and Mental Health During the COVID-19 Pandemic in Bangladesh %A Rashid Soron,Tanjir %A Ashiq,Md Ashiqur Rahman %A Al-Hakeem,Marzia %A Chowdhury,Zaid Farzan %A Uddin Ahmed,Helal %A Afrooz Chowdhury,Chaman %+ Telepsychiatry Research and Innovation Network Ltd, 3D, 2nd Floor, Rupayan Trade Center, Bangla Motor, Dhaka, 1205, Bangladesh, 880 1718827138, tanjirsoron@gmail.com %K domestic violence %K COVID-19 %K mental health %K violence %K Bangladesh %K lockdown %K isolation %K anxiety %K stress %K telemental health %K telepsychiatry %K web-based survey %D 2021 %7 13.9.2021 %9 Viewpoint %J JMIR Form Res %G English %X Background: The COVID-19 lockdown, the advent of working from home, and other unprecedent events have resulted in multilayer and multidimensional impacts on our personal, social, and occupational lives. Mental health conditions are deteriorating, financial crises are increasing in prevalence, and the need to stay at home has resulted in the increased prevalence of domestic violence. In Bangladesh, where domestic violence is already prevalent, the lockdown period and stay-at-home orders could result in more opportunities and increased scope for perpetrators of domestic violence. Objective: In this study, we aimed to determine the prevalence and pattern of domestic violence during the initial COVID-19 lockdown period in Bangladesh and the perceptions of domestic violence survivors with regard to mental health care. Methods: We conducted this cross-sectional web-based study among the Bangladeshi population and used a semistructured self-reported questionnaire to understand the patterns of domestic violence and perceptions on mental health care from August to September 2020. The questionnaire was disseminated on different organizational websites and social media pages (ie, those of organizations that provide mental health and domestic violence services). Data were analyzed by using IBM SPSS (version 22.0; IBM Corporation). Results: We found that 36.8% (50/136) of respondents had faced domestic violence at some point in their lives; psychological abuse was the most common type of violence. However, the prevalence of the economical abuse domestic violence type increased after the COVID-19 lockdown was enforced. Although 96.3% (102/136) of the participants believed that domestic violence survivors need mental health support, only 25% (34/136) of the respondents had an idea about the mental health services that are available for domestic violence survivors in Bangladesh and how and where they could avail mental health services. Conclusions: Domestic violence is one of the most well-known stressors that have direct impacts on physical and mental health. However, the burden of domestic violence is often underreported, and its impact on mental health is neglected in Bangladesh. The burden of this problem has increased during the COVID-19 crisis, and the cry for mental health support is obvious in the country. However, it is necessary to provide information about available support services; telepsychiatry can be good option for providing immediate mental health support in a convenient and cost-effective manner. %M 34346893 %R 10.2196/24624 %U https://formative.jmir.org/2021/9/e24624 %U https://doi.org/10.2196/24624 %U http://www.ncbi.nlm.nih.gov/pubmed/34346893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30854 %T Revealing Public Opinion Towards COVID-19 Vaccines With Twitter Data in the United States: Spatiotemporal Perspective %A Hu,Tao %A Wang,Siqin %A Luo,Wei %A Zhang,Mengxi %A Huang,Xiao %A Yan,Yingwei %A Liu,Regina %A Ly,Kelly %A Kacker,Viraj %A She,Bing %A Li,Zhenlong %+ Department of Geography, National University of Singapore, 1 Arts Link, #04-32 Block AS2, Singapore, 117570, Singapore, 65 65163851, geowl@nus.edu.sg %K Twitter %K public opinion %K COVID-19 vaccines %K sentiment analysis %K emotion analysis %K topic modeling %K COVID-19 %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34346888 %R 10.2196/30854 %U https://www.jmir.org/2021/9/e30854 %U https://doi.org/10.2196/30854 %U http://www.ncbi.nlm.nih.gov/pubmed/34346888 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e24081 %T A 3D Hologram With Mixed Reality Techniques to Improve Understanding of Pulmonary Lesions Caused by COVID-19: Randomized Controlled Trial %A Liu,Songxiang %A Xie,Mao %A Zhang,Zhicai %A Wu,Xinghuo %A Gao,Fei %A Lu,Lin %A Zhang,Jiayao %A Xie,Yi %A Yang,Fan %A Ye,Zhewei %+ Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430019, China, 86 13971213880, yezhewei@hust.edu.cn %K COVID-19 %K mixed reality %K hologram %K pulmonary %K lesion %K diagnostic %K imaging %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 34061760 %R 10.2196/24081 %U https://www.jmir.org/2021/9/e24081 %U https://doi.org/10.2196/24081 %U http://www.ncbi.nlm.nih.gov/pubmed/34061760 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e31240 %T Using Telehealth to Deliver Primary Care to Adolescents During and After the COVID-19 Pandemic: National Survey Study of US Primary Care Professionals %A Gilkey,Melissa B %A Kong,Wei Yi %A Huang,Qian %A Grabert,Brigid K %A Thompson,Peyton %A Brewer,Noel T %+ Department of Health Behavior, University of North Carolina at Chapel Hill, CB 7440, Chapel Hill, NC, 27599, United States, 1 9199668650, gilkey@email.unc.edu %K adolescent health %K primary care %K telemedicine %K health communication %K health services %K telehealth %K adolescent %K young adult %K teenager %K COVID-19 %K survey %K policy %K access %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to unprecedented use of telehealth, including by primary care professionals (PCPs) who serve adolescents. Objective: To inform future practice and policies, we sought to characterize PCPs’ recent experience using adolescent telehealth as well as their support for it after the COVID-19 pandemic is over. Methods: From February to March 2021, we conducted a web-based survey of 1047 PCPs in the United States. Our national sample included physicians (747/1047, 71%), advanced practice providers (177/1047, 17%), and nurses (123/1047, 12%) who provided primary care to adolescents aged 11-17 years. Results: Most PCPs reported using telehealth for a low, moderate, or high proportion of their adolescent patients in the three months prior to the survey (424/1047, 40%, 286/1047, 27%, and 219/1047, 21%, respectively); only 11% (118/1047) reported no use. A majority of respondents agreed that adolescent telehealth increases access to care (720/1047, 69%) and enables them to provide high-quality care (560/1047, 53%). Few believed that adolescent telehealth takes too much time (142/1047, 14%) or encourages health care overuse (157/1047, 15%). Most supported giving families the option of adolescent telehealth for primary care after the pandemic is over (683/1047, 65%) and believed that health insurance plans should continue to reimburse for telehealth visits (863/1047, 82%). Approximately two-thirds (702/1047, 67%) wanted to offer adolescent telehealth visits after the pandemic, with intentions being higher among those with recent telehealth experience (P<.001). Conclusions: PCPs in our national sample reported widespread use of and predominantly positive attitudes toward adolescent telehealth. Our findings also suggest broad support among PCPs for continuing to offer adolescent telehealth after the COVID-19 pandemic ends. %M 34406974 %R 10.2196/31240 %U https://www.jmir.org/2021/9/e31240 %U https://doi.org/10.2196/31240 %U http://www.ncbi.nlm.nih.gov/pubmed/34406974 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30800 %T Framing of and Attention to COVID-19 on Twitter: Thematic Analysis of Hashtags %A Tahamtan,Iman %A Potnis,Devendra %A Mohammadi,Ehsan %A Miller,Laura E %A Singh,Vandana %+ School of Information Sciences, The University of Tennessee, 1345 Circle Park Drive 451 Communications Building, Knoxville, TN, 37996-0332, United States, 1 865 974 2148, iman.tahamtan@gmail.com %K COVID-19 %K framing %K Twitter %K social media %K public opinion %K engagement %K public attention %K thematic analysis %K public health %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Although past research has focused on COVID-19–related frames in the news media, such research may not accurately capture and represent the perspectives of people from diverse backgrounds. Additionally, research on the public attention to COVID-19 as reflected through frames on social media is scarce. Objective: This study identified the frames about the COVID-19 pandemic in the public discourse on Twitter, which voices diverse opinions. This study also investigated the amount of public attention to those frames on Twitter. Methods: We collected 22 trending hashtags related to COVID-19 in the United States and 694,582 tweets written in English containing these hashtags in March 2020 and analyzed them via thematic analysis. Public attention to these frames was measured by evaluating the amount of public engagement with frames and public adoption of those frames. Results: We identified 9 frames including “public health guidelines,” “quarantine life,” “solidarity,” “evidence and facts,” “call for action,” “politics,” “post-pandemic life,” “shortage panic,” and “conflict.” Results showed that some frames such as “call for action” are more appealing than others during a global pandemic, receiving greater public adoption and engagement. The “call for action” frame had the highest engagement score, followed by “conflict” and “evidence and facts.” Additionally, “post-pandemic life” had the highest adoption score, followed by “call for action” and “shortage panic.” The findings indicated that the frequency of a frame on social media does not necessarily mean greater public adoption of or engagement with the frame. Conclusions: This study contributes to framing theory and research by demonstrating how trending hashtags can be used as new user-generated data to identify frames on social media. This study concludes that the identified frames such as “quarantine life” and “conflict” and themes such as “isolation” and “toilet paper panic” represent the consequences of the COVID-19 pandemic. The consequences could be (1) exclusively related to COVID-19, such as hand hygiene or isolation; (2) related to any health crisis such as social support of vulnerable groups; and (3) generic that are irrespective of COVID-19, such as homeschooling or remote working. %M 34406961 %R 10.2196/30800 %U https://www.jmir.org/2021/9/e30800 %U https://doi.org/10.2196/30800 %U http://www.ncbi.nlm.nih.gov/pubmed/34406961 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28116 %T Using an Individual-Centered Approach to Gain Insights From Wearable Data in the Quantified Flu Platform: Netnography Study %A Greshake Tzovaras,Bastian %A Senabre Hidalgo,Enric %A Alexiou,Karolina %A Baldy,Lukaz %A Morane,Basile %A Bussod,Ilona %A Fribourg,Melvin %A Wac,Katarzyna %A Wolf,Gary %A Ball,Mad %+ Center for Research & Interdisciplinarity, INSERM U1284, Université de Paris, 8bis Rue Charles V, Paris, 75004, France, 33 766752149, bgreshake@googlemail.com %K symptom tracking %K COVID-19 %K wearable devices %K self-tracking %K citizen science %K netnographic analysis %K cocreation %D 2021 %7 10.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Wearables have been used widely for monitoring health in general, and recent research results show that they can be used to predict infections based on physiological symptoms. To date, evidence has been generated in large, population-based settings. In contrast, the Quantified Self and Personal Science communities are composed of people who are interested in learning about themselves individually by using their own data, which are often gathered via wearable devices. Objective: This study aims to explore how a cocreation process involving a heterogeneous community of personal science practitioners can develop a collective self-tracking system for monitoring symptoms of infection alongside wearable sensor data. Methods: We engaged in a cocreation and design process with an existing community of personal science practitioners to jointly develop a working prototype of a web-based tool for symptom tracking. In addition to the iterative creation of the prototype (started on March 16, 2020), we performed a netnographic analysis to investigate the process of how this prototype was created in a decentralized and iterative fashion. Results: The Quantified Flu prototype allowed users to perform daily symptom reporting and was capable of presenting symptom reports on a timeline together with resting heart rates, body temperature data, and respiratory rates measured by wearable devices. We observed a high level of engagement; over half of the users (52/92, 56%) who engaged in symptom tracking became regular users and reported over 3 months of data each. Furthermore, our netnographic analysis highlighted how the current Quantified Flu prototype was a result of an iterative and continuous cocreation process in which new prototype releases sparked further discussions of features and vice versa. Conclusions: As shown by the high level of user engagement and iterative development process, an open cocreation process can be successfully used to develop a tool that is tailored to individual needs, thereby decreasing dropout rates. %M 34505836 %R 10.2196/28116 %U https://www.jmir.org/2021/9/e28116 %U https://doi.org/10.2196/28116 %U http://www.ncbi.nlm.nih.gov/pubmed/34505836 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e24295 %T Data Empowerment of Decision-Makers in an Era of a Pandemic: Intersection of “Classic” and Artificial Intelligence in the Service of Medicine %A Geva,Gil A %A Ketko,Itay %A Nitecki,Maya %A Simon,Shoham %A Inbar,Barr %A Toledo,Itay %A Shapiro,Michael %A Vaturi,Barak %A Votta,Yoni %A Filler,Daniel %A Yosef,Roey %A Shpitzer,Sagi A %A Hir,Nabil %A Peri Markovich,Michal %A Shapira,Shachar %A Fink,Noam %A Glasberg,Elon %A Furer,Ariel %+ Medical Corps, Israel Defense Force, IDF Medical Corps Headquarters, Tel HaShomer, Ramat Gan, 02149, Israel, 972 529277372, furera@gmail.com %K COVID-19 %K medical informatics %K decision-making %K pandemic %K data %K policy %K validation %K accuracy %K data analysis %D 2021 %7 10.9.2021 %9 Viewpoint %J J Med Internet Res %G English %X 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. %M 34313589 %R 10.2196/24295 %U https://www.jmir.org/2021/9/e24295 %U https://doi.org/10.2196/24295 %U http://www.ncbi.nlm.nih.gov/pubmed/34313589 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e30367 %T Adapting to the Pandemic: Protocol of a Web-Based Perinatal Health Study to Improve Maternal and Infant Outcomes %A Tzilos Wernette,Golfo %A Countryman,Kristina %A Mmeje,Okeoma %A Ngo,Quyen M %A Zlotnick,Caron %+ Department of Family Medicine, University of Michigan Medical School, 1018 Fuller Street, Ann Arbor, MI, 48104, United States, 1 17349987120, gtzilos@med.umich.edu %K COVID-19 %K pregnancy %K COVID-19 pandemic %K alcohol use %K drug use %K sexually transmitted infections %K technology-delivered interventions %D 2021 %7 10.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The identification of interconnected health risks during the perinatal period offers an opportunity to prevent negative maternal and infant health outcomes. Marijuana, opioid, and other substance use during pregnancy is a rapidly growing public health concern with significant and costly health consequences for the woman and the developing fetus. Pregnant persons who misuse substances are disproportionately more likely to engage in risky sexual behaviors resulting in sexually transmitted infections (STIs), which are on the rise in this population and can lead to adverse effects on maternal health and on fetal development. Objective: Our goal is to continue testing an innovative and low-cost technology-delivered intervention, the Health Check-Up for Expectant Moms (HCEM), which simultaneously targets alcohol and drug use and STI risk during pregnancy, both of which are on the rise during the COVID-19 pandemic. Methods: We describe the ways in which we have adapted the web-based HCEM intervention to continue recruitment and study enrollment during the pandemic. Results: Study recruitment, visits, and participant safety assessments were all successfully modified during the initial year of the COVID-19 pandemic. Compared to in-person recruitment that occurred prepandemic, remote recruitment yielded a greater proportion of women enrolled in the study (83/136, 61.0% vs 43/52, 83%) in a shorter period (12 months vs 7 months). Conclusions: Despite study challenges related to the pandemic, including time and effort adapting to a remote protocol, remote recruitment and visits for this study were found to constitute a successful approach. Trial Registration: ClinicalTrials.gov NCT03826342; https://clinicaltrials.gov/ct2/show/NCT03826342 International Registered Report Identifier (IRRID): DERR1-10.2196/30367 %M 34351867 %R 10.2196/30367 %U https://www.researchprotocols.org/2021/9/e30367 %U https://doi.org/10.2196/30367 %U http://www.ncbi.nlm.nih.gov/pubmed/34351867 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e26409 %T Estimation of COVID-19 Period Prevalence and the Undiagnosed Population in Canadian Provinces: Model-Based Analysis %A Hamadeh,Abdullah %A Feng,Zeny %A Niergarth,Jessmyn %A Wong,William WL %+ School of Pharmacy, University of Waterloo, 10A Victoria Street S, Kitchener, ON, N2G1C5, Canada, 1 519 888 4567 ext 21323, wwlwong@uwaterloo.ca %K COVID-19 %K prevalence %K undiagnosed proportion %K mathematical modeling %K estimate %K Canada %K diagnosis %K control %K distribution %K infectious disease %K model %K framework %K progression %K transmission %D 2021 %7 9.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The development of a successful COVID-19 control strategy requires a thorough understanding of the trends in geographic and demographic distributions of disease burden. In terms of the estimation of the population prevalence, this includes the crucial process of unravelling the number of patients who remain undiagnosed. Objective: This study estimates the period prevalence of COVID-19 between March 1, 2020, and November 30, 2020, and the proportion of the infected population that remained undiagnosed in the Canadian provinces of Quebec, Ontario, Alberta, and British Columbia. Methods: A model-based mathematical framework based on a disease progression and transmission model was developed to estimate the historical prevalence of COVID-19 using provincial-level statistics reporting seroprevalence, diagnoses, and deaths resulting from COVID-19. The framework was applied to three different age cohorts (< 30; 30-69; and ≥70 years) in each of the provinces studied. Results: The estimates of COVID-19 period prevalence between March 1, 2020, and November 30, 2020, were 4.73% (95% CI 4.42%-4.99%) for Quebec, 2.88% (95% CI 2.75%-3.02%) for Ontario, 3.27% (95% CI 2.72%-3.70%) for Alberta, and 2.95% (95% CI 2.77%-3.15%) for British Columbia. Among the cohorts considered in this study, the estimated total number of infections ranged from 2-fold the number of diagnoses (among Quebecers, aged ≥70 years: 26,476/53,549, 49.44%) to 6-fold the number of diagnoses (among British Columbians aged ≥70 years: 3108/18,147, 17.12%). Conclusions: Our estimates indicate that a high proportion of the population infected between March 1 and November 30, 2020, remained undiagnosed. Knowledge of COVID-19 period prevalence and the undiagnosed population can provide vital evidence that policy makers can consider when planning COVID-19 control interventions and vaccination programs. %M 34228626 %R 10.2196/26409 %U https://publichealth.jmir.org/2021/9/e26409 %U https://doi.org/10.2196/26409 %U http://www.ncbi.nlm.nih.gov/pubmed/34228626 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e28728 %T COVID-19 Health Crisis and Chronic Illness: Protocol for a Qualitative Study %A Ricadat,Élise %A Béliard,Aude %A Citrini,Marie %A Craus,Yann %A Gabarro,Céline %A Mamzer,Marie-France %A Marques,Ana %A Sannié,Thomas %A Teixeira,Maria %A Tocilovac,Marko %A Velpry,Livia %A Villa,François %A Virole,Louise %A Lefève,Céline %+ Institut La Personne en Médecine, Université de Paris, 5 rue Thomas Mann, Paris, 75013, France, 33 0157275249, louise.virole@sciencespo.fr %K chronic illness %K care %K prevention %K vulnerability %K health democracy %K COVID %K qualitative study %K COVID-19 %K pandemic %K risk %D 2021 %7 9.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The acute nature of the COVID-19 pandemic has put a strain on health resources that are usually dedicated to chronic illnesses. Resulting changes in care practices and networks have had major repercussions on the experience of people with chronic disorders. Objective: This paper presents the protocol of the Parcours, Associations, Réseau, Chronicité, Organisation, Usagers, Retour d’expérience, Soins (PARCOURS)-COVID study. The aim of this study is to evaluate the effects of reorganization of the health system on the usual care network of patients with chronic illness, which fosters and qualifies the quality and continuum of care provided. The first objective of this study is to document these patients’ experiences through transformations and adaptations of their network, both in the practical dimension (ie, daily life and care) and subjective dimension (ie, psychosocial experience of illness and relationship to the health system). The second objective of the study is to understand and acknowledge these reorganizations during the COVID-19 lockdown and postlockdown periods. The third objective is to produce better adapted recommendations for patients with chronic illness and value their experience for the management of future health crisis. Methods: The PARCOURS-COVID study is a qualitative and participatory research involving patient organizations as research partners and members of these organizations as part of the research team. Three group of chronic diseases have been selected regarding the specificities of the care network they mobilize: (1) cystic fibrosis and kidney disease, (2) hemophilia, and (3) mental health disorders. Four consecutive phases will be conducted, including (1) preparatory interviews with medical or associative actors of each pathology field; (2) in-depth individual interviews with patients of each pathology, analyzed using the qualitative method of thematic analysis; (3) results of both these phases will then be triangulated through interviews with members of each patient’s care ecosystem; and finally, (4) focus groups will be organized to discuss the results with research participants (ie, representatives of chronic disease associations; patients; and actors of the medical, psychosocial, and family care network) in a research-action framework. Results: The protocol study has undergone a peer review by the French National Research Agency’s scientific committee and has been approved by the research ethical committee of the University of Paris (registration number: IRB 00012020-59, June 28, 2020). The project received funding from August 2020 through April 2021. Expected results will be disseminated in 2021 and 2022. Conclusions: Our findings will better inform the stakes of the current health crisis on the management of patients with chronic illness and, more broadly, any future crisis for a population deemed to be at risk. They will also improve health democracy by supporting better transferability of knowledge between the scientific and citizen communities. International Registered Report Identifier (IRRID): DERR1-10.2196/28728 %M 34460413 %R 10.2196/28728 %U https://www.researchprotocols.org/2021/9/e28728 %U https://doi.org/10.2196/28728 %U http://www.ncbi.nlm.nih.gov/pubmed/34460413 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e30692 %T The Pandemic Year 2020: World Map of Coronavirus Research %A Klingelhöfer,Doris %A Braun,Markus %A Brüggmann,Dörthe %A Groneberg,David A %+ Institute of Occupational, Social and Environmental Medicine, Goethe University, Theodor-Stern-Kai 7, Frankfurt, 60590, Germany, 49 69 63016650, klingelhoefer@med.uni-frankfurt.de %K COVID-19 %K SARS-CoV-2 %K incidence, research funding %K socioeconomic factors %K bibliometrics %K bibliometric analysis %K global health %K public health %K health database %K online research %K research database %D 2021 %7 8.9.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34346891 %R 10.2196/30692 %U https://www.jmir.org/2021/9/e30692 %U https://doi.org/10.2196/30692 %U http://www.ncbi.nlm.nih.gov/pubmed/34346891 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e31409 %T COVID-19 Vaccine Perception in South Korea: Web Crawling Approach %A Lee,Hocheol %A Noh,Eun Bi %A Park,Sung Jong %A Nam,Hae Kweun %A Lee,Tae Ho %A Lee,Ga Ram %A Nam,Eun Woo %+ Department of Health Administration, Yonsei University Graduate School, Unit 412, Chang-jo gwan, 1 Yonseidae-gil, Wonju, 26493, Republic of Korea, 82 33 760 2413, ewnam@yonsei.ac.kr %K COVID-19 vaccine %K COVID-19 %K instagram %K social media %K infodemiology %K sentiment analysis %K vaccine perception %K South Korea %K web crawling %K AstraZeneca %K Pfizer %D 2021 %7 8.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34348890 %R 10.2196/31409 %U https://publichealth.jmir.org/2021/9/e31409 %U https://doi.org/10.2196/31409 %U http://www.ncbi.nlm.nih.gov/pubmed/34348890 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29396 %T Using Administrative Data to Explore Potentially Aberrant Provision of Virtual Care During COVID-19: Retrospective Cohort Study of Ontario Provincial Data %A Stamenova,Vess %A Chu,Cherry %A Pang,Andrea %A Tadrous,Mina %A Bhatia,R Sacha %A Cram,Peter %+ Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 268 0985, vess.stamenova@wchospital.ca %K telemedicine %K virtual care %K COVID-19 %K pandemic %K virtual health %K telehealth %K ambulatory visits %K physicians %K patients %K digital health %D 2021 %7 7.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to a rapid increase in virtual care use across the globe. Many health care systems have responded by creating virtual care billing codes that allow physicians to see their patients over telephone or video. This rapid liberalization of billing requirements, both in Canada and other countries, has led to concerns about potential abuse, but empirical data are limited. Objective: The objectives of this study were to examine whether there were substantial changes in physicians’ ambulatory visit volumes coinciding with the liberalization of virtual care billing rules and to describe the characteristics of physicians who significantly increased their ambulatory visit volumes during this period. We also sought to describe the relationship between visit volume changes in 2020 and the volumes of virtual care use among individual physicians and across specialties. Methods: We conducted a population-based, retrospective cohort study using health administrative data from the Ontario Health Insurance Plan, which was linked to the ICES Physician Database. We identified a unique cohort of providers based on physicians’ billings and calculated the ratio of total in-person and virtual ambulatory visits over the period from January to June 2020 (virtual predominating) relative to that over the period from January to June 2019 (in-person predominating) for each physician. Based on these ratios, we then stratified physicians into four groups: low-, same-, high-, and very high–use physicians. We then calculated various demographic and practice characteristics of physicians in each group. Results: Among 28,383 eligible physicians in 2020, the mean ratio of ambulatory visits in January to June 2020:2019 was 0.99 (SD 2.53; median 0.81, IQR 0.59-1.0). Out of 28,383 physicians, only 2672 (9.4%) fell into the high-use group and only 291 (1.0%) fell into the very high–use group. High-use physicians were younger, more recent graduates, more likely female, and less likely to be international graduates. They also had, on average, lower-volume practices. There was a significant positive correlation between percent virtual care and the 2020:2019 ratio only in the group of physicians who maintained their practice (R=0.35, P<.001). There was also a significant positive correlation between the 2020:2019 ratio and the percent virtual care per specialty (R=0.59, P<.01). Conclusions: During the early stages of the pandemic, the introduction of virtual care did not lead to significant increases in visit volume. Our results provide reassuring evidence that relaxation of billing requirements early in the COVID-19 pandemic in Ontario were not associated with widespread and aberrant billing behaviors. Furthermore, the strong relationship between the ability to maintain practice volumes and the use of virtual care suggests that the introduction of virtual care allowed for continued access to care for patients. %M 34313590 %R 10.2196/29396 %U https://www.jmir.org/2021/9/e29396 %U https://doi.org/10.2196/29396 %U http://www.ncbi.nlm.nih.gov/pubmed/34313590 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 9 %P e26513 %T Social Networking Site Use During the COVID-19 Pandemic and Its Associations With Social and Emotional Well-being in College Students: Survey Study %A Tuck,Alison B %A Thompson,Renee J %+ Department of Psychological and Brain Sciences, Washington University in St Louis, Campus Box 1125, One Brookings Drive, St Louis, MO, 63130, United States, 1 (314) 935 3502, alison.tuck@wustl.edu %K social media %K social networking sites %K COVID-19 %K loneliness %K well-being %D 2021 %7 7.9.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social distancing during the COVID-19 pandemic has reduced the frequency of in-person social interactions. College students were highly impacted, since many universities transferred curriculum from in-person to entirely online formats, physically separating students with little notice. With social distancing, their use of social networking sites (SNSs) likely changed during the COVID-19 pandemic, possibly holding implications for well-being. Objective: This study aimed to determine (1) how components of SNS use (ie, weekly frequency, time per day, habitual use, engagement, enjoyment, addiction, and emotional impact) changed from before to during COVID-19, (2) how these changes in SNS use were associated with pandemic-related social and emotional well-being, and (3) how SNS use and changes in use during the pandemic were associated with loneliness. Methods: College students (N=176) were surveyed during the time when their university campus in the United States was operating online. Participants completed the same SNS use questionnaires twice, once with regard to the month preceding the onset of COVID-19 and again with regard to the month since this time. They also reported the extent to which they experienced perceived change in social support resulting from the pandemic, pandemic-related stress, and general loneliness. Results: After the onset of COVID-19, participants showed an increase in daily time spent on SNSs (t169=5.53, d=0.42, P<.001), habitual use (t173=3.60, d=0.27, P<.001), and addiction (t173=4.96, d=0.38, P<.001); further, enjoyment on SNSs decreased (t173=–2.10, d=–0.16, P=.04) and the emotional impact of SNS activities became more negative (t172=–3.76, d=–0.29, P<.001). Increased perceived social support during COVID-19 was associated with changes in frequency of SNS use, time per day, addiction, and engagement (r>0.18 for all). Pandemic-related stress was associated with changes in SNS addiction and the extent to which one’s SNS content was related to the pandemic (r>0.20 for all). Loneliness was positively associated with SNS addiction (r=0.26) and negatively associated with SNS engagement (r=–0.19) during the pandemic. Loneliness was also negatively associated with changes in habit and engagement (r<–0.15 for all). Conclusions: Findings suggest that components of SNS use are associated with both positive and negative pandemic-related social outcomes, but largely negative pandemic-related emotional outcomes. Further, some components of SNS use are positively associated with loneliness (eg, addiction) while others show a negative association (eg, engagement). These findings provide a more nuanced picture of how SNS use is associated with social and emotional well-being during the time of a global health crisis when in-person interactions are scarce. %M 34313587 %R 10.2196/26513 %U https://formative.jmir.org/2021/9/e26513 %U https://doi.org/10.2196/26513 %U http://www.ncbi.nlm.nih.gov/pubmed/34313587 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29329 %T Health Belief Model Perspective on the Control of COVID-19 Vaccine Hesitancy and the Promotion of Vaccination in China: Web-Based Cross-sectional Study %A Chen,Hao %A Li,Xiaomei %A Gao,Junling %A Liu,Xiaoxi %A Mao,Yimeng %A Wang,Ruru %A Zheng,Pinpin %A Xiao,Qianyi %A Jia,Yingnan %A Fu,Hua %A Dai,Junming %+ Department of Preventive Medicine and Health Education, School of Public Health, Fudan University, No.138# Yixueyuan Road, Xuhui District, Shanghai, 200032, China, 86 021 54237358, jmdai@fudan.edu.cn %K COVID-19 pandemic %K vaccination behavior %K vaccine hesitancy %K health belief model %D 2021 %7 6.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The control of vaccine hesitancy and the promotion of vaccination are key protective measures against COVID-19. Objective: This study assesses the prevalence of vaccine hesitancy and the vaccination rate and examines the association between factors of the health belief model (HBM) and vaccination. Methods: A convenience sample of 2531 valid participants from 31 provinces and autonomous regions of mainland China were enrolled in this online survey study from January 1 to 24, 2021. Multivariable logistic regression was used to identify the associations of the vaccination rate and HBM factors with the prevalence of vaccine hesitancy after other covariates were controlled. Results: The prevalence of vaccine hesitancy was 44.3% (95% CI 42.3%-46.2%), and the vaccination rate was 10.4% (9.2%-11.6%). The factors that directly promoted vaccination behavior were a lack of vaccine hesitancy (odds ratio [OR] 7.75, 95% CI 5.03-11.93), agreement with recommendations from friends or family for vaccination (OR 3.11, 95% CI 1.75-5.52), and absence of perceived barriers to COVID-19 vaccination (OR 0.51, 95% CI 0.35-0.75). The factors that were directly associated with a higher vaccine hesitancy rate were a high level of perceived barriers (OR 1.63, 95% CI 1.36-1.95) and perceived benefits (OR 0.51, 95% CI 0.32-0.79). A mediating effect of self-efficacy, influenced by perceived barriers (standardized structure coefficient [SSC]=−0.71, P<.001), perceived benefits (SSC=0.58, P<.001), agreement with recommendations from authorities (SSC=0.27, P<.001), and agreement with recommendations from friends or family (SSC=0.31, P<.001), was negatively associated with vaccination (SSC=−0.45, P<.001) via vaccine hesitancy (SSC=−0.32, P<.001). Conclusions: It may be possible to increase the vaccination rate by reducing vaccine hesitancy and perceived barriers to vaccination and by encouraging volunteers to advocate for vaccination to their friends and family members. It is also important to reduce vaccine hesitancy by enhancing self-efficacy for vaccination, due to its crucial mediating function. %M 34280115 %R 10.2196/29329 %U https://www.jmir.org/2021/9/e29329 %U https://doi.org/10.2196/29329 %U http://www.ncbi.nlm.nih.gov/pubmed/34280115 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e28975 %T Association Between What People Learned About COVID-19 Using Web Searches and Their Behavior Toward Public Health Guidelines: Empirical Infodemiology Study %A Akpan,Ikpe Justice %A Aguolu,Obianuju Genevieve %A Kobara,Yawo Mamoua %A Razavi,Rouzbeh %A Akpan,Asuama A %A Shanker,Murali %+ Department of Management & Information Systems, Kent State University, 330 University Drive Northeast, New Philadelphia, OH, 44663, United States, 1 3303393391 ext 7572, iakpan@kent.edu %K internet %K novel coronavirus %K SARS-CoV-2 %K COVID-19 %K infodemiology %K misinformation %K conspiracy theories %K public health %D 2021 %7 2.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of the internet and web-based platforms to obtain public health information and manage health-related issues has become widespread in this digital age. The practice is so pervasive that the first reaction to obtaining health information is to “Google it.” As SARS-CoV-2 broke out in Wuhan, China, in December 2019 and quickly spread worldwide, people flocked to the internet to learn about the novel coronavirus and the disease, COVID-19. Lagging responses by governments and public health agencies to prioritize the dissemination of information about the coronavirus outbreak through the internet and the World Wide Web and to build trust gave room for others to quickly populate social media, online blogs, news outlets, and websites with misinformation and conspiracy theories about the COVID-19 pandemic, resulting in people’s deviant behaviors toward public health safety measures. Objective: The goals of this study were to determine what people learned about the COVID-19 pandemic through web searches, examine any association between what people learned about COVID-19 and behavior toward public health guidelines, and analyze the impact of misinformation and conspiracy theories about the COVID-19 pandemic on people’s behavior toward public health measures. Methods: This infodemiology study used Google Trends’ worldwide search index, covering the first 6 months after the SARS-CoV-2 outbreak (January 1 to June 30, 2020) when the public scrambled for information about the pandemic. Data analysis employed statistical trends, correlation and regression, principal component analysis (PCA), and predictive models. Results: The PCA identified two latent variables comprising past coronavirus epidemics (pastCoVepidemics: keywords that address previous epidemics) and the ongoing COVID-19 pandemic (presCoVpandemic: keywords that explain the ongoing pandemic). Both principal components were used significantly to learn about SARS-CoV-2 and COVID-19 and explained 88.78% of the variability. Three principal components fuelled misinformation about COVID-19: misinformation (keywords “biological weapon,” “virus hoax,” “common cold,” “COVID-19 hoax,” and “China virus”), conspiracy theory 1 (ConspTheory1; keyword “5G” or “@5G”), and conspiracy theory 2 (ConspTheory2; keyword “ingest bleach”). These principal components explained 84.85% of the variability. The principal components represent two measurements of public health safety guidelines—public health measures 1 (PubHealthMes1; keywords “social distancing,” “wash hands,” “isolation,” and “quarantine”) and public health measures 2 (PubHealthMes2; keyword “wear mask”)—which explained 84.7% of the variability. Based on the PCA results and the log-linear and predictive models, ConspTheory1 (keyword “@5G”) was identified as a predictor of people’s behavior toward public health measures (PubHealthMes2). Although correlations of misinformation (keywords “COVID-19,” “hoax,” “virus hoax,” “common cold,” and more) and ConspTheory2 (keyword “ingest bleach”) with PubHealthMes1 (keywords “social distancing,” “hand wash,” “isolation,” and more) were r=0.83 and r=–0.11, respectively, neither was statistically significant (P=.27 and P=.13, respectively). Conclusions: Several studies focused on the impacts of social media and related platforms on the spreading of misinformation and conspiracy theories. This study provides the first empirical evidence to the mainly anecdotal discourse on the use of web searches to learn about SARS-CoV-2 and COVID-19. %M 34280117 %R 10.2196/28975 %U https://www.jmir.org/2021/9/e28975 %U https://doi.org/10.2196/28975 %U http://www.ncbi.nlm.nih.gov/pubmed/34280117 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e29310 %T COVID-19 Data Utilization in North Carolina: Qualitative Analysis of Stakeholder Experiences %A Patterson,Jenny Rees %A Shaw,Donna %A Thomas,Sharita R %A Hayes,Julie A %A Daley,Christopher R %A Knight,Stefania %A Aikat,Jay %A Mieczkowska,Joanna O %A Ahalt,Stanley C %A Krishnamurthy,Ashok K %+ University of Iowa, 145 N. Riverside Drive, Iowa City, IA, 52242, United States, 1 3147490050, jennifer-patterson@uiowa.edu %K qualitative research %K interview %K COVID-19 %K SARS-CoV-2 %K pandemic %K data collection %K data reporting %K data %K public health %K coronavirus disease 2019 %D 2021 %7 2.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As the world faced the pandemic caused by the novel coronavirus disease 2019 (COVID-19), medical professionals, technologists, community leaders, and policy makers sought to understand how best to leverage data for public health surveillance and community education. With this complex public health problem, North Carolinians relied on data from state, federal, and global health organizations to increase their understanding of the pandemic and guide decision-making. Objective: We aimed to describe the role that stakeholders involved in COVID-19–related data played in managing the pandemic in North Carolina. The study investigated the processes used by organizations throughout the state in using, collecting, and reporting COVID-19 data. Methods: We used an exploratory qualitative study design to investigate North Carolina’s COVID-19 data collection efforts. To better understand these processes, key informant interviews were conducted with employees from organizations that collected COVID-19 data across the state. We developed an interview guide, and open-ended semistructured interviews were conducted during the period from June through November 2020. Interviews lasted between 30 and 45 minutes and were conducted by data scientists by videoconference. Data were subsequently analyzed using qualitative data analysis software. Results: Results indicated that electronic health records were primary sources of COVID-19 data. Often, data were also used to create dashboards to inform the public or other health professionals, to aid in decision-making, or for reporting purposes. Cross-sector collaboration was cited as a major success. Consistency among metrics and data definitions, data collection processes, and contact tracing were cited as challenges. Conclusions: Findings suggest that, during future outbreaks, organizations across regions could benefit from data centralization and data governance. Data should be publicly accessible and in a user-friendly format. Additionally, established cross-sector collaboration networks are demonstrably beneficial for public health professionals across the state as these established relationships facilitate a rapid response to evolving public health challenges. %M 34298500 %R 10.2196/29310 %U https://publichealth.jmir.org/2021/9/e29310 %U https://doi.org/10.2196/29310 %U http://www.ncbi.nlm.nih.gov/pubmed/34298500 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 9 %P e29576 %T Effect of the Period From COVID-19 Symptom Onset to Confirmation on Disease Duration: Quantitative Analysis of Publicly Available Patient Data %A Park,Myung-Bae %A Park,Eun Young %A Lee,Tae Sic %A Lee,Jinhee %+ Department of Psychiatry, Yonsei University Wonju College of Medicine, Ilsan-ro 20, Wonju, 26426, Republic of Korea, 82 1074470582, jinh.lee95@yonsei.ac.kr %K COVID-19 %K SARS-CoV-2 %K symptoms onset %K duration of prevalence %K confirmation %K South Korea %K data crawling %K social media %K Internet %K dataset %K symptom %K duration %K outcome %K diagnosis %K prevalence %D 2021 %7 1.9.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In general, early intervention in disease based on early diagnosis is considered to be very important for improving health outcomes. However, there is still insufficient evidence regarding how medical care that is based on the early diagnosis of confirmed cases can affect the outcome of COVID-19 treatment. Objective: We aimed to investigate the effect of the duration from the onset of clinical symptoms to confirmation of COVID-19 on the duration from the onset of symptoms to the resolution of COVID-19 (release from quarantine). Methods: For preliminary data collection, we performed data crawling to extract data from social networks, blogs, and official websites operated by local governments. We collected data from the 4002 confirmed cases in 33 cities reported up to May 31, 2020, for whom sex and age information could be verified. Subsequently, 2494 patients with unclear symptom onset dates and 1349 patients who had not been released or had no data about their release dates were excluded. Thus, 159 patients were finally included in this study. To investigate whether rapid confirmation reduces the prevalence period, we divided the duration from symptom onset to confirmation into quartiles of ≤1, ≤3, ≤6, and ≥7 days, respectively. We investigated the duration from symptom onset to release and that from confirmation to release according to these quartiles. Furthermore, we performed multiple regression analysis to investigate the effects of rapid confirmation after symptom onset on the treatment period, duration of prevalence, and duration until release from isolation. Results: We performed multiple regression analysis to investigate the association between rapid confirmation after symptom onset and the total prevalence period (faster release from isolation). The time from symptom onset to confirmation showed a negative association with the time from confirmation to release (t1=−3.58; P<.001) and a positive association with the time from symptom onset to release (t1=5.86; P<.001); these associations were statistically significant. Conclusions: The duration from COVID-19 symptom onset to confirmation date is an important variable for predicting disease prevalence, and these results support the hypothesis that a short duration of symptom onset to confirmation can reduce the time from symptom onset to release. %M 34280114 %R 10.2196/29576 %U https://www.jmir.org/2021/9/e29576 %U https://doi.org/10.2196/29576 %U http://www.ncbi.nlm.nih.gov/pubmed/34280114 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 9 %P e30406 %T Logistics Workers Are a Key Factor for SARS-CoV-2 Spread in Brazilian Small Towns: Case-Control Study %A Bernardes-Souza,Breno %A Júnior,Saulo Ricardo Costa %A Santos,Carolina Ali %A Neto,Raimundo Marques Do Nascimento %A Bottega,Fernando De Carvalho %A Godoy,Daiana Carolina %A Freitas,Bruno Lourençoni %A Silva,Daniela Leite Garcia %A Brinker,Titus Josef %A Nascimento,Raiza Aranha %A Tupinambás,Unaí %A Reis,Alexandre Barbosa %A Coura-Vital,Wendel %+ School of Medicine, Federal University of Ouro Preto, Morro do Cruzeiro University Campus, Ouro Preto, 35400000, Brazil, 55 31 3559 1001, brenoneps@gmail.com %K COVID-19 %K SARS-CoV-2 %K logistics workers %K risk factors %K household infection %D 2021 %7 1.9.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34388105 %R 10.2196/30406 %U https://publichealth.jmir.org/2021/9/e30406 %U https://doi.org/10.2196/30406 %U http://www.ncbi.nlm.nih.gov/pubmed/34388105 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 9 %P e28849 %T Implementing Home Office Work at a Large Psychiatric University Hospital in Switzerland During the COVID-19 Pandemic: Field Report %A Krückl,Jana Sophia %A Moeller,Julian %A Gaupp,Rainer %A Meier,Christoph E %A Roth,Carl Bénédict %A Lang,Undine Emmi %A Huber,Christian G %+ University Psychiatric Clinics Basel, University of Basel, Wilhelm Klein-Strasse 27, Basel, 4002, Switzerland, 41 61 325 52 00, jana.krueckl@upk.ch %K home office %K psychiatry %K employees %K mental health %K depression %K anxiety %K stress factors %K Patient Health Questionnaire %K PHQ-2 %K General Anxiety Disorder %K GAD-2 %K PHQ-D %K COVID-19 %K pandemic %D 2021 %7 1.9.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: During the COVID-19 pandemic in 2020, psychiatric hospitals all over the world had to adapt their services to the prevailing governmental regulations. As a consequence, home office use and telepsychiatry boomed. Objective: The purpose of this study was to evaluate the potential of home office use, its adoption, and the association of home office use with employees’ mental health in a large psychiatric university hospital in Switzerland. Methods: We obtained and analyzed home office implementation and use data from the psychiatric university hospital’s information technology services. We also conducted a cross-sectional web-based survey to assess the employees’ attitudes toward the clinic’s crisis management during the COVID-19 pandemic in early 2020. Part of this web-based survey consisted of questions about home office use between March and June 2020, attitudes toward home office implementation, and mental health. Three mental health measures assessed depressive symptoms (Patient Health Questionnaire [PHQ]–2), anxiety (General Anxiety Disorder [GAD]–2), and stress factors (stress module of the PHQ-D); a cut-off score ≥3 was used for the PHQ-2 and GAD-2. Results: Of the 200 participating employees, 69 reported that they had worked from home at least partially (34.5%). Home office use differed significantly across professional groups (χ162=72.72, P≤.001, n=200). Employees experienced neither depressive symptoms (mean 0.76, SD 1.14) nor anxiety (mean 0.70, SD 1.03). The employees reported minor psychosocial stressors (mean 2.83, SD 2.92). The number of reported stress factors varied significantly across groups with different levels of home office use (χ42=9.72, P=.04). Conclusions: In general, home office implementation appears to be feasible for large psychiatric hospitals, however, it is not equally feasible for all professional groups. Professional groups that require personal contact with patients and technical or manual tasks must work onsite. Further evaluation of home office use in psychiatric hospitals up to the development of clinics that function merely online will follow in future research. The situation created by the COVID-19 pandemic served as a stepping stone to promote home office use and should be used to improve employees’ work–life balance, to save employers costs and foster other benefits. %M 34115606 %R 10.2196/28849 %U https://mental.jmir.org/2021/9/e28849 %U https://doi.org/10.2196/28849 %U http://www.ncbi.nlm.nih.gov/pubmed/34115606 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 9 %P e28337 %T The Impact of COVID-19–Related Restrictions on Social and Daily Activities of Parents, People With Disabilities, and Older Adults: Protocol for a Longitudinal, Mixed Methods Study %A Reid,Holly %A Miller,William Cameron %A Esfandiari,Elham %A Mohammadi,Somayyeh %A Rash,Isabelle %A Tao,Gordon %A Simpson,Ethan %A Leong,Kai %A Matharu,Parmeet %A Sakakibara,Brodie %A Schmidt,Julia %A Jarus,Tal %A Forwell,Susan %A Borisoff,Jaimie %A Backman,Catherine %A Alic,Adam %A Brooks,Emily %A Chan,Janice %A Flockhart,Elliott %A Irish,Jessica %A Tsukura,Chihori %A Di Spirito,Nicole %A Mortenson,William Ben %+ Rehabilitation Research Program, GF Strong Rehabilitation Centre, 4255 Laurel Street, Vancouver, BC, Canada, 1 604 714 4108, bill.miller@ubc.ca %K COVID-19 %K longitudinal study %K spinal cord injury %K disability %K adult %K occupational disruption %K stroke %K older adults %D 2021 %7 1.9.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has led to wide-scale changes in societal organization. This has dramatically altered people’s daily activities, especially among families with young children, those living with disabilities such as spinal cord injury (SCI), those who have experienced a stroke, and older adults. Objective: We aim to (1) investigate how COVID-19 restrictions influence daily activities, (2) track the psychosocial effects of these restrictions over time, and (3) identify strategies to mitigate the potential negative effects of these restrictions. Methods: This is a longitudinal, concurrent, mixed methods study being conducted in British Columbia (BC), Canada. Data collection occurred at four time points, between April 2020 and February 2021. The first three data collection time points occurred within phases 1 to 3 of the Province of BC’s Restart Plan. The final data collection coincided with the initial distribution of the COVID-19 vaccines. At each time point, data regarding participants’ sociodemographics, depressive and anxiety symptoms, resilience, boredom, social support, instrumental activities of daily living, and social media and technology use were collected in an online survey. These data supplemented qualitative videoconference interviews exploring participants’ COVID-19–related experiences. Participants were also asked to upload photos representing their experience during the restriction period, which facilitated discussion during the final interview. Five groups of participants were recruited: (1) families with children under the age of 18 years, (2) adults with an SCI, (3) adults who experienced a stroke, (4) adults with other types of disabilities, and (5) older adults (>64 years of age) with no self-reported disability. The number of participants we could recruit from each group was limited, which may impact the validity of some subgroup analyses. Results: This study was approved by the University of British Columbia Behavioural Research Ethics Board (Approval No. H20-01109) on April 17, 2020. A total of 81 participants were enrolled in this study and data are being analyzed. Data analyses are expected to be completed in fall 2021; submission of multiple papers for publication is expected by winter 2021. Conclusions: Findings from our study will inform the development and recommendations of a new resource guide for the post–COVID-19 period and for future public health emergencies. International Registered Report Identifier (IRRID): DERR1-10.2196/28337 %M 34292163 %R 10.2196/28337 %U https://www.researchprotocols.org/2021/9/e28337 %U https://doi.org/10.2196/28337 %U http://www.ncbi.nlm.nih.gov/pubmed/34292163 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e25549 %T Patient and Professional Experiences With Virtual Antenatal Clinics During the COVID-19 Pandemic in a UK Tertiary Obstetric Hospital: Questionnaire Study %A Quinn,Lauren Marie %A Olajide,Oluwafumbi %A Green,Marsha %A Sayed,Hazem %A Ansar,Humera %+ University Hospitals of Leicester, Infirmary Square, Leicester, LE1 5WW, United Kingdom, 44 03003031573, lauren.quinn6@nhs.net %K antenatal %K virtual clinic %K technology %K COVID-19 %K United Kingdom %K pandemic %K feasibility %K effective %K telehealth %K virtual health %D 2021 %7 31.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic required rapid implementation of virtual antenatal care to keep pregnant women safe. This transition from face-to-face usual care had to be embraced by patients and professionals alike. Objective: We evaluated patients’ and professionals’ experiences with virtual antenatal clinic appointments during the COVID-19 pandemic to determine satisfaction and inquire into the safety and quality of care received. Methods: A total of 148 women who attended a virtual antenatal clinic appointment at our UK tertiary obstetric care center over a 2-week period provided feedback (n=92, 62% response rate). A further 37 health care professionals (HCPs) delivering care in the virtual antenatal clinics participated in another questionnaire study (37/45, 82% response rate). Results: We showed that women were highly satisfied with the virtual clinics, with 86% (127/148) rating their experience as good or very good, and this was not associated with any statistically significant differences in age (P=.23), ethnicity (P=.95), number of previous births (P=.65), or pregnancy losses (P=.94). Even though 56% (83/148) preferred face-to-face appointments, 44% (65/148) either expressed no preference or preferred virtual, and these preferences were not associated with significant differences in patient demographics. For HCPs, 67% (18/27) rated their experience of virtual clinics as good or very good, 78% (21/27) described their experience as the same or better than face-to-face clinics, 15% (4/27) preferred virtual clinics, and 44% (12/27) had no preference. Importantly, 67% (18/27) found it easy or very easy to adapt to virtual clinics. Over 90% of HCPs agreed virtual clinics should be implemented long-term. Conclusions: Our study demonstrates high satisfaction with telephone antenatal clinics during the pandemic, which supports the transition toward widespread digitalization of antenatal care suited to 21st-century patients and professionals. %M 34254940 %R 10.2196/25549 %U https://www.jmir.org/2021/8/e25549 %U https://doi.org/10.2196/25549 %U http://www.ncbi.nlm.nih.gov/pubmed/34254940 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e21817 %T Online Search Trends Influencing Anticoagulation in Patients With COVID-19: Observational Study %A Worrall,Amy P %A Kelly,Claire %A O'Neill,Aine %A O'Doherty,Murray %A Kelleher,Eoin %A Cushen,Anne Marie %A McNally,Cora %A McConkey,Samuel %A Glavey,Siobhan %A Lavin,Michelle %A de Barra,Eoghan %+ Department of Infectious Diseases, Beaumont Hospital, P.O. Box 1297, Beaumont Road, Dublin, 9, Ireland, 353 1 8093000, worralap@tcd.ie %K COVID-19 %K coronavirus %K online search engines %K anticoagulation %K thrombosis %K online influence %K health information dissemination %D 2021 %7 31.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Early evidence of COVID-19–associated coagulopathy disseminated rapidly online during the first months of 2020, followed by clinical debate about how best to manage thrombotic risks in these patients. The rapid online spread of case reports was followed by online interim guidelines, discussions, and worldwide online searches for further information. The impact of global online search trends and online discussion on local approaches to coagulopathy in patients with COVID-19 has not been studied. Objective: The goal of this study was to investigate the relationship between online search trends using Google Trends and the rate of appropriate venous thromboembolism (VTE) prophylaxis and anticoagulation therapy in a cohort of patients with COVID-19 admitted to a tertiary hospital in Ireland. Methods: A retrospective audit of anticoagulation therapy and VTE prophylaxis among patients with COVID-19 who were admitted to a tertiary hospital was conducted between February 29 and May 31, 2020. Worldwide Google search trends of the term “COVID-19” and anticoagulation synonyms during this time period were determined and correlated against one another using a Spearman correlation. A P value of <.05 was considered significant, and analysis was completed using Prism, version 8 (GraphPad). Results: A statistically significant Spearman correlation (P<.001, r=0.71) was found between the two data sets, showing an increase in VTE prophylaxis in patients with COVID-19 with increasing online searches worldwide. This represents a proxy for online searches and discussion, dissemination of information, and Google search trends relating to COVID-19 and clotting risk, in particular, which correlated with an increasing trend of providing thromboprophylaxis and anticoagulation therapy to patients with COVID-19 in our tertiary center. Conclusions: We described a correlation of local change in clinical practice with worldwide online dialogue and digital search trends that influenced individual clinicians, prior to the publication of formal guidelines or a local quality-improvement intervention. %M 34292865 %R 10.2196/21817 %U https://formative.jmir.org/2021/8/e21817 %U https://doi.org/10.2196/21817 %U http://www.ncbi.nlm.nih.gov/pubmed/34292865 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e29957 %T Exploring the Utility of Google Mobility Data During the COVID-19 Pandemic in India: Digital Epidemiological Analysis %A Kishore,Kamal %A Jaswal,Vidushi %A Verma,Madhur %A Koushal,Vipin %+ All India Institute of Medical Sciences, Jodhpur Romana Road, Bathinda, 151001, India, 91 9466445513, drmadhurverma@gmail.com %K COVID-19 %K lockdown %K nonpharmaceutical Interventions %K social distancing %K digital surveillance %K Google Community Mobility Reports %K community mobility %D 2021 %7 30.8.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Association between human mobility and disease transmission has been established for COVID-19, but quantifying the levels of mobility over large geographical areas is difficult. Google has released Community Mobility Reports (CMRs) containing data about the movement of people, collated from mobile devices. Objective: The aim of this study is to explore the use of CMRs to assess the role of mobility in spreading COVID-19 infection in India. Methods: In this ecological study, we analyzed CMRs to determine human mobility between March and October 2020. The data were compared for the phases before the lockdown (between March 14 and 25, 2020), during lockdown (March 25-June 7, 2020), and after the lockdown (June 8-October 15, 2020) with the reference periods (ie, January 3-February 6, 2020). Another data set depicting the burden of COVID-19 as per various disease severity indicators was derived from a crowdsourced API. The relationship between the two data sets was investigated using the Kendall tau correlation to depict the correlation between mobility and disease severity. Results: At the national level, mobility decreased from –38% to –77% for all areas but residential (which showed an increase of 24.6%) during the lockdown compared to the reference period. At the beginning of the unlock phase, the state of Sikkim (minimum cases: 7) with a –60% reduction in mobility depicted more mobility compared to –82% in Maharashtra (maximum cases: 1.59 million). Residential mobility was negatively correlated (–0.05 to –0.91) with all other measures of mobility. The magnitude of the correlations for intramobility indicators was comparatively low for the lockdown phase (correlation ≥0.5 for 12 indicators) compared to the other phases (correlation ≥0.5 for 45 and 18 indicators in the prelockdown and unlock phases, respectively). A high correlation coefficient between epidemiological and mobility indicators was observed for the lockdown and unlock phases compared to the prelockdown phase. Conclusions: Mobile-based open-source mobility data can be used to assess the effectiveness of social distancing in mitigating disease spread. CMR data depicted an association between mobility and disease severity, and we suggest using this technique to supplement future COVID-19 surveillance. %M 34174780 %R 10.2196/29957 %U https://publichealth.jmir.org/2021/8/e29957 %U https://doi.org/10.2196/29957 %U http://www.ncbi.nlm.nih.gov/pubmed/34174780 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e30164 %T Association of COVID-19 Risk Misperceptions With Household Isolation in the United States: Survey Study %A Ladapo,Joseph A %A Rothwell,Jonathan T %A Ramirez,Christina M %+ Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, 1100 Glendon Ave, Suite 850, Los Angeles, CA, 90024, United States, 1 3107942728, jladapo@mednet.ucla.edu %K COVID-19 %K pandemic %K mental health %K public health %K isolation %K loneliness %K guideline %K risk %K perception %K United States %K health risk %K well-being %D 2021 %7 30.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adverse mental and emotional health outcomes are increasingly recognized as a public health challenge associated with the COVID-19 pandemic. Objective: The goal of this study was to examine the association of COVID-19 risk misperceptions with self-reported household isolation, a potential risk factor for social isolation and loneliness. Methods: We analyzed data from the Franklin Templeton-Gallup Economics of Recovery Study (July to December 2020) of 24,649 US adults. We also analyzed data from the Gallup Panel (March 2020 to February 2021), which included 123,516 observations about loneliness. The primary outcome was self-reported household isolation, which we defined as a respondent having no contact or very little contact with people outside their household, analogous to quarantining. Results: From July to December 2020, 53% to 57% of respondents reported living in household isolation. Most participants reported beliefs about COVID-19 health risks that were inaccurate, and overestimation of health risk was most common. For example, while deaths in persons younger than 55 years old accounted for 7% of total US deaths, respondents estimated that this population represented 43% of deaths. Overestimating COVID-19 health risks was associated with increased self-reported household isolation, with percentage differences ranging from 5.6 to 11.8 (P<.001 at each time point). Characteristics associated with self-reported household isolation from the July and August 2020 surveys and persisting in the December 2020 survey included younger age (18 to 39 years), having a serious medical condition, having a household member with a serious medical condition, and identifying as a Democrat. In the Gallup Panel, self-reported household isolation was associated with a higher prevalence of loneliness. Conclusions: Pandemic-related harms to emotional and mental well-being may be attenuated by reducing risk overestimation and household isolation preferences that exceed public health guidelines. %M 34253507 %R 10.2196/30164 %U https://formative.jmir.org/2021/8/e30164 %U https://doi.org/10.2196/30164 %U http://www.ncbi.nlm.nih.gov/pubmed/34253507 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e28169 %T The COVID-19 Citizen Science Study: Protocol for a Longitudinal Digital Health Cohort Study %A Beatty,Alexis L %A Peyser,Noah D %A Butcher,Xochitl E %A Carton,Thomas W %A Olgin,Jeffrey E %A Pletcher,Mark J %A Marcus,Gregory M %+ Division of Cardiology, University of California, San Francisco, 505 Parnassus Ave, San Francisco, CA, 94117, United States, 1 415 476 3450, greg.marcus@ucsf.edu %K COVID-19 %K digital technology %K participant engagement %K electronic health records %K mobile app %K mHealth %K digital health %D 2021 %7 30.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has catalyzed a global public response and innovation in clinical study methods. Objective: The COVID-19 Citizen Science study was designed to generate knowledge about participant-reported COVID-19 symptoms, behaviors, and disease occurrence. Methods: COVID-19 Citizen Science is a longitudinal cohort study launched on March 26, 2020, on the Eureka Research Platform. This study illustrates important advances in digital clinical studies, including entirely digital study participation, targeted recruitment strategies, electronic consent, recurrent and time-updated assessments, integration with smartphone-based measurements, analytics for recruitment and engagement, connection with partner studies, novel engagement strategies such as participant-proposed questions, and feedback in the form of real-time results to participants. Results: As of February 2021, the study has enrolled over 50,000 participants. Study enrollment and participation are ongoing. Over the lifetime of the study, an average of 59% of participants have completed at least one survey in the past 4 weeks. Conclusions: Insights about COVID-19 symptoms, behaviors, and disease occurrence can be drawn through digital clinical studies. Continued innovation in digital clinical study methods represents the future of clinical research. International Registered Report Identifier (IRRID): DERR1-10.2196/28169 %M 34310336 %R 10.2196/28169 %U https://www.researchprotocols.org/2021/8/e28169 %U https://doi.org/10.2196/28169 %U http://www.ncbi.nlm.nih.gov/pubmed/34310336 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30715 %T Exploring the Expression Differences Between Professionals and Laypeople Toward the COVID-19 Vaccine: Text Mining Approach %A Luo,Chen %A Ji,Kaiyuan %A Tang,Yulong %A Du,Zhiyuan %+ Institute of Communication Studies, Communication University of China, No 1 Dingfuzhuang East Street, Chaoyang District, Beijing, 100024, China, 86 13217810927, longbao0927@163.com %K COVID-19 %K vaccine %K Zhihu %K structural topic modeling %K medical professional %K laypeople %K adverse reactions %K vaccination %K vaccine effectiveness %K vaccine development %D 2021 %7 27.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is still rampant all over the world. Until now, the COVID-19 vaccine is the most promising measure to subdue contagion and achieve herd immunity. However, public vaccination intention is suboptimal. A clear division lies between medical professionals and laypeople. While most professionals eagerly promote the vaccination campaign, some laypeople exude suspicion, hesitancy, and even opposition toward COVID-19 vaccines. Objective: This study aims to employ a text mining approach to examine expression differences and thematic disparities between the professionals and laypeople within the COVID-19 vaccine context. Methods: We collected 3196 answers under 65 filtered questions concerning the COVID-19 vaccine from the China-based question and answer forum Zhihu. The questions were classified into 5 categories depending on their contents and description: adverse reactions, vaccination, vaccine effectiveness, social implications of vaccine, and vaccine development. Respondents were also manually coded into two groups: professional and laypeople. Automated text analysis was performed to calculate fundamental expression characteristics of the 2 groups, including answer length, attitude distribution, and high-frequency words. Furthermore, structural topic modeling (STM), as a cutting-edge branch in the topic modeling family, was used to extract topics under each question category, and thematic disparities were evaluated between the 2 groups. Results: Laypeople are more prevailing in the COVID-19 vaccine–related discussion. Regarding differences in expression characteristics, the professionals posted longer answers and showed a conservative stance toward vaccine effectiveness than did laypeople. Laypeople mentioned countries more frequently, while professionals were inclined to raise medical jargon. STM discloses prominent topics under each question category. Statistical analysis revealed that laypeople preferred the “safety of Chinese-made vaccine” topic and other vaccine-related issues in other countries. However, the professionals paid more attention to medical principles and professional standards underlying the COVID-19 vaccine. With respect to topics associated with the social implications of vaccines, the 2 groups showed no significant difference. Conclusions: Our findings indicate that laypeople and professionals share some common grounds but also hold divergent focuses toward the COVID-19 vaccine issue. These incongruities can be summarized as “qualitatively different” in perspective rather than “quantitatively different” in scientific knowledge. Among those questions closely associated with medical expertise, the “qualitatively different” characteristic is quite conspicuous. This study boosts the current understanding of how the public perceives the COVID-19 vaccine, in a more nuanced way. Web-based question and answer forums are a bonanza for examining perception discrepancies among various identities. STM further exhibits unique strengths over the traditional topic modeling method in statistically testing the topic preference of diverse groups. Public health practitioners should be keenly aware of the cognitive differences between professionals and laypeople, and pay special attention to the topics with significant inconsistency across groups to build consensus and promote vaccination effectively. %M 34346885 %R 10.2196/30715 %U https://www.jmir.org/2021/8/e30715 %U https://doi.org/10.2196/30715 %U http://www.ncbi.nlm.nih.gov/pubmed/34346885 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 8 %P e27977 %T Factors to Effective Telemedicine Visits During the COVID-19 Pandemic: Cohort Study %A Gmunder,Kristin Nicole %A Ruiz,Jose W %A Franceschi,Dido %A Suarez,Maritza M %+ University of Miami Miller School of Medicine, 1600 NW 10th Ave #1140, Miami, FL, 33136, United States, 1 908 635 9107, kgmunder@med.miami.edu %K telemedicine %K COVID-19 %K patient portals %K delivery of health care %K telehealth %K pandemic %K digital health %D 2021 %7 27.8.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: With COVID-19 there was a rapid and abrupt rise in telemedicine implementation often without sufficient time for providers or patients to adapt. As telemedicine visits are likely to continue to play an important role in health care, it is crucial to strive for a better understanding of how to ensure completed telemedicine visits in our health system. Awareness of these barriers to effective telemedicine visits is necessary for a proactive approach to addressing issues. Objective: The objective of this study was to identify variables that may affect telemedicine visit completion in order to determine actions that can be enacted across the entire health system to benefit all patients. Methods: Data were collected from scheduled telemedicine visits (n=362,764) at the University of Miami Health System (UHealth) between March 1, 2020 and October 31, 2020. Descriptive statistics, mixed effects logistic regression, and random forest modeling were used to identify the most important patient-agnostic predictors of telemedicine completion. Results: Using descriptive statistics, struggling telemedicine specialties, providers, and clinic locations were identified. Through mixed effects logistic regression (adjusting for clustering at the clinic site level), the most important predictors of completion included previsit phone call/SMS text message reminder status (confirmed vs not answered) (odds ratio [OR] 6.599, 95% CI 6.483-6.717), MyUHealthChart patient portal status (not activated vs activated) (OR 0.315, 95% CI 0.305-0.325), provider’s specialty (primary care vs medical specialty) (OR 1.514, 95% CI 1.472-1.558), new to the UHealth system (yes vs no) (OR 1.285, 95% CI 1.201-1.374), and new to provider (yes vs no) (OR 0.875, 95% CI 0.859-0.891). Random forest modeling results mirrored those from logistic regression. Conclusions: The highest association with a completed telemedicine visit was the previsit appointment confirmation by the patient via phone call/SMS text message. An active patient portal account was the second strongest variable associated with completion, which underscored the importance of patients having set up their portal account before the telemedicine visit. Provider’s specialty was the third strongest patient-agnostic characteristic associated with telemedicine completion rate. Telemedicine will likely continue to have an integral role in health care, and these results should be used as an important guide to improvement efforts. As a first step toward increasing completion rates, health care systems should focus on improvement of patient portal usage and use of previsit reminders. Optimization and intervention are necessary for those that are struggling with implementing telemedicine. We advise setting up a standardized workflow for staff. %M 34254936 %R 10.2196/27977 %U https://medinform.jmir.org/2021/8/e27977 %U https://doi.org/10.2196/27977 %U http://www.ncbi.nlm.nih.gov/pubmed/34254936 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e24181 %T Implementation of Digital Monitoring Services During the COVID-19 Pandemic for Patients With Chronic Diseases: Design Science Approach %A Lapão,Luís Velez %A Peyroteo,Mariana %A Maia,Melanie %A Seixas,Jorge %A Gregório,João %A Mira da Silva,Miguel %A Heleno,Bruno %A Correia,Jorge César %+ Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Rua da Junqueira, 100, Lisbon, 1349-008, Portugal, 351 213652600, luis.lapao@ihmt.unl.pt %K primary healthcare %K information systems %K telemedicine %K implementation %K design science research %K COVID-19 %K monitoring %K chronic disease %K elderly %K digital health %D 2021 %7 26.8.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34313591 %R 10.2196/24181 %U https://www.jmir.org/2021/8/e24181 %U https://doi.org/10.2196/24181 %U http://www.ncbi.nlm.nih.gov/pubmed/34313591 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e27681 %T Development of a COVID-19 Web Information Transmission Structure Based on a Quadruple Helix Model: Webometric Network Approach Using Bing %A Zhu,Yu Peng %A Park,Han Woo %+ Department of Media and Communication, Yeungnam University, 214-1 Dae-dong, Gyeongsan-si, Republic of Korea, 82 53 810 2275, hanpark@ynu.ac.kr %K quadruple helix model %K COVID-19 %K structural analysis %K content analysis %K network analysis %K public health %K webometrics %K infodemiology %K infoveillance %K development %K internet %K online health information %K structure %K communication %K big data %D 2021 %7 26.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Developing an understanding of the social structure and phenomenon of pandemic information sources worldwide is immensely significant. Objective: Based on the quadruple helix model, the aim of this study was to construct and analyze the structure and content of the internet information sources regarding the COVID-19 pandemic, considering time and space. The broader goal was to determine the status and limitations of web information transmission and online communication structure during public health emergencies. Methods: By sorting the second top-level domain, we divided the structure of network information sources into four levels: government, educational organizations, companies, and nonprofit organizations. We analyzed the structure of information sources and the evolution of information content at each stage using quadruple helix and network analysis methods. Results: The results of the structural analysis indicated that the online sources of information in Asia were more diverse than those in other regions in February 2020. As the pandemic spread in April, the information sources in non-Asian regions began to diversify, and the information source structure diversified further in July. With the spread of the pandemic, for an increasing number of countries, not only the government authorities of high concern but also commercial and educational organizations began to produce and provide significant amounts of information and advice. Nonprofit organizations also produced information, but to a lesser extent. The impact of the virus spread from the initial public level of the government to many levels within society. After April, the government’s role in the COVID-19 network information was central. The results of the content analysis showed that there was an increased focus on discussion regarding public health–related campaign materials at all stages. The information content changed with the changing stages. In the early stages, the basic situation regarding the virus and its impact on health attracted most of the attention. Later, the content was more focused on prevention. The business and policy environment also changed from the beginning of the pandemic, and the social changes caused by the pandemic became a popular discussion topic. Conclusions: For public health emergencies, some online and offline information sources may not be sufficient. Diversified institutions must pay attention to public health emergencies and actively respond to multihelical information sources. In terms of published messages, the educational sector plays an important role in public health events. However, educational institutions release less information than governments and businesses. This study proposes that the quadruple helix not only has research significance in the field of scientific cooperation but could also be used to perform effective research regarding web information during crises. This is significant for further development of the quadruple helix model in the medical internet research area. %M 34280119 %R 10.2196/27681 %U https://www.jmir.org/2021/8/e27681 %U https://doi.org/10.2196/27681 %U http://www.ncbi.nlm.nih.gov/pubmed/34280119 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e26604 %T Identifying Communities at Risk for COVID-19–Related Burden Across 500 US Cities and Within New York City: Unsupervised Learning of the Coprevalence of Health Indicators %A Deonarine,Andrew %A Lyons,Genevieve %A Lakhani,Chirag %A De Brouwer,Walter %+ XY.ai, 56 JFK Street, Cambridge, MA, 02138, United States, 1 8575000461, andrew@xy.ai %K COVID-19 %K satellite imagery %K built environment %K social determinants of health %K machine learning %K artificial intelligence %K community %K risk %K United States %K indicator %K comorbidity %K environment %K population %K determinant %K mortality %K prediction %D 2021 %7 26.8.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Although it is well-known that older individuals with certain comorbidities are at the highest risk for complications related to COVID-19 including hospitalization and death, we lack tools to identify communities at the highest risk with fine-grained spatial resolution. Information collected at a county level obscures local risk and complex interactions between clinical comorbidities, the built environment, population factors, and other social determinants of health. Objective: This study aims to develop a COVID-19 community risk score that summarizes complex disease prevalence together with age and sex, and compares the score to different social determinants of health indicators and built environment measures derived from satellite images using deep learning. Methods: We developed a robust COVID-19 community risk score (COVID-19 risk score) that summarizes the complex disease co-occurrences (using data for 2019) for individual census tracts with unsupervised learning, selected on the basis of their association with risk for COVID-19 complications such as death. We mapped the COVID-19 risk score to corresponding zip codes in New York City and associated the score with COVID-19–related death. We further modeled the variance of the COVID-19 risk score using satellite imagery and social determinants of health. Results: Using 2019 chronic disease data, the COVID-19 risk score described 85% of the variation in the co-occurrence of 15 diseases and health behaviors that are risk factors for COVID-19 complications among ~28,000 census tract neighborhoods (median population size of tracts 4091). The COVID-19 risk score was associated with a 40% greater risk for COVID-19–related death across New York City (April and September 2020) for a 1 SD change in the score (risk ratio for 1 SD change in COVID-19 risk score 1.4; P<.001) at the zip code level. Satellite imagery coupled with social determinants of health explain nearly 90% of the variance in the COVID-19 risk score in the United States in census tracts (r2=0.87). Conclusions: The COVID-19 risk score localizes risk at the census tract level and was able to predict COVID-19–related mortality in New York City. The built environment explained significant variations in the score, suggesting risk models could be enhanced with satellite imagery. %M 34280122 %R 10.2196/26604 %U https://publichealth.jmir.org/2021/8/e26604 %U https://doi.org/10.2196/26604 %U http://www.ncbi.nlm.nih.gov/pubmed/34280122 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e29419 %T The Persistence of the Impact of COVID-19–Related Distress, Mood Inertia, and Loneliness on Mental Health During a Postlockdown Period in Germany: An Ecological Momentary Assessment Study %A Haucke,Matthias %A Liu,Shuyan %A Heinzel,Stephan %+ Department of Psychiatry and Psychotherapy, Charité – Universitätsmedizin Berlin, Campus Charité Mitte, Charitéplatz 1, Berlin, Germany, 49 30450517002, siyan908@hotmail.com %K COVID-19 %K outbreaks %K epidemics %K pandemics %K psychological responses and emotional well-being %K ecological momentary assessment %K risk and protective factors %K low incidence and restrictions %D 2021 %7 26.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The first wave of the COVID-19 pandemic in early 2020 increased mental health problems globally. However, little is known about mental health problems during a low-incidence period of the pandemic without strict public health measures. Objective: We aim to investigate whether COVID-19–related risk factors for mental health problems persist beyond lockdown measures. We targeted a vulnerable population that is at risk of developing low mental health and assessed their daily dynamics of mood and emotion regulation after a strict lockdown. Methods: During a postlockdown period in Germany (between August 8, 2020, and November 1, 2020), we conducted an ecological momentary assessment with 131 participants who experienced at least mild COVID-19–related distress and loneliness. To estimate negative mood inertia, we built a lag-1 three-level autoregressive model. Results: We found that information exposure and active daily COVID-19 cases did not have an impact on negative mood amid a postlockdown period. However, there was a day-to-day carryover effect of negative mood. In addition, worrying about COVID-19, feeling restricted by COVID-19, and feeling lonely increased negative mood. Conclusions: The mental health of a vulnerable population is still challenged by COVID-19–related stressors after the lifting of a strict lockdown. This study highlights the need to protect mental health during postpandemic periods. %M 34347622 %R 10.2196/29419 %U https://mental.jmir.org/2021/8/e29419 %U https://doi.org/10.2196/29419 %U http://www.ncbi.nlm.nih.gov/pubmed/34347622 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26227 %T Satisfaction and Usability of an Information and Communications Technology–Based System by Clinically Healthy Patients With COVID-19 and Medical Professionals: Cross-sectional Survey and Focus Group Interview Study %A Bae,Ye Seul %A Kim,Kyung Hwan %A Choi,Sae Won %A Ko,Taehoon %A Lim,Jun Seo %A Piao,Meihua %+ Department of Thoracic & Cardiovascular Surgery, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 220727546, kkh726@snu.ac.kr %K COVID-19 %K mobile app %K telemedicine %K wearable device %K vital sign %K satisfaction %K usability %D 2021 %7 26.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital health care is an important strategy in the war against COVID-19. South Korea introduced living and treatment support centers (LTSCs) to control regional outbreaks and care for patients with asymptomatic or mild COVID-19. Seoul National University Hospital (SNUH) introduced information and communications technology (ICT)–based solutions to manage clinically healthy patients with COVID-19. Objective: This study aims to investigate satisfaction and usability by patients and health professionals in the optimal use of a mobile app and wearable device that SNUH introduced to the LTSC for clinically healthy patients with COVID-19. Methods: Online surveys and focus group interviews were conducted to collect quantitative and qualitative data. Results: Regarding usability testing of the wearable device, perceived usefulness had the highest mean score of 4.45 (SD 0.57) points out of 5. Regarding usability of the mobile app, perceived usefulness had the highest mean score of 4.62 (SD 0.48) points out of 5. Regarding satisfaction items for the mobile app among medical professionals, the “self-reporting” item had the highest mean score of 4.42 (SD 0.58) points out of 5. In focus group interviews of health care professionals, hospital information system interfacing was the most important functional requirement for ICT-based COVID-19 telemedicine. Conclusions: Improvement of patient safety and reduction of the burden on medical staff were the expected positive outcomes. Stability and reliability of the device, patient education, accountability, and reimbursement issues should be considered as part of the development of remote patient monitoring. In responding to a novel contagious disease, telemedicine and a wearable device were shown to be useful during a global crisis. %M 34254946 %R 10.2196/26227 %U https://formative.jmir.org/2021/8/e26227 %U https://doi.org/10.2196/26227 %U http://www.ncbi.nlm.nih.gov/pubmed/34254946 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 8 %P e30099 %T Evaluating the Impact of COVID-19 on the Adoption of Virtual Care in General Practice in 20 Countries (inSIGHT): Protocol and Rationale Study %A Neves,Ana Luísa %A Li,Edmond %A Serafini,Alice %A Jimenez,Geronimo %A Lingner,Heidrun %A Koskela,Tuomas H %A Hoffman,Robert D %A Collins,Claire %A Petek,Davorina %A Claveria,Ana %A Tsopra,Rosy %A Irving,Greg %A Gusso,Gustavo %A O’Neill,Braden Gregory %A Hoedebecke,Kyle %A Espitia,Sandra Milena %A Ungan,Mehmet %A Nessler,Katarzyna %A Lazic,Vanja %A Laranjo,Liliana %A Memarian,Ensieh %A Fernandez,Maria Jose %A Ghafur,Saira %A Fontana,Gianluca %A Majeed,Azeem %A Car,Josip %A Darzi,Ara %+ Institute of Global Health Innovation, Department of Surgery & Cancer, Faculty of Medicine, Imperial College London, Room 1035/7, QEQM Wing, St Mary’s Hospital Campus, London, W2 1NY, United Kingdom, 44 02033127259, ana.luisa.neves14@imperial.ac.uk %K primary care %K telemedicine %K virtual care %K digital-first models %K quality of care %K patient safety %D 2021 %7 26.8.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In recent decades, virtual care has emerged as a promising option to support primary care delivery. However, despite the potential, adoption rates remained low. With the outbreak of COVID-19, it has suddenly been pushed to the forefront of care delivery. As we progress into the second year of the COVID-19 pandemic, there is a need and opportunity to review the impact remote care had in primary care settings and reassess its potential future role. Objective: This study aims to explore the perspectives of general practitioners (GPs) and family doctors on the (1) use of virtual care during the COVID-19 pandemic, (2) perceived impact on quality and safety of care, and (3) essential factors for high-quality and sustainable use of virtual care in the future. Methods: This study used an online cross-sectional questionnaire completed by GPs distributed across 20 countries. The survey was hosted in Qualtrics and distributed using email, social media, and the researchers’ personal contact networks. GPs were eligible for the survey if they were working mainly in primary care during the period of the COVID-19 pandemic. Descriptive statistical analysis will be performed for quantitative variables, and relationships between the use of virtual care and perceptions on impact on quality and safety of care and participants’ characteristics may be explored. Qualitative data (free-text responses) will be analyzed using framework analysis. Results: Data collection took place from June 2020 to September 2020. As of this manuscript’s submission, a total of 1605 GP respondents participated in the questionnaire. Further data analysis is currently ongoing. Conclusions: The study will provide a comprehensive overview of the availability of virtual care technologies, perceived impact on quality and safety of care, and essential factors for high-quality future use. In addition, a description of the underlying factors that influence this adoption and perceptions, in both individual GP and family doctor characteristics and the context in which they work, will be provided. While the COVID-19 pandemic may prove the first great stress test of the capabilities, capacity, and robustness of digital systems currently in use, remote care will likely remain an increasingly common approach in the future. There is an imperative to identify the main lessons from this unexpected transformation and use them to inform policy decisions and health service design. International Registered Report Identifier (IRRID): DERR1-10.2196/30099 %M 34292867 %R 10.2196/30099 %U https://www.researchprotocols.org/2021/8/e30099 %U https://doi.org/10.2196/30099 %U http://www.ncbi.nlm.nih.gov/pubmed/34292867 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28716 %T Changes in Public Response Associated With Various COVID-19 Restrictions in Ontario, Canada: Observational Infoveillance Study Using Social Media Time Series Data %A Chum,Antony %A Nielsen,Andrew %A Bellows,Zachary %A Farrell,Eddie %A Durette,Pierre-Nicolas %A Banda,Juan M %A Cupchik,Gerald %+ Department of Applied Health Sciences, Brock University, 1812 Sir Isaac Brock Way, St. Catharines, ON, L2S 3A1, Canada, 1 905 688 5550, antony.chum@gmail.com %K COVID-19 %K public opinion %K social media %K sentiment analysis %K public health restrictions %K infodemiology %K infoveillance %K coronavirus %K evaluation %D 2021 %7 25.8.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34227996 %R 10.2196/28716 %U https://www.jmir.org/2021/8/e28716 %U https://doi.org/10.2196/28716 %U http://www.ncbi.nlm.nih.gov/pubmed/34227996 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 8 %P e28736 %T Factors Associated With Psychological Disturbances During the COVID-19 Pandemic: Multicountry Online Study %A Plomecka,Martyna %A Gobbi,Susanna %A Neckels,Rachael %A Radzinski,Piotr %A Skorko,Beata %A Lazzeri,Samuel %A Almazidou,Kristina %A Dedic,Alisa %A Bakalovic,Asja %A Hrustic,Lejla %A Ashraf,Zainab %A Es Haghi,Sarvin %A Rodriguez-Pino,Luis %A Waller,Verena %A Jabeen,Hafsa %A Alp,A Beyza %A Behnam,Mehdi %A Shibli,Dana %A Baranczuk-Turska,Zofia %A Haq,Zeeshan %A Qureshi,Salah %A Strutt,Adriana M %A Jawaid,Ali %+ Center of Excellence for Neural Plasticity and Brain Disorders: BRAINCITY, Nencki Institute of Experimental Biology, Ludwika Pasteura 3, Warsaw, 02-093, Poland, 48 518892048, a.jawaid@nencki.edu.pl %K COVID-19 %K pandemic %K mental health %K depression %K posttraumatic stress disorder %K general psychological disturbance %K global %D 2021 %7 19.8.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: Accumulating evidence suggests that the COVID-19 pandemic has negatively impacted the mental health of individuals. However, the susceptibility of individuals to be impacted by the pandemic is variable, suggesting potential influences of specific factors related to participants’ demographics, attitudes, and practices. Objective: We aimed to identify the factors associated with psychological symptoms related to the effects of the first wave of the pandemic in a multicountry cohort of internet users. Methods: This study anonymously screened 13,332 internet users worldwide for acute psychological symptoms related to the COVID-19 pandemic from March 29 to April 14, 2020, during the first wave of the pandemic amidst strict lockdown conditions. A total of 12,817 responses were considered valid. Moreover, 1077 participants from Europe were screened a second time from May 15 to May 30, 2020, to ascertain the presence of psychological effects after the ease down of restrictions. Results: Female gender, pre-existing psychiatric conditions, and prior exposure to trauma were identified as notable factors associated with increased psychological symptoms during the first wave of COVID-19 (P<.001). The same factors, in addition to being related to someone who died due to COVID-19 and using social media more than usual, were associated with persistence of psychological disturbances in the limited second assessment of European participants after the restrictions had relatively eased (P<.001). Optimism, ability to share concerns with family and friends like usual, positive prediction about COVID-19, and daily exercise were related to fewer psychological symptoms in both assessments (P<.001). Conclusions: This study highlights the significant impact of the COVID-19 pandemic at the worldwide level on the mental health of internet users and elucidates prominent associations with their demographics, history of psychiatric disease risk factors, household conditions, certain personality traits, and attitudes toward COVID-19. %M 34254939 %R 10.2196/28736 %U https://mental.jmir.org/2021/8/e28736 %U https://doi.org/10.2196/28736 %U http://www.ncbi.nlm.nih.gov/pubmed/34254939 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e25907 %T Next-Generation Digital Biomarkers for Tuberculosis and Antibiotic Stewardship: Perspective on Novel Molecular Digital Biomarkers in Sweat, Saliva, and Exhaled Breath %A Brasier,Noe %A Osthoff,Michael %A De Ieso,Fiorangelo %A Eckstein,Jens %+ Department of Digitalization & ICT, University Hospital Basel, Markgräflerhof / Innovation Lab Hebelstrasse 10, Basel, 4056, Switzerland, 41 797025837, noe.brasier@usb.ch %K digital biomarkers %K active tuberculosis %K drug resistance %K wearable %K smart biosensors %K iSudorology %K infectious diseases %D 2021 %7 19.8.2021 %9 Original Paper %J J Med Internet Res %G English %X The internet of health care things enables a remote connection between health care professionals and patients wearing smart biosensors. Wearable smart devices are potentially affordable, sensitive, specific, user-friendly, rapid, robust, lab-independent, and deliverable to the end user for point-of-care testing. The datasets derived from these devices are known as digital biomarkers. They represent a novel patient-centered approach to collecting longitudinal, context-derived health insights. Adding automated, analytical smartphone applications will enable their use in high-, middle-, and low-income countries. So far, digital biomarkers have been focused primarily on accelerometer data and heart rate due to well-established sensors originating from the consumer market. Novel emerging smart biosensors will detect biomarkers (or compounds) independent of a lab and noninvasively in sweat, saliva, and exhaled breath. These molecular digital biomarkers are a promising novel approach to reduce the burden from 2 major infectious diseases with urgent unmet needs: tuberculosis and infections with multidrug resistant pathogens. Active tuberculosis (aTbc) is one of the deadliest diseases from an infectious agent. However, a simple and reliable test for its detection is still missing. Furthermore, inappropriate antimicrobial use leads to the development of antimicrobial resistance, which is associated with high mortality and health care costs. From this perspective, we discuss the innovative approach of a noninvasive and lab-independent collection of novel biomarkers to detect aTbc, which at the same time may additionally serve as a scalable therapeutic drug monitoring approach for antibiotics. These molecular digital biomarkers are next-generation digital biomarkers and have the potential to shape the future of infectious diseases. %M 34420925 %R 10.2196/25907 %U https://www.jmir.org/2021/8/e25907 %U https://doi.org/10.2196/25907 %U http://www.ncbi.nlm.nih.gov/pubmed/34420925 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 3 %P e22524 %T Infrared Thermal Imaging of Patients With Acute Upper Respiratory Tract Infection: Mixed Methods Analysis %A Zhang,Zuopeng %A Cao,ZanFeng %A Deng,Fangge %A Yang,Zhanzheng %A Ma,Sige %A Guan,Qianting %A Liu,Rong %A He,Zhuosen %+ State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, 151 Yanjiang Xi Lu, Guangzhou City, Guangdong Province, China, Guangzhou, 510120, China, 86 13234006746, fangge256@sina.com %K acute upper respiratory tract %K infrared thermography %K qualitative study %K quantitative study %D 2021 %7 19.8.2021 %9 Original Paper %J Interact J Med Res %G English %X Background: Upper respiratory tract infection is a common disease of the respiratory system. Its incidence is very high, and it can even cause pandemics. Infrared thermal imaging (IRTI) can provide an objective and quantifiable reference for the visual diagnosis of people with acute respiratory tract infection, and it can function as an effective indicator of clinical diagnosis. Objective: The aims of this study are to observe and analyze the infrared expression location and characteristics of patients with acute upper respiratory tract infection through IRTI technology and to clearly express the quantification of temperature, analyze the role of IRTI in acute upper respiratory tract diagnostic research, and understand the impact of IRTI in qualitative and quantitative research. Methods: From December 2018 to February 2019, 154 patients with acute upper respiratory tract infection were randomly selected from the emergency department of the First Affiliated Hospital of Guangzhou Medical University. Among these patients, 73 were men and 81 were women. The subjects were divided into two groups according to the presence of fever, namely, fever and nonfever groups. Qualitative and quantitative analyses of the infrared thermal images were performed to compare the results before and after application of the technology. Results: Using the method described in this paper, through the analysis of experimental data, we elucidated the role of IRTI in the diagnosis of acute upper respiratory tract infection, and we found that qualitative and quantitative IRTI analyses play important roles. Through the combination of theory and experimental data, the IRTI analysis showed good results in identifying acute upper respiratory tract infection. Conclusions: IRTI technology plays an important role in identifying the infrared expression location and characteristics of patients with acute upper respiratory tract infection as well as in the quantification of clear expression of body temperature, and it provides an objective and quantifiable reference basis for elucidating the pathogenesis of these patients. %M 34420912 %R 10.2196/22524 %U https://www.i-jmr.org/2021/3/e22524 %U https://doi.org/10.2196/22524 %U http://www.ncbi.nlm.nih.gov/pubmed/34420912 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e27892 %T The Roles of General Health and COVID-19 Proximity in Contact Tracing App Usage: Cross-sectional Survey Study %A Witteveen,Dirk %A de Pedraza,Pablo %+ European Commission, DG Joint Research Centre, Directorate I – Competences, Unit I.1 - Monitoring, Indicators and Impact Evaluation, Via E. Fermi 2749, TP 361, Ispra (VA), I-21027, Italy, 39 033278380, pablo.depedraza@ec.europa.eu %K COVID-19 %K contact tracing %K socioeconomic factors %K labor market status %K privacy %K data sharing %K pandemic %K mobile health %K public health %K smartphone %K mobile phone %D 2021 %7 18.8.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Contact tracing apps are considered useful means to monitor SARS-CoV-2 infections during the off-peak stages of the COVID-19 pandemic. Their effectiveness is, however, dependent on the uptake of such COVID-19 apps. Objective: We examined the role of individuals’ general health status in their willingness to use a COVID-19 tracing app as well as the roles of socioeconomic characteristics and COVID-19 proximity. Methods: We drew data from the WageIndicator Foundation Living and Working in Coronavirus Times survey. The survey collected data on labor market status as well as the potential confounders of the relationship between general health and COVID-19 tracing app usage, such as sociodemographics and regular smartphone usage data. The survey also contained information that allowed us to examine the role of COVID-19 proximity, such as whether an individual has contracted SARS-CoV-2, whether an individual has family members and colleagues with COVID-19, and whether an individual exhibits COVID-19 pandemic–induced depressive and anxiety symptoms. We selected data that were collected in Spain, Italy, Germany, and the Netherlands from individuals aged between 18 and 70 years (N=4504). Logistic regressions were used to measure individuals’ willingness to use a COVID-19 tracing app. Results: We found that the influence that socioeconomic factors have on COVID-19 tracing app usage varied dramatically between the four countries, although individuals experiencing forms of not being employed (ie, recent job loss and inactivity) consistently had a lower willingness to use a contact tracing app (effect size: 24.6%) compared to that of employees (effect size: 33.4%; P<.001). Among the selected COVID-19 proximity indicators, having a close family member with SARS-CoV-2 infection was associated with higher contact tracing app usage (effect size: 36.3% vs 27.1%; P<.001). After accounting for these proximity factors and the country-based variations therein, we found that having a poorer general health status was significantly associated with a much higher likelihood of contact tracing app usage; compared to a self-reported “very good” health status (estimated probability of contact tracing app use: 29.6%), the “good” (estimated probability: +4.6%; 95% CI 1.2%-8.1%) and “fair or bad” (estimated probability: +6.3%; 95% CI 2.3%-10.3%) health statuses were associated with a markedly higher willingness to use a COVID-19 tracing app. Conclusions: Current public health policies aim to promote the use of smartphone-based contact tracing apps during the off-peak periods of the COVID-19 pandemic. Campaigns that emphasize the health benefits of COVID-19 tracing apps may contribute the most to the uptake of such apps. Public health campaigns that rely on digital platforms would also benefit from seriously considering the country-specific distribution of privacy concerns. %M 34081602 %R 10.2196/27892 %U https://publichealth.jmir.org/2021/8/e27892 %U https://doi.org/10.2196/27892 %U http://www.ncbi.nlm.nih.gov/pubmed/34081602 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e29029 %T Natural Language Processing Insight into LGBTQ+ Youth Mental Health During the COVID-19 Pandemic: Longitudinal Content Analysis of Anxiety-Provoking Topics and Trends in Emotion in LGBTeens Microcommunity Subreddit %A Stevens,Hannah R %A Acic,Irena %A Rhea,Sofia %+ Department of Communication, University of California, Davis, 1 Shields Ave, Davis, CA, 95616, United States, 1 530 752 0966, hrstevens@ucdavis.edu %K COVID-19 %K natural language processing %K LGBTQ+ %K mental health %K anxiety %K emotion %K coronavirus %K outbreak %D 2021 %7 17.8.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Widespread fear surrounding COVID-19, coupled with physical and social distancing orders, has caused severe adverse mental health outcomes. Little is known, however, about how the COVID-19 crisis has impacted LGBTQ+ youth, who disproportionately experienced a high rate of adverse mental health outcomes before the COVID-19 pandemic. Objective: We aimed to address this knowledge gap by harnessing natural language processing methodologies to investigate the evolution of conversation topics in the most popular subreddit for LGBTQ+ youth. Methods: We generated a data set of all r/LGBTeens subreddit posts (n=39,389) between January 1, 2020 and February 1, 2021 and analyzed meaningful trends in anxiety, anger, and sadness in the posts. Because the distribution of anxiety before widespread social distancing orders was meaningfully different from the distribution after (P<.001), we employed latent Dirichlet allocation to examine topics that provoked this shift in anxiety. Results: We did not find any differences in LGBTQ+ youth anger and sadness before and after government-mandated social distancing; however, anxiety increased significantly (P<.001). Further analysis revealed a list of 10 anxiety-provoking topics discussed during the pandemic: attraction to a friend, coming out, coming out to family, discrimination, education, exploring sexuality, gender pronouns, love and relationship advice, starting a new relationship, and struggling with mental health. Conclusions: During the COVID-19 pandemic, LGBTQ+ teens increased their reliance on anonymous discussion forums when discussing anxiety-provoking topics. LGBTQ+ teens likely perceived anonymous forums as safe spaces for discussing lifestyle stressors during COVID-19 disruptions (eg, school closures). The list of prevalent anxiety-provoking topics in LGBTQ+ teens’ anonymous discussions can inform future mental health interventions in LGBTQ+ youth. %M 34402803 %R 10.2196/29029 %U https://publichealth.jmir.org/2021/8/e29029 %U https://doi.org/10.2196/29029 %U http://www.ncbi.nlm.nih.gov/pubmed/34402803 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e29556 %T Digital Surveillance Through an Online Decision Support Tool for COVID-19 Over One Year of the Pandemic in Italy: Observational Study %A Tozzi,Alberto Eugenio %A Gesualdo,Francesco %A Urbani,Emanuele %A Sbenaglia,Alessandro %A Ascione,Roberto %A Procopio,Nicola %A Croci,Ileana %A Rizzo,Caterina %+ Multifactorial and Complex Diseases Research Area, Bambino Gesù Children's Hospital IRCCS, Piazza S. Onofrio, 4, Rome, 00165, Italy, 39 3388437474, francesco.gesualdo@opbg.net %K COVID-19 %K public health %K surveillance %K digital surveillance %K internet %K online decision support system %K decision support %K support %K online tool %K Italy %K observational %D 2021 %7 13.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Italy has experienced severe consequences (ie, hospitalizations and deaths) during the COVID-19 pandemic. Online decision support systems (DSS) and self-triage applications have been used in several settings to supplement health authority recommendations to prevent and manage COVID-19. A digital Italian health tech startup, Paginemediche, developed a noncommercial, online DSS with a chat user interface to assist individuals in Italy manage their potential exposure to COVID-19 and interpret their symptoms since early in the pandemic. Objective: This study aimed to compare the trend in online DSS sessions with that of COVID-19 cases reported by the national health surveillance system in Italy, from February 2020 to March 2021. Methods: We compared the number of sessions by users with a COVID-19–positive contact and users with COVID-19–compatible symptoms with the number of cases reported by the national surveillance system. To calculate the distance between the time series, we used the dynamic time warping algorithm. We applied Symbolic Aggregate approXimation (SAX) encoding to the time series in 1-week periods. We calculated the Hamming distance between the SAX strings. We shifted time series of online DSS sessions 1 week ahead. We measured the improvement in Hamming distance to verify the hypothesis that online DSS sessions anticipate the trends in cases reported to the official surveillance system. Results: We analyzed 75,557 sessions in the online DSS; 65,207 were sessions by symptomatic users, while 19,062 were by contacts of individuals with COVID-19. The highest number of online DSS sessions was recorded early in the pandemic. Second and third peaks were observed in October 2020 and March 2021, respectively, preceding the surge in notified COVID-19 cases by approximately 1 week. The distance between sessions by users with COVID-19 contacts and reported cases calculated by dynamic time warping was 61.23; the distance between sessions by symptomatic users was 93.72. The time series of users with a COVID-19 contact was more consistent with the trend in confirmed cases. With the 1-week shift, the Hamming distance between the time series of sessions by users with a COVID-19 contact and reported cases improved from 0.49 to 0.46. We repeated the analysis, restricting the time window to between July 2020 and December 2020. The corresponding Hamming distance was 0.16 before and improved to 0.08 after the time shift. Conclusions: Temporal trends in the number of online COVID-19 DSS sessions may precede the trend in reported COVID-19 cases through traditional surveillance. The trends in sessions by users with a contact with COVID-19 may better predict reported cases of COVID-19 than sessions by symptomatic users. Data from online DSS may represent a useful supplement to traditional surveillance and support the identification of early warning signals in the COVID-19 pandemic. %M 34292866 %R 10.2196/29556 %U https://www.jmir.org/2021/8/e29556 %U https://doi.org/10.2196/29556 %U http://www.ncbi.nlm.nih.gov/pubmed/34292866 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 3 %P e28049 %T Emergence of the First Strains of SARS-CoV-2 Lineage B.1.1.7 in Romania: Genomic Analysis %A Lobiuc,Andrei %A Dimian,Mihai %A Sturdza,Olga %A Filip,Roxana %A Covasa,Mihai %+ Department of Human Health and Development, College of Physical Exercise and Sport, Stefan cel Mare University of Suceava, Str Universitatii 13, Suceava, 720229, Romania, 40 746900574, mcovasa@usm.ro %K infectious disease %K COVID-19 %K strain %K virus %K Romania %K transmission %K spread %K mutation %K impact %K case study %K genome %K sequencing %K genetics %K epidemiology %K variant %K virology %K lineage %D 2021 %7 13.8.2021 %9 Original Paper %J JMIRx Med %G English %X Background: The United Kingdom reported the emergence of a new and highly transmissible SARS-CoV-2 variant (B.1.1.7) that rapidly spread to other countries. The impact of this new mutation—which occurs in the S protein—on infectivity, virulence, and current vaccine effectiveness is still under evaluation. Objective: The aim of this study is to sequence SARS-CoV-2 samples of cases in Romania to detect the B.1.1.7 variant and compare these samples with sequences submitted to GISAID. Methods: SARS-CoV-2 samples were sequenced and amino acid substitution analysis was performed using the CoV-GLUE platform. Results: We have identified the first cases of the B.1.1.7 variant in samples collected from Romanian patients, of which one was traced to the region of the United Kingdom where the new variant was originally sequenced. Mutations in nonstructural protein 3 (Nsp3; N844S and D455N) and ORF3a (L15F) were also detected, indicating common ancestry with UK strains as well as remote connections with strains from Nagasaki, Japan. Conclusions: These results indicate, for the first time, the presence and characteristics of the new variant B.1.1.7 in Romania and underscore the need for increased genomic sequencing in patients with confirmed COVID-19. %M 34424256 %R 10.2196/28049 %U https://med.jmirx.org/2021/3/e28049 %U https://doi.org/10.2196/28049 %U http://www.ncbi.nlm.nih.gov/pubmed/34424256 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e26565 %T Understanding Physicians’ Preferences for Telemedicine During the COVID-19 Pandemic: Cross-sectional Study %A Nies,Sarah %A Patel,Shae %A Shafer,Melissa %A Longman,Laura %A Sharif,Iman %A Pina,Paulo %+ Family Health Centers at New York University Langone, 5800 3rd Avenue, Brooklyn, NY, 11220, United States, 1 2153474369, paulo.pina@nyulangone.org %K telemedicine %K federally qualified health care center %K primary care %K COVID-19 %K telehealth %K physician %K doctor %K preference %K perspective %K dissemination %K appropriate %K cross-sectional %K survey %D 2021 %7 13.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In contrast to the current broad dissemination of telemedicine across medical specialties, previous research focused on the effectiveness of telemedicine in special populations and for behavioral health encounters, demonstrating that both physician and patient factors impact the efficacious use of telemedicine. Objective: We aim to evaluate physician perceptions of the appropriateness of telemedicine for patients attending the primary care practices of a federally qualified health center in New York City. Methods: We used an anonymous cross-sectional survey including closed- and open-ended questions. We used chi-square to test whether providers from certain specialties were more likely to state they would use telemedicine in the future. We used t tests to compare age between those who would versus would not use telemedicine. We then used logistic regression to test whether age and specialty were both correlated with the desire to use telemedicine in the future. We used thematic content analysis to describe the reasons providers felt they would not want to use telemedicine in the future and to describe the situations for which they felt telemedicine would be appropriate. Results: Of 272 health care providers who were sent the electronic survey, 157 (58%) responded within the 2-week survey time frame. The mean age of providers was 45 (range 28-75) years. Overall, 80% (126/157) stated they would use telemedicine in the future. Compared to the family medicine, internal medicine, behavioral health, dental, and obstetrics and gynecology specialties, providers from pediatrics, med-peds, subspecialties, and surgery (protelemedicine specialties) were more likely to believe telemedicine would be useful post pandemic (61/67 [91%] vs 65/90 [72%]; P<.001). Providers who reported they would use telemedicine in the future were younger (mean age 44, range 42-46 years vs mean age 50, range 46-55 years; P=.048). In the regression analysis, both protelemedicine specialties and age were significantly associated with odds of reporting they would use telemedicine in the future (prospecialties: odds ratio 5.2, 95% CI 1.7-16.2; younger age: odds ratio 1.05, 95% CI 1.01-1.08). Providers who did not want to use telemedicine in the future cited concerns about inadequate patient care, lack of physical patient interaction, technology issues, and lack of necessity. Providers who felt telemedicine would be useful cited the following situations: follow-up visits, medication refills, urgent care, patient convenience, and specific conditions such as behavioral health, dermatology visits, and chronic care management. Conclusions: The majority of health providers in this resource-limited setting in a federally qualified health center believed that telemedicine would be useful for providing care after the pandemic is over. %M 34227993 %R 10.2196/26565 %U https://formative.jmir.org/2021/8/e26565 %U https://doi.org/10.2196/26565 %U http://www.ncbi.nlm.nih.gov/pubmed/34227993 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30612 %T Predictors of COVID-19 Preventive Perceptions and Behaviors Among Millennials: Two Cross-sectional Survey Studies %A Beaudoin,Christopher E %A Hong,Traci %+ College of Communication, Boston University, 640 Commonwealth Ave, Boston, MA, 02215, United States, 1 617 353 3450, cebeau@bu.edu %K COVID-19 %K coronavirus %K pandemic %K preventive perceptions %K preventive behaviors %K health information seeking %K political party identification %K COVID-19 testing %D 2021 %7 12.8.2021 %9 Original Paper %J J Med Internet Res %G English %X 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 (β=.22, P<.001), self-efficacy (β=.15, P=.02), and response efficacy (β=.25, P<.001) as well as, at nearing significance, higher perceptions of susceptibility (β=.11, P=.07). In Study 2, respondents with higher levels of digital HISB for self had significantly higher perceptions of severity (β=.25, P<.001), susceptibility (β=.14, P<.001), and preventive behaviors (β=.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 (β=−.14, P=.02) and response efficacy (β=−.13, P=.03) and, at nearing significance, lower perceptions of severity (β=−.10, P=.08) and susceptibility (β=−.12, P=.06). In Study 2, respondents who identified as being more Republican had significantly lower perceptions of severity (β=−.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 (β=.17, P=.006) and significantly lower perceptions of severity in Study 2 (β=−.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. %M 34182460 %R 10.2196/30612 %U https://www.jmir.org/2021/8/e30612 %U https://doi.org/10.2196/30612 %U http://www.ncbi.nlm.nih.gov/pubmed/34182460 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 3 %P e29324 %T The Influence of COVID-19 Vaccination on Daily Cases, Hospitalization, and Death Rate in Tennessee, United States: Case Study %A Roghani,Ali %+ Division of Epidemiology, University of Utah, 383 Colorow Drive, Salt Lake City, UT, 84108, United States, 1 210 410 5779, ali_roghani@hotmail.com %K COVID-19 %K pandemic %K vaccination %K vaccine %K strategy %K vaccination strategy %K hospitalization %K mortality rates %K older adults %K mortality %D 2021 %7 12.8.2021 %9 Original Paper %J JMIRx Med %G English %X Background: The COVID-19 outbreak highlights our vulnerability to novel infections, and vaccination remains a foreseeable method to return to normal life. However, infrastructure is inadequate for the immediate vaccination of the whole population. Therefore, policies have adopted a strategy to vaccinate older adults and vulnerable populations while delaying vaccination for others. Objective: This study aimed to understand how age-specific vaccination strategies reduce daily cases, hospitalizations, and death rates using official statistics for Tennessee, United States. Methods: This study used publicly available data on COVID-19, including vaccination rates, positive cases, hospitalizations, and deaths from the Tennessee Department of Health. Data from the first date of vaccination (December 17, 2020) to March 3, 2021, were retrieved. The rates were adjusted by 2019 data from the US Census Bureau, and age groups were stratified into 10-year intervals starting with 21 years of age. Results: The findings showed that vaccination strategy can reduce the numbers of patients with COVID-19 in all age groups, with lower hospitalization and death rates in older populations. Older adults had a 95% lower death rate from December to March; no change in the death rate of other age groups was observed. The hospitalization rate was reduced by 80% for people aged ≥80 years, while people who were 50 to 70 years old had nearly the same hospitalization rate as prior to vaccination. Conclusions: This research indicates that targeting older age groups for vaccination is the optimal way to avoid higher transmissions and reduce hospitalization and death rates. %M 34424255 %R 10.2196/29324 %U https://med.jmirx.org/2021/3/e29324 %U https://doi.org/10.2196/29324 %U http://www.ncbi.nlm.nih.gov/pubmed/34424255 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e29150 %T Long-term Effects of the COVID-19 Pandemic on Public Sentiments in Mainland China: Sentiment Analysis of Social Media Posts %A Tan,Hao %A Peng,Sheng-Lan %A Zhu,Chun-Peng %A You,Zuo %A Miao,Ming-Cheng %A Kuai,Shu-Guang %+ Shanghai Key Laboratory of Mental Health and Psychological Crisis Intervention, Key Laboratory of Brain Functional Genomics (Ministry of Education), The Institute of Brain and Education Innovation, School of Psychology and Cognitive Science, East China Normal University, Room 309, Old Library Building, No. 3663, North Zhongshan Road, Shanghai, 200062, China, 86 15618582866, shuguang.kuai@gmail.com %K COVID-19 %K emotional trauma %K public sentiment on social media %K long-term effect %D 2021 %7 12.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 outbreak has induced negative emotions among people. These emotions are expressed by the public on social media and are rapidly spread across the internet, which could cause high levels of panic among the public. Understanding the changes in public sentiment on social media during the pandemic can provide valuable information for developing appropriate policies to reduce the negative impact of the pandemic on the public. Previous studies have consistently shown that the COVID-19 outbreak has had a devastating negative impact on public sentiment. However, it remains unclear whether there has been a variation in the public sentiment during the recovery phase of the pandemic. Objective: In this study, we aim to determine the impact of the COVID-19 pandemic in mainland China by continuously tracking public sentiment on social media throughout 2020. Methods: We collected 64,723,242 posts from Sina Weibo, China’s largest social media platform, and conducted a sentiment analysis based on natural language processing to analyze the emotions reflected in these posts. Results: We found that the COVID-19 pandemic not only affected public sentiment on social media during the initial outbreak but also induced long-term negative effects even in the recovery period. These long-term negative effects were no longer correlated with the number of new confirmed COVID-19 cases both locally and nationwide during the recovery period, and they were not attributed to the postpandemic economic recession. Conclusions: The COVID-19 pandemic induced long-term negative effects on public sentiment in mainland China even as the country recovered from the pandemic. Our study findings remind public health and government administrators of the need to pay attention to public mental health even once the pandemic has concluded. %M 34280118 %R 10.2196/29150 %U https://www.jmir.org/2021/8/e29150 %U https://doi.org/10.2196/29150 %U http://www.ncbi.nlm.nih.gov/pubmed/34280118 %0 Journal Article %@ 2564-1891 %I JMIR Publications %V 1 %N 1 %P e28800 %T Analyzing Social Media to Explore the Attitudes and Behaviors Following the Announcement of Successful COVID-19 Vaccine Trials: Infodemiology Study %A Boucher,Jean-Christophe %A Cornelson,Kirsten %A Benham,Jamie L %A Fullerton,Madison M %A Tang,Theresa %A Constantinescu,Cora %A Mourali,Mehdi %A Oxoby,Robert J %A Marshall,Deborah A %A Hemmati,Hadi %A Badami,Abbas %A Hu,Jia %A Lang,Raynell %+ School of Public Policy and Department of Political Science, University of Calgary, 906 8 Ave SW 5th Floor, Calgary, AB, Canada, 1 403 220 8565, jc.boucher@ucalgary.ca %K coronavirus %K COVID-19 %K public health %K social media %K Twitter %K behavior %K risk reduction %K attitudes %K social network analysis %K machine learning %D 2021 %7 12.8.2021 %9 Original Paper %J JMIR Infodemiology %G English %X Background: The rollout of COVID-19 vaccines has brought vaccine hesitancy to the forefront in managing this pandemic. COVID-19 vaccine hesitancy is fundamentally different from that of other vaccines due to the new technologies being used, rapid development, and widespread global distribution. Attitudes on vaccines are largely driven by online information, particularly information on social media. The first step toward influencing attitudes about immunization is understanding the current patterns of communication that characterize the immunization debate on social media platforms. Objective: We aimed to evaluate societal attitudes, communication trends, and barriers to COVID-19 vaccine uptake through social media content analysis to inform communication strategies promoting vaccine acceptance. Methods: Social network analysis (SNA) and unsupervised machine learning were used to characterize COVID-19 vaccine content on Twitter globally. Tweets published in English and French were collected through the Twitter application programming interface between November 19 and 26, 2020, just following the announcement of initial COVID-19 vaccine trials. SNA was used to identify social media clusters expressing mistrustful opinions on COVID-19 vaccination. Based on the SNA results, an unsupervised machine learning approach to natural language processing using a sentence-level algorithm transfer function to detect semantic textual similarity was performed in order to identify the main themes of vaccine hesitancy. Results: The tweets (n=636,516) identified that the main themes driving the vaccine hesitancy conversation were concerns of safety, efficacy, and freedom, and mistrust in institutions (either the government or multinational corporations). A main theme was the safety and efficacy of mRNA technology and side effects. The conversation around efficacy was that vaccines were unlikely to completely rid the population of COVID-19, polymerase chain reaction testing is flawed, and there is no indication of long-term T-cell immunity for COVID-19. Nearly one-third (45,628/146,191, 31.2%) of the conversations on COVID-19 vaccine hesitancy clusters expressed concerns for freedom or mistrust of institutions (either the government or multinational corporations) and nearly a quarter (34,756/146,191, 23.8%) expressed criticism toward the government’s handling of the pandemic. Conclusions: Social media content analysis combined with social network analysis provides insights into the themes of the vaccination conversation on Twitter. The themes of safety, efficacy, and trust in institutions will need to be considered, as targeted outreach programs and intervention strategies are deployed on Twitter to improve the uptake of COVID-19 vaccination. %M 34447924 %R 10.2196/28800 %U https://infodemiology.jmir.org/2021/1/e28800 %U https://doi.org/10.2196/28800 %U http://www.ncbi.nlm.nih.gov/pubmed/34447924 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e30251 %T Leveraging Transfer Learning to Analyze Opinions, Attitudes, and Behavioral Intentions Toward COVID-19 Vaccines: Social Media Content and Temporal Analysis %A Liu,Siru %A Li,Jili %A Liu,Jialin %+ Department of Medical Informatics, West China Hospital, Sichuan University, No 37 Wainan Guoxuexiang Street, Chengdu, 610041, China, 86 28 85422306, dljl8@163.com %K vaccine %K COVID-19 %K leveraging transfer learning %K pandemic %K infodemiology %K infoveillance %K public health %K social media %K content analysis %K machine learning %K online health %D 2021 %7 10.8.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34254942 %R 10.2196/30251 %U https://www.jmir.org/2021/8/e30251 %U https://doi.org/10.2196/30251 %U http://www.ncbi.nlm.nih.gov/pubmed/34254942 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e29268 %T Self-Focused and Other-Focused Health Concerns as Predictors of the Uptake of Corona Contact Tracing Apps: Empirical Study %A große Deters,Fenne %A Meier,Tabea %A Milek,Anne %A Horn,Andrea B %+ Weizenbaum Institute for the Networked Society, Hardenbergstraße 32, Berlin, 10623, Germany, 49 331977 3710, fenne.grosse.deters@uni-potsdam.de %K COVID-19 %K corona contact tracing app %K digital proximity tracing %K preventive behavior %K health concern %K prosocial motivation %K public health %K risk perception, eHealth, Corona-Warn-App %K SwissCovid %K contact tracing app %K contact tracing %D 2021 %7 10.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Corona contact tracing apps are a novel and promising measure to reduce the spread of COVID-19. They can help to balance the need to maintain normal life and economic activities as much as possible while still avoiding exponentially growing case numbers. However, a majority of citizens need to be willing to install such an app for it to be effective. Hence, knowledge about drivers for app uptake is crucial. Objective: This study aimed to add to our understanding of underlying psychological factors motivating app uptake. More specifically, we investigated the role of concern for one’s own health and concern to unknowingly infect others. Methods: A two-wave survey with 346 German-speaking participants from Switzerland and Germany was conducted. We measured the uptake of two decentralized contact tracing apps officially launched by governments (Corona-Warn-App, Germany; SwissCovid, Switzerland), as well as concerns regarding COVID-19 and control variables. Results: Controlling for demographic variables and general attitudes toward the government and the pandemic, logistic regression analysis showed a significant effect of self-focused concerns (odds ratio [OR] 1.64, P=.002). Meanwhile, concern of unknowingly infecting others did not contribute significantly to the prediction of app uptake over and above concern for one’s own health (OR 1.01, P=.92). Longitudinal analyses replicated this pattern and showed no support for the possibility that app uptake provokes changes in levels of concern. Testing for a curvilinear relationship, there was no evidence that “too much” concern leads to defensive reactions and reduces app uptake. Conclusions: As one of the first studies to assess the installation of already launched corona tracing apps, this study extends our knowledge of the motivational landscape of app uptake. Based on this, practical implications for communication strategies and app design are discussed. %M 34227995 %R 10.2196/29268 %U https://www.jmir.org/2021/8/e29268 %U https://doi.org/10.2196/29268 %U http://www.ncbi.nlm.nih.gov/pubmed/34227995 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28249 %T Mining of Opinions on COVID-19 Large-Scale Social Restrictions in Indonesia: Public Sentiment and Emotion Analysis on Online Media %A Tri Sakti,Andi Muhammad %A Mohamad,Emma %A Azlan,Arina Anis %+ Centre for Research in Media and Communication, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, UKM Bangi, Bangi, 43600, Malaysia, 60 0123065261, arina@ukm.edu.my %K large-scale social restrictions %K social media %K public sentiment %K Twitter %K COVID-19 %K infodemiology %K infoveillance %D 2021 %7 9.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: One of the successful measures to curb COVID-19 spread in large populations is the implementation of a movement restriction order. Globally, it was observed that countries implementing strict movement control were more successful in controlling the spread of the virus as compared with those with less stringent measures. Society’s adherence to the movement control order has helped expedite the process to flatten the pandemic curve as seen in countries such as China and Malaysia. At the same time, there are countries facing challenges with society’s nonconformity toward movement restriction orders due to various claims such as human rights violations as well as sociocultural and economic issues. In Indonesia, society’s adherence to its large-scale social restrictions (LSSRs) order is also a challenge to achieve. Indonesia is regarded as among the worst in Southeast Asian countries in terms of managing the spread of COVID-19. It is proven by the increased number of daily confirmed cases and the total number of deaths, which was more than 6.21% (1351/21,745) of total active cases as of May 2020. Objective: The aim of this study was to explore public sentiments and emotions toward the LSSR and identify issues, fear, and reluctance to observe this restriction among the Indonesian public. Methods: This study adopts a sentiment analysis method with a supervised machine learning approach on COVID-19-related posts on selected media platforms (Twitter, Facebook, Instagram, and YouTube). The analysis was also performed on COVID-19-related news contained in more than 500 online news platforms recognized by the Indonesian Press Council. Social media posts and news originating from Indonesian online media between March 31 and May 31, 2020, were analyzed. Emotion analysis on Twitter platform was also performed to identify collective public emotions toward the LSSR. Results: The study found that positive sentiment surpasses other sentiment categories by 51.84% (n=1,002,947) of the total data (N=1,934,596) collected via the search engine. Negative sentiment was recorded at 35.51% (686,892/1,934,596) and neutral sentiment at 12.65% (244,757/1,934,596). The analysis of Twitter posts also showed that the majority of public have the emotion of “trust” toward the LSSR. Conclusions: Public sentiment toward the LSSR appeared to be positive despite doubts on government consistency in executing the LSSR. The emotion analysis also concluded that the majority of people believe in LSSR as the best method to break the chain of COVID-19 transmission. Overall, Indonesians showed trust and expressed hope toward the government’s ability to manage this current global health crisis and win against COVID-19. %M 34280116 %R 10.2196/28249 %U https://www.jmir.org/2021/8/e28249 %U https://doi.org/10.2196/28249 %U http://www.ncbi.nlm.nih.gov/pubmed/34280116 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e29205 %T Census Tract Patterns and Contextual Social Determinants of Health Associated With COVID-19 in a Hispanic Population From South Texas: A Spatiotemporal Perspective %A Bauer,Cici %A Zhang,Kehe %A Lee,Miryoung %A Fisher-Hoch,Susan %A Guajardo,Esmeralda %A McCormick,Joseph %A de la Cerda,Isela %A Fernandez,Maria E %A Reininger,Belinda %+ Department of Biostatistics and Data Science, School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler Street, Houston, TX, 77030, United States, 1 713 500 9581, cici.x.bauer@uth.tmc.edu %K COVID-19 %K spatial pattern %K social determinants of health %K Bayesian %K underserved population %K health inequity %D 2021 %7 5.8.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34081608 %R 10.2196/29205 %U https://publichealth.jmir.org/2021/8/e29205 %U https://doi.org/10.2196/29205 %U http://www.ncbi.nlm.nih.gov/pubmed/34081608 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e28630 %T Telemedical Approaches to Managing Gestational Diabetes Mellitus During COVID-19: Systematic Review %A Eberle,Claudia %A Stichling,Stefanie %+ Medicine with specialization in Internal Medicine and General Medicine, Hochschule Fulda - University of Applied Sciences, Leiptziger Strasse 123, Fulda, 36037, Germany, 49 661 9640 ext 6328, claudia.eberle@hs-fulda.de %K gestational diabetes %K telemedicine %K mobile applications %K COVID-19 %K systematic review %K digital health %K diabetes %D 2021 %7 5.8.2021 %9 Review %J JMIR Pediatr Parent %G English %X Background: In 2019, a new coronavirus emerged in China, and the disease caused by the virus (COVID-19) was rapidly classified as a pandemic. Pregnant women with gestational diabetes mellitus (GDM) are considered to be at risk for severe COVID-19. In the context of the pandemic, there are serious concerns regarding adverse effects on maternal and neonatal outcomes for women with GDM. Effective treatments for patients with GDM are therefore particularly important. Due to contact restrictions and infection risks, digital approaches such as telemedicine are suitable alternatives. Objective: This systematic review aims to summarize currently available evidence on maternal and offspring outcomes of pregnant women with GDM and COVID-19 and to examine telemedical interventions to improve maternal glycemic control during the COVID-19 pandemic. Methods: Publications were systematically identified by searching the Cochrane Library, MEDLINE via PubMed, Web of Science Core Collection, Embase, and CINAHL databases for studies published up to March 2021. We sorted the COVID-19 studies by outcome and divided the telemedical intervention studies into web-based and app-based groups. We analyzed case reports (COVID-19) and both randomized and nonrandomized controlled clinical trials (telemedicine). To determine the change in glycated hemoglobin A1c (HbA1c), we pooled appropriate studies and calculated the differences in means, with 95% CIs, for the intervention and control groups at the end of the interventions. Results: Regarding COVID-19 studies, we identified 11 case reports, 3 letters, 1 case series, and 1 retrospective single-center study. In total, 41 patients with GDM and COVID-19 were analyzed. The maternal and neonatal outcomes were extremely heterogeneous. We identified adverse outcomes for mother and child through the interaction of GDM and COVID-19, such as cesarean deliveries and low Apgar scores. Furthermore, we selected 9 telemedicine-related articles: 6 were randomized controlled trials, 2 were clinical controlled trials, and 1 was a quasi-experimental design. In total, we analyzed 480 patients with GDM in the intervention groups and 494 in the control groups. Regarding the quality of the 9 telemedical studies, 4 were rated as strong, 4 as moderate, and 1 as weak. Telemedical interventions can contribute to favorable impacts on HbA1c and fasting blood glucose values in the context of the COVID-19 pandemic. Meta-analysis revealed a mean difference in HbA1c of –0.19% (95% CI 0.34% to 0.03%) for all telemedical interventions, –0.138% (95% CI –0.24% to –0.04%) for the web-based interventions, and –0.305% (96% CI –0.88% to 0.27%) for the app-based interventions. Conclusions: Telemedicine is an effective approach in the context of COVID-19 and GDM because it enables social distancing and represents optimal care of patients with GDM, especially with regard to glycemic control, which is very important in view of the identified adverse maternal and neonatal outcomes. Further research is needed. %M 34081604 %R 10.2196/28630 %U https://pediatrics.jmir.org/2021/3/e28630 %U https://doi.org/10.2196/28630 %U http://www.ncbi.nlm.nih.gov/pubmed/34081604 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 8 %P e28074 %T Association Between Public Opinion and Malaysian Government Communication Strategies About the COVID-19 Crisis: Content Analysis of Image Repair Strategies in Social Media %A Masngut,Nasaai %A Mohamad,Emma %+ Centre for Research in Media and Communication, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, Jalan Nik Ahmed Kamil, Bangi, 43600, Malaysia, 60 389215456, emmamohamad@ukm.edu.my %K COVID-19 %K crisis %K health communication %K image repair %K Malaysian government %K sentiment %K communication %K content analysis %K public opinion %K social media %K strategy %D 2021 %7 4.8.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 health crisis has posed an unprecedented challenge for governments worldwide to manage and communicate about the pandemic effectively, while maintaining public trust. Good leadership image in times of a health emergency is paramount to ensure public confidence in governments’ abilities to manage the crisis. Objective: The aim of this study was to identify types of image repair strategies utilized by the Malaysian government in their communication about COVID-19 in the media and analyze public responses to these messages on social media. Methods: Content analysis was employed to analyze 120 media statements and 382 comments retrieved from Facebook pages of 2 mainstream newspapers—Berita Harian and The Star. These media statements and comments were collected within a span of 6 weeks prior to and during the first implementation of Movement Control Order by the Malaysian Government. The media statements were analyzed according to Image Repair Theory to categorize strategies employed in government communications related to COVID-19 crisis. Public opinion responses were measured using modified lexicon-based sentiment analysis to categorize positive, negative, and neutral statements. Results: The Malaysian government employed all 5 Image Repair Theory strategies in their communications in both newspapers. The strategy most utilized was reducing offensiveness (75/120, 62.5%), followed by corrective action (30/120, 25.0%), evading responsibilities (10/120, 8.3%), denial (4/120, 3.3%), and mortification (1/120, 0.8%). This study also found multiple substrategies in government media statements including denial, shifting blame, provocation, defeasibility, accident, good intention, bolstering, minimization, differentiation, transcendence, attacking accuser, resolve problem, prevent recurrence, admit wrongdoing, and apologize. This study also found that 64.7% of public opinion was positive in response to media statements made by the Malaysian government and also revealed a significant positive association (P=.04) between image repair strategies utilized by the Malaysian government and public opinion. Conclusions: Communication in the media may assist the government in fostering positive support from the public. Suitable image repair strategies could garner positive public responses and help build trust in times of crisis. %M 34156967 %R 10.2196/28074 %U https://www.jmir.org/2021/8/e28074 %U https://doi.org/10.2196/28074 %U http://www.ncbi.nlm.nih.gov/pubmed/34156967 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e28195 %T Forecasting COVID-19 Hospital Census: A Multivariate Time-Series Model Based on Local Infection Incidence %A Nguyen,Hieu M %A Turk,Philip J %A McWilliams,Andrew D %+ Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Charlotte, NC, 28204, United States, 1 9706914892, hieu.nguyen@atriumhealth.org %K COVID-19 %K forecasting %K time-series model %K vector error correction model %K hospital census %K hospital resource utilization %K infection incidence %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 has been one of the most serious global health crises in world history. During the pandemic, health care systems require accurate forecasts for key resources to guide preparation for patient surges. Forecasting the COVID-19 hospital census is among the most important planning decisions to ensure adequate staffing, number of beds, intensive care units, and vital equipment. Objective: The goal of this study was to explore the potential utility of local COVID-19 infection incidence data in developing a forecasting model for the COVID-19 hospital census. Methods: The study data comprised aggregated daily COVID-19 hospital census data across 11 Atrium Health hospitals plus a virtual hospital in the greater Charlotte metropolitan area of North Carolina, as well as the total daily infection incidence across the same region during the May 15 to December 5, 2020, period. Cross-correlations between hospital census and local infection incidence lagging up to 21 days were computed. A multivariate time-series framework, called the vector error correction model (VECM), was used to simultaneously incorporate both time series and account for their possible long-run relationship. Hypothesis tests and model diagnostics were performed to test for the long-run relationship and examine model goodness of fit. The 7-days-ahead forecast performance was measured by mean absolute percentage error (MAPE), with time-series cross-validation. The forecast performance was also compared with an autoregressive integrated moving average (ARIMA) model in the same cross-validation time frame. Based on different scenarios of the pandemic, the fitted model was leveraged to produce 60-days-ahead forecasts. Results: The cross-correlations were uniformly high, falling between 0.7 and 0.8. There was sufficient evidence that the two time series have a stable long-run relationship at the .01 significance level. The model had very good fit to the data. The out-of-sample MAPE had a median of 5.9% and a 95th percentile of 13.4%. In comparison, the MAPE of the ARIMA had a median of 6.6% and a 95th percentile of 14.3%. Scenario-based 60-days-ahead forecasts exhibited concave trajectories with peaks lagging 2 to 3 weeks later than the peak infection incidence. In the worst-case scenario, the COVID-19 hospital census can reach a peak over 3 times greater than the peak observed during the second wave. Conclusions: When used in the VECM framework, the local COVID-19 infection incidence can be an effective leading indicator to predict the COVID-19 hospital census. The VECM model had a very good 7-days-ahead forecast performance and outperformed the traditional ARIMA model. Leveraging the relationship between the two time series, the model can produce realistic 60-days-ahead scenario-based projections, which can inform health care systems about the peak timing and volume of the hospital census for long-term planning purposes. %M 34346897 %R 10.2196/28195 %U https://publichealth.jmir.org/2021/8/e28195 %U https://doi.org/10.2196/28195 %U http://www.ncbi.nlm.nih.gov/pubmed/34346897 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 8 %P e26111 %T With Great Hopes Come Great Expectations: Access and Adoption Issues Associated With COVID-19 Vaccines %A Su,Zhaohui %A McDonnell,Dean %A Cheshmehzangi,Ali %A Li,Xiaoshan %A Maestro,Daniel %A Šegalo,Sabina %A Ahmad,Junaid %A Hao,Xiaoning %+ Division of Health Security Research, China National Health Development Research Center, National Health Commission, P.R. China, No. 9 Chegongzhuang Street, Xicheng District, Beijing, 100044, China, 86 010 88385748, haoxn@nhei.cn %K COVID-19 %K coronavirus %K COVID-19 vaccine %K made in China %K vaccine efficacy %K vaccine safety %K vaccine %K China %K expectation %K safety %K efficacy %K infectious disease %K public health %K consequence %K public health %K standard %D 2021 %7 4.8.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Although COVID-19 vaccines are becoming increasingly available, their ability to effectively control and contain the spread of the COVID-19 pandemic is highly contingent on an array of factors. This paper discusses how limitations to vaccine accessibility, issues associated with vaccine side effects, concerns regarding vaccine efficacy, along with the persistent prevalence of vaccine hesitancy among the public, including health care professionals, might impact the potential of COVID-19 vaccines to curb the pandemic. We draw insights from the literature to identify practical solutions that could boost people’s adoption of COVID-19 vaccines and their accessibility. We conclude with a discussion on health experts’ and government officials’ moral and ethical responsibilities to the public, even in light of the urgency to adopt and endorse “the greatest amount of good for the greatest number” utilitarian philosophy in controlling and managing the spread of COVID-19. %M 33560997 %R 10.2196/26111 %U https://publichealth.jmir.org/2021/8/e26111 %U https://doi.org/10.2196/26111 %U http://www.ncbi.nlm.nih.gov/pubmed/33560997 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 8 %P e28568 %T Physiologic Response to the Pfizer-BioNTech COVID-19 Vaccine Measured Using Wearable Devices: Prospective Observational Study %A Hajduczok,Alexander G %A DiJoseph,Kara M %A Bent,Brinnae %A Thorp,Audrey K %A Mullholand,Jon B %A MacKay,Stuart A %A Barik,Sabrina %A Coleman,Jamie J %A Paules,Catharine I %A Tinsley,Andrew %+ Division of Internal Medicine, Department of Medicine, Penn State Health Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, United States, 1 7168634928, alexander.hajduczok@jefferson.edu %K COVID-19 %K wearable devices %K remote physiologic monitoring %K heart rate %K heart rate variability %K respiratory rate %K sleep %K REM sleep %K deep sleep %K wearable %K vaccine %K monitoring %K respiratory %K physiological %K cohort %D 2021 %7 4.8.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Pfizer-BioNTech COVID-19 vaccine uses a novel messenger RNA technology to elicit a protective immune response. Short-term physiologic responses to the vaccine have not been studied using wearable devices. Objective: We aim to characterize physiologic changes in response to COVID-19 vaccination in a small cohort of participants using a wearable device (WHOOP Strap 3.0). This is a proof of concept for using consumer-grade wearable devices to monitor response to COVID-19 vaccines. Methods: In this prospective observational study, physiologic data from 19 internal medicine residents at a single institution that received both doses of the Pfizer-BioNTech COVID-19 vaccine was collected using the WHOOP Strap 3.0. The primary outcomes were percent change from baseline in heart rate variability (HRV), resting heart rate (RHR), and respiratory rate (RR). Secondary outcomes were percent change from baseline in total, rapid eye movement, and deep sleep. Exploratory outcomes included local and systemic reactogenicity following each dose and prophylactic analgesic use. Results: In 19 individuals (mean age 28.8, SD 2.2 years; n=10, 53% female), HRV was decreased on day 1 following administration of the first vaccine dose (mean –13.44%, SD 13.62%) and second vaccine dose (mean –9.25%, SD 22.6%). RHR and RR showed no change from baseline after either vaccine dose. Sleep duration was increased up to 4 days post vaccination, after an initial decrease on day 1. Increased sleep duration prior to vaccination was associated with a greater change in HRV. Local and systemic reactogenicity was more severe after dose two. Conclusions: This is the first observational study of the physiologic response to any of the novel COVID-19 vaccines as measured using wearable devices. Using this relatively small healthy cohort, we provide evidence that HRV decreases in response to both vaccine doses, with no significant changes in RHR or RR. Sleep duration initially decreased following each dose with a subsequent increase thereafter. Future studies with a larger sample size and comparison to other inflammatory and immune biomarkers such as antibody response will be needed to determine the true utility of this type of continuous wearable monitoring in regards to vaccine responses. Our data raises the possibility that increased sleep prior to vaccination may impact physiologic responses and may be a modifiable way to increase vaccine response. These results may inform future studies using wearables for monitoring vaccine responses. Trial Registration: ClinicalTrials.gov NCT04304703; https://www.clinicaltrials.gov/ct2/show/NCT04304703 %M 34236995 %R 10.2196/28568 %U https://formative.jmir.org/2021/8/e28568 %U https://doi.org/10.2196/28568 %U http://www.ncbi.nlm.nih.gov/pubmed/34236995 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e28888 %T The Influence of COVID-19 Information Sources on the Attitudes and Practices Toward COVID-19 Among the General Public of Saudi Arabia: Cross-sectional Online Survey Study %A Alshareef,Noor %A Yunusa,Ismaeel %A Al-Hanawi,Mohammed Khaled %+ Department of Health Services and Hospital Administration, Faculty of Economics and Administration, King Abdulaziz University, University Building 125 Faculties Street, Jeddah, 80200, Saudi Arabia, 966 556522222, mkalhanawi@kau.edu.sa %K attitudes %K communications media %K COVID-19 %K information-seeking behavior %K pandemics %K practices %K Saudi Arabia %K social media %K sources %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has resulted in panic among the general public, leading many people to seek out information related to COVID-19 through various sources, including social media and traditional media. Identifying public preferences for obtaining such information may help health authorities to effectively plan successful health preventive and educational intervention strategies. Objective: The aim of this study was to examine the impact of the types of sources used for obtaining COVID-19 information on the attitudes and practices of the general public in Saudi Arabia during the pandemic, and to identify the socioeconomic and demographic factors associated with the use of different sources of information. Methods: This study used data from a cross-sectional online survey conducted on residents of Saudi Arabia from March 20 to 24, 2020. Data were analyzed using descriptive, bivariate, and multivariable logistic regression analyses. Bivariate analysis of categorical variables was performed to determine the associations between information sources and socioeconomic and demographic factors. Multivariable logistic regression analyses were employed to examine whether socioeconomic and demographic variables were associated with the source of information used to obtain information about COVID-19. Moreover, univariable and multivariable logistic regression analyses were conducted to examine how sources of information influence attitudes and practices of adhering to preventive measures. Results: In this analysis of cross-sectional survey data, 3358 participants were included. Most participants reported using social media, followed by the Ministry of Health (MOH) of the Kingdom of Saudi Arabia, as their primary source of information. Seeking information via social media was significantly associated with lower odds of having an optimistic attitude (adjusted odds ratio [aOR] 0.845, 95% CI 0.733-0.974; P=.02) and adhering to preventive measures (aOR 0.725, 95% CI 0.630-0.835; P<.001) compared to other sources of information. Participants who obtained their COVID-19 information via the MOH had greater odds of having an optimistic attitude (aOR 1.437, 95% CI 1.234-1.673; P<.001) and adhering to preventive measures (aOR 1.393, 95% CI 1.201-1.615; P<.001) than those who obtained information via other sources. Conclusions: This study provides evidence that different sources of information influence attitudes and preventive actions differently within a pandemic crisis context. Health authorities in Saudi Arabia should pay attention to the use of appropriate social media channels and sources to allow for more effective dissemination of critical information to the public. %M 34081610 %R 10.2196/28888 %U https://publichealth.jmir.org/2021/7/e28888 %U https://doi.org/10.2196/28888 %U http://www.ncbi.nlm.nih.gov/pubmed/34081610 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e27618 %T Public Awareness and Utilization of 937-Telephone Health Services in the Kingdom of Saudi Arabia Before and During the COVID-19 Pandemic: Longitudinal Study %A Al-Rayes,Saja A %A Alumran,Arwa %A Aljabri,Duaa %A Aljaffary,Afnan %A Aldoukhi,Ethar %A Alahmedalyousif,Zainab %A Al Madani,Reem %+ Health Information Management and Technology Department, College of Public Health, Imam Abdulrahman bin Faisal University, King Faisal Road, Dammam, Saudi Arabia, 966 1333333766, aaljaffari@iau.edu.sa %K awareness %K COVID-19 %K Kingdom of Saudi Arabia %K telehealth %K telemedicine %K utilization %D 2021 %7 30.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Telehealth plays a key role in supporting health care systems and influencing methods of health care delivery. Government laws and medical operating protocols have been largely modified to provide remote care to reduce social contact and ensure a safer patient environment. In the Kingdom of Saudi Arabia (KSA), the Ministry of Health (MOH) introduced several forms of telemedicine as alternatives to face-to-face consultations in clinical settings. Objective: This study aimed to assess the awareness and utilization of telehealth services before and during the COVID-19 outbreak in the KSA. Methods: In this longitudinal study, we compared the awareness and utilization of 937-telephone health services (ie, a toll-free telephone service to provide medical and administrative health care services at any time for the population) before and during the COVID-19 outbreak in the KSA. Using a convenience sampling technique, a validated web-based questionnaire was distributed on social media platforms (Facebook, Twitter, and WhatsApp) at 2 timepoints: before (February 2019) and during (May 2020) the COVID-19 pandemic. Results: The study sample comprised a total of 1961 participants who completed the questionnaire before (n=1303, 66%) and during (n=658, 33%) the COVID-19 pandemic. Both awareness (before=46% vs during=78%) and utilization (before=42% vs during=48%) of the 937-telephone health services increased significantly during the pandemic (P<.001). No significant association of the awareness or utilization of 937-telephone health services before and during the COVID-19 pandemic was found with respect to the participants’ age, education level, having children, or having any chronic disease. Conclusions: Our findings indicate significant increases in the awareness and utilization of 937-telephone health services during the early days of the COVID-19 pandemic, suggesting an increase in public acceptance of the service and providing evidence of an equitable telemedicine service for the population. Further studies are needed to provide a deeper understanding of the barriers and facilitators to the use of 937-telephone health services for different groups of the population. %M 34156963 %R 10.2196/27618 %U https://www.jmir.org/2021/7/e27618 %U https://doi.org/10.2196/27618 %U http://www.ncbi.nlm.nih.gov/pubmed/34156963 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e29315 %T Development, Acceptance, and Concerns Surrounding App-Based Services to Overcome the COVID-19 Outbreak in South Korea: Web-Based Survey Study %A Park,Jihwan %A Han,Jinhyun %A Kim,Yerin %A Rho,Mi Jung %+ Department of Urology, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea, 82 222585905, romy1018@naver.com %K COVID-19 %K app-based services %K acceptance %K concerns %K epidemiological investigation, self-route management app, privacy %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Since the COVID-19 outbreak, South Korea has been engaged in various efforts to overcome the pandemic. One of them is to provide app-based COVID-19–related services to the public. As the pandemic continues, a need for various apps has emerged, including COVID-19 apps that can support activities aimed at overcoming the COVID-19 pandemic. Objective: We aimed to determine which apps were considered the most necessary according to users and evaluate the current status of the development of COVID-19–related apps in South Korea. We also aimed to determine users’ acceptance and concerns related to using apps to support activities to combat COVID-19. Methods: We collected data from 1148 users from a web-based survey conducted between November 11 and December 6, 2020. Basic statistical analysis, multiple response analysis, and the Wilcoxon rank sum test were performed using R software. We then manually classified the current status of the development of COVID-19–related apps. Results: In total, 68.4% (785/1148) of the respondents showed high willingness to protect themselves from COVID-19 by using related apps. Users considered the epidemiological investigation app to be the most necessary app (709/1148, 61.8%) overall, followed by the self-management app for self-isolation (613/1148, 53.4%), self-route management app (605/1148, 52.7%), COVID-19 symptom management app (483/1148, 42.1%), COVID-19–related information provision app (339/1148, 29.5%), and mental health management app (270/1148, 23.5%). Despite the high intention to use these apps, users were also concerned about privacy issues and media exposure. Those who had an underlying disease and had experience using COVID-19–related apps showed significantly higher intentions to use those apps (P=.05 and P=.01, respectively). Conclusions: Targeting users is very important in order to design and develop the most necessary apps. Furthermore, to gain the public’s trust and make the apps available to as many people as possible, it is vital to develop diverse apps in which privacy protection is maximized. %M 34137726 %R 10.2196/29315 %U https://medinform.jmir.org/2021/7/e29315 %U https://doi.org/10.2196/29315 %U http://www.ncbi.nlm.nih.gov/pubmed/34137726 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e29195 %T Social Media Opinions on Working From Home in the United States During the COVID-19 Pandemic: Observational Study %A Xiong,Ziyu %A Li,Pin %A Lyu,Hanjia %A Luo,Jiebo %+ University of Rochester, 3101 Wegmans Hall, Rochester, NY, 14627, United States, 1 585 276 5784, jluo@cs.rochester.edu %K characterization %K COVID-19 %K social media %K topic modeling %K Twitter %K work from home %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 34254941 %R 10.2196/29195 %U https://medinform.jmir.org/2021/7/e29195 %U https://doi.org/10.2196/29195 %U http://www.ncbi.nlm.nih.gov/pubmed/34254941 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e23528 %T Building an Interactive Geospatial Visualization Application for National Health Care–Associated Infection Surveillance: Development Study %A Zheng,Shuai %A Edwards,Jonathan R %A Dudeck,Margaret A %A Patel,Prachi R %A Wattenmaker,Lauren %A Mirza,Muzna %A Tejedor,Sheri Chernetsky %A Lemoine,Kent %A Benin,Andrea L %A Pollock,Daniel A %+ Division of Healthcare Quality Promotion, Centers for Disease Control and Prevention, 1600 Clifton Road, Atlanta, GA, United States, 1 4045614316, lgu3@cdc.gov %K data visualization %K geospatial information system %K health care–associated infection %D 2021 %7 30.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Centers for Disease Control and Prevention’s (CDC’s) National Healthcare Safety Network (NHSN) is the most widely used health care–associated infection (HAI) and antimicrobial use and resistance surveillance program in the United States. Over 37,000 health care facilities participate in the program and submit a large volume of surveillance data. These data are used by the facilities themselves, the CDC, and other agencies and organizations for a variety of purposes, including infection prevention, antimicrobial stewardship, and clinical quality measurement. Among the summary metrics made available by the NHSN are standardized infection ratios, which are used to identify HAI prevention needs and measure progress at the national, regional, state, and local levels. Objective: To extend the use of geospatial methods and tools to NHSN data, and in turn to promote and inspire new uses of the rendered data for analysis and prevention purposes, we developed a web-enabled system that enables integrated visualization of HAI metrics and supporting data. Methods: We leveraged geocoding and visualization technologies that are readily available and in current use to develop a web-enabled system designed to support visualization and interpretation of data submitted to the NHSN from geographically dispersed sites. The server–client model–based system enables users to access the application via a web browser. Results: We integrated multiple data sets into a single-page dashboard designed to enable users to navigate across different HAI event types, choose specific health care facility or geographic locations for data displays, and scale across time units within identified periods. We launched the system for internal CDC use in January 2019. Conclusions: CDC NHSN statisticians, data analysts, and subject matter experts identified opportunities to extend the use of geospatial methods and tools to NHSN data and provided the impetus to develop NHSNViz. The development effort proceeded iteratively, with the developer adding or enhancing functionality and including additional data sets in a series of prototype versions, each of which incorporated user feedback. The initial production version of NHSNViz provides a new geospatial analytic resource built in accordance with CDC user requirements and extensible to additional users and uses in subsequent versions. %M 34328436 %R 10.2196/23528 %U https://publichealth.jmir.org/2021/7/e23528 %U https://doi.org/10.2196/23528 %U http://www.ncbi.nlm.nih.gov/pubmed/34328436 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 3 %P e28255 %T Impact of Modifiable Risk Factors on the Occurrence of Cutaneous Leishmaniasis in Diyala, Iraq: Case-Control Study %A Lehlewa,Asaad Mahdi %A Khaleel,Hanan Abdulghafoor %A Lami,Faris %A Hasan,Saif Aldeen Falah %A Malick,Hasanain Asmail %A Mohammed,Razzaq Hashim %A Abdulmottaleb,Qais Abdulazziz %+ Communicable Diseases Control Center, Public Health Directorate, Ministry of Health of Iraq, Alandalus Square, Baghdad, Iraq, 964 7901472335, drhanan.cdcciq@gmail.com %K cutaneous leishmaniasis %K outbreak %K Iraq %K risk factors %K risk %K disease %K infectious disease %K disease prevention %K prevention %D 2021 %7 30.7.2021 %9 Original Paper %J JMIRx Med %G English %X 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. %M 37725543 %R 10.2196/28255 %U https://med.jmirx.org/2021/3/e28255 %U https://doi.org/10.2196/28255 %U http://www.ncbi.nlm.nih.gov/pubmed/37725543 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e29952 %T Measuring the Impact of COVID-19 on Siyan Mental Health Patients Using the Epidemic-Pandemic Impacts Inventory: Survey Study %A Shah,Anish %A Darling,Michele %A Arstein-Kerslake,Olivia %A Morgan,Tiffany %A Vance Tovrea,Aubreen %A Young,James %A Laines,Helen %+ Siyan Clinical Corporation, 480 Tesconi Cir B, Santa Rosa, CA, 95401, United States, 1 707 206 7273, ashah@siyanclinical.com %K COVID-19 %K coronavirus %K pandemic %K mental health %K social isolation %K wellness %D 2021 %7 29.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Recent research has shown that the impacts of the COVID-19 pandemic and social isolation on people’s mental health are quite extensive, but there are limited studies on the effects of the pandemic on patients with mental health disorders. Objective: The objective of this study was to assess the negative impacts of the COVID-19 pandemic on individuals who have previously sought treatment for a mental health disorder. Methods: This study uses the newly developed Epidemic-Pandemic Impacts Inventory (EPII) survey. This tool was designed to assess tangible impacts of epidemics and pandemics across personal and social life domains. From November 9, 2020, to February 18, 2021, a total of 245 adults recruited from a mental health clinic completed the consent form and responded to the survey link from the Siyan Clinical Corporation and Siyan Clinical Research practices located in Santa Rosa, California, USA. Results: We found that the least affected age group included individuals aged 75 years or older. This was followed closely by the 65- to 75-year-old age group. People with children under the age of 18 years also reported both more negative indicators associated with the pandemic and more positive indicators compared to those without children at home. Gender queer, nonconforming, and transgender individuals may also be at higher risk for more negative impacts associated with the pandemic. When respondents were assessed with regard to their mental health diagnosis, no differences were noted. Substance use also increased during the pandemic. Conclusions: In conclusion, the data collected here may serve as foundational research in the prevention, care, and treatment of mental health disorders during pandemics such as COVID-19. Populations such as those with previously diagnosed mental health disorders are particularly at risk for negative effects of pandemic-related stressors such as social isolation, especially if they have children in the household, are part of a younger age group, or have substance use disorder. Gender may also be a factor. Further, the EPII survey may prove to be a useful tool in understanding these effects. Overall, these data may be a critical step toward understanding the effects of the COVID-19 pandemic on populations with a mental health diagnosis, which may aid mental health practitioners in understanding the consequences of pandemics on their patients’ overall well-being. Trial Registration: ClinicalTrials.gov NCT04568135; https://clinicaltrials.gov/ct2/show/NCT04568135 %M 34323851 %R 10.2196/29952 %U https://formative.jmir.org/2021/7/e29952 %U https://doi.org/10.2196/29952 %U http://www.ncbi.nlm.nih.gov/pubmed/34323851 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e27992 %T Clinical Utility and Functionality of an Artificial Intelligence–Based App to Predict Mortality in COVID-19: Mixed Methods Analysis %A Abdulaal,Ahmed %A Patel,Aatish %A Al-Hindawi,Ahmed %A Charani,Esmita %A Alqahtani,Saleh A %A Davies,Gary W %A Mughal,Nabeela %A Moore,Luke Stephen Prockter %+ National Institute for Health Research Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Commonwealth Building 8th Floor, Du Cane Road, London, W12 0NN, United Kingdom, 44 2033158273, l.moore@imperial.ac.uk %K app %K artificial intelligence %K coronavirus %K COVID-19 %K development %K function %K graphical user interface %K machine learning %K model %K mortality %K neural network %K prediction %K usability %K utility %D 2021 %7 28.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The artificial neural network (ANN) is an increasingly important tool in the context of solving complex medical classification problems. However, one of the principal challenges in leveraging artificial intelligence technology in the health care setting has been the relative inability to translate models into clinician workflow. Objective: Here we demonstrate the development of a COVID-19 outcome prediction app that utilizes an ANN and assesses its usability in the clinical setting. Methods: Usability assessment was conducted using the app, followed by a semistructured end-user interview. Usability was specified by effectiveness, efficiency, and satisfaction measures. These data were reported with descriptive statistics. The end-user interview data were analyzed using the thematic framework method, which allowed for the development of themes from the interview narratives. In total, 31 National Health Service physicians at a West London teaching hospital, including foundation physicians, senior house officers, registrars, and consultants, were included in this study. Results: All participants were able to complete the assessment, with a mean time to complete separate patient vignettes of 59.35 (SD 10.35) seconds. The mean system usability scale score was 91.94 (SD 8.54), which corresponds to a qualitative rating of “excellent.” The clinicians found the app intuitive and easy to use, with the majority describing its predictions as a useful adjunct to their clinical practice. The main concern was related to the use of the app in isolation rather than in conjunction with other clinical parameters. However, most clinicians speculated that the app could positively reinforce or validate their clinical decision-making. Conclusions: Translating artificial intelligence technologies into the clinical setting remains an important but challenging task. We demonstrate the effectiveness, efficiency, and system usability of a web-based app designed to predict the outcomes of patients with COVID-19 from an ANN. %M 34115603 %R 10.2196/27992 %U https://formative.jmir.org/2021/7/e27992 %U https://doi.org/10.2196/27992 %U http://www.ncbi.nlm.nih.gov/pubmed/34115603 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 7 %P e28905 %T Assessment of Preparedness for Remote Teaching and Learning to Transform Health Professions Education in Sub-Saharan Africa in Response to the COVID-19 Pandemic: Protocol for a Mixed Methods Study With a Case Study Approach %A Kagawa,Mike Nantamu %A Chipamaunga,Shalote %A Prozesky,Detlef %A Kafumukache,Elliot %A Gwini,Rudo %A Kandawasvika,Gwendoline %A Katowa-Mukwato,Patricia %A Masanganise,Rangarirai %A Pretorius,Louise %A Wessels,Quenton %A Dithole,Kefalotse S %A Marimo,Clemence %A Mubuuke,Aloysius Gonzaga %A Mbalinda,Scovia Nalugo %A van der Merwe,Lynette %A Nyoni,Champion N %+ Department of Obstetrics and Gynaecology, School of Medicine, Makerere University College of Health Sciences, PO Box 7072, Kampala, 256, Uganda, 256 0772449313, kagawanm@gmail.com %K Africa %K COVID-19 %K emergency remote teaching %K formal online learning %K pandemic %D 2021 %7 28.7.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The current COVID-19 pandemic is affecting all aspects of society worldwide. To combat the pandemic, measures such as face mask–wearing, hand-washing and -sanitizing, movement restrictions, and social distancing have been introduced. These measures have significantly disrupted education, particularly health professions education, which depends on student-patient contact for the development of clinical competence. The wide-ranging consequences of the pandemic are immense, and health professions education institutions in sub-Saharan Africa have not been spared. Objective: This paper describes a protocol for assessing the preparedness of selected health professions education institutions in sub-Saharan Africa for remote teaching and learning during the COVID-19 pandemic. Methods: A mixed-methods design with a case study approach will be used. The awareness, desire, knowledge, ability, and reinforcement model of change was selected as the conceptual framework to guide the study. Eight higher education institutions in 6 sub-Saharan countries have participated in this study. Data will be collected through electronic surveys from among whole populations of academic staff, students, and administrators in undergraduate medicine and nursing programs. Qualitative and quantitative data from each institution will be analyzed as a case study, which will yield an inventory of similar cases grouped for comparison. Quantitative data will be analyzed for each institution and then compared to determine associations among variables and differences among programs, institutions, or countries. Results: Our findings will provide information to higher education institutions, particularly those offering health professions education programs, in Africa regarding the preparedness for remote teaching and learning to influence efforts related to web-based teaching and learning, which is envisaged to become the new normal in the future. Conclusions: This study has not received any funding, and any costs involved were borne by individual consortium members at the various institutions. Ethics approval from the institutional review board was obtained at various times across the participating sites, which were free to commence data collection as soon as approval was obtained. Data collection was scheduled to begin on October 1, 2020, and end on February 28, 2021. As of this submission, data collection has been completed, and a total of 1099 participants have been enrolled. Data analysis has not yet commenced. International Registered Report Identifier (IRRID): DERR1-10.2196/28905 %M 34254943 %R 10.2196/28905 %U https://www.researchprotocols.org/2021/7/e28905 %U https://doi.org/10.2196/28905 %U http://www.ncbi.nlm.nih.gov/pubmed/34254943 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e29060 %T The Effect of a Wordless, Animated, Social Media Video Intervention on COVID-19 Prevention: Online Randomized Controlled Trial %A Vandormael,Alain %A Adam,Maya %A Greuel,Merlin %A Gates,Jennifer %A Favaretti,Caterina %A Hachaturyan,Violetta %A Bärnighausen,Till %+ Heidelberg Institute of Global Health, Heidelberg University, 130.3 Im Neuenheimer Feld, Heidelberg, 69120, Germany, 49 163 481 3452, alain.vandormael@uni-heidelberg.de %K social media %K cultural and social implications %K randomized controlled trial %K list experiment %K information literacy %K COVID-19 %K pandemic %K digital health %K infodemiology %K global health %K public health %D 2021 %7 27.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Innovative approaches to the dissemination of evidence-based COVID-19 health messages are urgently needed to counter social media misinformation about the pandemic. To this end, we designed a short, wordless, animated global health communication video (the CoVideo), which was rapidly distributed through social media channels to an international audience. Objective: The objectives of this study were to (1) establish the CoVideo’s effectiveness in improving COVID-19 prevention knowledge, and (2) establish the CoVideo’s effectiveness in increasing behavioral intent toward COVID-19 prevention. Methods: In May and June 2020, we enrolled 15,163 online participants from the United States, Mexico, the United Kingdom, Germany, and Spain. We randomized participants to (1) the CoVideo arm, (2) an attention placebo control (APC) arm, and (3) a do-nothing arm, and presented 18 knowledge questions about preventive COVID-19 behaviors, which was our first primary endpoint. To measure behavioral intent, our second primary endpoint, we randomized participants in each arm to five list experiments. Results: Globally, the video intervention was viewed 1.2 million times within the first 10 days of its release and more than 15 million times within the first 4 months. Knowledge in the CoVideo arm was significantly higher (mean 16.95, 95% CI 16.91-16.99) than in the do-nothing (mean 16.86, 95% CI 16.83-16.90; P<.001) arm. We observed high baseline levels of behavioral intent to perform many of the preventive behaviors featured in the video intervention. We were only able to detect a statistically significant impact of the CoVideo on one of the five preventive behaviors. Conclusions: Despite high baseline levels, the intervention was effective at boosting knowledge of COVID-19 prevention. We were only able to capture a measurable change in behavioral intent toward one of the five COVID-19 preventive behaviors examined in this study. The global reach of this health communication intervention and the high voluntary engagement of trial participants highlight several innovative features that could inform the design and dissemination of public health messages. Short, wordless, animated videos, distributed by health authorities via social media, may be an effective pathway for rapid global health communication during health crises. Trial Registration: German Clinical Trials Register DRKS00021582; https://tinyurl.com/6r4zkbbn International Registered Report Identifier (IRRID): RR2-10.1186/s13063-020-04942-7 %M 34174778 %R 10.2196/29060 %U https://publichealth.jmir.org/2021/7/e29060 %U https://doi.org/10.2196/29060 %U http://www.ncbi.nlm.nih.gov/pubmed/34174778 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e20994 %T Experiences With Internet Triaging of 9498 Outpatients Daily at the Largest Public Hospital in Taiwan During the COVID-19 Pandemic: Observational Study %A Lu,Ding-Heng %A Hsu,Chia-An %A Yuan,Eunice J %A Fen,Jun-Jeng %A Lee,Chung-Yuan %A Ming,Jin-Lain %A Chen,Tzeng-Ji %A Lee,Wui-Chiang %A Chen,Shih-Ann %+ Information Management Office, Taipei Veterans General Hospital, No 201, Sec 2, Shih-Pai Road, Taipei, 11217, Taiwan, 886 2 2871 2121, fenjj@vghtpe.gov.tw %K COVID-19 %K hospital %K information services %K outpatients %K patient %K SARS-CoV-2 %K triage %K virus %D 2021 %7 27.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: During pandemics, acquiring outpatients’ travel, occupation, contact, and cluster histories is one of the most important measures in assessing the disease risk among incoming patients. Previous means of acquiring this information in the examination room have been insufficient in preventing disease spread. Objective: This study aimed to demonstrate the deployment of an automatic system to triage outpatients over the internet. Methods: An automatic system was incorporated in the existing web-based appointment system of the hospital and deployed along with its on-site counterpart. Automatic queries to the virtual private network travel and contact history database with each patient’s national ID number were made for each attempt to acquire the patient’s travel and contact histories. Patients with relevant histories were denied registration or entry. Text messages were sent to patients without a relevant history for an expedited route of entry if applicable. Results: A total of 127,857 visits were recorded. Among all visits, 91,195 were registered on the internet. In total, 71,816 of them generated text messages for an expedited route of entry. Furthermore, 65 patients had relevant histories, as revealed by the virtual private network database, and were denied registration or entry. Conclusions: An automatic triage system to acquire outpatients’ relevant travel and contact histories was deployed rapidly in one of the largest academic medical centers in Taiwan. The updated system successfully denied patients with relevant travel or contact histories entry to the hospital, thus preventing long lines outside the hospital. Further efforts could be made to integrate the system with the electronic medical record system. %M 34043524 %R 10.2196/20994 %U https://medinform.jmir.org/2021/7/e20994 %U https://doi.org/10.2196/20994 %U http://www.ncbi.nlm.nih.gov/pubmed/34043524 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e29463 %T Development of a Video-Observed Therapy System to Improve Monitoring of Tuberculosis Treatment in Thailand: Mixed-Methods Study %A Kumwichar,Ponlagrit %A Chongsuvivatwong,Virasakdi %A Prappre,Tagoon %+ Epidemiology Unit, Faculty of Medicine, Prince of Songkla University, Kanjanavanich Rd, Kho Hong, Hat Yai District, Songkhla, 90110, Thailand, 66 74451165, cvirasak@medicine.psu.ac.th %K app %K mixed-methods analysis %K remote monitoring %K therapy %K tuberculosis %K user experience %K video directly observed therapy %K video-enhanced therapy %K video-observed therapy %D 2021 %7 27.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Directly observed therapy programs for monitoring tuberculosis (TB) treatment in Thailand are unsustainable, especially during the COVID-19 pandemic. The current video-observed therapy (VOT) system, the Thai VOT (TH VOT), was developed to replace the directly observed therapy program. Objective: This study aimed to describe the VOT system design and identify the potential for system improvements. Methods: This pilot study was conducted in Na Yong district, a small district in Trang province, south of Thailand. The TH VOT system consists of a smartphone app for patients, a secured web-based platform for staff, items used, and standard operating procedures. There were three groups of users: observers who were TB staff, healthy volunteers as simulated patients, and patients with active TB. All participants were trained to follow the standard operating procedures. After 2-week usage, VOT session records were analyzed to measure the compliance of the patients and observers. The User Experience Questionnaire was used to lead the participant users to focus on 6 standard dimensions of usability, and was supplemented with an in-depth interview to identify potential system improvements from users’ experience. Results: Only 2 of 16 patients with currently active TB had a usable smartphone. Sixty of 70 drug-taking sessions among 2 patients and 3 simulated patients in 2 weeks were recorded and uploaded. Only 37 sessions were inspected by the observers within 24 hours. All participants needed a proper notification system. An audit system was also requested. Conclusions: Before upscaling, the cost of smartphone lending, audit management, and notification systems should be elucidated. %M 34313602 %R 10.2196/29463 %U https://formative.jmir.org/2021/7/e29463 %U https://doi.org/10.2196/29463 %U http://www.ncbi.nlm.nih.gov/pubmed/34313602 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e28812 %T Evaluation of a Parsimonious COVID-19 Outbreak Prediction Model: Heuristic Modeling Approach Using Publicly Available Data Sets %A Gupta,Agrayan K %A Grannis,Shaun J %A Kasthurirathne,Suranga N %+ Indiana University, 107 S Indiana Ave, Bloomington, IN, 47405, United States, 1 812 855 4848, aggupta@iu.edu %K coronavirus %K COVID-19 %K emerging outbreak %K modeling disease outbreak %K precision public health %K predictive modeling %D 2021 %7 26.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has changed public health policies and human and community behaviors through lockdowns and mandates. Governments are rapidly evolving policies to increase hospital capacity and supply personal protective equipment and other equipment to mitigate disease spread in affected regions. Current models that predict COVID-19 case counts and spread are complex by nature and offer limited explainability and generalizability. This has highlighted the need for accurate and robust outbreak prediction models that balance model parsimony and performance. Objective: We sought to leverage readily accessible data sets extracted from multiple states to train and evaluate a parsimonious predictive model capable of identifying county-level risk of COVID-19 outbreaks on a day-to-day basis. Methods: Our modeling approach leveraged the following data inputs: COVID-19 case counts per county per day and county populations. We developed an outbreak gold standard across California, Indiana, and Iowa. The model utilized a per capita running 7-day sum of the case counts per county per day and the mean cumulative case count to develop baseline values. The model was trained with data recorded between March 1 and August 31, 2020, and tested on data recorded between September 1 and October 31, 2020. Results: The model reported sensitivities of 81%, 92%, and 90% for California, Indiana, and Iowa, respectively. The precision in each state was above 85% while specificity and accuracy scores were generally >95%. Conclusions: Our parsimonious model provides a generalizable and simple alternative approach to outbreak prediction. This methodology can be applied to diverse regions to help state officials and hospitals with resource allocation and to guide risk management, community education, and mitigation strategies. %M 34156964 %R 10.2196/28812 %U https://www.jmir.org/2021/7/e28812 %U https://doi.org/10.2196/28812 %U http://www.ncbi.nlm.nih.gov/pubmed/34156964 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e24651 %T Candidemia Risk Prediction (CanDETEC) Model for Patients With Malignancy: Model Development and Validation in a Single-Center Retrospective Study %A Yoo,Junsang %A Kim,Si-Ho %A Hur,Sujeong %A Ha,Juhyung %A Huh,Kyungmin %A Cha,Won Chul %+ Department of Emergency Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81, Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea, 82 2 3410 2053, wc.cha@samsung.com %K candidemia %K precision medicine %K supervised machine learning %K decision support systems, clinical %K infection control %K decision support %K machine learning %K development %K validation %K prediction %K risk %K model %D 2021 %7 26.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Appropriate empirical treatment for candidemia is associated with reduced mortality; however, the timely diagnosis of candidemia in patients with sepsis remains poor. Objective: We aimed to use machine learning algorithms to develop and validate a candidemia prediction model for patients with cancer. Methods: We conducted a single-center retrospective study using the cancer registry of a tertiary academic hospital. Adult patients diagnosed with malignancies between January 2010 and December 2018 were included. Our study outcome was the prediction of candidemia events. A stratified undersampling method was used to extract control data for algorithm learning. Multiple models were developed—a combination of 4 variable groups and 5 algorithms (auto-machine learning, deep neural network, gradient boosting, logistic regression, and random forest). The model with the largest area under the receiver operating characteristic curve (AUROC) was selected as the Candida detection (CanDETEC) model after comparing its performance indexes with those of the Candida Score Model. Results: From a total of 273,380 blood cultures from 186,404 registered patients with cancer, we extracted 501 records of candidemia events and 2000 records as control data. Performance among the different models varied (AUROC 0.771- 0.889), with all models demonstrating superior performance to that of the Candida Score (AUROC 0.677). The random forest model performed the best (AUROC 0.889, 95% CI 0.888-0.889); therefore, it was selected as the CanDETEC model. Conclusions: The CanDETEC model predicted candidemia in patients with cancer with high discriminative power. This algorithm could be used for the timely diagnosis and appropriate empirical treatment of candidemia. %M 34309570 %R 10.2196/24651 %U https://medinform.jmir.org/2021/7/e24651 %U https://doi.org/10.2196/24651 %U http://www.ncbi.nlm.nih.gov/pubmed/34309570 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e27982 %T Age and Social Disparities in the Use of Telemedicine During the COVID-19 Pandemic in Japan: Cross-sectional Study %A Miyawaki,Atsushi %A Tabuchi,Takahiro %A Ong,Michael K %A Tsugawa,Yusuke %+ Department of Public Health, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 1130033, Japan, 81 3 5841 3494, amiyawaki-tky@umin.ac.jp %K telemedicine %K telehealth %K disparity %K access to care %K COVID-19 %K Japan %D 2021 %7 23.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of telemedicine outpatient visits has increased dramatically during the COVID-19 pandemic in many countries. Although disparities in access to telemedicine by age and socioeconomic status (SES) have been well-documented, evidence is limited as to how these disparities changed during the COVID-19 pandemic. Moreover, the equity of patient access to telemedicine has been scarcely reported in Japan, despite the huge potential for telemedicine expansion. Objective: We aimed to investigate changes due to age and SES disparities in telemedicine use during the COVID-19 pandemic in Japan. Methods: Using data from a large internet survey conducted between August 25 and September 30, 2020, in Japan, we examined the associations of participant age and SES (educational attainment, urbanicity of residence, and income level) with their telemedicine use in the following two time periods during the pandemic: April 2020 and August-September 2020. Results: Of the 24,526 participants aged 18 to 79 years (50.8% [n=12,446] women), the proportion of individuals who reported using telemedicine increased from 2.0% (n=497) in April 2020 to 4.7% (n=1159) in August-September 2020. After adjusting for potential confounders, younger individuals were more likely to use telemedicine than older individuals in April 2020. Although this pattern persisted in August-September 2020, we also observed a substantial increase in telemedicine use among individuals aged 70 to 79 years (adjusted rates, 0.2% in April 2020 vs 3.8% in August-September 2020; P<.001 after multiple comparisons). We found disparities in telemedicine use by SES in August-September 2020 that did not exist in April 2020. In August-September 2020, individuals with a university degree were more likely to use telemedicine than those with a high school diploma or less (adjusted rates, 6.6% vs 3.5%; P<.001). Individuals living in urban areas exhibited higher rates of telemedicine use than those living in rural areas only in August-September 2020 (adjusted rates, 5.2% vs 3.8%; P<.001). Disparities in telemedicine use by income level were not observed in either time period. Conclusions: In general, younger individuals increased their use of telemedicine compared to older individuals during the pandemic, although individuals in their 70s also increased their use of telemedicine. Disparities in telemedicine use by educational attainment and urbanicity of residence widened during the COVID-19 pandemic. %M 34259641 %R 10.2196/27982 %U https://www.jmir.org/2021/7/e27982 %U https://doi.org/10.2196/27982 %U http://www.ncbi.nlm.nih.gov/pubmed/34259641 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 4 %N 3 %P e24791 %T A Global Overview of COVID-19 Research in the Pediatric Field: Bibliometric Review %A Monzani,Alice %A Tagliaferri,Francesco %A Bellone,Simonetta %A Genoni,Giulia %A Rabbone,Ivana %+ Division of Pediatrics, Department of Health Sciences, Università del Piemonte Orientale, Via Solaroli 17, Novara, 28100, Italy, 39 03213733868, alice.monzani@med.uniupo.it %K COVID-19 %K SARS-CoV-2 %K children %K pediatrics %K bibliometric review %K publications %K research %K literature %K review %D 2021 %7 23.7.2021 %9 Review %J JMIR Pediatr Parent %G English %X Background: Since the beginning of the COVID-19 pandemic, a great number of papers have been published in the pediatric field. Objective: We aimed to assess research around the globe on COVID-19 in the pediatric field by bibliometric analysis, identifying publication trends and topic dissemination and showing the relevance of publishing authors, institutions, and countries. Methods: The Scopus database was comprehensively searched for all indexed documents published between January 1, 2020, and June 11, 2020, dealing with COVID-19 in the pediatric population (0-18 years). A machine learning bibliometric methodology was applied to evaluate the total number of papers and citations, journal and publication types, the top productive institutions and countries and their scientific collaboration, and core keywords. Results: A total of 2301 papers were retrieved, with an average of 4.8 citations per article. Of this, 1078 (46.9%) were research articles, 436 (18.9%) were reviews, 363 (15.8%) were letters, 186 (8.1%) were editorials, 7 (0.3%) were conference papers, and 231 (10%) were categorized as others. The studies were published in 969 different journals, headed by The Lancet. The retrieved papers were published by a total of 12,657 authors from 114 countries. The most productive countries were the United States, China, and Italy. The four main clusters of keywords were pathogenesis and clinical characteristics (keyword occurrences: n=2240), public health issues (n=352), mental health (n=82), and therapeutic aspects (n=70). Conclusions: In the pediatric field, a large number of articles were published within a limited period on COVID-19, testifying to the rush to spread new findings on the topic in a timely manner. The leading authors, countries, and institutions evidently belonged to the most impacted geographical areas. A focus on the pediatric population was often included in general articles, and pediatric research about COVID-19 mainly focused on the clinical features, public health issues, and psychological impact of the disease. %M 34081597 %R 10.2196/24791 %U https://pediatrics.jmir.org/2021/3/e24791 %U https://doi.org/10.2196/24791 %U http://www.ncbi.nlm.nih.gov/pubmed/34081597 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e27865 %T Acceptability and Feasibility of the Transfer of Face-to-Face Group Therapy to Online Group Chats in a Psychiatric Outpatient Setting During the COVID-19 Pandemic: Longitudinal Observational Study %A Scholl,Julia %A Kohls,Elisabeth %A Görges,Frauke %A Steinbrecher,Marc %A Baldofski,Sabrina %A Moessner,Markus %A Rummel-Kluge,Christine %+ Department of Psychiatry and Psychotherapy, Universitätsklinikum Leipzig, Semmelweisstraße 10, Haus 13, Leipzig, 04103, Germany, 49 3419724464, Christine.Rummel-Kluge@medizin.uni-leipzig.de %K online %K group chats %K COVID-19 pandemic %K psychiatric outpatient setting %K online interventions %K e-mental health %K COVID-19 %K pandemic %K mental health %K psychoeducation %K online chat %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: At the height of the COVID-19 pandemic, several mental health care providers were obliged to shut down outpatient services, including group therapy and psychoeducational sessions. The lockdown in many countries is a serious threat to people’s mental well-being, especially for individuals with severe mental illnesses. Discontinued outpatient treatments and disruption of daily routines are considered to be risk factors for destabilization of patients with mental illness. Objective: The aim of this study was to evaluate the acceptability, usability, and feasibility of a group chat program to replace cancelled face-to-face group sessions in an outpatient psychiatric department. Methods: Participants (N=33) were recruited in the outpatient department of a large university medical center in Leipzig, Germany. Former face-to-face group participants were invited to take part in a therapist-guided group-chat for 4 weeks (8 sessions) and were asked to evaluate the program via self-administered standardized questionnaires at baseline (T0, preintervention), after every chat session (T1), and posttreatment (T2, after 4-6 weeks). The chat groups were specific to the following mental disorder diagnoses and based on the same therapeutic principles and techniques as the former face-to-face groups: anxiety, depression, obsessive-compulsive disorder, and adult attention-deficit/hyperactivity disorder (ADHD). Sociodemographic measures, attitudes toward the COVID-19 pandemic, depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), treatment credibility/expectancy (Credibility Expectancy Questionnaire), and participants’ satisfaction (Client Satisfaction Questionnaire-8 [ZUF-8]) were measured. Results: Participants joined an average of 5 out of 8 offered chat sessions. Participation rates in the respective groups were highest in the ADHD group (8.6/11, 78%) and lowest in the anxiety group (3.7/9, 41%). The overall preintervention level of depressive symptoms was moderate and showed a slight, nonsignificant improvement at posttreatment (T0: mean 10.7, SD 5.5; T2: mean 10.2, SD 5.5). A similar result was observed regarding quality of life (T0: median 41.7-68.8; T2: median 50-70.3). Treatment credibility and expectancy scores were medium-high (T0: meancredibility 18.1, SD 3.8; meanexpectancy 11.2, SD 5.1; T2: meancredibility 17.1, SD 4.8; meanexpectancy 10.3, SD 5.8). Further, significant correlations were detected between posttreatment expectancy score and posttreatment PHQ-9 score (r=–0.41, P=.02), posttreatment physical quality of life (r=0.54, P=.001), and posttreatment psychological quality of life (r=0.53, P=.002). Overall, participants’ satisfaction with the program was very high, both after chat sessions and at posttreatment (ZUF-8: mean score 20.6, SD 1.0). Of all participants, a majority (27/31, 87%) rated the program as excellent/good and indicated they would recommend the group chat program to a friend in need of similar help (23/31, 74%). Conclusions: A therapist-guided group chat program to substitute outpatient group setting treatment during the COVID-19 lockdown was shown to be feasible, usable, and highly acceptable for participants. Web-based programs such as this one provide an easy-to-implement tool to successfully stabilize participants during a difficult time, such as the COVID-19 pandemic. Trial Registration: German Clinical Trials Register DRKS00021527; https://tinyurl.com/3btyxc2r %M 34161252 %R 10.2196/27865 %U https://formative.jmir.org/2021/7/e27865 %U https://doi.org/10.2196/27865 %U http://www.ncbi.nlm.nih.gov/pubmed/34161252 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e25926 %T Mobile Delivery of Mindfulness-Based Smoking Cessation Treatment Among Low-Income Adults During the COVID-19 Pandemic: Pilot Randomized Controlled Trial %A Mhende,Josephine %A Bell,Sharrill A %A Cottrell-Daniels,Cherell %A Luong,Jackie %A Streiff,Micah %A Dannenfelser,Mark %A Hayat,Matthew J %A Spears,Claire Adams %+ Georgia State University, 140 Decatur Street, Suite 400, Atlanta, GA, 30303, United States, 1 404 413 9335, cspears@gsu.edu %K acceptability %K addiction %K African American %K cessation %K COVID-19 %K feasibility %K income %K low socioeconomic status %K mHealth %K mindfulness %K minority %K smoking %K SMS %K text messaging %K treatment %D 2021 %7 23.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Smoking is the leading cause of premature death, and low-income adults experience disproportionate burden from tobacco. Mindfulness interventions show promise for improving smoking cessation. A text messaging program “iQuit Mindfully” was developed to deliver just-in-time support for quitting smoking among low-income adults. A pilot study of iQuit Mindfully was conducted in spring 2020, during the COVID-19 pandemic, among low-income and predominantly African American smokers. Objective: This pilot study examined the acceptability and feasibility of delivering Mindfulness-Based Addiction Treatment via mHealth during the COVID-19 pandemic. Methods: Participants were adult cigarette smokers (n=23), of whom 8 (34.8%) were female, 19 (82.6%) were African American, and 18 (78.3%) had an annual income of 80%). Results: As rated by the evaluators, the SARI surveillance system achieved its objectives. The system’s flexibility (percent score: 86%) and acceptability (percent score: 82%) were rated as “excellent,” and simplicity (percent score: 74%) and stability (percent score: 75%) were rated as “good.” The percent score for timeliness was 23% in 2018, which indicated poor timeliness. The overall data quality percent score of the SARI system was 98.5%. Despite its many strengths, the SARI system has some weaknesses. For example, it depends on irregular external financial support. Conclusions: The SARI surveillance system was useful in estimating morbidity and mortality, monitoring the trends of the disease, and promoting research for informing prevention and control measures. The overall performance of the SARI surveillance system was good. We recommend expanding the system by promoting private health facilities’ (eg, private hospitals and private health centers) engagement in SARI surveillance, establishing an electronic database at central and peripheral sites, and providing the National Central Public Health Laboratory with the reagents needed for disease confirmation. %M 34255695 %R 10.2196/27621 %U https://publichealth.jmir.org/2021/7/e27621 %U https://doi.org/10.2196/27621 %U http://www.ncbi.nlm.nih.gov/pubmed/34255695 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 7 %P e29986 %T Ambulatory Risk Models for the Long-Term Prevention of Sepsis: Retrospective Study %A Lee,Jewel Y %A Molani,Sevda %A Fang,Chen %A Jade,Kathleen %A O'Mahony,D Shane %A Kornilov,Sergey A %A Mico,Lindsay T %A Hadlock,Jennifer J %+ Institute for Systems Biology, 401 Terry Ave N, Seattle, WA, 98109, United States, jhadlock@isbscience.org %K sepsis %K machine learning %K electronic health records %K risk prediction %K clinical decision making %K prevention %K risk factors %D 2021 %7 8.7.2021 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 34086596 %R 10.2196/29986 %U https://medinform.jmir.org/2021/7/e29986 %U https://doi.org/10.2196/29986 %U http://www.ncbi.nlm.nih.gov/pubmed/34086596 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e29942 %T The Reliability and Quality of YouTube Videos as a Source of Public Health Information Regarding COVID-19 Vaccination: Cross-sectional Study %A Chan,Calvin %A Sounderajah,Viknesh %A Daniels,Elisabeth %A Acharya,Amish %A Clarke,Jonathan %A Yalamanchili,Seema %A Normahani,Pasha %A Markar,Sheraz %A Ashrafian,Hutan %A Darzi,Ara %+ Department of Surgery & Cancer, Imperial College London, 10th floor, Queen Elizabeth Queen Mother Building, St. Mary's Hospital, South Wharf Road, London, W2 1NY, United Kingdom, 44 02033126666, vs1108@imperial.ac.uk %K COVID-19 %K infodemiology %K public health %K quality %K reliability %K social media %K vaccination %K vaccine %K video %K web-based health information %K YouTube %D 2021 %7 8.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34081599 %R 10.2196/29942 %U https://publichealth.jmir.org/2021/7/e29942 %U https://doi.org/10.2196/29942 %U http://www.ncbi.nlm.nih.gov/pubmed/34081599 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 7 %P e27044 %T Prediction of Asthma Hospitalizations for the Common Cold Using Google Trends: Infodemiology Study %A Sousa-Pinto,Bernardo %A Halonen,Jaana I %A Antó,Aram %A Jormanainen,Vesa %A Czarlewski,Wienczyslawa %A Bedbrook,Anna %A Papadopoulos,Nikolaos G %A Freitas,Alberto %A Haahtela,Tari %A Antó,Josep M %A Fonseca,João Almeida %A Bousquet,Jean %+ MEDCIDS – Department of Community Medicine, Information and Health Decision Sciences; Faculty of Medicine, University of Porto, Rua Dr. Plácido da Costa s/n, Porto, Portugal, 351 225513600, bernardosousapinto@protonmail.com %K asthma %K common cold %K Google Trends %K hospitalizations %K time series analysis %K mobile phone %D 2021 %7 6.7.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In contrast to air pollution and pollen exposure, data on the occurrence of the common cold are difficult to incorporate in models predicting asthma hospitalizations. Objective: This study aims to assess whether web-based searches on common cold would correlate with and help to predict asthma hospitalizations. Methods: We analyzed all hospitalizations with a main diagnosis of asthma occurring in 5 different countries (Portugal, Spain, Finland, Norway, and Brazil) for a period of approximately 5 years (January 1, 2012-December 17, 2016). Data on web-based searches on common cold were retrieved from Google Trends (GT) using the pseudo-influenza syndrome topic and local language search terms for common cold for the same countries and periods. We applied time series analysis methods to estimate the correlation between GT and hospitalization data. In addition, we built autoregressive models to forecast the weekly number of asthma hospitalizations for a period of 1 year (June 2015-June 2016) based on admissions and GT data from the 3 previous years. Results: In time series analyses, GT data on common cold displayed strong correlations with asthma hospitalizations occurring in Portugal (correlation coefficients ranging from 0.63 to 0.73), Spain (ρ=0.82-0.84), and Brazil (ρ=0.77-0.83) and moderate correlations with those occurring in Norway (ρ=0.32-0.35) and Finland (ρ=0.44-0.47). Similar patterns were observed in the correlation between forecasted and observed asthma hospitalizations from June 2015 to June 2016, with the number of forecasted hospitalizations differing on average between 12% (Spain) and 33% (Norway) from observed hospitalizations. Conclusions: Common cold–related web-based searches display moderate-to-strong correlations with asthma hospitalizations and may be useful in forecasting them. %M 34255692 %R 10.2196/27044 %U https://www.jmir.org/2021/7/e27044 %U https://doi.org/10.2196/27044 %U http://www.ncbi.nlm.nih.gov/pubmed/34255692 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 7 %P e28656 %T Social Media as a Platform for Recruitment to a National Survey During the COVID-19 Pandemic: Feasibility and Cost Analysis %A Green,Heidi %A Fernandez,Ritin %A MacPhail,Catherine %+ School of Nursing, University of Wollongong, Northfields Ave, 2522, Wollongong, Australia, 61 0412108532, Heidi.Lord@health.nsw.gov.au %K social media %K survey %K online recruitment %K COVID-19 %K pandemic %K methodology %D 2021 %7 6.7.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: With improved accessibility to social media globally, health researchers are capitalizing on social media platforms to recruit participants for research studies. This has particularly been the case during the COVID-19 pandemic, when researchers were not able to use traditional methods of recruitment. Nevertheless, there is limited evidence on the feasibility of social media for recruiting a national sample. Objective: This paper describes the use of social media as a tool for recruiting a national sample of adults to a web-based survey during the COVID-19 pandemic. Methods: Between August and October 2020, participants were recruited through Facebook via two advertisement campaigns (paid option and no-cost option) into a web-based survey exploring the relationship between social determinants of health and well-being of adults during the COVID-19 pandemic. Data were analyzed using SPSS software and Facebook metrics that were autogenerated by Facebook Ads Manager. Poststratification weights were calculated to match the Australian population on the basis of gender, age, and state or territory based on the 2016 Australian census data. Results: In total, 9594 people were reached nationally with the paid option and potentially 902,000 people were reached through the no-cost option, resulting in a total of 1211 survey responses. The total cost of the advertisement campaign was Aus $649.66 (US $489.23), resulting in an overall cost per click of Aus $0.25 (US $0.19). Conclusions: Facebook is a feasible and cost-effective method of recruiting participants for a web-based survey, enabling recruitment of population groups that are considered hard to reach or marginalized. Recruitment through Facebook facilitated diversity, with participants varying in socioeconomic status, geographical location, educational attainment, and age. %M 34133315 %R 10.2196/28656 %U https://formative.jmir.org/2021/7/e28656 %U https://doi.org/10.2196/28656 %U http://www.ncbi.nlm.nih.gov/pubmed/34133315 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e27627 %T Risk Factors of Cholera Transmission in Al Hudaydah, Yemen: Case-Control Study %A Qaserah,Abdulqawi Mohammed %A Al Amad,Mohammed Abdullah %A Al Serouri,Abdulwahed Abduljabbar %A Khader,Yousef Saleh %+ Rapid Response Team, Yemen Ministry of Public Health and Population, P.O. Box 299, Al-Hasabah, Sana'a, Yemen, 967 772435532, aabuhosam33@gmail.com %K cholera %K outbreak %K risk factors, Yemen %K Field Epidemiology Training Program %D 2021 %7 5.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Yemen has recently faced the largest cholera outbreak in the world, which started at the end of 2016. By the end of 2017, the cumulative reported cases from all governorates reached 777,229 with 2134 deaths. Al Hudaydah was one of the most strongly affected areas, with 88,741 (18%) cases and 244 (12%) deaths reported. Objective: The aim of this study was to determine the risk factors associated with cholera transmission in Al Hudaydah city, Yemen. Methods: From December 1, 2017 to January 10, 2018, a total of 104 patients with cholera (57 women and 47 men) who presented at cholera treatment centers in Al Hudaydah city with three or more watery stools in a 24-hour period and with moderate or severe dehydration were identified for inclusion in this study. Each case was matched by age and gender with two controls who were living in the neighboring house. A semistructured questionnaire was used to collect data on behavioral and environmental risk factors such as drinking water from public wells, storing water in containers, consumption of unwashed vegetables or fruits, and sharing a toilet. Results: The median age of the cases and controls was 20 years (range 5-80) and 23 years (range 5-85), respectively. Only 6% of cases and 4% of controls were employed. Multivariate analysis showed that eating unwashed vegetables or fruits (odds ratio [OR] 7.0, 95% CI 1.6-30.6, P=.01), storing water in containers (OR 3.0, 95% CI 1.3-7.3, P=.01), drinking water from a public well (OR 2.5, 95% CI 1.1-5.7, P=.02), and using a public toilet (OR 5.2, 95% CI 1.1-24.4, P=.04) were significantly associated with cholera infection risk. Conclusions: The cholera transmission risk factors in Al Hudaydah city were related to water and sanitation hygiene. Therefore, increasing awareness of the population on the importance of water chlorination, and washing fruits and vegetables through a health education campaign is strongly recommended. %M 36260393 %R 10.2196/27627 %U https://publichealth.jmir.org/2021/7/e27627 %U https://doi.org/10.2196/27627 %U http://www.ncbi.nlm.nih.gov/pubmed/36260393 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 7 %P e29213 %T The Psychosocial Impacts of COVID-19 on a Sample of Australian Adults: Cross-sectional Survey and Sentiment Analysis %A Ryan,Jillian %A Sellak,Hamza %A Brindal,Emily %+ Precision Health Future Science Platform, Commonwealth Scientific and Industrial Research Organisation, 13 Kintore Avenue, Adelaide, 5000, Australia, 61 8 8305 0644, jillian.ryan@csiro.au %K COVID-19 %K natural language processing %K behavioural science %K NLP %K behavior %K impact %K Australia %K community %K sentiment %K data set %K machine learning %D 2021 %7 2.7.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has had enormous impacts on people’s lives, including disruptions to their normal ways of behaving, working, and interacting with others. Understanding and documenting these experiences is important to inform the ongoing response to COVID-19 and disaster preparedness efforts. Objective: The aim of this study was to examine the psychosocial impacts of COVID-19 on a sample of Australian adults. Methods: The data analyzed were derived from a larger cross-sectional survey of Australian adults that was administered during the month of May 2020. Participants (N=3483) were asked in which ways COVID-19 had most greatly impacted them; the responses produced a text data set containing 1 COVID-19 impact story for each participant, totaling 86,642 words. Participants also completed assessments of their sociodemographic characteristics (sex, age, financial stress), level of concern related to COVID-19, personality trait profile, and satisfaction with life. Impact stories were analyzed using sentiment analysis and compared against the Theoretical Domains Framework to determine the most frequently impacted life domains. Finally, a multinomial regression analysis, stratified by participant sex, was conducted to identify the associations of psychological and demographic socializations with sentiment toward COVID-19. Results: In total, 3483 participants completed the survey, the majority of whom were female (n=2793, 80.2%). Participants’ impact stories were most commonly categorized as neutral (1544/3483, 44.3%), followed by negative (1136/3483, 32.6%) and positive (802/3483, 23.1%). The most frequently impacted life domains included behavioral regulation, environmental context and resources, social influences, and emotions, suggesting that the COVID-19 pandemic was impacting these areas of participants’ lives the most. Finally, the regression results suggested that for women, lower satisfaction with life and higher financial stress were associated with increased likelihood of negative, rather than positive, sentiment (P<.001); however, the proportion of variance in the sentiment that was explained was very small (<5%). Conclusions: Participant sentiment toward COVID-19 varied. High rates of neutral and negative sentiment were identified. Positive sentiment was identified but was not as common. Impacts to different areas of people’s lives were identified, with a major emphasis on behavioral regulation and related domains such as social influences, environmental context and resources, and emotions. Findings may inform the development of mental health and social support resources and interventions to help alleviate the psychosocial consequences of disaster response measures. %M 34081594 %R 10.2196/29213 %U https://publichealth.jmir.org/2021/7/e29213 %U https://doi.org/10.2196/29213 %U http://www.ncbi.nlm.nih.gov/pubmed/34081594 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e22075 %T Advancing Mental Health and Psychological Support for Health Care Workers Using Digital Technologies and Platforms %A Ye,Jiancheng %+ Feinberg School of Medicine, Northwestern University, 633 N Saint Clair St, Chicago, IL, United States, 1 312 503 3690, jiancheng.ye@u.northwestern.edu %K mental health %K health care workers %K health informatics %K digital intervention %K health technology %K mobile health %K COVID-19 %D 2021 %7 30.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is a global public health crisis that has not only endangered the lives of patients but also resulted in increased psychological issues among medical professionals, especially frontline health care workers. As the crisis caused by the pandemic shifts from acute to protracted, attention should be paid to the devastating impacts on health care workers’ mental health and social well-being. Digital technologies are being harnessed to support the responses to the pandemic, which provide opportunities to advance mental health and psychological support for health care workers. Objective: The aim of this study is to develop a framework to describe and organize the psychological and mental health issues that health care workers are facing during the COVID-19 pandemic. Based on the framework, this study also proposes interventions from digital health perspectives that health care workers can leverage during and after the pandemic. Methods: The psychological problems and mental health issues that health care workers have encountered during the COVID-19 pandemic were reviewed and analyzed based on the proposed MEET (Mental Health, Environment, Event, and Technology) framework, which also demonstrated the interactions among mental health, digital interventions, and social support. Results: Health care workers are facing increased risk of experiencing mental health issues due to the COVID-19 pandemic, including burnout, fear, worry, distress, pressure, anxiety, and depression. These negative emotional stressors may cause psychological problems for health care workers and affect their physical and mental health. Digital technologies and platforms are playing pivotal roles in mitigating psychological issues and providing effective support. The proposed framework enabled a better understanding of how to mitigate the psychological effects during the pandemic, recover from associated experiences, and provide comprehensive institutional and societal infrastructures for the well-being of health care workers. Conclusions: The COVID-19 pandemic presents unprecedented challenges due to its prolonged uncertainty, immediate threat to patient safety, and evolving professional demands. It is urgent to protect the mental health and strengthen the psychological resilience of health care workers. Given that the pandemic is expected to exist for a long time, caring for mental health has become a “new normal” that needs a strengthened multisector collaboration to facilitate support and reduce health disparities. The proposed MEET framework could provide structured guidelines for further studies on how technology interacts with mental and psychological health for different populations. %M 34106874 %R 10.2196/22075 %U https://formative.jmir.org/2021/6/e22075 %U https://doi.org/10.2196/22075 %U http://www.ncbi.nlm.nih.gov/pubmed/34106874 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e28643 %T Making the COVID-19 Pandemic a Driver for Digital Health: Brazilian Strategies %A Donida,Bruna %A da Costa,Cristiano André %A Scherer,Juliana Nichterwitz %+ SOFTWARELAB - Software Innovation Laboratory, Universidade do Vale do Rio dos Sinos, Av. Unisinos 950, São Leopoldo, 93022-750, Brazil, 55 5135908161, cac@unisinos.br %K COVID-19 %K digital technology %K Brazil %K public health %K medical informatics %K digital health %K strategy %K outbreak %K system %K data %K health data %K implementation %K monitoring %D 2021 %7 29.6.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 outbreak exposed several problems faced by health systems worldwide, especially concerning the safe and rapid generation and sharing of health data. However, this pandemic scenario has also facilitated the rapid implementation and monitoring of technologies in the health field. In view of the occurrence of the public emergency caused by SARS-CoV-2 in Brazil, the Department of Informatics of the Brazilian Unified Health System created a contingency plan. In this paper, we aim to report the digital health strategies applied in Brazil and the first results obtained during the fight against COVID-19. Conecte SUS, a platform created to store all the health data of an individual throughout their life, is the center point of the Brazilian digital strategy. Access to the platform can be obtained through an app by the patient and the health professionals involved in the case. Health data sharing became possible due to the creation of the National Health Data Network (Rede Nacional de Dados em Saúde, RNDS). A mobile app was developed to guide citizens regarding the need to go to a health facility and to assist in disseminating official news about the virus. The mobile app can also alert the user if they have had contact with an infected person. The official numbers of cases and available hospital beds are updated and published daily on a website containing interactive graphs. These data are obtained due to creating a web-based notification system that uses the RNDS to share information about the cases. Preclinical care through telemedicine has become essential to prevent overload in health facilities. The exchange of experiences between medical teams from large centers and small hospitals was made possible using telehealth. Brazil took a giant step toward digital health adoption, creating and implementing important initiatives; however, these initiatives do not yet cover the entire health system. It is expected that the sharing of health data that are maintained and authorized by the patient will become a reality in the near future. The intention is to obtain better clinical outcomes, cost reduction, and faster and better services in the public health network. %M 34101613 %R 10.2196/28643 %U https://publichealth.jmir.org/2021/6/e28643 %U https://doi.org/10.2196/28643 %U http://www.ncbi.nlm.nih.gov/pubmed/34101613 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e28757 %T Psychological Impacts of the COVID-19 Pandemic Among Portuguese and Swiss Higher-Education Students: Protocol for a Mixed Methods Study %A Querido,Ana %A Aissaoui,Djamel %A Dixe,Maria Dos Anjos %A Schwander-Maire,Françoise %A Cara-Nova,Tanya %A Charepe,Zaida %A Laranjeira,Carlos %+ School of Health Sciences, Polytechnic of Leiria, Campus 2, Morro do Lena - Alto do Vieiro, Apartado 4137, Leiria, 2411-901, Portugal, 351 966936420, ana.querido@ipleiria.pt %K study protocol %K pandemic %K students %K mental health %K COVID-19 %D 2021 %7 29.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Higher-education students are particularly vulnerable to both everyday stressors and mental health problems. Public health emergencies may generate a range of unforeseen potential stressors for vulnerable individuals and communities. The current pandemic has apparently led to an increase in psychiatric symptoms among these students. Objective: The goal of this study is to characterize the psychological impact of the COVID-19 pandemic among Portuguese and Swiss higher-education students. Methods: This project will use a mixed methods sequential explanatory design in Portugal and Switzerland, with two consecutive phases. During Phase I, a quantitative study will assess the psychological responses of higher-education students during the COVID-19 pandemic. A convenience sampling method will be used for collecting information from students. The association between variables will be determined with univariable and multivariable analyses. During Phase II, qualitative data will be collected in order to understand the determinants of psychological stress and the strategies adopted by students as a result of the COVID-19 pandemic, as well as to identify their opinions and feelings about the teaching-learning process during quarantine. In this phase, participants will be selected using a maximum-variation sampling method. Data from focus group discussions will be coded and inductively analyzed using a thematic analysis approach. Finally, quantitative and qualitative results will be merged during interpretation to provide complementary perspectives. Results: This paper describes and discusses the protocol for this mixed methods study, which will be completed in December 2021. This study was formally approved by the local ethics committee (CE/IPLEIRIA/22/2020) in Portugal and authorized by the Swiss Association of Research Ethics Committees, swissethics (CER-VD-2020-02889). Conclusions: This research can contribute to the development of teaching tools and methods that reinforce positive mental health strategies, hope, and adaptive coping among students, and to the development of a class on mental health interventions in the context of catastrophic and traumatic events. This project will also help government stakeholders as well as health and education professionals safeguard the psychological well-being of students facing an expanding COVID-19 pandemic. International Registered Report Identifier (IRRID): PRR1-10.2196/28757 %M 34081598 %R 10.2196/28757 %U https://www.researchprotocols.org/2021/6/e28757 %U https://doi.org/10.2196/28757 %U http://www.ncbi.nlm.nih.gov/pubmed/34081598 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e29733 %T The Impact of COVID-19 Vaccine Communication, Acceptance, and Practices (CO-VIN-CAP) on Vaccine Hesitancy in an Indian Setting: Protocol for a Cross-sectional Study %A Surapaneni,Krishna Mohan %A Kaur,Mahima %A Kaur,Ritika %A Grover,Ashoo %A Joshi,Ashish %+ Panimalar Medical College Hospital & Research Institute, Varadharajapuram, Poonamallee, Tamil Nadu, Chennai, 600123, India, 91 9789099989, krishnamohan.surapaneni@gmail.com %K COVID-19 vaccine %K vaccine hesitancy %K vaccine acceptance %K unintended consequences %K vaccination %K COVID-19 %K pandemic %K coronavirus %K infectious disease %K protocol %K vaccine %D 2021 %7 24.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19 vaccines are considered to be a key to limiting and eliminating the infectious disease. However, the success of the vaccination program will rely on the rates of vaccine acceptance among the population. Objective: This study aims to examine the factors that influence vaccine hesitancy and vaccine acceptance, and to explore the unintended consequences of COVID-19 infections. The study will further explore the association between sociodemographic characteristics; health status; COVID-19–related knowledge, attitude, and practices; and its influence on vaccine hesitancy and acceptance among individuals living in urban and rural settings of Chennai, Tamil Nadu in the southern state of India. Methods: A cross-sectional study will be conducted between January 2021 and January 2023. A sample of approximately 25,000 individuals will be recruited and enrolled using a nonprobability complete enumeration sampling method from 11 selected urban and rural settings of Chennai. The data will be collected at one time point by administering the questionnaire to the eligible study participants. The collected data will be used to assess the rates of vaccine acceptance; hesitancy; and knowledge, attitudes, practices, and beliefs regarding COVID-19 and COVID-19 vaccines. Lastly, the study questionnaire will be used to assess the unintended consequences of COVID-19 infection. Results: A pilot of 2500 individuals has been conducted to pretest the survey questionnaire. The data collection was initiated on March 1, 2021, and the initial results are planned for publication by June 2021. Descriptive analysis of the gathered data will be performed using SAS v9.1, and reporting of the results will be done at 95% CIs and P=.049. The study will help explore the burden of vaccine acceptance and hesitancy among individuals living in urban and rural settings of Chennai. Further, it will help to examine the variables that influence vaccine acceptance and hesitancy. Lastly, the findings will help to design and develop a user-centered informatics platform that can deliver multimedia-driven health education modules tailored to facilitate vaccine uptake in varied settings. Conclusions: The proposed study will help in understanding the rate and determinants of COVID-19 vaccine acceptance and hesitancy among the population of Chennai. The findings of the study would further facilitate the development of a multifaceted intervention to enhance vaccine acceptance among the population. International Registered Report Identifier (IRRID): DERR1-10.2196/29733 %R 10.2196/29733 %U https://www.researchprotocols.org/2021/6/e29733/ %U https://doi.org/10.2196/29733 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e29561 %T Monitoring Beliefs and Physiological Measures Using Wearable Sensors and Smartphone Technology Among Students at Risk of COVID-19: Protocol for a mHealth Study %A Cislo,Christine %A Clingan,Caroline %A Gilley,Kristen %A Rozwadowski,Michelle %A Gainsburg,Izzy %A Bradley,Christina %A Barabas,Jenny %A Sandford,Erin %A Olesnavich,Mary %A Tyler,Jonathan %A Mayer,Caleb %A DeMoss,Matthew %A Flora,Christopher %A Forger,Daniel B %A Cunningham,Julia Lee %A Tewari,Muneesh %A Choi,Sung Won %+ Division of Pediatric Hematology Oncology, Department of Pediatrics, University of Michigan, 1500 E Medical Center Dr, D4118 Medical Professional Building, Ann Arbor, MI, 48109, United States, 1 7342165349, sungchoi@med.umich.edu %K college students %K COVID-19 %K global pandemic %K mental health %K mHealth %K pandemic %K risk monitoring %K wearable sensors %K well-being %D 2021 %7 24.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has significantly impacted lives and greatly affected the mental health and public safety of an already vulnerable population—college students. Social distancing and isolation measures have presented challenges to students’ mental health. mHealth apps and wearable sensors may help monitor students at risk of COVID-19 and support their mental well-being. Objective: This study aimed to monitor students at risk of COVID-19 by using a wearable sensor and a smartphone-based survey. Methods: We conducted a prospective study on undergraduate and graduate students at a public university in the Midwest United States. Students were instructed to download the Fitbit, Social Rhythms, and Roadmap 2.0 apps onto their personal smartphone devices (Android or iOS). Subjects consented to provide up to 10 saliva samples during the study period. Surveys were administered through the Roadmap 2.0 app at five timepoints: at baseline, 1 month later, 2 months later, 3 months later, and at study completion. The surveys gathered information regarding demographics, COVID-19 diagnoses and symptoms, and mental health resilience, with the aim of documenting the impact of COVID-19 on the college student population. Results: This study enrolled 2158 college students between September 2020 and January 2021. Subjects are currently being followed-up for 1 academic year. Data collection and analysis are currently underway. Conclusions: This study examined student health and well-being during the COVID-19 pandemic and assessed the feasibility of using a wearable sensor and a survey in a college student population, which may inform the role of our mHealth tools in assessing student health and well-being. Finally, using data derived from a wearable sensor, biospecimen collection, and self-reported COVID-19 diagnosis, our results may provide key data toward the development of a model for the early prediction and detection of COVID-19. Trial Registration: ClinicalTrials.gov NCT04766788; https://clinicaltrials.gov/ct2/show/NCT04766788 International Registered Report Identifier (IRRID): DERR1-10.2196/29561 %R 10.2196/29561 %U https://www.researchprotocols.org/2021/6/e29561/ %U https://doi.org/10.2196/29561 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e28944 %T Determinants of Catalan Public Primary Care Professionals’ Intention to Use Digital Clinical Consultations (eConsulta) in the Post–COVID-19 Context: Mixed Methods Study %A Saigí-Rubió,Francesc %A Vidal-Alaball,Josep %A Torrent-Sellens,Joan %A Jiménez-Zarco,Ana %A López Segui,Francesc %A Carrasco Hernandez,Marta %A Alzaga Reig,Xavier %A Bonet Simó,Josep Maria %A Abizanda González,Mercedes %A Piera-Jimenez,Jordi %A Solans,Oscar %+ Health Promotion in Rural Areas Research Group, Gerencia Territorial de la Catalunya Central, Institut Catala de la Salut, Carrer Pica d'Estats, 36, Sant Fruitos de Bages, 08272, Spain, 34 6930040, jvidal.cc.ics@gencat.cat %K COVID-19 %K teleconsultation %K eConsultation %K eHealth %K intention to use %K digital health %K Technology Acceptance Model %K TAM %K remote consultation %K telemedicine %K digital technology %K intention %K technology assessment %K telehealth %K pandemic %K digital tool %D 2021 %7 24.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Telemedicine has become a necessary component of clinical practice for the purpose of providing safer patient care during lockdowns due to the COVID-19 pandemic. It has been used to support the health care needs of patients with COVID-19 and routine primary care patients alike. However, this change has not been fully consolidated. Objective: The objective of this study was to analyze the determinants of health care professionals’ intention to use the eConsulta digital clinical consultation tool in the post–COVID-19 context. Methods: A literature review of the Technology Acceptance Model allowed us to construct a theoretical model and establish a set of hypotheses on the influence of a variety of different factors relating to health care professionals, as well as the institutions where they work, on their intention to use eConsulta. In order to confirm the proposed model, a mixed qualitative and quantitative methodology was used, and a questionnaire was designed to serve as the data collection instrument. The data were analyzed using univariate and bivariate analysis techniques. To confirm the theoretical model, exploratory factor analysis and binary logistic regression were applied. Results: The most important variables were related to perceived benefits (B=2.408) and the type of use that individuals habitually made of eConsulta (B=0.715). Environmental pressure (B=0.678), experience with technology (B=0.542), gender (B=0.639), and the degree to which eConsulta had been implemented (B=0.266) were other variables influencing the intention to use the tool in the post–COVID-19 context. When replicating the previous analysis according to professional group, experience with technology and gender in the physician group, and experience with tool use and the center where a professional worked in the nurse group, were found to be of considerable importance. Conclusions: The implementation and use of eConsulta had increased significantly as a consequence of the COVID-19 pandemic, and the majority of health care professionals were satisfied with its use in practice and planned to incorporate it into their practices in the post–COVID-19 context. Perceived benefits and environmental pressure were determining factors in their attitude toward and intention to use eConsulta. %R 10.2196/28944 %U https://www.jmir.org/2021/6/e28944/ %U https://doi.org/10.2196/28944 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e28925 %T COVID-19 Infection, Reinfection, and Vaccine Effectiveness in Arizona Frontline and Essential Workers: Protocol for a Longitudinal Cohort Study %A Lutrick,Karen %A Ellingson,Katherine D %A Baccam,Zoe %A Rivers,Patrick %A Beitel,Shawn %A Parker,Joel %A Hollister,James %A Sun,Xiaoxiao %A Gerald,Joe K %A Komatsu,Kenneth %A Kim,Elizabeth %A LaFleur,Bonnie %A Grant,Lauren %A Yoo,Young M %A Kumar,Archana %A Mayo Lamberte,Julie %A Cowling,Benjamin J %A Cobey,Sarah %A Thornburg,Natalie J %A Meece,Jennifer K %A Kutty,Preeta %A Nikolich-Zugich,Janko %A Thompson,Mark G %A Burgess,Jefferey L %+ Family and Community Medicine, College of Medicine - Tucson, University of Arizona, 655 N Alvernon Way, Suite 228, Tucson, AZ, 85711, United States, 1 520 626 3236, klutrick@arizona.edu %K SARS-CoV-2 %K COVID-19 %K health care personnel %K first responders %K essential workers %D 2021 %7 24.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %R 10.2196/28925 %U https://www.researchprotocols.org/2021/6/e28925/ %U https://doi.org/10.2196/28925 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e27623 %T Incidence, Trend, and Mortality of Human Exposure to Rabies in Yemen, 2011-2017: Observational Study %A Abdulmoghni,Rihana Taher %A Al-Ward,Ahmed Hasan %A Al-Moayed,Khaled Abdullah %A AL-Amad,Mohammed Abdullah %A Khader,Yousef S %+ Yemen Field Epidemiology Training Program, Ministry of Public Health and Population, Al-Asbahy Area, Al-Sabain District, Sana'a, Yemen, 967 775242320, dr.rihana@ymail.com %K rabies %K incidence %K trend %K mortality %D 2021 %7 22.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Rabies remains a neglected and poorly controlled disease throughout the developing world, particularly in Africa and Asia, where most human rabies deaths occur. Objective: This study aimed to describe the epidemiology of rabies exposures, its trend, and its geographical distribution in Yemen. Methods: Cumulative data from a rabies surveillance system for the period 2011-2017 were obtained from the National Rabies Control Program as paper-based annual reports. Data included the number of persons bitten by a suspected rabid animal, their gender and age, and the result of the animal’s laboratory test. Human cases were defined as those exposed to rabies virus bitten by a suspected rabid animal, exposed to a confirmed rabid animal and then received postexposure prophylaxis (PEP), and deaths occurred after exposure to a confirmed rabid animal after having rabies symptoms during 2011-2017. Results: From 2011 to 2017, a total of 76,049 persons were bitten by a suspected rabid animal. Of these, 21,927 (28.83%) were exposed to positively confirmed rabid animals and then received PEP, and 295 (0.38%) rabies-related deaths occurred. Of all cases with rabies exposure, 50,882 (66.91%) were males. The most affected age group by animal bites (31,816/76,041, 41.84%), positive exposure (8945/21,927, 40.79%), and rabies deaths (143/295, 48.47%) was 5-14 years. Rabies vaccines and immunoglobulins quantities were least available in 2016 and 2017. The annual incidence rate of exposure to animal bites and rabies exposure was 50 and 14 per 100,000, respectively. The annual mortality rate was 2 per 1,000,000. The highest incidence rate of animal bites was in Dhamar (112 per 100,000) and Ibb (94 per 100,000), whereas the highest incidence of exposed cases was in Amanat Al Asimah (40 per 100,000) and Ibb (37 per 100,000). Mortality rate was the highest in Amanat Al Asimah (6 deaths per 1,000,000) followed by Ibb and Dhamar (4 deaths per 1,000,000 in both). Conclusions: Rabies remains a worrying health problem in Yemen with higher percentage reported among children and males. Targeting school-age populations by education, communication, and information campaigns about preventive measures is strongly recommended. An electronic system should be introduced to improve reporting. It is important to have a sufficient supply of vaccines and immunoglobulins in control units, especially in the at-risk or impacted governorates. Future studies are suggested to determine incidences and risk factors of disease progression. %M 34156339 %R 10.2196/27623 %U https://publichealth.jmir.org/2021/6/e27623 %U https://doi.org/10.2196/27623 %U http://www.ncbi.nlm.nih.gov/pubmed/34156339 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e27968 %T Using Emerging Telehealth Technology as a Future Model in Vietnam During the COVID-19 Pandemic: Practical Experience From Phutho General Hospital %A Nguyen,Ngoc Huy %A Nguyen,An Quang %A Ha,Van Thi Bich %A Duong,Phuong Xuan %A Nguyen,Thong Van %+ Department of Health, Phutho Province, Tran Phu Str, Viet Tri, 0084, Vietnam, 84 0985179888, ngochuynguyen8888@gmail.com %K telehealth %K telemedicine %K teleconsultation %K COVID-19 %K Vietnam %K digital health %K pandemic %D 2021 %7 22.6.2021 %9 Viewpoint %J JMIR Form Res %G English %X Telehealth has emerged as a model of modern technology for health care services in Vietnam during the COVID-19 pandemic. To actively prevent the outbreak of COVID-19 by using a national digital transformation program, the Vietnamese Ministry of Health launched project 2628/Quyet dinh-Bo y te, which approved a scheme for remote medical examinations and treatments for 2020 to 2025. The project aims to connect 1000 hospitals to strengthen the quality of medical services by using the expertise of central hospitals to support rural areas via provincial hospitals. Phutho General Hospital (PGH) is one of leading provincial hospitals that participated in and applied the early telehealth systems in Vietnam. By using telehealth systems, PGH can offer valuable support to doctors’ activities by streamlining and facilitating their work. Telehealth was demonstrated to be feasible, acceptable, and effective at PGH in Vietnam, and it resulted in considerable improvements in health care outcomes. The COVID-19 pandemic has facilitated the acceleration and enhancement of telehealth in Vietnam. The success of telehealth in Phutho may be a useful reference for other parts of the world. However, this telehealth system focuses on the connectivity among doctors rather than the connectivity between doctors and patients, which is an area that needs further assessment. %M 34078590 %R 10.2196/27968 %U https://formative.jmir.org/2021/6/e27968 %U https://doi.org/10.2196/27968 %U http://www.ncbi.nlm.nih.gov/pubmed/34078590 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26655 %T Engagement With COVID-19 Public Health Measures in the United States: A Cross-sectional Social Media Analysis from June to November 2020 %A Massey,Daisy %A Huang,Chenxi %A Lu,Yuan %A Cohen,Alina %A Oren,Yahel %A Moed,Tali %A Matzner,Pini %A Mahajan,Shiwani %A Caraballo,César %A Kumar,Navin %A Xue,Yuchen %A Ding,Qinglan %A Dreyer,Rachel %A Roy,Brita %A Krumholz,Harlan %+ Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, 1 Church St, Suite 200, New Haven, CT, United States, 1 203 764 5885, harlan.krumholz@yale.edu %K COVID-19 %K public perception %K social media %K infodemiology %K infoveillance %K infodemic %K social media research %K social listening %K social media analysis %K natural language processing %K Reddit data %K Facebook data %K COVID-19 public health measures %K public health %K surveillance %K engagement %K United States %K cross-sectional %K Reddit %K Facebook %K behavior %K perception %K NLP %D 2021 %7 21.6.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 34086593 %R 10.2196/26655 %U https://www.jmir.org/2021/6/e26655 %U https://doi.org/10.2196/26655 %U http://www.ncbi.nlm.nih.gov/pubmed/34086593 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e26303 %T Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE): Overview, Components, and Public Health Applications %A Burkom,Howard %A Loschen,Wayne %A Wojcik,Richard %A Holtry,Rekha %A Punjabi,Monika %A Siwek,Martina %A Lewis,Sheri %+ Johns Hopkins University Applied Physics Laboratory, 11100 Johns Hopkins Road, Laurel, MD, 20723, United States, 1 240 228 5000 ext 4361, Howard.Burkom@jhuapl.edu %K health surveillance %K outbreak detection %K population health %D 2021 %7 21.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Electronic Surveillance System for the Early Notification of Community-Based Epidemics (ESSENCE) is a secure web-based tool that enables health care practitioners to monitor health indicators of public health importance for the detection and tracking of disease outbreaks, consequences of severe weather, and other events of concern. The ESSENCE concept began in an internally funded project at the Johns Hopkins University Applied Physics Laboratory, advanced with funding from the State of Maryland, and broadened in 1999 as a collaboration with the Walter Reed Army Institute for Research. Versions of the system have been further developed by Johns Hopkins University Applied Physics Laboratory in multiple military and civilian programs for the timely detection and tracking of health threats. Objective: This study aims to describe the components and development of a biosurveillance system increasingly coordinating all-hazards health surveillance and infectious disease monitoring among large and small health departments, to list the key features and lessons learned in the growth of this system, and to describe the range of initiatives and accomplishments of local epidemiologists using it. Methods: The features of ESSENCE include spatial and temporal statistical alerting, custom querying, user-defined alert notifications, geographical mapping, remote data capture, and event communications. To expedite visualization, configurable and interactive modes of data stratification and filtering, graphical and tabular customization, user preference management, and sharing features allow users to query data and view geographic representations, time series and data details pages, and reports. These features allow ESSENCE users to gather and organize the resulting wealth of information into a coherent view of population health status and communicate findings among users. Results: The resulting broad utility, applicability, and adaptability of this system led to the adoption of ESSENCE by the Centers for Disease Control and Prevention, numerous state and local health departments, and the Department of Defense, both nationally and globally. The open-source version of Suite for Automated Global Electronic bioSurveillance is available for global, resource-limited settings. Resourceful users of the US National Syndromic Surveillance Program ESSENCE have applied it to the surveillance of infectious diseases, severe weather and natural disaster events, mass gatherings, chronic diseases and mental health, and injury and substance abuse. Conclusions: With emerging high-consequence communicable diseases and other health conditions, the continued user requirement–driven enhancements of ESSENCE demonstrate an adaptable disease surveillance capability focused on the everyday needs of public health. The challenge of a live system for widely distributed users with multiple different data sources and high throughput requirements has driven a novel, evolving architecture design. %M 34152271 %R 10.2196/26303 %U https://publichealth.jmir.org/2021/6/e26303 %U https://doi.org/10.2196/26303 %U http://www.ncbi.nlm.nih.gov/pubmed/34152271 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e29314 %T COVID-19 and Open Notes: A New Method to Enhance Patient Safety and Trust %A Blease,Charlotte %A Salmi,Liz %A Hägglund,Maria %A Wachenheim,Deborah %A DesRoches,Catherine %+ Division of General Medicine, Beth Israel Deaconess Medical Center, 133 Brookline Avenue, HVMA Second Floor Annex, Boston, MA, 02215, United States, 1 6173201281, cblease@bidmc.harvard.edu %K COVID-19 %K patient portals %K electronic health records %K patient safety %K patient-centered care %D 2021 %7 21.6.2021 %9 Viewpoint %J JMIR Ment Health %G English %X From April 5, 2021, as part of the 21st Century Cures Act, all providers in the United States must offer patients access to the medical information housed in their electronic records. Via secure health portals, patients can log in to access lab and test results, lists of prescribed medications, referral appointments, and the narrative reports written by clinicians (so-called open notes). As US providers implement this practice innovation, we describe six promising ways in which patients' access to their notes might help address problems that either emerged with or were exacerbated by the COVID-19 pandemic. %M 34081603 %R 10.2196/29314 %U https://mental.jmir.org/2021/6/e29314 %U https://doi.org/10.2196/29314 %U http://www.ncbi.nlm.nih.gov/pubmed/34081603 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e28094 %T Mobile Tuberculosis Treatment Support Tools to Increase Treatment Success in Patients with Tuberculosis in Argentina: Protocol for a Randomized Controlled Trial %A Iribarren,Sarah %A Milligan,Hannah %A Goodwin,Kyle %A Aguilar Vidrio,Omar Alfonso %A Chirico,Cristina %A Telles,Hugo %A Morelli,Daniela %A Lutz,Barry %A Sprecher,Jennifer %A Rubinstein,Fernando %+ Biobehavioral Nursing and Health Informatics, University of Washington, 1959 NE Pacific Street, HSB, Box 357266, Seattle, WA, 98195, United States, 1 2065435211, sjiribar@uw.edu %K tuberculosis %K disease management %K infectious disease %K mHealth %K digital health %K direct drug metabolite test %K mobile phone %D 2021 %7 21.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Tuberculosis (TB) is an urgent global health threat and the world’s deadliest infectious disease despite being largely curable. A critical challenge is to ensure that patients adhere to the full course of treatment to prevent the continued spread of the disease and development of drug-resistant disease. Mobile health interventions hold promise to provide the required adherence support to improve TB treatment outcomes. Objective: This study aims to evaluate the effectiveness of the TB treatment support tools (TB-TSTs) intervention on treatment outcomes (success and default) and to assess patient and provider perceptions of the facilitators and barriers to TB-TSTs implementation. Methods: The TB-TSTs study is an open-label, randomized controlled trial with 2 parallel groups in which 400 adult patients newly diagnosed with TB will be randomly assigned to receive usual care or usual care plus TB-TSTs. Participants will be recruited on a rolling basis from 4 clinical sites in Argentina. The intervention consists of a smartphone progressive web app, a treatment supporter (eg, TB nurse, physician, or social worker), and a direct adherence test strip engineered for home use. Intervention group participants will report treatment progress and interact with a treatment supporter using the app and metabolite urine test strip. The primary outcome will be treatment success. Secondary outcomes will include treatment default rates, self-reported adherence, technology use, and usability. We will assess patients’ and providers’ perceptions of barriers to implementation and synthesize lessons learned. We hypothesize that the TB-TSTs intervention will be more effective because it allows patients and TB supporters to monitor and address issues in real time and provide tailored support. We will share the results with stakeholders and policy makers. Results: Enrollment began in November 2020, with a delayed start due to the COVID-19 pandemic, and complete enrollment is expected by approximately July 2022. Data collection and follow-up are expected to be completed 6 months after the last patient is enrolled. Results from the analyses based on the primary end points are expected to be submitted for publication within a year of data collection completion. Conclusions: To our knowledge, this randomized controlled trial will be the first study to evaluate a patient-centered remote treatment support strategy using a mobile tool and a home-based direct drug metabolite test. The results will provide robust scientific evidence on the effectiveness, implementation, and adoption of mobile health tools. The findings have broader implications not only for TB adherence but also more generally for chronic disease management and will improve our understanding of how to support patients facing challenging treatment regimens. Trial Registration: ClinicalTrials.gov NCT04221789; https://clinicaltrials.gov/ct2/show/NCT04221789. International Registered Report Identifier (IRRID): DERR1-10.2196/28094 %M 34152281 %R 10.2196/28094 %U https://www.researchprotocols.org/2021/6/e28094 %U https://doi.org/10.2196/28094 %U http://www.ncbi.nlm.nih.gov/pubmed/34152281 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e28648 %T Language and Sentiment Regarding Telemedicine and COVID-19 on Twitter: Longitudinal Infodemiology Study %A Pollack,Catherine C %A Gilbert-Diamond,Diane %A Alford-Teaster,Jennifer A %A Onega,Tracy %+ Department of Biomedical Data Science, Geisel School of Medicine at Dartmouth College, 1 Medical Center Drive, Lebanon, NH, 03766, United States, 1 540 497 3419, Catherine.c.pollack.gr@dartmouth.edu %K telemedicine %K telehealth %K COVID-19 pandemic %K social media %K sentiment analysis %K Twitter %K COVID-19 %K pandemic %D 2021 %7 21.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has necessitated a rapid shift in how individuals interact with and receive fundamental services, including health care. Although telemedicine is not a novel technology, previous studies have offered mixed opinions surrounding its utilization. However, there exists a dearth of research on how these opinions have evolved over the course of the current pandemic. Objective: This study aims to evaluate how the language and sentiment surrounding telemedicine has evolved throughout the COVID-19 pandemic. Methods: Tweets published between January 1, 2020, and April 24, 2021, containing at least one telemedicine-related and one COVID-19–related search term (“telemedicine-COVID”) were collected from the Twitter full archive search (N=351,718). A comparator sample containing only COVID-19 terms (“general-COVID”) was collected and sampled based on the daily distribution of telemedicine-COVID tweets. In addition to analyses of retweets and favorites, sentiment analysis was performed on both data sets in aggregate and within a subset of tweets receiving the top 100 most and least retweets. Results: Telemedicine gained prominence during the early stages of the pandemic (ie, March through May 2020) before leveling off and reaching a steady state from June 2020 onward. Telemedicine-COVID tweets had a 21% lower average number of retweets than general-COVID tweets (incidence rate ratio 0.79, 95% CI 0.63-0.99; P=.04), but there was no difference in favorites. A majority of telemedicine-COVID tweets (180,295/351,718, 51.3%) were characterized as “positive,” compared to only 38.5% (135,434/351,401) of general-COVID tweets (P<.001). This trend was also true on a monthly level from March 2020 through April 2021. The most retweeted posts in both telemedicine-COVID and general-COVID data sets were authored by journalists and politicians. Whereas the majority of the most retweeted posts within the telemedicine-COVID data set were positive (55/101, 54.5%), a plurality of the most retweeted posts within the general-COVID data set were negative (44/89, 49.4%; P=.01). Conclusions: During the COVID-19 pandemic, opinions surrounding telemedicine evolved to become more positive, especially when compared to the larger pool of COVID-19–related tweets. Decision makers should capitalize on these shifting public opinions to invest in telemedicine infrastructure and ensure its accessibility and success in a postpandemic world. %M 34086591 %R 10.2196/28648 %U https://www.jmir.org/2021/6/e28648 %U https://doi.org/10.2196/28648 %U http://www.ncbi.nlm.nih.gov/pubmed/34086591 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26368 %T Public Interest in Immunity and the Justification for Intervention in the Early Stages of the COVID-19 Pandemic: Analysis of Google Trends Data %A Lee,Jinhee %A Kwan,Yunna %A Lee,Jun Young %A Shin,Jae Il %A Lee,Keum Hwa %A Hong,Sung Hwi %A Han,Young Joo %A Kronbichler,Andreas %A Smith,Lee %A Koyanagi,Ai %A Jacob,Louis %A Choi,SungWon %A Ghayda,Ramy Abou %A Park,Myung-Bae %+ Department of Gerontology Health and Welfare, Pai Chai University, 155-40, Baejae-ro, Seo-gu, Daejeon, 35345, Republic of Korea, 82 425205037, parkmb@pcu.ac.kr %K COVID-19 %K social big data %K infodemiology %K infoveillance %K social listening %K immune %K vitamin %K big data %K public interest %K intervention %K immune system %K immunity %K trends %K Google Trends %K internet %K digital health %K web-based health information %K correlation %K social media %K infectious disease %D 2021 %7 18.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The use of social big data is an important emerging concern in public health. Internet search volumes are useful data that can sensitively detect trends of the public's attention during a pandemic outbreak situation. Objective: Our study aimed to analyze the public’s interest in COVID-19 proliferation, identify the correlation between the proliferation of COVID-19 and interest in immunity and products that have been reported to confer an enhancement of immunity, and suggest measures for interventions that should be implemented from a health and medical point of view. Methods: To assess the level of public interest in infectious diseases during the initial days of the COVID-19 outbreak, we extracted Google search data from January 20, 2020, onward and compared them to data from March 15, 2020, which was approximately 2 months after the COVID-19 outbreak began. In order to determine whether the public became interested in the immune system, we selected coronavirus, immune, and vitamin as our final search terms. Results: The increase in the cumulative number of confirmed COVID-19 cases that occurred after January 20, 2020, had a strong positive correlation with the search volumes for the terms coronavirus (R=0.786; P<.001), immune (R=0.745; P<.001), and vitamin (R=0.778; P<.001), and the correlations between variables were all mutually statistically significant. Moreover, these correlations were confirmed on a country basis when we restricted our analyses to the United States, the United Kingdom, Italy, and Korea. Our findings revealed that increases in search volumes for the terms coronavirus and immune preceded the actual occurrences of confirmed cases. Conclusions: Our study shows that during the initial phase of the COVID-19 crisis, the public’s desire and actions of strengthening their own immune systems were enhanced. Further, in the early stage of a pandemic, social media platforms have a high potential for informing the public about potentially helpful measures to prevent the spread of an infectious disease and provide relevant information about immunity, thereby increasing the public’s knowledge. %M 34038375 %R 10.2196/26368 %U https://www.jmir.org/2021/6/e26368 %U https://doi.org/10.2196/26368 %U http://www.ncbi.nlm.nih.gov/pubmed/34038375 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e26267 %T The Anticipated Future of Public Health Services Post COVID-19: Viewpoint %A Bashier,Haitham %A Ikram,Aamer %A Khan,Mumtaz Ali %A Baig,Mirza %A Al Gunaid,Magid %A Al Nsour,Mohannad %A Khader,Yousef %+ Jordan University of Science and Technology, Alramtha-Amman Street, Irbid, 22110, Jordan, 962 796802040, yskhader@just.edu.jo %K COVID-19 %K public health %K health system %K health services %D 2021 %7 18.6.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X In March 2020, the World Health Organization declared COVID-19 as a global pandemic. The COVID-19 pandemic has affected various public health functions and essential services in different ways and magnitudes. Although all countries have witnessed the effect of COVID-19, the impact differed based on many factors including the integrity and resiliency of the countries’ health systems. This paper presents opinions and expectations of the authors about the anticipated changes in the future of public health at the global, regional, and national levels. The viewpoint is based on the current efforts and challenges that various stakeholders have carried out to control COVID-19 and the contribution from the literature on the future of public health. Numerous agencies and actors are involved in the fight against COVID-19 with variations in their effectiveness. The public health services showed weaknesses in most of the countries, in addition to the lack of adequate curative medicine settings. The pandemic highlighted the need for better governance and stronger and more resilient health systems and capacities. The COVID-19 experience has also emphasized the importance of coordination and collaboration among the countries and stakeholders. The COVID-19 pandemic might lead to a wide discussion to improve international and national approaches to prepare for and respond to similar events in terms of preparedness and response mechanisms and tools. Public health will not be the same as before COVID-19. New health priorities, approaches, and new agendas will be on the table of the global platforms and initiatives. More investment in research and technology to meet the demand for new vaccines and medicines, innovative methods like distance learning and working, more respect and remuneration to health professionals, and normalization of the public health and social measures that were induced during the COVID-19 pandemic are expected to be seen in future. %M 33592576 %R 10.2196/26267 %U https://publichealth.jmir.org/2021/6/e26267 %U https://doi.org/10.2196/26267 %U http://www.ncbi.nlm.nih.gov/pubmed/33592576 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 6 %P e27140 %T Indications of Depressive Symptoms During the COVID-19 Pandemic in Germany: Comparison of National Survey and Twitter Data %A Cohrdes,Caroline %A Yenikent,Seren %A Wu,Jiawen %A Ghanem,Bilal %A Franco-Salvador,Marc %A Vogelgesang,Felicitas %+ Mental Health Research Unit, Department of Epidemiology and Health Monitoring, Robert Koch Institute, General-Pape-Str. 62-66, Berlin, 12101, Germany, 49 30 18754 2692, CohrdesC@rki.de %K depressive symptoms %K GEDA/EHIS survey %K Twitter %K COVID-19 %K pandemic %K social contact ban %K temporal progression %K data correspondence %K public mental health surveillance %K depression %K survey %K social media %K data %K infodemiology %K infoveillance %K twitter %K mental health %K public health %K surveillance %K monitoring %K symptom %D 2021 %7 18.6.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The current COVID-19 pandemic is associated with extensive individual and societal challenges, including challenges to both physical and mental health. To date, the development of mental health problems such as depressive symptoms accompanying population-based federal distancing measures is largely unknown, and opportunities for rapid, effective, and valid monitoring are currently a relevant matter of investigation. Objective: In this study, we aim to investigate, first, the temporal progression of depressive symptoms during the COVID-19 pandemic and, second, the consistency of the results from tweets and survey-based self-reports of depressive symptoms within the same time period. Methods: Based on a cross-sectional population survey of 9011 German adolescents and adults (n=4659, 51.7% female; age groups from 15 to 50 years and older) and a sample of 88,900 tweets (n=74,587, 83.9% female; age groups from 10 to 50 years and older), we investigated five depressive symptoms (eg, depressed mood and energy loss) using items from the Patient Health Questionnaire (PHQ-8) before, during, and after relaxation of the first German social contact ban from January to July 2020. Results: On average, feelings of worthlessness were the least frequently reported symptom (survey: n=1011, 13.9%; Twitter: n=5103, 5.7%) and fatigue or loss of energy was the most frequently reported depressive symptom (survey: n=4472, 51.6%; Twitter: n=31,005, 34.9%) among both the survey and Twitter respondents. Young adult women and people living in federal districts with high COVID-19 infection rates were at an increased risk for depressive symptoms. The comparison of the survey and Twitter data before and after the first contact ban showed that German adolescents and adults had a significant decrease in feelings of fatigue and energy loss over time. The temporal progression of depressive symptoms showed high correspondence between both data sources (ρ=0.76-0.93; P<.001), except for diminished interest and depressed mood, which showed a steady increase even after the relaxation of the contact ban among the Twitter respondents but not among the survey respondents. Conclusions: Overall, the results indicate relatively small differences in depressive symptoms associated with social distancing measures during the COVID-19 pandemic and highlight the need to differentiate between positive (eg, energy level) and negative (eg, depressed mood) associations and variations over time. The results also underscore previous suggestions of Twitter data’s potential to help identify hot spots of declining and improving public mental health and thereby help provide early intervention measures, especially for young and middle-aged adults. Further efforts are needed to investigate the long-term consequences of recurring lockdown phases and to address the limitations of social media data such as Twitter data to establish real-time public mental surveillance approaches. %M 34142973 %R 10.2196/27140 %U https://mental.jmir.org/2021/6/e27140 %U https://doi.org/10.2196/27140 %U http://www.ncbi.nlm.nih.gov/pubmed/34142973 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e28708 %T Telerehabilitation for Lung Transplant Candidates and Recipients During the COVID-19 Pandemic: Program Evaluation %A Wickerson,Lisa %A Helm,Denise %A Gottesman,Chaya %A Rozenberg,Dmitry %A Singer,Lianne G %A Keshavjee,Shaf %A Sidhu,Aman %+ Toronto Lung Transplant Program, University Health Network, 585 University Ave, Toronto, ON, M5G 2N2, Canada, 1 437 229 0049, lisa.wickerson@uhn.ca %K telerehabilitation %K lung %K transplant %K rehabilitation %K COVID-19 %K usage %K satisfaction %K app %K outcome %K telemedicine %D 2021 %7 17.6.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 pandemic resulted in a rapid shift from center-based rehabilitation to telerehabilitation for chronic respiratory disease and lung transplantation due to infection control precautions. Clinical experience with this delivery model on a large scale has not been described. Objective: The aim of this study is to describe usage and satisfaction of providers and lung transplant (LTx) candidates and recipients and functional outcomes following the broad implementation of telerehabilitation with remote patient monitoring during the first wave of the COVID-19 pandemic. Methods: This study was a program evaluation of providers, LTx candidates, and early LTx recipients who used a web-based, remote monitoring app for at least four weeks between March 16 and September 1, 2020, to participate in telerehabilitation. Within-subjects analysis was performed for physical activity, Self-efficacy For Exercise (SEE) scale score, aerobic and resistance exercise volumes, 6-minute walk test results, and Short Physical Performance Battery (SPPB) results. Results: In total, 78 LTx candidates and 33 recipients were included (57 [51%] males, mean age 58 [SD 12] years, 58 [52%] with interstitial lung disease, 34 [31%] with chronic obstructive pulmonary disease). A total of 50 (64%) LTx candidates and 17 (51%) LTx recipients entered ≥10 prescribed exercise sessions into the app during the study time frame. In addition, 35/42 (83%) candidates agreed the app helped prepare them for surgery and 18/21 (85%) recipients found the app helpful in their self-recovery. The strongest barrier perceived by physiotherapists delivering the telerehabilitation was patient access to home exercise and monitoring equipment. Between the time of app registration and ≥4 weeks on the waiting list, 26 LTx candidates used a treadmill, with sessions increasing in mean duration (from 16 to 22 minutes, P=.002) but not speed (from 1.7 to 1.75 mph, P=.31). Quadriceps weight (pounds) for leg extension did not change (median 3.5, IQR 2.4-5 versus median 4.3, IQR 3-5; P=.08; n=37). On the Rapid Assessment of Physical Activity questionnaire (RAPA), 57% of LTx candidates scored as active, which improved to 87% (P=.02; n=23). There was a decrease in pretransplant 6-minute walk distance (6MWD) from 346 (SD 84) meters to 307 (SD 85) meters (P=.002; n=45) and no change in the SPPB result (12 [IQR 9.5-12] versus 12 [IQR 10-12]; P=.90; n=42). A total of 9 LTx recipients used a treadmill that increased in speed (from 1.9 to 2.7 mph; P=.003) between hospital discharge and three months posttransplant. Quadriceps weight increased (3 [IQR 0-3] pounds versus 5 [IQR 3.8-6.5] pounds; P<.001; n=15). At three months posttransplant, 76% of LTx recipients scored as active (n=17), with a high total SEE score of 74 (SD 11; n=12). In addition, three months posttransplant, 6MWD was 62% (SD 18%) predicted (n=8). Conclusions: We were able to provide telerehabilitation despite challenges around exercise equipment. This early experience will inform the development of a robust and equitable telerehabilitation model beyond the COVID-19 pandemic. %M 34048354 %R 10.2196/28708 %U https://mhealth.jmir.org/2021/6/e28708 %U https://doi.org/10.2196/28708 %U http://www.ncbi.nlm.nih.gov/pubmed/34048354 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26956 %T Social Media and Research Publication Activity During Early Stages of the COVID-19 Pandemic: Longitudinal Trend Analysis %A Taneja,Sonia L %A Passi,Monica %A Bhattacharya,Sumona %A Schueler,Samuel A %A Gurram,Sandeep %A Koh,Christopher %+ Liver Diseases Branch, National Institutes of Diabetes and Digestive and Kidney Diseases, 10 Center Drive, Clinical Research Center, 5-2740, Bethesda, MD, 20892, United States, 1 301 443 9402, christopher.koh@nih.gov %K coronavirus %K COVID-19 %K social media %K gastroenterology %K SARS-CoV-2 %K research %K literature %K dissemination %K Twitter %K preprint %D 2021 %7 17.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has highlighted the importance of rapid dissemination of scientific and medical discoveries. Current platforms available for the distribution of scientific and clinical research data and information include preprint repositories and traditional peer-reviewed journals. In recent times, social media has emerged as a helpful platform to share scientific and medical discoveries. Objective: This study aimed to comparatively analyze activity on social media (specifically, Twitter) and that related to publications in the form of preprint and peer-reviewed journal articles in the context of COVID-19 and gastroenterology during the early stages of the COVID-19 pandemic. Methods: COVID-19–related data from Twitter (tweets and user data) and articles published in preprint servers (bioRxiv and medRxiv) as well as in the PubMed database were collected and analyzed during the first 6 months of the pandemic, from December 2019 through May 2020. Global and regional geographic and gastrointestinal organ–specific social media trends were compared to preprint and publication activity. Any relationship between Twitter activity and preprint articles published and that between Twitter activity and PubMed articles published overall, by organ system, and by geographic location were identified using Spearman’s rank-order correlation. Results: Over the 6-month period, 73,079 tweets from 44,609 users, 7164 journal publications, and 4702 preprint publications were retrieved. Twitter activity (ie, number of tweets) peaked in March 2020, whereas preprint and publication activity (ie, number of articles published) peaked in April 2020. Overall, strong correlations were identified between trends in Twitter activity and preprint and publication activity (P<.001 for both). COVID-19 data across the three platforms mainly concentrated on pulmonology or critical care, but when analyzing the field of gastroenterology specifically, most tweets pertained to pancreatology, most publications focused on hepatology, and most preprints covered hepatology and luminal gastroenterology. Furthermore, there were significant positive associations between trends in Twitter and publication activity for all gastroenterology topics (luminal gastroenterology: P=.009; hepatology and inflammatory bowel disease: P=.006; gastrointestinal endoscopy: P=.007), except pancreatology (P=.20), suggesting that Twitter activity did not correlate with publication activity for this topic. Finally, Twitter activity was the highest in the United States (7331 tweets), whereas PubMed activity was the highest in China (1768 publications). Conclusions: The COVID-19 pandemic has highlighted the potential of social media as a vehicle for disseminating scientific information during a public health crisis. Sharing and spreading information on COVID-19 in a timely manner during the pandemic has been paramount; this was achieved at a much faster pace on social media, particularly on Twitter. Future investigation could demonstrate how social media can be used to augment and promote scholarly activity, especially as the world begins to increasingly rely on digital or virtual platforms. Scientists and clinicians should consider the use of social media in augmenting public awareness regarding their scholarly pursuits. %M 33974550 %R 10.2196/26956 %U https://www.jmir.org/2021/6/e26956 %U https://doi.org/10.2196/26956 %U http://www.ncbi.nlm.nih.gov/pubmed/33974550 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e24251 %T The Interplay Between Policy and COVID-19 Outbreaks in South Asia: Longitudinal Trend Analysis of Surveillance Data %A Welch,Sarah B %A Kulasekere,Dinushi Amanda %A Prasad,P V Vara %A Moss,Charles B %A Murphy,Robert Leo %A Achenbach,Chad J %A Ison,Michael G %A Resnick,Danielle %A Singh,Lauren %A White,Janine %A Issa,Tariq Z %A Culler,Kasen %A Boctor,Michael J %A Mason,Maryann %A Oehmke,James Francis %A Faber,Joshua Marco Mitchell %A Post,Lori Ann %+ Buehler Center for Health Policy & Economics, Feinberg School of Medicine, Northwestern University, Arthur J Rubloff Building, 420 E Superior St, Chicago, IL, 60611, United States, 1 312 503 5017, lori.post@northwestern.edu %K 7-day lag %K acceleration %K Bangladesh %K Bhutan %K COVID-19 surveillance %K COVID-19 %K dynamic panel data %K India %K jerk %K Maldives %K Pakistan %K South Asia %K speed %K Sri Lanka %D 2021 %7 17.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 transmission rates in South Asia initially were under control when governments implemented health policies aimed at controlling the pandemic such as quarantines, travel bans, and border, business, and school closures. Governments have since relaxed public health restrictions, which resulted in significant outbreaks, shifting the global epicenter of COVID-19 to India. Ongoing systematic public health surveillance of the COVID-19 pandemic is needed to inform disease prevention policy to re-establish control over the pandemic within South Asia. Objective: This study aimed to inform public health leaders about the state of the COVID-19 pandemic, how South Asia displays differences within and among countries and other global regions, and where immediate action is needed to control the outbreaks. Methods: We extracted COVID-19 data spanning 62 days from public health registries and calculated traditional and enhanced surveillance metrics. We use an empirical difference equation to measure the daily number of cases in South Asia as a function of the prior number of cases, the level of testing, and weekly shifts in variables with a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano–Bond estimator in R. Results: Traditional surveillance metrics indicate that South Asian countries have an alarming outbreak, with India leading the region with 310,310 new daily cases in accordance with the 7-day moving average. Enhanced surveillance indicates that while Pakistan and Bangladesh still have a high daily number of new COVID-19 cases (n=4819 and n=3878, respectively), their speed of new infections declined from April 12-25, 2021, from 2.28 to 2.18 and 3.15 to 2.35 daily new infections per 100,000 population, respectively, which suggests that their outbreaks are decreasing and that these countries are headed in the right direction. In contrast, India’s speed of new infections per 100,000 population increased by 52% during the same period from 14.79 to 22.49 new cases per day per 100,000 population, which constitutes an increased outbreak. Conclusions: Relaxation of public health restrictions and the spread of novel variants fueled the second wave of the COVID-19 pandemic in South Asia. Public health surveillance indicates that shifts in policy and the spread of new variants correlate with a drastic expansion in the pandemic, requiring immediate action to mitigate the spread of COVID-19. Surveillance is needed to inform leaders whether policies help control the pandemic. %M 34081593 %R 10.2196/24251 %U https://publichealth.jmir.org/2021/6/e24251 %U https://doi.org/10.2196/24251 %U http://www.ncbi.nlm.nih.gov/pubmed/34081593 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e28269 %T An Urban Population Health Observatory System to Support COVID-19 Pandemic Preparedness, Response, and Management: Design and Development Study %A Brakefield,Whitney S %A Ammar,Nariman %A Olusanya,Olufunto A %A Shaban-Nejad,Arash %+ Center for Biomedical Informatics, Department of Pediatrics, College of Medicine, University of Tennessee Health Science Center, 50 N Dunlap Street, Memphis, TN, 38103, United States, 1 901 287 583, ashabann@uthsc.edu %K causal inference %K COVID-19 surveillance %K COVID-19 %K digital health %K health disparities %K knowledge integration %K SARS-CoV-2 %K Social Determinants of Health %K surveillance %K urban health %D 2021 %7 16.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34081605 %R 10.2196/28269 %U https://publichealth.jmir.org/2021/6/e28269 %U https://doi.org/10.2196/28269 %U http://www.ncbi.nlm.nih.gov/pubmed/34081605 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 10 %N 2 %P e27823 %T Early Identification of COVID-19 Infection Using Remote Cardiorespiratory Monitoring: Three Case Reports %A Polsky,Michael %A Moraveji,Neema %+ Pulmonary Associates of Richmond, 1000 Boulders Parkway, Suite 101, North Chesterfield, VA, 23225, United States, 1 804 320 4243, mpolsky@paraccess.com %K COVID-19 %K remote patient monitoring %K wearable sensors %K monitoring %K case study %K preidentification %K lung %K data collection %K respiration %K prediction %D 2021 %7 16.6.2021 %9 Original Paper %J Interact J Med Res %G English %X Background: The adoption of remote patient monitoring (RPM) in routine medical care requires increased understanding of the physiologic changes accompanying disease development and the proactive interventions that will improve outcomes. Objective: The aim of this study is to present three case reports that highlight the capability of RPM to enable early identification of viral infection with COVID-19 in patients with chronic respiratory disease. Methods: Patients at a large pulmonary practice who were enrolled in a respiratory RPM program and who had contracted COVID-19 were identified. The RPM system (Spire Health) contains three components: (1) Health Tags (Spire Health), undergarment waistband-adhered physiologic monitors that include a respiratory rate sensor; (2) an app on a smartphone; and (3) a web dashboard for use by respiratory therapists. The physiologic data of 9 patients with COVID out of 1000 patients who were enrolled for monitoring were retrospectively reviewed, and 3 instances were identified where the RPM system had notified clinicians of physiologic deviation due to the viral infection. Results: Physiologic deviations from respective patient baselines occurred during infection onset and, although the infection manifested differently in each case, were identified by the RPM system. In the first case, the patient was symptomatic; in the second case, the patient was presymptomatic; and in the third case, the patient varied from asymptomatic to mildly symptomatic. Conclusions: RPM systems intended for long-term use and that use patient-specific baselines can highlight physiologic changes early in the course of acute disease, such as COVID-19 infection. These cases demonstrate opportunities for earlier diagnosis, treatment, and isolation. This study supports the need for further research into how RPM can be effectively integrated into clinical practice. %M 34086588 %R 10.2196/27823 %U https://www.i-jmr.org/2021/2/e27823 %U https://doi.org/10.2196/27823 %U http://www.ncbi.nlm.nih.gov/pubmed/34086588 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e26452 %T Inpatient Telemedicine Implementation as an Infection Control Response to COVID-19: Qualitative Process Evaluation Study %A Safaeinili,Nadia %A Vilendrer,Stacie %A Williamson,Emma %A Zhao,Zicheng %A Brown-Johnson,Cati %A Asch,Steven M %A Shieh,Lisa %+ Department of Medicine, School of Medicine, Stanford University, 1265 Welch Rd x216, Stanford, CA, 94305, United States, 1 8053001922, nadiasaf@stanford.edu %K telemedicine %K inpatient %K COVID-19 %K qualitative %K RE-AIM %K infection control %K personal protective equipment %K implementation science %K quality improvement %D 2021 %7 16.6.2021 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 34033576 %R 10.2196/26452 %U https://formative.jmir.org/2021/6/e26452 %U https://doi.org/10.2196/26452 %U http://www.ncbi.nlm.nih.gov/pubmed/34033576 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e24510 %T Directly Observed Therapy to Measure Adherence to Tuberculosis Medication in Observational Research: Protocol for a Prospective Cohort Study %A Ragan,Elizabeth J %A Gill,Christopher J %A Banos,Matthew %A Bouton,Tara C %A Rooney,Jennifer %A Horsburgh,Charles R %A Warren,Robin M %A Myers,Bronwyn %A Jacobson,Karen R %+ Section of Infectious Diseases, Boston Medical Center, 801 Massachusetts Avenue, Boston, MA, 02118, United States, 1 617 414 5213, kjacobso@bu.edu %K tuberculosis %K directly observed therapy %K treatment adherence and compliance %K medication adherence %K mobile applications %D 2021 %7 16.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: A major challenge for prospective, clinical tuberculosis (TB) research is accurately defining a metric for measuring medication adherence. Objective: We aimed to design a method to capture directly observed therapy (DOT) via mobile health carried out by community workers. The program was created specifically to measure TB medication adherence for a prospective TB cohort in Western Cape Province, South Africa. Methods: Community workers collect daily adherence data on mobile smartphones. Participant-level adherence, program-level adherence, and program function are systematically monitored to assess DOT program implementation. A data dashboard allows for regular visualization of indicators. Numerous design elements aim to prevent or limit data falsification and ensure study data integrity. Results: The cohort study is ongoing and data collection is in progress. Enrollment began on May 16, 2017, and as of January 12, 2021, a total of 236 participants were enrolled. Adherence data will be used to analyze the study’s primary aims and to investigate adherence as a primary outcome. Conclusions: The DOT program includes a mobile health application for data collection as well as a monitoring framework and dashboard. This approach has potential to be adapted for other settings to improve the capture of medication adherence in clinical TB research. Trial Registration: Clinicaltrials.gov NCT02840877; https://clinicaltrials.gov/ct2/show/NCT02840877 %M 34132642 %R 10.2196/24510 %U https://www.researchprotocols.org/2021/6/e24510 %U https://doi.org/10.2196/24510 %U http://www.ncbi.nlm.nih.gov/pubmed/34132642 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26892 %T Constructing High-Fidelity Phenotype Knowledge Graphs for Infectious Diseases With a Fine-Grained Semantic Information Model: Development and Usability Study %A Deng,Lizong %A Chen,Luming %A Yang,Tao %A Liu,Mi %A Li,Shicheng %A Jiang,Taijiao %+ Center of Systems Medicine, Institute of Basic Medical Sciences, Chinese Academy of Medical Sciences & Peking Union Medical College, #5 Dong Dan San Tiao, Dongcheng District, Beijing, 100005, China, 86 051262873781, taijiao@ibms.pumc.edu.cn %K knowledge graph %K knowledge granularity %K machine learning %K high-fidelity phenotyping %K phenotyping %K phenotype %K semantic %D 2021 %7 15.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Phenotypes characterize the clinical manifestations of diseases and provide important information for diagnosis. Therefore, the construction of phenotype knowledge graphs for diseases is valuable to the development of artificial intelligence in medicine. However, phenotype knowledge graphs in current knowledge bases such as WikiData and DBpedia are coarse-grained knowledge graphs because they only consider the core concepts of phenotypes while neglecting the details (attributes) associated with these phenotypes. Objective: To characterize the details of disease phenotypes for clinical guidelines, we proposed a fine-grained semantic information model named PhenoSSU (semantic structured unit of phenotypes). Methods: PhenoSSU is an “entity-attribute-value” model by its very nature, and it aims to capture the full semantic information underlying phenotype descriptions with a series of attributes and values. A total of 193 clinical guidelines for infectious diseases from Wikipedia were selected as the study corpus, and 12 attributes from SNOMED-CT were introduced into the PhenoSSU model based on the co-occurrences of phenotype concepts and attribute values. The expressive power of the PhenoSSU model was evaluated by analyzing whether PhenoSSU instances could capture the full semantics underlying the descriptions of the corresponding phenotypes. To automatically construct fine-grained phenotype knowledge graphs, a hybrid strategy that first recognized phenotype concepts with the MetaMap tool and then predicted the attribute values of phenotypes with machine learning classifiers was developed. Results: Fine-grained phenotype knowledge graphs of 193 infectious diseases were manually constructed with the BRAT annotation tool. A total of 4020 PhenoSSU instances were annotated in these knowledge graphs, and 3757 of them (89.5%) were found to be able to capture the full semantics underlying the descriptions of the corresponding phenotypes listed in clinical guidelines. By comparison, other information models, such as the clinical element model and the HL7 fast health care interoperability resource model, could only capture the full semantics underlying 48.4% (2034/4020) and 21.8% (914/4020) of the descriptions of phenotypes listed in clinical guidelines, respectively. The hybrid strategy achieved an F1-score of 0.732 for the subtask of phenotype concept recognition and an average weighted accuracy of 0.776 for the subtask of attribute value prediction. Conclusions: PhenoSSU is an effective information model for the precise representation of phenotype knowledge for clinical guidelines, and machine learning can be used to improve the efficiency of constructing PhenoSSU-based knowledge graphs. Our work will potentially shift the focus of medical knowledge engineering from a coarse-grained level to a more fine-grained level. %M 34128811 %R 10.2196/26892 %U https://www.jmir.org/2021/6/e26892 %U https://doi.org/10.2196/26892 %U http://www.ncbi.nlm.nih.gov/pubmed/34128811 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e28140 %T Teleconsultation in the Management of Elective Orthopedic and Spinal Conditions During the COVID-19 Pandemic: Prospective Cohort Study of Patient Experiences %A Melian,Christina %A Frampton,Christopher %A Wyatt,Michael Charles %A Kieser,David %+ Renaissance School of Medicine at Stony Brook University, 101 Nicolls Road, Health Sciences Center, Level 4, Stony Brook, NY, 11794-8434, United States, 1 631 444 2111, christina.melian@stonybrookmedicine.edu %K telemedicine %K patient satisfaction %K orthopedic surgery %K telehealth %K COVID-19 %K pandemic %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The global adoption of teleconsultation has been expedited as a result of the COVID-19 pandemic. By allowing remote communication, teleconsultation may help limit the spread of the virus while maintaining the crucial patient-provider relationship. Objective: The aim of this study is to evaluate the value of teleconsultation compared to in-person visits in the management of elective orthopedic and spinal procedures. Methods: This was a prospective observational cohort study of 853 patients receiving orthopedic and spinal care at a private outpatient clinic in New Zealand. Patients were randomly divided into two groups: (1) patients receiving telephone consultation remotely, and (2) patients receiving in-person office consultations at the outpatient clinic. All patients received telephone consultations for 4 weeks during the mandated COVID-19 lockdown, followed by 4 weeks of telephone or in-person consultation. Patient preference, satisfaction, and duration of visit were recorded. Comparisons of patient preference between groups, visit type, sex, and location were performed using chi-square tests; similarly, satisfaction scores and visit durations were compared using a general linear model. Results: We report that 91% (353/388) of patients in the telephone group preferred teleconsultation over in-person office visits during the COVID-19 lockdown (P<.001). A combined-group analysis showed that 55.3% (446/807) of all patients preferred teleconsultation compared to 31.2% (252/807) who preferred in-person office visits (P<.001). Patients in the telephone group reported significantly higher satisfaction scores (mean 9.95, SD 0.04, 95% CI 9.87-10.03) compared to patients in the in-person group (mean 9.53, SE 0.04, 95% CI 9.45-9.62; P<.001). Additionally, in-person consultations were significantly longer in duration compared to telephone consultations, with a mean visit time of 6.70 (SE 0.18) minutes, 95% CI 6.32-7.02, compared to 5.10 (SE 0.17) minutes, 95% CI 4.73-5.42 (P<.001). Conclusions: Patients who use telephone consultations are more likely to prefer it over traditional, in-person visits in the future. This increased preference, coupled with higher patient satisfaction scores and shorter duration of visits, suggests that teleconsultation has a role in orthopedic surgery, which may even extend beyond the COVID-19 pandemic. %M 34048355 %R 10.2196/28140 %U https://formative.jmir.org/2021/6/e28140 %U https://doi.org/10.2196/28140 %U http://www.ncbi.nlm.nih.gov/pubmed/34048355 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e25010 %T Potential Impact of a Paper About COVID-19 and Smoking on Twitter Users’ Attitudes Toward Smoking: Observational Study %A Tao,Chunliang %A Diaz,Destiny %A Xie,Zidian %A Chen,Long %A Li,Dongmei %A O’Connor,Richard %+ Department of Clinical and Translational Research, University of Rochester Medical Center, 265 Crittenden Boulevard CU 420708, Rochester, NY, 14642-0708, United States, 1 5852767285, Dongmei_Li@urmc.rochester.edu %K COVID-19 %K smoking %K Twitter %K infodemiology %K infodemic %K infoveillance %K impact %K attitude %K perception %K observational %K social media %K cross-sectional %K dissemination %K research %D 2021 %7 15.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: A cross-sectional study (Miyara et al, 2020) conducted by French researchers showed that the rate of current daily smoking was significantly lower in patients with COVID-19 than in the French general population, implying a potentially protective effect of smoking. Objective: We aimed to examine the dissemination of the Miyara et al study among Twitter users and whether a shift in their attitudes toward smoking occurred after its publication as preprint on April 21, 2020. Methods: Twitter posts were crawled between April 14 and May 4, 2020, by the Tweepy stream application programming interface, using a COVID-19–related keyword query. After filtering, the final 1929 tweets were classified into three groups: (1) tweets that were not related to the Miyara et al study before it was published, (2) tweets that were not related to Miyara et al study after it was published, and (3) tweets that were related to Miyara et al study after it was published. The attitudes toward smoking, as expressed in the tweets, were compared among the above three groups using multinomial logistic regression models in the statistical analysis software R (The R Foundation). Results: Temporal analysis showed a peak in the number of tweets discussing the results from the Miyara et al study right after its publication. Multinomial logistic regression models on sentiment scores showed that the proportion of negative attitudes toward smoking in tweets related to the Miyara et al study after it was published (17.07%) was significantly lower than the proportion in tweets that were not related to the Miyara et al study, either before (44/126, 34.9%; P<.001) or after the Miyara et al study was published (68/198, 34.3%; P<.001). Conclusions: The public’s attitude toward smoking shifted in a positive direction after the Miyara et al study found a lower incidence of COVID-19 cases among daily smokers. %M 33939624 %R 10.2196/25010 %U https://formative.jmir.org/2021/6/e25010 %U https://doi.org/10.2196/25010 %U http://www.ncbi.nlm.nih.gov/pubmed/33939624 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e22999 %T Estimating the COVID-19 Spread Through Real-time Population Mobility Patterns: Surveillance in Low- and Middle-Income Countries %A Tyrovolas,Stefanos %A Giné-Vázquez,Iago %A Fernández,Daniel %A Morena,Marianthi %A Koyanagi,Ai %A Janko,Mark %A Haro,Josep Maria %A Lin,Yang %A Lee,Paul %A Pan,William %A Panagiotakos,Demosthenes %A Molassiotis,Alex %+ School of Nursing, Hong Kong Polytechnic University, PQ402, Hung Hom, Kowloon, Hong Kong, 852 2766 5648, stefanos.tyrovolas@polyu.edu.hk %K COVID-19 %K transmission %K digital public health %K social distancing %K policy %K mobile data %K estimate %K real-time %K pattern %K surveillance %K low and middle-income countries %K emerging countries %K database %K surveillance %D 2021 %7 14.6.2021 %9 Original Paper %J J Med Internet Res %G English %X 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 were obtained 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. %M 33950850 %R 10.2196/22999 %U https://www.jmir.org/2021/6/e22999 %U https://doi.org/10.2196/22999 %U http://www.ncbi.nlm.nih.gov/pubmed/33950850 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e24285 %T Real-time Prediction of the Daily Incidence of COVID-19 in 215 Countries and Territories Using Machine Learning: Model Development and Validation %A Peng,Yuanyuan %A Li,Cuilian %A Rong,Yibiao %A Pang,Chi Pui %A Chen,Xinjian %A Chen,Haoyu %+ Joint Shantou International Eye Center, Shantou University & the Chinese University of Hong Kong, Joint Shantou International Eye Center, North Dongxia Road, Shantou, 515041, China, 86 075488393560, drchenhaoyu@gmail.com %K COVID-19 %K daily incidence %K real-time prediction %K machine learning %K Google Trends %K infoveillance %K infodemiology %K digital health %K digital public health %K surveillance %K prediction %K incidence %K policy %K prevention %K model %D 2021 %7 14.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Advanced prediction of the daily incidence of COVID-19 can aid policy making on the prevention of disease spread, which can profoundly affect people's livelihood. In previous studies, predictions were investigated for single or several countries and territories. Objective: We aimed to develop models that can be applied for real-time prediction of COVID-19 activity in all individual countries and territories worldwide. Methods: Data of the previous daily incidence and infoveillance data (search volume data via Google Trends) from 215 individual countries and territories were collected. A random forest regression algorithm was used to train models to predict the daily new confirmed cases 7 days ahead. Several methods were used to optimize the models, including clustering the countries and territories, selecting features according to the importance scores, performing multiple-step forecasting, and upgrading the models at regular intervals. The performance of the models was assessed using the mean absolute error (MAE), root mean square error (RMSE), Pearson correlation coefficient, and Spearman correlation coefficient. Results: Our models can accurately predict the daily new confirmed cases of COVID-19 in most countries and territories. Of the 215 countries and territories under study, 198 (92.1%) had MAEs <10 and 187 (87.0%) had Pearson correlation coefficients >0.8. For the 215 countries and territories, the mean MAE was 5.42 (range 0.26-15.32), the mean RMSE was 9.27 (range 1.81-24.40), the mean Pearson correlation coefficient was 0.89 (range 0.08-0.99), and the mean Spearman correlation coefficient was 0.84 (range 0.2-1.00). Conclusions: By integrating previous incidence and Google Trends data, our machine learning algorithm was able to predict the incidence of COVID-19 in most individual countries and territories accurately 7 days ahead. %M 34081607 %R 10.2196/24285 %U https://www.jmir.org/2021/6/e24285 %U https://doi.org/10.2196/24285 %U http://www.ncbi.nlm.nih.gov/pubmed/34081607 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e26417 %T A 5-Minute Cognitive Assessment for Safe Remote Use in Patients With COVID-19: Clinical Case Series %A Beresford,Thomas %A Ronan,Patrick J %A Hipp,Daniel %+ Laboratory for Clinical and Translational Research in Psychiatry, Rocky Mountain Regional VA Medical Center, (116), 1700 North Wheeling Street, Aurora, CO, 80045, United States, 1 7207237374, thomas.beresford@ucdenver.edu %K cognition %K COVID-19 %K safety %K remote use %K delirium %K brain injury, brain %K diagnosis %K assessment %K test %K telehealth %K telemedicine %D 2021 %7 14.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Early clinical experience during the COVID-19 pandemic has begun to elucidate that the disease can cause brain function changes that may result in compromised cognition both acutely and during variable recovery periods. Reports on cognitive assessment of patients with COVID-19 are often limited to orientation alone. Further assessment may seem to create an inappropriate burden for patients with acute COVID-19, which is characterized by fatigue and confusion, and may also compromise examiner safety. Objective: The aims of this study were to assess cognition in patients with COVID-19 as comprehensively as possible in a brief format, while observing safety precautions, and to establish a clear face value of the external validity of the assessment. Methods: We adapted a brief cognitive assessment, previously applied to liver transplant candidates and medical/surgical inpatients, for remote use in patients hospitalized for COVID-19 treatment. Collecting quality assurance data from telephone-administered assessments, this report presents a series of 6 COVID-19 case vignettes to illustrate the use of this 5-minute assessment in the diagnosis and treatment of brain effects. Primary medical teams referred the cases for neuropsychiatric consultation. Results: The age of the patients varied over four decades, and none of them were able to engage meaningfully with their surroundings on admission. On follow-up examination 6 to 10 days later, 4 of the 6 patients had recovered working memory, and only 1 had recovered calculation ability. Of the 6 patients, 2 were capable of complex judgment responses, while none of the cases completed frontal executive function testing in the normal range. Conclusions: Cognitive assessment in patients with COVID-19 using this remote examination reveals patterns of cognitive recovery that vary among cases and are far more complex than loss of orientation. In this series, testing of specific temporal, parietal, and frontal lobe functions suggests that calculation ability, judgment, and especially frontal executive functions may characterize the effects of COVID-19 on the brain. Used widely and serially, this examination method can potentially inform our understanding of the effects of COVID-19 on the brain and of healing from the virus. %M 34010137 %R 10.2196/26417 %U https://formative.jmir.org/2021/6/e26417 %U https://doi.org/10.2196/26417 %U http://www.ncbi.nlm.nih.gov/pubmed/34010137 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e29802 %T Health Information Seeking Behaviors on Social Media During the COVID-19 Pandemic Among American Social Networking Site Users: Survey Study %A Neely,Stephen %A Eldredge,Christina %A Sanders,Ron %+ School of Public Affairs, College of Arts and Sciences, University of South Florida, 4202 E Fowler Ave, Tampa, FL, 33620, United States, 1 8139748423, srneely@usf.edu %K social media %K internet %K communication %K public health %K COVID-19 %K usage %K United States %K information seeking %K web-based health information %K survey %K mistrust %D 2021 %7 11.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In recent years, medical journals have emphasized the increasingly critical role that social media plays in the dissemination of public health information and disease prevention guidelines. However, platforms such as Facebook and Twitter continue to pose unique challenges for clinical health care providers and public health officials alike. In order to effectively communicate during public health emergencies, such as the COVID-19 pandemic, it is increasingly critical for health care providers and public health officials to understand how patients gather health-related information on the internet and adjudicate the merits of such information. Objective: With that goal in mind, we conducted a survey of 1003 US-based adults to better understand how health consumers have used social media to learn and stay informed about the COVID-19 pandemic, the extent to which they have relied on credible scientific information sources, and how they have gone about fact-checking pandemic-related information. Methods: A web-based survey was conducted with a sample that was purchased through an industry-leading market research provider. The results were reported with a 95% confidence level and a margin of error of 3. Participants included 1003 US-based adults (aged ≥18 years). Participants were selected via a stratified quota sampling approach to ensure that the sample was representative of the US population. Balanced quotas were determined (by region of the country) for gender, age, race, and ethnicity. Results: The results showed a heavy reliance on social media during the COVID-19 pandemic; more than three-quarters of respondents (762/1003, 76%) reported that they have relied on social media at least “a little,” and 59.2% (594/1003) of respondents indicated that they read information about COVID-19 on social media at least once per week. According to the findings, most social media users (638/1003, 63.6%) were unlikely to fact-check what they see on the internet with a health professional, despite the high levels of mistrust in the accuracy of COVID-19–related information on social media. We also found a greater likelihood of undergoing vaccination among those following more credible scientific sources on social media during the pandemic (χ216=50.790; φ=0.258; P<.001). Conclusions: The findings suggest that health professionals will need to be both strategic and proactive when engaging with health consumers on social media if they hope to counteract the deleterious effects of misinformation and disinformation. Effective training, institutional support, and proactive collaboration can help health professionals adapt to the evolving patterns of health information seeking. %M 34043526 %R 10.2196/29802 %U https://www.jmir.org/2021/6/e29802 %U https://doi.org/10.2196/29802 %U http://www.ncbi.nlm.nih.gov/pubmed/34043526 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27632 %T Assessing COVID-19 Vaccine Hesitancy, Confidence, and Public Engagement: A Global Social Listening Study %A Hou,Zhiyuan %A Tong,Yixin %A Du,Fanxing %A Lu,Linyao %A Zhao,Sihong %A Yu,Kexin %A Piatek,Simon J %A Larson,Heidi J %A Lin,Leesa %+ School of Public Health, Fudan University, Mailbox 250, 138# Yixueyuan Road, Xuhui District, Shanghai, 200030, China, 86 2133563935, zyhou@fudan.edu.cn %K COVID-19 vaccine %K hesitancy %K infoveillance %K infodemiology %K confidence %K acceptance %K engagement %K social media %K COVID-19 %D 2021 %7 11.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Monitoring public confidence and hesitancy is crucial for the COVID-19 vaccine rollout. Social media listening (infoveillance) can not only monitor public attitudes on COVID-19 vaccines but also assess the dissemination of and public engagement with these opinions. Objective: This study aims to assess global hesitancy, confidence, and public engagement toward COVID-19 vaccination. Methods: We collected posts mentioning the COVID-19 vaccine between June and July 2020 on Twitter from New York (United States), London (United Kingdom), Mumbai (India), and Sao Paulo (Brazil), and Sina Weibo posts from Beijing (China). In total, we manually coded 12,886 posts from the five global metropolises with high COVID-19 burdens, and after assessment, 7032 posts were included in the analysis. We manually double-coded these posts using a coding framework developed according to the World Health Organization’s Confidence, Complacency, and Convenience model of vaccine hesitancy, and conducted engagement analysis to investigate public communication about COVID-19 vaccines on social media. Results: Among social media users, 36.4% (571/1568) in New York, 51.3% (738/1440) in London, 67.3% (144/214) in Sao Paulo, 69.8% (726/1040) in Mumbai, and 76.8% (2128/2770) in Beijing indicated that they intended to accept a COVID-19 vaccination. With a high perceived risk of getting COVID-19, more tweeters in New York and London expressed a lack of confidence in vaccine safety, distrust in governments and experts, and widespread misinformation or rumors. Tweeters from Mumbai, Sao Paulo, and Beijing worried more about vaccine production and supply, whereas tweeters from New York and London had more concerns about vaccine distribution and inequity. Negative tweets expressing lack of vaccine confidence and misinformation or rumors had more followers and attracted more public engagement online. Conclusions: COVID-19 vaccine hesitancy is prevalent worldwide, and negative tweets attract higher engagement on social media. It is urgent to develop an effective vaccine campaign that boosts public confidence and addresses hesitancy for COVID-19 vaccine rollouts. %M 34061757 %R 10.2196/27632 %U https://www.jmir.org/2021/6/e27632 %U https://doi.org/10.2196/27632 %U http://www.ncbi.nlm.nih.gov/pubmed/34061757 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e25021 %T Digital Solutions to Alleviate the Burden on Health Systems During a Public Health Care Crisis: COVID-19 as an Opportunity %A Willems,Sofie H %A Rao,Jyotsna %A Bhambere,Sailee %A Patel,Dipu %A Biggins,Yvonne %A Guite,Jessica W %+ Center for Advancement in Managing Pain, School of Nursing, The University of Connecticut, 231 Glenbrook Road, Storrs, CT, 06269-4026, United States, 1 215 964 5582, jessica.guite@uconn.com %K coronavirus %K digital health %K multiplatform %K chat %K symptom tracking %K well-being %K COVID-19 %K online platform %K symptom %K monitoring %K follow-up %D 2021 %7 11.6.2021 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X The COVID-19 pandemic has generated unprecedented and sustained health management challenges worldwide. Health care systems continue to struggle to support the needs of the majority of infected individuals that are either asymptomatic or have mild symptoms. In addition, long-term effects in the form of long-lasting COVID-19 symptoms or widespread mental health issues aggravated by the pandemic pose a burden on health care systems worldwide. This viewpoint article considers aspects of digital health care solutions and how they can play an ongoing role in safely addressing gaps in the health care support available from initially and repeatedly overwhelmed providers and systems. Digital solutions can be readily designed to address this need and can be flexible enough to adapt to the evolving management requirements of various stakeholders to reduce COVID-19 infection rates, acute hospitalizations, and mortality. Multiplatform solutions provide a hybrid model of care, which can include mobile and online platforms accompanied by direct clinician input and feedback. Desirable components to be included are discussed, including symptom tracking, patient education, well-being support, and bidirectional communication between patients and clinicians. Customizable and scalable digital health platforms not only can be readily adapted to further meet the needs of employers and public health stakeholders during the ongoing pandemic, but also hold relevance for flexibly meeting broader care management needs into the future. %M 34033575 %R 10.2196/25021 %U https://mhealth.jmir.org/2021/6/e25021 %U https://doi.org/10.2196/25021 %U http://www.ncbi.nlm.nih.gov/pubmed/34033575 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 2 %P e25560 %T Machine Learning for Risk Group Identification and User Data Collection in a Herpes Simplex Virus Patient Registry: Algorithm Development and Validation Study %A Surodina,Svitlana %A Lam,Ching %A Grbich,Svetislav %A Milne-Ives,Madison %A van Velthoven,Michelle %A Meinert,Edward %+ Centre for Health Technology, University of Plymouth, 6 Kirkby Place, Room 2, Plymouth, PL4 6DN, United Kingdom, 44 1752600600, edward.meinert@plymouth.ac.uk %K data collection %K herpes simplex virus %K registries %K machine learning %K risk assessment %K artificial intelligence %K medical information system %K user-centered design %K predictor %K risk %D 2021 %7 11.6.2021 %9 Original Paper %J JMIRx Med %G English %X Background: Researching people with herpes simplex virus (HSV) is challenging because of poor data quality, low user engagement, and concerns around stigma and anonymity. Objective: This project aimed to improve data collection for a real-world HSV registry by identifying predictors of HSV infection and selecting a limited number of relevant questions to ask new registry users to determine their level of HSV infection risk. Methods: The US National Health and Nutrition Examination Survey (NHANES, 2015-2016) database includes the confirmed HSV type 1 and type 2 (HSV-1 and HSV-2, respectively) status of American participants (14-49 years) and a wealth of demographic and health-related data. The questionnaires and data sets from this survey were used to form two data sets: one for HSV-1 and one for HSV-2. These data sets were used to train and test a model that used a random forest algorithm (devised using Python) to minimize the number of anonymous lifestyle-based questions needed to identify risk groups for HSV. Results: The model selected a reduced number of questions from the NHANES questionnaire that predicted HSV infection risk with high accuracy scores of 0.91 and 0.96 and high recall scores of 0.88 and 0.98 for the HSV-1 and HSV-2 data sets, respectively. The number of questions was reduced from 150 to an average of 40, depending on age and gender. The model, therefore, provided high predictability of risk of infection with minimal required input. Conclusions: This machine learning algorithm can be used in a real-world evidence registry to collect relevant lifestyle data and identify individuals’ levels of risk of HSV infection. A limitation is the absence of real user data and integration with electronic medical records, which would enable model learning and improvement. Future work will explore model adjustments, anonymization options, explicit permissions, and a standardized data schema that meet the General Data Protection Regulation, Health Insurance Portability and Accountability Act, and third-party interface connectivity requirements. %M 37725536 %R 10.2196/25560 %U https://xmed.jmir.org/2021/2/e25560 %U https://doi.org/10.2196/25560 %U http://www.ncbi.nlm.nih.gov/pubmed/37725536 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e23976 %T A Rapid Assessment of the Impact of COVID-19 on Asian Americans: Cross-sectional Survey Study %A Quach,Thu %A Ðoàn,Lan N %A Liou,Julia %A Ponce,Ninez A %+ Asian Health Services, 101 8th Street, Suite 100, Oakland, CA, 94607, United States, 1 510 735 3179, tquach@ahschc.org %K COVID-19 %K Asian American %K testing %K mental health %K barrier %K behavior %K impact %K discrimination %K inequality %K disparity %K experience %K COVID %K violence %K culture %K stress %K anti-Asian violence %D 2021 %7 11.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The diverse Asian American population has been impacted by the COVID-19 pandemic, but due to limited data and other factors, disparities experienced by this population are hidden. Objective: This study aims to describe the Asian American community’s experiences during the COVID-19 pandemic, focusing on the Greater San Francisco Bay Area, California, and to better inform a Federally Qualified Health Center’s (FQHC) health care services and response to challenges faced by the community. Methods: We conducted a cross-sectional survey between May 20 and June 23, 2020, using a multipronged recruitment approach, including word-of-mouth, FQHC patient appointments, and social media posts. The survey was self-administered online or administered over the phone by FQHC staff in English, Cantonese, Mandarin, and Vietnamese. Survey question topics included COVID-19 testing and preventative behaviors, economic impacts of COVID-19, experience with perceived mistreatment due to their race/ethnicity, and mental health challenges. Results: Among 1297 Asian American respondents, only 3.1% (39/1273) had previously been tested for COVID-19, and 46.6% (392/841) stated that they could not find a place to get tested. In addition, about two-thirds of respondents (477/707) reported feeling stressed, and 22.6% (160/707) reported feeling depressed. Furthermore, 5.6% (72/1275) of respondents reported being treated unfairly because of their race/ethnicity. Among respondents who experienced economic impacts from COVID-19, 32.2% (246/763) had lost their regular jobs and 22.5% (172/763) had reduced hours or reduced income. Additionally, 70.1% (890/1269) of respondents shared that they avoid leaving their home to go to public places (eg, grocery stores, church, and school). Conclusions: We found that Asian Americans had lower levels of COVID-19 testing and limited access to testing, a high prevalence of mental health issues and economic impacts, and a high prevalence of risk-avoidant behaviors (eg, not leaving the house) in the early months of the COVID-19 pandemic. These findings provide preliminary insights into the impact of the COVID-19 pandemic on Asian American communities served by an FQHC and underscore the longstanding need for culturally and linguistically appropriate approaches to providing mental health, outreach, and education services. These findings led to the establishment of the first Asian multilingual and multicultural COVID-19 testing sites in the local area where the study was conducted, and laid the groundwork for subsequent COVID-19 programs, specifically contact tracing and vaccination programs. %M 34019478 %R 10.2196/23976 %U https://publichealth.jmir.org/2021/6/e23976 %U https://doi.org/10.2196/23976 %U http://www.ncbi.nlm.nih.gov/pubmed/34019478 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e23294 %T Acceptability of the Medication Event Reminder Monitor for Promoting Adherence to Multidrug-Resistant Tuberculosis Therapy in Two Indian Cities: Qualitative Study of Patients and Health Care Providers %A Thomas,Beena E %A Kumar,J Vignesh %A Periyasamy,Murugesan %A Khandewale,Amit Subhash %A Hephzibah Mercy,J %A Raj,E Michael %A Kokila,S %A Walgude,Apurva Shashikant %A Gaurkhede,Gunjan Rahul %A Kumbhar,Jagannath Dattatraya %A Ovung,Senthanro %A Paul,Mariyamma %A Rajkumar,B Sathyan %A Subbaraman,Ramnath %+ Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, MV237, Boston, MA, 02111, United States, 1 6176360985, ramnath.subbaraman@tufts.edu %K tuberculosis %K drug-resistant %K medication adherence %K mHealth %K digital adherence technologies %K India %D 2021 %7 10.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Patients with multidrug-resistant tuberculosis (MDR-TB) face challenges adhering to medications, given that treatment is prolonged and has a high rate of adverse effects. The Medication Event Reminder Monitor (MERM) is a digital pillbox that provides pill-taking reminders and facilitates the remote monitoring of medication adherence. Objective: This study aims to assess the MERM’s acceptability to patients and health care providers (HCPs) during pilot implementation in India’s public sector MDR-TB program. Methods: From October 2017 to September 2018, we conducted qualitative interviews with patients who were undergoing MDR-TB therapy and were being monitored with the MERM and HCPs in the government program in Chennai and Mumbai. Interview transcripts were independently coded by 2 researchers and analyzed to identify the emergent themes. We organized findings by using the Unified Theory of Acceptance and Use of Technology (UTAUT), which outlines 4 constructs that predict technology acceptance—performance expectancy, effort expectancy, social influence, and facilitating conditions. Results: We interviewed 65 patients with MDR-TB and 10 HCPs. In patient interviews, greater acceptance of the MERM was related to perceptions that the audible and visual reminders improved medication adherence and that remote monitoring reduced the frequency of clinic visits (performance expectancy), that the device’s organization and labeling of medications made it easier to take them correctly (effort expectancy), that the device facilitated positive family involvement in the patient’s care (social influences), and that remote monitoring made patients feel more cared for by the health system (facilitating conditions). Lower patient acceptance was related to problems with the durability of the MERM’s cardboard construction and difficulties with portability and storage because of its large size (effort expectancy), concerns regarding stigma and the disclosure of patients’ MDR-TB diagnoses (social influences), and the incorrect understanding of the MERM because of suboptimal counseling (facilitating conditions). In their interviews, HCPs reported that MERM implementation resulted in fewer in-person interactions with patients and thus allowed HCPs to dedicate more time to other tasks, which improved job satisfaction. Conclusions: Several features of the MERM support its acceptability among patients with MDR-TB and HCPs, and some barriers to patient use could be addressed by improving the design of the device. However, some barriers, such as disease-related stigma, are more difficult to modify and may limit use of the MERM among some patients with MDR-TB. Further research is needed to assess the accuracy of MERM for measuring adherence, its effectiveness for improving treatment outcomes, and patients’ sustained use of the device in larger scale implementation. %M 34110300 %R 10.2196/23294 %U https://www.jmir.org/2021/6/e23294 %U https://doi.org/10.2196/23294 %U http://www.ncbi.nlm.nih.gov/pubmed/34110300 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e29528 %T Community Mitigation of COVID-19 and Portrayal of Testing on TikTok: Descriptive Study %A Basch,Corey H %A Mohlman,Jan %A Fera,Joseph %A Tang,Hao %A Pellicane,Alessia %A Basch,Charles E %+ Department of Public Health, William Paterson University, University Hall, Wayne, NJ, 07470, United States, 1 9737202603, baschc@wpunj.edu %K TikTok %K social media %K COVID-19 %K testing %K disgust %K anxiety %K content analysis %K communication %K infodemiology %K infoveillance %K public health %K digital public health %K digital health %K community mitigation %D 2021 %7 10.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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 (α=.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. %M 34081591 %R 10.2196/29528 %U https://publichealth.jmir.org/2021/6/e29528 %U https://doi.org/10.2196/29528 %U http://www.ncbi.nlm.nih.gov/pubmed/34081591 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e25674 %T The Presence of Fungal and Parasitic Infections in Substances of Human Origin and Their Transmission via Transfusions and Transplantations: Protocol for Two Systematic Reviews %A Dinas,Petros C %A Domanovic,Dragoslav %A Koutedakis,Yiannis %A Hadjichristodoulou,Christos %A Stefanidis,Ioannis %A Papadopoulou,Kalliope %A Dimas,Konstantinos %A Perivoliotis,Konstantinos %A Tepetes,Konstantinos %A Flouris,Andreas D %+ FAME Laboratory, Department of Physical Education and Sport Science, University of Thessaly, Karies, Trikala, 42100, Greece, 30 6974010118, petros.cd@gmail.com %K fungal and parasitic infections %K donor-derived substances %K transplantation %K transfusion %D 2021 %7 10.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 34110295 %R 10.2196/25674 %U https://www.researchprotocols.org/2021/6/e25674 %U https://doi.org/10.2196/25674 %U http://www.ncbi.nlm.nih.gov/pubmed/34110295 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e24378 %T Building Social-Ecological System Resilience to Tackle Antimicrobial Resistance Across the One Health Spectrum: Protocol for a Mixed Methods Study %A Lambraki,Irene Anna %A Majowicz,Shannon Elizabeth %A Parmley,Elizabeth Jane %A Wernli,Didier %A Léger,Anaïs %A Graells,Tiscar %A Cousins,Melanie %A Harbarth,Stephan %A Carson,Carolee %A Henriksson,Patrik %A Troell,Max %A Jørgensen,Peter Søgaard %+ School of Public Health and Health Systems, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 41790, ilambrak@uwaterloo.ca %K antimicrobial resistance %K One Health %K resilience %K transdisciplinary %K participatory %K interventions %K systems dynamics %K social-ecological system %D 2021 %7 10.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 34110296 %R 10.2196/24378 %U https://www.researchprotocols.org/2021/6/e24378 %U https://doi.org/10.2196/24378 %U http://www.ncbi.nlm.nih.gov/pubmed/34110296 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e27102 %T Considerations for the Design and Implementation of COVID-19 Contact Tracing Apps: Scoping Review %A Osmanlliu,Esli %A Rafie,Edmond %A Bédard,Sylvain %A Paquette,Jesseca %A Gore,Genevieve %A Pomey,Marie-Pascale %+ Division of Pediatric Emergency Medicine, Department of Pediatrics, Montreal Children’s Hospital, McGill University Health Centre, MUHC Glen Site, 1001 Décarie Blvd, Montreal, QC, H4A 3J1, Canada, 1 514 412 4499, esli.osmanlliu@mcgill.ca %K COVID-19 %K contact tracing %K exposure notification %K app %K design %K implementation %K participatory %K eHealth %K surveillance %K monitoring %K review %D 2021 %7 9.6.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Given the magnitude and speed of SARS-CoV-2 transmission, achieving timely and effective manual contact tracing has been a challenging task. Early in the pandemic, contact tracing apps generated substantial enthusiasm due to their potential for automating tracing and reducing transmission rates while enabling targeted confinement strategies. However, although surveys demonstrate public interest in using such apps, their actual uptake remains limited. Their social acceptability is challenged by issues around privacy, fairness, and effectiveness, among other concerns. Objective: This study aims to examine the extent to which design and implementation considerations for contact tracing apps are detailed in the available literature, focusing on aspects related to participatory and responsible eHealth innovation, and synthesize recommendations that support the development of successful COVID-19 contact tracing apps and related eHealth technologies. Methods: Searches were performed on five databases, and articles were selected based on eligibility criteria. Papers pertaining to the design, implementation, or acceptability of contact tracing apps were included. Articles published since 2019, written in English or French, and for which the full articles were available were considered eligible for analysis. To assess the scope of the knowledge found in the current literature, we used three complementary frameworks: (1) the Holistic Framework to Improve the Uptake and Impact of eHealth Technologies, (2) the Montreal model, and (3) the Responsible Innovation in Health Assessment Tool. Results: A total of 63 articles qualified for the final analysis. Less than half of the selected articles cited the need for a participatory process (n=25, 40%), which nonetheless was the most frequently referenced item of the Framework to Improve the Uptake and Impact of eHealth Technologies. Regarding the Montreal model, stakeholder consultation was the most frequently described level of engagement in the development of contact tracing apps (n=24, 38%), while collaboration and partnership were cited the least (n=2, 3%). As for the Responsible Innovation in Health framework, all the articles (n=63, 100%) addressed population health, whereas only 2% (n=1) covered environmental considerations. Conclusions: Most studies lacked fundamental aspects of eHealth development and implementation. Our results demonstrate that stakeholders of COVID-19 contact tracing apps lack important information to be able to critically appraise this eHealth innovation. This may have contributed to the modest uptake of contact tracing apps worldwide. We make evidence-informed recommendations regarding data management, communication, stakeholder engagement, user experience, and implementation strategies for the successful and responsible development of contact tracing apps. %M 34038376 %R 10.2196/27102 %U https://mhealth.jmir.org/2021/6/e27102 %U https://doi.org/10.2196/27102 %U http://www.ncbi.nlm.nih.gov/pubmed/34038376 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e26043 %T 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 %A Moore,Ryan C %A Lee,Angela Y %A Hancock,Jeffrey T %A Halley,Meghan C %A Linos,Eleni %+ Department of Communication, Stanford University, 450 Jane Stanford Way, Building 120, Room 110, Stanford, CA, 94305, United States, 1 650 723 5499, hancockj@stanford.edu %K COVID-19 %K natural language processing %K public health messaging %K social distancing compliance %K age differences %K older adults %K younger adults %K age %K NLP %K public health %K elderly %K youth %K adult %K emotion %K compliance %K guideline %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 33914689 %R 10.2196/26043 %U https://humanfactors.jmir.org/2021/2/e26043 %U https://doi.org/10.2196/26043 %U http://www.ncbi.nlm.nih.gov/pubmed/33914689 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26285 %T Using Fear and Anxiety Related to COVID-19 to Predict Cyberchondria: Cross-sectional Survey Study %A Wu,Xue %A Nazari,Nabi %A Griffiths,Mark D %+ Department of Psychology, Faculty of Literature and Human Sciences, Lorestan University, PO Box 465, Khorramabad, Iran, 98 09197119027, Nazariirani@gmail.com %K COVID-19 %K cyberchondria %K COVID-19 fear %K COVID-19 anxiety %K anxiety sensitivity %K anxiety %K intolerance of uncertainty %K mental health %K survey %K SEM %D 2021 %7 9.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Studies have highlighted that fear and anxiety generated by COVID-19 are important psychological factors that affect all populations. There currently remains a lack of research on specific amplification factors regarding fear and anxiety in the context of the COVID-19 pandemic. Despite established associations between anxiety sensitivity, intolerance of uncertainty, and cyberchondria, empirical data investigating the associations between these three variables, particularly in the context of the COVID-19 pandemic, are currently lacking. Urgent research is needed to better understand the role of repeated media consumption concerning COVID-19 in amplifying fear and anxiety related to COVID-19. Objective: This study investigated the associations between fear of COVID-19, COVID-19 anxiety, and cyberchondria. Methods: Convenience sampling was used to recruit respondents to participate in an online survey. The survey, which was distributed via social media and academic forums, comprised the Cyberchondria Severity Scale, Fear of COVID-19 Scale, Coronavirus Anxiety Scale, Anxiety Sensitivity Index, and Intolerance of Uncertainty Scale. Multiple mediation analyses were conducted using structural equation modeling. Results: A total of 694 respondents (males: n=343, females: n=351) completed the online survey. The results showed that fear and anxiety generated by COVID-19 predicted cyberchondria (fear: β=.39, SE 0.04, P<.001, t=11.16, 95% CI 0.31-0.45; anxiety: β=.25, SE 0.03, P<.001, t=7.67, 95% CI 0.19-0.32). In addition, intolerance of uncertainty and anxiety sensitivity mediated the relationship between fear and anxiety generated by COVID-19 with cyberchondria. In a reciprocal model, the standardized total effects of cyberchondria on fear of COVID-19 (β=.45, SE 0.04, P<.001, t=15.31, 95% CI 0.39-0.51) and COVID-19 anxiety (β=.36, SE 0.03, P<.001, t=11.29, 95% CI 0.30-0.41) were statistically significant, with moderate effect sizes. Compared to males, females obtained significantly higher scores for cyberchondria (t1,692=–2.85, P=.004, Cohen d=0.22), COVID-19 anxiety (t1,692=–3.32, P<.001, Cohen d=0.26), and anxiety sensitivity (t1,692=–3.69, P<.001, Cohen d=0.29). Conclusions: The findings provide a better understanding of the role of COVID-19 in amplifying cyberchondria. Based on these results, cyberchondria must be viewed as a significant public health issue. Importantly, increasing awareness about cyberchondria and online behavior at both the individual and collective levels must be prioritized to enhance preparedness and to reduce the adverse effects of current and future medical crises. %M 34014833 %R 10.2196/26285 %U https://www.jmir.org/2021/6/e26285 %U https://doi.org/10.2196/26285 %U http://www.ncbi.nlm.nih.gov/pubmed/34014833 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e24312 %T A Wake-up Call for Burnout in Portuguese Physicians During the COVID-19 Outbreak: National Survey Study %A Ferreira,Sónia %A Sousa,Mafalda Machado %A Moreira,Pedro Silva %A Sousa,Nuno %A Picó-Pérez,Maria %A Morgado,Pedro %+ Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Universidade do Minho, Campus de Gualtar, Braga, 4710-057, Portugal, 351 253 604928, pedromorgado@med.uminho.pt %K COVID-19 %K anxiety %K coronavirus %K depression %K frontline %K health care professionals %K health care staff %K obsessive compulsive disorder %K SARS-CoV-2 %K stress %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 outbreak has imposed physical and psychological pressure on health care professionals, including frontline physicians. Hence, evaluating the mental health status of physicians during the current pandemic is important to define future preventive guidelines among health care stakeholders. Objective: In this study, we intended to study alterations in the mental health status of Portuguese physicians working at the frontline during the COVID-19 pandemic and potential sociodemographic factors influencing their mental health status. Methods: A nationwide survey was conducted during May 4-25, 2020, to infer differences in mental health status (depression, anxiety, stress, and obsessive compulsive symptoms) between Portuguese physicians working at the frontline during the COVID-19 pandemic and other nonfrontline physicians. A representative sample of 420 participants stratified by age, sex, and the geographic region was analyzed (200 frontline and 220 nonfrontline participants). Moreover, we explored the influence of several sociodemographic factors on mental health variables including age, sex, living conditions, and household composition. Results: Our results show that being female (β=1.1; t=2.5; P=.01) and working at the frontline (β=1.4; t=2.9; P=.004) are potential risk factors for stress. In contrast, having a house with green space was a potentially beneficial factor for stress (β=–1.5; t=–2.5; P=.01) and anxiety (β=–1.1; t=–2.4; P=.02). Conclusions: It is important to apply protective mental health measures for physicians to avoid the long-term effects of stress, such as burnout. %M 33630744 %R 10.2196/24312 %U https://publichealth.jmir.org/2021/6/e24312 %U https://doi.org/10.2196/24312 %U http://www.ncbi.nlm.nih.gov/pubmed/33630744 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e27888 %T How New Mexico Leveraged a COVID-19 Case Forecasting Model to Preemptively Address the Health Care Needs of the State: Quantitative Analysis %A Castro,Lauren A %A Shelley,Courtney D %A Osthus,Dave %A Michaud,Isaac %A Mitchell,Jason %A Manore,Carrie A %A Del Valle,Sara Y %+ Information Systems & Modeling Group, Analytics, Intelligence and Technology Division, Los Alamos National Laboratory, PO Box 1663, Los Alamos, NM, 87545, United States, 1 505 667 7544, lcastro@lanl.gov %K COVID-19 %K forecasting %K health care %K prediction %K forecast %K model %K quantitative %K hospital %K ICU %K ventilator %K intensive care unit %K probability %K trend %K plan %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Prior to the COVID-19 pandemic, US hospitals relied on static projections of future trends for long-term planning and were only beginning to consider forecasting methods for short-term planning of staffing and other resources. With the overwhelming burden imposed by COVID-19 on the health care system, an emergent need exists to accurately forecast hospitalization needs within an actionable timeframe. Objective: Our goal was to leverage an existing COVID-19 case and death forecasting tool to generate the expected number of concurrent hospitalizations, occupied intensive care unit (ICU) beds, and in-use ventilators 1 day to 4 weeks in the future for New Mexico and each of its five health regions. Methods: We developed a probabilistic model that took as input the number of new COVID-19 cases for New Mexico from Los Alamos National Laboratory’s COVID-19 Forecasts Using Fast Evaluations and Estimation tool, and we used the model to estimate the number of new daily hospital admissions 4 weeks into the future based on current statewide hospitalization rates. The model estimated the number of new admissions that would require an ICU bed or use of a ventilator and then projected the individual lengths of hospital stays based on the resource need. By tracking the lengths of stay through time, we captured the projected simultaneous need for inpatient beds, ICU beds, and ventilators. We used a postprocessing method to adjust the forecasts based on the differences between prior forecasts and the subsequent observed data. Thus, we ensured that our forecasts could reflect a dynamically changing situation on the ground. Results: Forecasts made between September 1 and December 9, 2020, showed variable accuracy across time, health care resource needs, and forecast horizon. Forecasts made in October, when new COVID-19 cases were steadily increasing, had an average accuracy error of 20.0%, while the error in forecasts made in September, a month with low COVID-19 activity, was 39.7%. Across health care use categories, state-level forecasts were more accurate than those at the regional level. Although the accuracy declined as the forecast was projected further into the future, the stated uncertainty of the prediction improved. Forecasts were within 5% of their stated uncertainty at the 50% and 90% prediction intervals at the 3- to 4-week forecast horizon for state-level inpatient and ICU needs. However, uncertainty intervals were too narrow for forecasts of state-level ventilator need and all regional health care resource needs. Conclusions: Real-time forecasting of the burden imposed by a spreading infectious disease is a crucial component of decision support during a public health emergency. Our proposed methodology demonstrated utility in providing near-term forecasts, particularly at the state level. This tool can aid other stakeholders as they face COVID-19 population impacts now and in the future. %M 34003763 %R 10.2196/27888 %U https://publichealth.jmir.org/2021/6/e27888 %U https://doi.org/10.2196/27888 %U http://www.ncbi.nlm.nih.gov/pubmed/34003763 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e27280 %T Development of the 12-Item Social Media Disinformation Scale and its Association With Social Media Addiction and Mental Health Related to COVID-19 in Tunisia: Survey-Based Pilot Case Study %A Guelmami,Noomen %A Ben Khalifa,Maher %A Chalghaf,Nasr %A Kong,Jude Dzevela %A Amayra,Tannoubi %A Wu,Jianhong %A Azaiez,Fairouz %A Bragazzi,Nicola Luigi %+ Department of Mathematics and Statistics, York University, 4700 Keele Street, Toronto, ON, M3J 1P3, Canada, 1 2818392210, robertobragazzi@gmail.com %K COVID-19 pandemic %K media disinformation %K social media addiction %K mental health %K scale validation %D 2021 %7 9.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In recent years, online disinformation has increased. Fake news has been spreading about the COVID-19 pandemic. Since January 2020, the culprits and antidotes to disinformation have been digital media and social media. Objective: Our study aimed to develop and test the psychometric properties of the 12-item Social Media Disinformation Scale (SMDS-12), which assesses the consumption, confidence, and sharing of information related to COVID-19 by social media users. Methods: A total of 874 subjects were recruited over two phases: the exploratory phase group had a mean age of 28.39 years (SD 9.32) and the confirmatory phase group had a mean age of 32.84 years (SD 12.72). Participants completed the SMDS-12, the Internet Addiction Test, the COVID-19 Fear Scale, and the 10-item Perceived Stress Scale. The SMDS-12 was initially tested by exploratory factor analysis and was subsequently tested by confirmatory factor analysis. Results: The test supported the three-factor structure. In addition, no items were removed from the measurement scale, with three factors explaining up to 73.72% of the total variance, and the items had a lambda factor loading ranging from 0.73 to 0.85. Subsequently, confirmatory factor analysis confirmed the robustness of the measure by referring to a wide range of goodness-of-fit indices that met the recommended standards. The construct validity of the scale was supported by its convergent and discriminant validity. The reliability of the instrument examined by means of three internal consistency indices, and the corrected item-total correlation, demonstrated that the three dimensions of the instrument were reliable: Cronbach α values were .89, .88, and .88 for the consumption, confidence, and sharing subscales, respectively. The corrected item-total correlation ranged from 0.70 to 0.78. The correlation of the instrument’s dimensions with internet addiction and mental health factors showed positive associations. Conclusions: The SMDS-12 can be reliably utilized to measure the credibility of social media disinformation and can be adapted to measure the credibility of disinformation in other contexts. %M 34021742 %R 10.2196/27280 %U https://formative.jmir.org/2021/6/e27280 %U https://doi.org/10.2196/27280 %U http://www.ncbi.nlm.nih.gov/pubmed/34021742 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e27625 %T The Rotavirus Surveillance System in Yemen: Evaluation Study %A Lardi,Eman Abdullah %A Al Kuhlani,Sharaf Sharaf %A Al Amad,Mohammed Abdullah %A Al Serouri,Abdulwahed Abduljabar %A Khader,Yousef Saleh %+ Field Epidemiology Training Program, Ministry of Public Health and Population, AL-Hasaba, Mazda street, Sana'a, Yemen, 967 771866574, eman2020-2020@hotmail.com %K Rotavirus %K surveillance system %K evaluation, Yemen %D 2021 %7 8.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Rotavirus (RV) kills over 185,000 children <5 years every year and is responsible for over one-third of all child diarrheal deaths worldwide. The Rotavirus Surveillance System (RVSS) in Yemen was launched in 2007 at five sentinel sites to monitor the impact of the vaccine on RV morbidity and mortality. Objective: This study aimed to determine the usefulness of the RVSS, assess its performance, and identify the strengths and weaknesses of its implementation. Methods: The Centers for Disease Control and Prevention’s updated guidelines on evaluating a public health surveillance system were used to evaluate the RVSS. In this assessment, qualitative indicators, such as usefulness, flexibility, stability, simplicity, and acceptability, were assessed through in-depth interviews with stakeholders at the central level and semistructured questionnaires with the sentinel site coordinators. The indicators for quantitative attributes—sensitivity, positive predictive value (PPV), completeness, and timeliness—were assessed by reviewing the results of laboratory samples and a random sample of case report forms. The scores for the indicators were expressed as poor (<60%), average (60% to <80%), and good (≥80%). Results: The overall usefulness score of the RVSS was 73%, indicating an average rank. The RVSS was rated as having good flexibility (91%) and stability (81%), and average simplicity (77%) and acceptability (76%). In terms of quantitative attributes, the system was poor for sensitivity (16%), average for PPV (73%), and good for completeness (100%) and timeliness (100%). Conclusions: Although the system attributes were flexible, stable, capable of providing quality data, and performing timely data reporting, some attributes still needed improvements (eg, usefulness, simplicity, acceptability, and PPV). There is a need for a gradual replacement of donor funds with government funds to ensure sustainability. The RVSS in Yemen strongly requires a progressive increase in the number of sites in governorates and sensitivity enhancement. %M 34100759 %R 10.2196/27625 %U https://publichealth.jmir.org/2021/6/e27625 %U https://doi.org/10.2196/27625 %U http://www.ncbi.nlm.nih.gov/pubmed/34100759 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 7 %N 2 %P e27384 %T Virtual Mind-Body Programming for Patients With Cancer During the COVID-19 Pandemic: Qualitative Study %A Emard,Nicholas %A Lynch,Kathleen A %A Liou,Kevin T %A Atkinson,Thomas %A Green,Angela K %A Daly,Bobby %A Trevino,Kelly %A Mao,Jun J %+ Bendheim Integrative Medicine Center, Department of Medicine, Memorial Sloan Kettering Cancer Center, 1429 First Ave, New York, NY, 10021, United States, 1 646 888 0866, maoj@mskcc.org %K cancer %K fitness %K meditation %K stress %K COVID-19 %K qualitative %K coping %K wellbeing %K psychosocial %K virtual health %D 2021 %7 8.6.2021 %9 Original Paper %J JMIR Cancer %G English %X Background: Patients with cancer are particularly vulnerable to stress and anxiety during the COVID-19 pandemic. Social distancing is critical for patients with cancer; however, it can also reduce their access to psychosocial coping resources. Objective: The aim of this study was to explore patient experiences to generate a model of how virtual mind-body programs can support the psychosocial well-being of patients with cancer. Methods: We conducted a qualitative study among patients (aged ≥18 years) who participated in a virtual mind-body program offered by a National Cancer Institute–designated Comprehensive Cancer Center during the COVID-19 pandemic. The program consisted of mind-body group therapy sessions of fitness, yoga, tai chi, dance therapy, music therapy, and meditation. Live integrative medicine clinicians held each session via Zoom videoconferencing for 30-45 minutes. In semistructured phone interviews (n=30), patients were asked about their overall impressions and perceptions of the benefits of the sessions, including impacts on stress and anxiety. Interviews were analyzed using grounded theory. Results: Among the 30 participants (average age 64.5 years, SD 9.36, range 40-80, 29 female), three major themes were identified relating to experiences in the virtual mind-body program: (1) the sessions helped the patients maintain structured routines and motivated them to adhere to healthy behaviors; (2) the sessions enhanced coping with COVID-19-related-stressors, allowing patients to “refocus” and “re-energize”; and (3) the sessions allowed patients to connect, fostering social relationships during a time of isolation. These themes informed the constructs of a novel behavioral-psychological-social coping model for patients with cancer. Conclusions: Virtual mind-body programming supported patients with cancer during the COVID-19 pandemic through a behavioral-psychological-social coping model by enhancing psychological coping for external stressors, supporting adherence to motivation and health behaviors, and increasing social connection and camaraderie. These programs have potential to address the behavioral, psychological, and social challenges faced by patients with cancer during and beyond the COVID-19 pandemic. The constructs of the conceptual model proposed in this study can inform future interventions to support isolated patients with cancer. Further clinical trials are needed to confirm the specific benefits of virtual mind-body programming for the psychosocial well-being and healthy behaviors of patients with cancer. %M 33882018 %R 10.2196/27384 %U https://cancer.jmir.org/2021/2/e27384 %U https://doi.org/10.2196/27384 %U http://www.ncbi.nlm.nih.gov/pubmed/33882018 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27348 %T Patient Empowerment During the COVID-19 Pandemic by Ensuring Safe and Fast Communication of Test Results: Implementation and Performance of a Tracking System %A Völkel,Gunnar %A Fürstberger,Axel %A Schwab,Julian D %A Werle,Silke D %A Ikonomi,Nensi %A Gscheidmeier,Thomas %A Kraus,Johann M %A Groß,Alexander %A Holderried,Martin %A Balig,Julien %A Jobst,Franz %A Kuhn,Peter %A Kuhn,Klaus A %A Kohlbacher,Oliver %A Kaisers,Udo X %A Seufferlein,Thomas %A Kestler,Hans A %+ Institute of Medical Systems Biology, Ulm University, Albert-Einstein-Allee 11, Ulm, 89081, Germany, 49 731 500 24500, hans.kestler@uni-ulm.de %K process optimization %K patient empowerment %K data security %K COVID-19 %K clinical information system %K platform independent %K eHealth %K telemedicine %K quality management %D 2021 %7 7.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Overcoming the COVID-19 crisis requires new ideas and strategies for online communication of personal medical information and patient empowerment. Rapid testing of a large number of subjects is essential for monitoring and delaying the spread of SARS-CoV-2 in order to mitigate the pandemic’s consequences. People who do not know that they are infected may not stay in quarantine and, thus, risk infecting others. Unfortunately, the massive number of COVID-19 tests performed is challenging for both laboratories and the units that conduct throat swabs and communicate the results. Objective: The goal of this study was to reduce the communication burden for health care professionals. We developed a secure and easy-to-use tracking system to report COVID-19 test results online that is simple to understand for the tested subjects as soon as these results become available. Instead of personal calls, the system updates the status and the results of the tests automatically. This aims to reduce the delay when informing testees about their results and, consequently, to slow down the virus spread. Methods: The application in this study draws on an existing tracking tool. With this open-source and browser-based online tracking system, we aim to minimize the time required to inform the tested person and the testing units (eg, hospitals or the public health care system). The system can be integrated into the clinical workflow with very modest effort and avoids excessive load to telephone hotlines. Results: The test statuses and results are published on a secured webpage, enabling regular status checks by patients; status checks are performed without the use of smartphones, which has some importance, as smartphone usage diminishes with age. Stress tests and statistics show the performance of our software. CTest is currently running at two university hospitals in Germany—University Hospital Ulm and University Hospital Tübingen—with thousands of tests being performed each week. Results show a mean number of 10 (SD 2.8) views per testee. Conclusions: CTest runs independently of existing infrastructures, aims at straightforward integration, and aims for the safe transmission of information. The system is easy to use for testees. QR (Quick Response) code links allow for quick access to the test results. The mean number of views per entry indicates a reduced amount of time for both health care professionals and testees. The system is quite generic and can be extended and adapted to other communication tasks. %M 33999836 %R 10.2196/27348 %U https://www.jmir.org/2021/6/e27348 %U https://doi.org/10.2196/27348 %U http://www.ncbi.nlm.nih.gov/pubmed/33999836 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 6 %P e27753 %T Best Practice Guidance for Digital Contact Tracing Apps: A Cross-disciplinary Review of the Literature %A O'Connell,James %A Abbas,Manzar %A Beecham,Sarah %A Buckley,Jim %A Chochlov,Muslim %A Fitzgerald,Brian %A Glynn,Liam %A Johnson,Kevin %A Laffey,John %A McNicholas,Bairbre %A Nuseibeh,Bashar %A O'Callaghan,Michael %A O'Keeffe,Ian %A Razzaq,Abdul %A Rekanar,Kaavya %A Richardson,Ita %A Simpkin,Andrew %A Storni,Cristiano %A Tsvyatkova,Damyanka %A Walsh,Jane %A Welsh,Thomas %A O'Keeffe,Derek %+ School of Medicine, National University of Ireland Galway, Clinical Sciences Institute, Costello Road, Galway, H91 V4AY, Ireland, 353 (0)91 495960, derek.okeeffe@nuigalway.ie %K digital contact tracing %K automated contact tracing %K COVID-19 %K SARS-CoV-2 %K mHealth %K mobile app %K app %K tracing %K monitoring %K surveillance %K review %K best practice %K design %D 2021 %7 7.6.2021 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Digital contact tracing apps have the potential to augment contact tracing systems and disrupt COVID-19 transmission by rapidly identifying secondary cases prior to the onset of infectiousness and linking them into a system of quarantine, testing, and health care worker case management. The international experience of digital contact tracing apps during the COVID-19 pandemic demonstrates how challenging their design and deployment are. Objective: This study aims to derive and summarize best practice guidance for the design of the ideal digital contact tracing app. Methods: A collaborative cross-disciplinary approach was used to derive best practice guidance for designing the ideal digital contact tracing app. A search of the indexed and gray literature was conducted to identify articles describing or evaluating digital contact tracing apps. MEDLINE was searched using a combination of free-text terms and Medical Subject Headings search terms. Gray literature sources searched were the World Health Organization Institutional Repository for Information Sharing, the European Centre for Disease Prevention and Control publications library, and Google, including the websites of many health protection authorities. Articles that were acceptable for inclusion in this evidence synthesis were peer-reviewed publications, cohort studies, randomized trials, modeling studies, technical reports, white papers, and media reports related to digital contact tracing. Results: Ethical, user experience, privacy and data protection, technical, clinical and societal, and evaluation considerations were identified from the literature. The ideal digital contact tracing app should be voluntary and should be equitably available and accessible. User engagement could be enhanced by small financial incentives, enabling users to tailor aspects of the app to their particular needs and integrating digital contact tracing apps into the wider public health information campaign. Adherence to the principles of good data protection and privacy by design is important to convince target populations to download and use digital contact tracing apps. Bluetooth Low Energy is recommended for a digital contact tracing app's contact event detection, but combining it with ultrasound technology may improve a digital contact tracing app's accuracy. A decentralized privacy-preserving protocol should be followed to enable digital contact tracing app users to exchange and record temporary contact numbers during contact events. The ideal digital contact tracing app should define and risk-stratify contact events according to proximity, duration of contact, and the infectiousness of the case at the time of contact. Evaluating digital contact tracing apps requires data to quantify app downloads, use among COVID-19 cases, successful contact alert generation, contact alert receivers, contact alert receivers that adhere to quarantine and testing recommendations, and the number of contact alert receivers who subsequently are tested positive for COVID-19. The outcomes of digital contact tracing apps' evaluations should be openly reported to allow for the wider public to review the evaluation of the app. Conclusions: In conclusion, key considerations and best practice guidance for the design of the ideal digital contact tracing app were derived from the literature. %M 34003764 %R 10.2196/27753 %U https://mhealth.jmir.org/2021/6/e27753 %U https://doi.org/10.2196/27753 %U http://www.ncbi.nlm.nih.gov/pubmed/34003764 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e28055 %T Multimodule Web-Based COVID-19 Anxiety and Stress Resilience Training (COAST): Single-Cohort Feasibility Study With First Responders %A Heyen,Janna Marie %A Weigl,Noé %A Müller,Mario %A Müller,Stefan %A Eberle,Urs %A Manoliu,Andrei %A Vetter,Stefan %A Brown,Adam D %A Berger,Thomas %A Kleim,Birgit %+ Department of Psychiatry, Psychotherapy and Psychosomatics, University of Zurich, Lenggstrasse 31, PO Box 1931, Zürich, CH-8032, Switzerland, 41 (0)44 384 21 11, birgit.kleim@pukzh.ch %K anxiety %K COVID-19 %K electronic mental health %K feasibility %K first responder %K mental health %K mindfulness %K resilience %K self-efficacy %K sleep quality %K stress %K training %D 2021 %7 7.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Since the emergence of COVID-19, health care workers and first responders have been at a high risk for mental health symptoms owing to their exposure to the virus and increased work stress during the pandemic. Although interventions exist to address mental health issues following exposure to disasters, emergencies, and humanitarian crises, considerably less is known about web-based unguided interventions to help mitigate the negative impacts of such events. Additionally, in contexts in which emergencies reduce access to in-person care, remote forms of support are critical, yet there are limited studies on the use of such interventions. Evidence-based, easy-to-use, scalable interventions are direly needed for this population. Objective: This study aimed to develop and test the feasibility of an unguided electronic mental health program, COVID-19 Anxiety and Stress Resilience Training (COAST), tailored to first responders and health care personnel, based on scientific evidence and empirically based techniques. Methods: We developed COVID-19–specific training modules focusing on several domains that are previously reported as key to resilience and stress recovery: self-efficacy, mindfulness, sleep quality, and positive thinking. The program was made available to 702 first responders between May and August 2020, during the COVID-19 pandemic. Sociodemographic, work-, and COVID-19–related information was collected, and psychometric questionnaires were completed. We examined user acceptance and user activity, including module choice and participant feedback. Results: In total, 52 of 702 (7%) first responders to whom we reached out used the program at least once. COAST use was independent of age, sex, or baseline levels of self-efficacy, mindful awareness, sleep quality, and positive thinking (for all, P>.39). First responders who had tested positive and those who had been quarantined were more likely to engage in the program. A click count analysis per module showed that participants used the self-efficacy and mindfulness modules most often, with 382 and 122 clicks, respectively, over 15 weeks. Overall, first responders expressed satisfaction with the program. Conclusions: Engagement of first responders in the multimodule web-based COAST program was feasible and the first responder cohort expressed overall satisfaction with the program. Those in more difficult circumstances, including those in quarantine and those who tested positive, may be more likely to engage in such programs. Further controlled studies could pave the way for efficacy studies and the development of additional modules, including just-in-time interventions or blended interventions combining individual use of an unguided self-help intervention, such as COAST, with subsequent individual psychotherapy for those who continue to experience stress and psychological symptoms. %M 33999835 %R 10.2196/28055 %U https://formative.jmir.org/2021/6/e28055 %U https://doi.org/10.2196/28055 %U http://www.ncbi.nlm.nih.gov/pubmed/33999835 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e28892 %T Mental Health and Behavior of College Students During the COVID-19 Pandemic: Longitudinal Mobile Smartphone and Ecological Momentary Assessment Study, Part II %A Mack,Dante L %A DaSilva,Alex W %A Rogers,Courtney %A Hedlund,Elin %A Murphy,Eilis I %A Vojdanovski,Vlado %A Plomp,Jane %A Wang,Weichen %A Nepal,Subigya K %A Holtzheimer,Paul E %A Wagner,Dylan D %A Jacobson,Nicholas C %A Meyer,Meghan L %A Campbell,Andrew T %A Huckins,Jeremy F %+ Department of Psychological and Brain Sciences, Dartmouth College, Moore Hall, 3 Maynard St, Hanover, NH, 03755, United States, 1 603 646 3181, f002vhk@dartmouth.edu %K anxiety %K college %K COVID-19 %K COVID fatigue %K depression %K George Floyd %K mobile sensing %K phone usage %K sleep %K digital phenotyping %D 2021 %7 4.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since late 2019, the lives of people across the globe have been disrupted by COVID-19. Millions of people have become infected with the disease, while billions of people have been continually asked or required by local and national governments to change their behavioral patterns. Previous research on the COVID-19 pandemic suggests that it is associated with large-scale behavioral and mental health changes; however, few studies have been able to track these changes with frequent, near real-time sampling or compare these changes to previous years of data for the same individuals. Objective: By combining mobile phone sensing and self-reported mental health data in a cohort of college-aged students enrolled in a longitudinal study, we seek to understand the behavioral and mental health impacts associated with the COVID-19 pandemic, measured by interest across the United States in the search terms coronavirus and COVID fatigue. Methods: Behaviors such as the number of locations visited, distance traveled, duration of phone use, number of phone unlocks, sleep duration, and sedentary time were measured using the StudentLife mobile smartphone sensing app. Depression and anxiety were assessed using weekly self-reported ecological momentary assessments, including the Patient Health Questionnaire-4. The participants were 217 undergraduate students. Differences in behaviors and self-reported mental health collected during the Spring 2020 term, as compared to previous terms in the same cohort, were modeled using mixed linear models. Results: Linear mixed models demonstrated differences in phone use, sleep, sedentary time and number of locations visited associated with the COVID-19 pandemic. In further models, these behaviors were strongly associated with increased interest in COVID fatigue. When mental health metrics (eg, depression and anxiety) were added to the previous measures (week of term, number of locations visited, phone use, sedentary time), both anxiety and depression (P<.001) were significantly associated with interest in COVID fatigue. Notably, these behavioral and mental health changes are consistent with those observed around the initial implementation of COVID-19 lockdowns in the spring of 2020. Conclusions: In the initial lockdown phase of the COVID-19 pandemic, people spent more time on their phones, were more sedentary, visited fewer locations, and exhibited increased symptoms of anxiety and depression. As the pandemic persisted through the spring, people continued to exhibit very similar changes in both mental health and behaviors. Although these large-scale shifts in mental health and behaviors are unsurprising, understanding them is critical in disrupting the negative consequences to mental health during the ongoing pandemic. %M 33900935 %R 10.2196/28892 %U https://www.jmir.org/2021/6/e28892 %U https://doi.org/10.2196/28892 %U http://www.ncbi.nlm.nih.gov/pubmed/33900935 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27300 %T Partisan Differences in Twitter Language Among US Legislators During the COVID-19 Pandemic: Cross-sectional Study %A Guntuku,Sharath Chandra %A Purtle,Jonathan %A Meisel,Zachary F %A Merchant,Raina M %A Agarwal,Anish %+ Department of Computer and Information Science, University of Pennsylvania, 3300 Walnut St, Philadelphia, PA, 19103, United States, 1 215 615 3211, sharathg@cis.upenn.edu %K Twitter %K COVID-19 %K digital health %K US legislators %K natural language processing %K policy makers %K social media %K policy %K politics %K language %K cross-sectional %K content %K sentiment %K infodemiology %K infoveillance %D 2021 %7 3.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As policy makers continue to shape the national and local responses to the COVID-19 pandemic, the information they choose to share and how they frame their content provide key insights into the public and health care systems. Objective: We examined the language used by the members of the US House and Senate during the first 10 months of the COVID-19 pandemic and measured content and sentiment based on the tweets that they shared. Methods: We used Quorum (Quorum Analytics Inc) to access more than 300,000 tweets posted by US legislators from January 1 to October 10, 2020. We used differential language analyses to compare the content and sentiment of tweets posted by legislators based on their party affiliation. Results: We found that health care–related themes in Democratic legislators’ tweets focused on racial disparities in care (odds ratio [OR] 2.24, 95% CI 2.22-2.27; P<.001), health care and insurance (OR 1.74, 95% CI 1.7-1.77; P<.001), COVID-19 testing (OR 1.15, 95% CI 1.12-1.19; P<.001), and public health guidelines (OR 1.25, 95% CI 1.22-1.29; P<.001). The dominant themes in the Republican legislators’ discourse included vaccine development (OR 1.51, 95% CI 1.47-1.55; P<.001) and hospital resources and equipment (OR 1.22, 95% CI 1.18-1.25). Nonhealth care–related topics associated with a Democratic affiliation included protections for essential workers (OR 1.55, 95% CI 1.52-1.59), the 2020 election and voting (OR 1.31, 95% CI 1.27-1.35), unemployment and housing (OR 1.27, 95% CI 1.24-1.31), crime and racism (OR 1.22, 95% CI 1.18-1.26), public town halls (OR 1.2, 95% CI 1.16-1.23), the Trump Administration (OR 1.22, 95% CI 1.19-1.26), immigration (OR 1.16, 95% CI 1.12-1.19), and the loss of life (OR 1.38, 95% CI 1.35-1.42). The themes associated with the Republican affiliation included China (OR 1.89, 95% CI 1.85-1.92), small business assistance (OR 1.27, 95% CI 1.23-1.3), congressional relief bills (OR 1.23, 95% CI 1.2-1.27), press briefings (OR 1.22, 95% CI 1.19-1.26), and economic recovery (OR 1.2, 95% CI 1.16-1.23). Conclusions: Divergent language use on social media corresponds to the partisan divide in the first several months of the course of the COVID-19 public health crisis. %M 33939620 %R 10.2196/27300 %U https://www.jmir.org/2021/6/e27300 %U https://doi.org/10.2196/27300 %U http://www.ncbi.nlm.nih.gov/pubmed/33939620 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e28265 %T Correlation of Population SARS-CoV-2 Cycle Threshold Values to Local Disease Dynamics: Exploratory Observational Study %A Tso,Chak Foon %A Garikipati,Anurag %A Green-Saxena,Abigail %A Mao,Qingqing %A Das,Ritankar %+ Dascena, Inc, 12333 Sowden Rd, Ste B, Private Mailbox 65148, Houston, TX, 77080-2059, United States, 1 826 9508, qmao@dascena.com %K reverse transcription polymerase chain reaction %K testing %K cycle threshold %K COVID-19 %K epidemiology %K Rt %K exploratory %K correlation %K population %K threshold %K disease dynamic %K distribution %K transmission %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Despite the limitations in the use of cycle threshold (CT) values for individual patient care, population distributions of CT values may be useful indicators of local outbreaks. Objective: We aimed to conduct an exploratory analysis of potential correlations between the population distribution of cycle threshold (CT) values and COVID-19 dynamics, which were operationalized as percent positivity, transmission rate (Rt), and COVID-19 hospitalization count. Methods: In total, 148,410 specimens collected between September 15, 2020, and January 11, 2021, from the greater El Paso area were processed in the Dascena COVID-19 Laboratory. The daily median CT value, daily Rt, daily count of COVID-19 hospitalizations, daily change in percent positivity, and rolling averages of these features were plotted over time. Two-way scatterplots and linear regression were used to evaluate possible associations between daily median CT values and outbreak measures. Cross-correlation plots were used to determine whether a time delay existed between changes in daily median CT values and measures of community disease dynamics. Results: Daily median CT values negatively correlated with the daily Rt values (P<.001), the daily COVID-19 hospitalization counts (with a 33-day time delay; P<.001), and the daily changes in percent positivity among testing samples (P<.001). Despite visual trends suggesting time delays in the plots for median CT values and outbreak measures, a statistically significant delay was only detected between changes in median CT values and COVID-19 hospitalization counts (P<.001). Conclusions: This study adds to the literature by analyzing samples collected from an entire geographical area and contextualizing the results with other research investigating population CT values. %M 33999831 %R 10.2196/28265 %U https://publichealth.jmir.org/2021/6/e28265 %U https://doi.org/10.2196/28265 %U http://www.ncbi.nlm.nih.gov/pubmed/33999831 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e25876 %T Gender Differences in State Anxiety Related to Daily Function Among Older Adults During the COVID-19 Pandemic: Questionnaire Study %A Rosenblum,Sara %A Cohen Elimelech,Ortal %+ The Laboratory of Complex Human Activity and Participation, Department of Occupational Therapy, University of Haifa, Mount Carmel, Haifa, 31905, Israel, 972 4 8240474, rosens@research.haifa.ac.il %K COVID-19 %K coronavirus %K anxiety %K cognition %K aging %K eHealth %K online data %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Aging %G English %X Background: The COVID-19 pandemic poses a challenge to people’s day-to-day functioning and emotional and physical health, especially among older adults. Objective: The aim of this study is to analyze gender differences in state anxiety, daily functional self-actualization, and functional cognition as well as the relationships among those factors in older adults during the COVID-19 pandemic lockdown. Methods: We collected data on the web from a sample of 204 people (102 men and 102 women) aged 60 years and older. In addition to a demographic questionnaire, we used the State-Trait Personality Inventory to assess state anxiety, the Daily Functional Actualization questionnaire to evaluate daily functional self-actualization, and the Daily Living Questionnaire to measure functional cognition. Results: Significant gender differences were found for state anxiety (t202=−2.36, P=.02); daily functional self-actualization (t202=2.15, P=.03); and the functional cognition components: complex tasks (Z=−3.07, P=.002); cognitive symptoms that might be interfering (Z=−2.15, P=.028); executive functions (Z=−2.21, P=.024); and executive function monitoring (Z=−2.21, P=.027). Significant medium correlations were found between both state anxiety level and daily functional self-actualization (r=−0.62, P<.001) and functional cognition (r=0.37-0.40, P<.001). Gender predicted 3% of the variance in state anxiety level, while daily functional self-actualization predicted 41% and complex activities (Daily Living Questionnaire) predicted an additional 3% (F3,200=58.01, P<.001). Conclusions: In older adults, anxiety is associated with cognitive decline, which may harm daily functional abilities and lead to social isolation, loneliness, and decreased well-being. Self-awareness and knowledge of gender differences and relationships between common available resources of daily functional self-actualization and functional cognition with anxiety may be strengthening factors in crisis periods such as the COVID-19 pandemic. %M 33939623 %R 10.2196/25876 %U https://aging.jmir.org/2021/2/e25876 %U https://doi.org/10.2196/25876 %U http://www.ncbi.nlm.nih.gov/pubmed/33939623 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e27189 %T The Effect of Test Timing on the Probability of Positive SARS-CoV-2 Swab Test Results: Mixed Model Approach %A Benoni,Roberto %A Panunzi,Silvia %A Campagna,Irene %A Moretti,Francesca %A Lo Cascio,Giuliana %A Spiteri,Gianluca %A Porru,Stefano %A Tardivo,Stefano %+ Postgraduate School of Hygiene and Preventive Medicine, University of Verona, Strada Le Grazie, 8, Verona, 37134, Italy, 39 0458027659, roberto.benoni90@gmail.com %K close contact %K COVID-19 %K health care workers %K health surveillance %K swab test timing %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 34003761 %R 10.2196/27189 %U https://publichealth.jmir.org/2021/6/e27189 %U https://doi.org/10.2196/27189 %U http://www.ncbi.nlm.nih.gov/pubmed/34003761 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 6 %P e28497 %T Using Electronic Health Records to Mitigate Workplace Burnout Among Clinicians During the COVID-19 Pandemic: Field Study in Iran %A Esmaeilzadeh,Pouyan %A Mirzaei,Tala %+ Department of Information Systems and Business Analytics, College of Business, Florida International University, Modesto A Maidique Campus 11200 SW 8th St, RB 261 B, Miami, FL, 33199, United States, 1 3053483302, pesmaeil@fiu.edu %K COVID-19 %K pandemic %K clinician burnout %K electronic health record %K health information technologies %K hospital intervention %D 2021 %7 3.6.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic spread worldwide in 2020. Notably, in the countries dealing with massive casualties, clinicians have worked in new conditions characterized by a heavy workload and a high risk of being infected. The issue of clinician burnout during the pandemic has attracted considerable attention in health care research. Electronic health records (EHRs) provide health care workers with several features to meet a health system’s clinical needs. Objective: We aim to examine how the use of EHR features affects the burnout of clinicians working in hospitals that have special wards for confirmed COVID-19 cases. Methods: Using an online survey, we collected data from 368 physicians, physician assistants, and nurses working in six hospitals that have implemented EHRs in the city of Tehran in Iran. We used logistic regression to assess the association between burnout and awareness of EHR features, EHR system usability, concerns about COVID-19, technology solutions, hospital technology interventions, hospital preparedness, and professional efficacy adjusted for demographic and practice characteristics. Results: The primary outcome of our study was self-reported burnout during the COVID-19 pandemic. Of the 368 respondents, 36% (n=134) reported having at least one symptom of burnout. Participants indicated that the leading cause of EHR-related stress is inadequate training for using technology (n=159, 43%), followed by having less face-to-face time with patients (n=140, 38%). Positive perceptions about the EHR’s ease of use were associated with lower odds of burnout symptoms. More interventions, such as clear communication of regulations; transparency in policies, expectations, and goals regarding the use of technology in the clinical workflow; and hospital preparedness to cope with the challenges of the pandemic, were associated with lower odds of burnout. Conclusions: The use of EHR applications, hospital pandemic preparation programs, and transparent technology-related policies and procedures throughout the epidemic can be substantial mitigators of technology-based stress and clinician burnout. Hospitals will then be better positioned to devise or modify technology-related policies and procedures to support physicians’ and nurses’ well-being during the COVID-19 pandemic. Training programs, transparency in communications of regulations, and developing a clear channel for informing clinicians of changes in policies may help reduce burnout symptoms among physicians and nurses during a pandemic. Providing easily accessible mentorship through teleconsultation and 24-hour available information technology support may also help to mitigate the odds of burnout. %M 34033578 %R 10.2196/28497 %U https://medinform.jmir.org/2021/6/e28497 %U https://doi.org/10.2196/28497 %U http://www.ncbi.nlm.nih.gov/pubmed/34033578 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e28253 %T Quantifying Online News Media Coverage of the COVID-19 Pandemic: Text Mining Study and Resource %A Krawczyk,Konrad %A Chelkowski,Tadeusz %A Laydon,Daniel J %A Mishra,Swapnil %A Xifara,Denise %A Gibert,Benjamin %A Flaxman,Seth %A Mellan,Thomas %A Schwämmle,Veit %A Röttger,Richard %A Hadsund,Johannes T %A Bhatt,Samir %+ Department of Mathematics and Computer Science, University of Southern Denmark, Campusvej 55, Odense, DK-5230, Denmark, 45 6550 2387, konradk@imada.sdu.dk %K text mining %K COVID-19 %K infoveillance %K sentiment analysis %K public health %D 2021 %7 2.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Before the advent of an effective vaccine, nonpharmaceutical interventions, such as mask-wearing, social distancing, and lockdowns, have been the primary measures to combat the COVID-19 pandemic. Such measures are highly effective when there is high population-wide adherence, which requires information on current risks posed by the pandemic alongside a clear exposition of the rules and guidelines in place. Objective: Here we analyzed online news media coverage of COVID-19. We quantified the total volume of COVID-19 articles, their sentiment polarization, and leading subtopics to act as a reference to inform future communication strategies. Methods: We collected 26 million news articles from the front pages of 172 major online news sources in 11 countries (available online at SciRide). Using topic detection, we identified COVID-19–related content to quantify the proportion of total coverage the pandemic received in 2020. The sentiment analysis tool Vader was employed to stratify the emotional polarity of COVID-19 reporting. Further topic detection and sentiment analysis was performed on COVID-19 coverage to reveal the leading themes in pandemic reporting and their respective emotional polarizations. Results: We found that COVID-19 coverage accounted for approximately 25.3% of all front-page online news articles between January and October 2020. Sentiment analysis of English-language sources revealed that overall COVID-19 coverage was not exclusively negatively polarized, suggesting wide heterogeneous reporting of the pandemic. Within this heterogenous coverage, 16% of COVID-19 news articles (or 4% of all English-language articles) can be classified as highly negatively polarized, citing issues such as death, fear, or crisis. Conclusions: The goal of COVID-19 public health communication is to increase understanding of distancing rules and to maximize the impact of governmental policy. The extent to which the quantity and quality of information from different communication channels (eg, social media, government pages, and news) influence public understanding of public health measures remains to be established. Here we conclude that a quarter of all reporting in 2020 covered COVID-19, which is indicative of information overload. In this capacity, our data and analysis form a quantitative basis for informing health communication strategies along traditional news media channels to minimize the risks of COVID-19 while vaccination is rolled out. %M 33900934 %R 10.2196/28253 %U https://www.jmir.org/2021/6/e28253 %U https://doi.org/10.2196/28253 %U http://www.ncbi.nlm.nih.gov/pubmed/33900934 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e27989 %T Quality and Adoption of COVID-19 Tracing Apps and Recommendations for Development: Systematic Interdisciplinary Review of European Apps %A Kahnbach,Leonie %A Lehr,Dirk %A Brandenburger,Jessica %A Mallwitz,Tim %A Jent,Sophie %A Hannibal,Sandy %A Funk,Burkhardt %A Janneck,Monique %+ Department of Health Psychology and Applied Biological Psychology, Leuphana University of Lüneburg, Universitätsallee 1, C1.120, Lüneburg, 21335, Germany, 49 4131 677 2720, lehr@leuphana.de %K COVID-19 %K contact tracing %K app-based tracing %K Mobile App Rating Scale %K user engagement %K human–computer interaction %D 2021 %7 2.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Simulation study results suggest that COVID-19 contact tracing apps have the potential to achieve pandemic control. Concordantly, high app adoption rates were a stipulated prerequisite for success. Early studies on potential adoption were encouraging. Several factors predicting adoption rates were investigated, especially pertaining to user characteristics. Since then, several countries have released COVID-19 contact tracing apps. Objective: This study’s primary aim is to investigate the quality characteristics of national European COVID-19 contact tracing apps, thereby shifting attention from user to app characteristics. The secondary aim is to investigate associations between app quality and adoption. Finally, app features contributing to higher app quality were identified. Methods: Eligible COVID-19 contact tracing apps were those released by national health authorities of European Union member states, former member states, and countries of the European Free Trade Association, all countries with comparable legal standards concerning personal data protection and app use voluntariness. The Mobile App Rating Scale was used to assess app quality. An interdisciplinary team, consisting of two health and two human–computer interaction scientists, independently conducted Mobile App Rating Scale ratings. To investigate associations between app quality and adoption rates and infection rates, Bayesian linear regression analyses were conducted. Results: We discovered 21 national COVID-19 contact tracing apps, all demonstrating high quality overall and high-level functionality, aesthetics, and information quality. However, the average app adoption rate of 22.9% (SD 12.5%) was below the level recommended by simulation studies. Lower levels of engagement-oriented app design were detected, with substantial variations between apps. By regression analyses, the best-case adoption rate was calculated by assuming apps achieve the highest ratings. The mean best-case adoption rates for engagement and overall app quality were 39.5% and 43.6%, respectively. Higher adoption rates were associated with lower cumulative infection rates. Overall, we identified 5 feature categories (symptom assessment and monitoring, regularly updated information, individualization, tracing, and communication) and 14 individual features that contributed to higher app quality. These 14 features were a symptom checker, a symptom diary, statistics on COVID-19, app use, public health instructions and restrictions, information of burden on health care system, assigning personal data, regional updates, control over tracing activity, contact diary, venue check-in, chats, helplines, and app-sharing capacity. Conclusions: European national health authorities have generally released high quality COVID-19 contact tracing apps, with regard to functionality, aesthetics, and information quality. However, the app’s engagement-oriented design generally was of lower quality, even though regression analyses results identify engagement as a promising optimization target to increase adoption rates. Associations between higher app adoption and lower infection rates are consistent with simulation study results, albeit acknowledging that app use might be part of a broader set of protective attitudes and behaviors for self and others. Various features were identified that could guide further engagement-enhancing app development. %M 33890867 %R 10.2196/27989 %U https://www.jmir.org/2021/6/e27989 %U https://doi.org/10.2196/27989 %U http://www.ncbi.nlm.nih.gov/pubmed/33890867 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e27917 %T Impact of Public Health and Social Measures on the COVID-19 Pandemic in the United States and Other Countries: Descriptive Analysis %A Zweig,Sophia Alison %A Zapf,Alexander John %A Xu,Hanmeng %A Li,Qingfeng %A Agarwal,Smisha %A Labrique,Alain Bernard %A Peters,David H %+ Department of Epidemiology, Johns Hopkins University Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21202, United States, 1 9175749743, szweig3@jh.edu %K surveillance %K COVID-19 %K public health %K health policy %K global health %K policy %K epidemiology %K descriptive epidemiology %D 2021 %7 2.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The United States of America has the highest global number of COVID-19 cases and deaths, which may be due in part to delays and inconsistencies in implementing public health and social measures (PHSMs). Objective: In this descriptive analysis, we analyzed the epidemiological evidence for the impact of PHSMs on COVID-19 transmission in the United States and compared these data to those for 10 other countries of varying income levels, population sizes, and geographies. Methods: We compared PHSM implementation timing and stringency against COVID-19 daily case counts in the United States and against those in Canada, China, Ethiopia, Japan, Kazakhstan, New Zealand, Singapore, South Korea, Vietnam, and Zimbabwe from January 1 to November 25, 2020. We descriptively analyzed the impact of border closures, contact tracing, household confinement, mandated face masks, quarantine and isolation, school closures, limited gatherings, and states of emergency on COVID-19 case counts. We also compared the relationship between global socioeconomic indicators and national pandemic trajectories across the 11 countries. PHSMs and case count data were derived from various surveillance systems, including the Health Intervention Tracking for COVID-19 database, the World Health Organization PHSM database, and the European Centre for Disease Prevention and Control. Results: Implementing a specific package of 4 PHSMs (quarantine and isolation, school closures, household confinement, and the limiting of social gatherings) early and stringently was observed to coincide with lower case counts and transmission durations in Vietnam, Zimbabwe, New Zealand, South Korea, Ethiopia, and Kazakhstan. In contrast, the United States implemented few PHSMs stringently or early and did not use this successful package. Across the 11 countries, national income positively correlated (r=0.624) with cumulative COVID-19 incidence. Conclusions: Our findings suggest that early implementation, consistent execution, adequate duration, and high adherence to PHSMs represent key factors of reducing the spread of COVID-19. Although national income may be related to COVID-19 progression, a country’s wealth appears to be less important in controlling the pandemic and more important in taking rapid, centralized, and consistent public health action. %M 33975277 %R 10.2196/27917 %U https://publichealth.jmir.org/2021/6/e27917 %U https://doi.org/10.2196/27917 %U http://www.ncbi.nlm.nih.gov/pubmed/33975277 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e27185 %T Acceptability of Research and Health Care Visits During the COVID-19 Pandemic: Cross-sectional Survey Study %A Ross,Kathryn M %A Hong,Young-Rock %A Krukowski,Rebecca A %A Miller,Darci R %A Lemas,Dominick J %A Cardel,Michelle I %+ Department of Clinical and Health Psychology, College of Public Health and Health Professions, University of Florida, PO Box 10065, Gainesville, FL, 32610, United States, 1 3522948433, kmross@phhp.ufl.edu %K COVID-19 %K health care access %K telehealth %K research recruitment %K telemedicine %K belief %K access %K willingness %K cross-sectional %K survey %D 2021 %7 2.6.2021 %9 Short Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has had a widespread impact on attendance in biomedical research and health care visits. Objective: This study aimed to identify when and how American adults might feel comfortable about resuming in-person research and health care visits. Methods: Cross-sectional questionnaire data were collected from 135 adults (age: median 48 years; women: n=113, 83.7%; White participants: n=92, 68.2%) who were engaged in health-related research. Results: More than half of the respondents (65/122, 53.3%) felt that the COVID-19 pandemic positively affected their desire to participate in research. Although 73.6% (95/129) of respondents also indicated a willingness to attend in-person health care visits while Centers for Disease Control and Prevention (CDC) guidelines are implemented, 85.8% (109/127) indicated a willingness to attend in-person, outdoor visits, and 92.2% (118/128) reported a willingness to attend drive-through visits (with CDC guidelines implemented during both visit types). Videoconferencing was the most preferred format for intervention visits; however, adults over the age of 65 years preferred this format less than younger adults (P=.001). Conclusions: Researchers and clinicians should continue to provide opportunities for continuing the conduction of remote-based interventions while enforcing CDC guidelines during in-person visits. %M 34033577 %R 10.2196/27185 %U https://formative.jmir.org/2021/6/e27185 %U https://doi.org/10.2196/27185 %U http://www.ncbi.nlm.nih.gov/pubmed/34033577 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e27590 %T Epidemiology of Diphtheria in Yemen, 2017-2018: Surveillance Data Analysis %A Moghalles,Suaad Ameen %A Aboasba,Basher Ahmed %A Alamad,Mohammed Abdullah %A Khader,Yousef Saleh %+ Yemen Field Epidemiology Training Programme, Ministry of Public Health and Population, Hadh Street, Sana'a, 00967, Yemen, 967 735 800 572, smughalles@gmail.com %K diphtheria %K epidemiology %K incidence %K case fatality rate %D 2021 %7 2.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As a consequence of war and the collapse of the health system in Yemen, which prevented many people from accessing health facilities to obtain primary health care, vaccination coverage was affected, leading to a deadly diphtheria epidemic at the end of 2017. Objective: This study aimed to describe the epidemiology of diphtheria in Yemen and determine its incidence and case fatality rate. Methods: Data were obtained from the diphtheria surveillance program 2017-2018, using case definitions of the World Health Organization. A probable case was defined as a case involving a person having laryngitis, pharyngitis, or tonsillitis and an adherent membrane of the tonsils, pharynx, and/or nose. A confirmed case was defined as a probable case that was laboratory confirmed or linked epidemiologically to a laboratory-confirmed case. Data from the Central Statistical Organization was used to calculate the incidence per 100,000 population. A P value <.05 was considered significant. Results: A total of 2243 cases were reported during the period between July 2017 and August 2018. About 49% (1090/2243, 48.6%) of the cases were males. About 44% (978/2243, 43.6%) of the cases involved children aged 5 to 15 years. Respiratory tract infection was the predominant symptom (2044/2243, 91.1%), followed by pseudomembrane (1822/2243, 81.2%). Based on the vaccination status, the percentages of partially vaccinated, vaccinated, unvaccinated, and unknown status patients were 6.6% (148/2243), 30.8% (690/2243), 48.6% (10902243), and 14.0% (315/2243), respectively. The overall incidence of diphtheria was 8 per 100,000 population. The highest incidence was among the age group <15 years (11 per 100,000 population), and the lowest incidence was among the age group ≥15 years (5 per 100,000 population). The overall case fatality rate among all age groups was 5%, and it was higher (10%) in the age group <5 years. Five governorates that were difficult to access (Raymah, Abyan, Sa'ada, Lahj, and Al Jawf) had a very high case fatality rate (22%). Conclusions: Diphtheria affected a large number of people in Yemen in 2017-2018. The majority of patients were partially or not vaccinated. Children aged ≤15 years were more affected, with higher fatality among children aged <5 years. Five governorates that were difficult to access had a case fatality rate twice that of the World Health Organization estimate (5%-10%). To control the diphtheria epidemic in Yemen, it is recommended to increase routine vaccination coverage and booster immunizations, increase public health awareness toward diphtheria, and strengthen the surveillance system for early detection and immediate response. %M 34076583 %R 10.2196/27590 %U https://publichealth.jmir.org/2021/6/e27590 %U https://doi.org/10.2196/27590 %U http://www.ncbi.nlm.nih.gov/pubmed/34076583 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 6 %P e26385 %T Interests, Motives, and Psychological Burdens in Times of Crisis and Lockdown: Google Trends Analysis to Inform Policy Makers %A Rotter,Dominik %A Doebler,Philipp %A Schmitz,Florian %+ Department of Psychology, University of Duisburg-Essen, Universitätsstraße 2, Essen, 45141, Germany, 49 201 183 2173, dominik.rotter@uni-due.de %K coronavirus %K Google Trends %K infodemiology %K infoveillance %K pandemic %K information search %K trend %K COVID-19 %K burden %K mental health %K policy %K online health information %D 2021 %7 1.6.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In the face of the COVID-19 pandemic, the German government and the 16 German federal states implemented a variety of nonpharmaceutical interventions (NPIs) to decelerate the spread of the SARS-CoV-2 virus and thus prevent a collapse of the health care system. These measures comprised, among others, social distancing, the temporary closure of shops and schools, and a ban of large public gatherings and meetings with people not living in the same household. Objective: It is fair to assume that the issued NPIs have heavily affected social life and psychological functioning. We therefore aimed to examine possible effects of this lockdown in conjunction with daily new infections and the state of the national economy on people’s interests, motives, and other psychological states. Methods: We derived 249 keywords from the Google Trends database, tapping into 27 empirically and rationally selected psychological domains. To overcome issues with reliability and specificity of individual indicator variables, broad factors were derived by means of time series factor analysis. All domains were subjected to a change point analysis and time series regression analysis with infection rates, NPIs, and the state of the economy as predictors. All keywords and analyses were preregistered prior to analysis. Results: With the pandemic arriving in Germany, significant increases in people’s search interests were observed in virtually all domains. Although most of the changes were short-lasting, each had a distinguishable onset during the lockdown period. Regression analysis of the Google Trends data confirmed pronounced autoregressive effects for the investigated variables, while forecasting by means of the tested predictors (ie, daily new infections, NPIs, and the state of economy) was moderate at best. Conclusions: Our findings indicate that people’s interests, motives, and psychological states are heavily affected in times of crisis and lockdown. Specifically, disease- and virus-related domains (eg, pandemic disease, symptoms) peaked early, whereas personal health strategies (eg, masks, homeschooling) peaked later during the lockdown. Domains addressing social life and psychosocial functioning showed long-term increases in public interest. Renovation was the only domain to show a decrease in search interest with the onset of the lockdown. As changes in search behavior are consistent over multiple domains, a Google Trends analysis may provide information for policy makers on how to adapt and develop intervention, information, and prevention strategies, especially when NPIs are in effect. %M 33999837 %R 10.2196/26385 %U https://www.jmir.org/2021/6/e26385 %U https://doi.org/10.2196/26385 %U http://www.ncbi.nlm.nih.gov/pubmed/33999837 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 6 %P e26463 %T Physicians’ Perspectives of Telemedicine During the COVID-19 Pandemic in China: Qualitative Survey Study %A Liu,Jialin %A Liu,Siru %A Zheng,Tao %A Bi,Yongdong %+ Department of Medical Informatics, West China Hospital, Sichuan University, No.37 Guoxuexiang street, Chengdu, 610041, China, 86 2885422306, dljl8@163.com %K telemedicine %K COVID-19 %K survey %K physician %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Generalized restriction of movement due to the COVID-19 pandemic, together with unprecedented pressure on the health system, has disrupted routine care for non–COVID-19 patients. Telemedicine should be vigorously promoted to reduce the risk of infections and to offer medical assistance to restricted patients. Objective: The purpose of this study was to understand physicians’ attitudes toward and perspectives of telemedicine during and after the COVID-19 pandemic, in order to provide support for better implementation of telemedicine. Methods: We surveyed all physicians (N=148), from October 17 to 25, 2020, who attended the clinical informatics PhD program at West China Medical School, Sichuan University, China. The physicians came from 57 hospitals in 16 provinces (ie, municipalities) across China, 54 of which are 3A-level hospitals, two are 3B-level hospitals, and one is a 2A-level hospital. Results: Among 148 physicians, a survey response rate of 87.2% (129/148) was attained. The average age of the respondents was 35.6 (SD 3.9) years (range 23-48 years) and 67 out of 129 respondents (51.9%) were female. The respondents come from 37 clinical specialties in 55 hospitals located in 14 provinces (ie, municipalities) across Eastern, Central, and Western China. A total of 94.6% (122/129) of respondents’ hospitals had adopted a telemedicine system; however, 34.1% (44/129) of the physicians had never used a telemedicine system and only 9.3% (12/129) used one frequently (≥1 time/week). A total of 91.5% (118/129) and 88.4% (114/129) of physicians were willing to use telemedicine during and after the COVID-19 pandemic, respectively. Physicians considered the inability to examine patients in person to be the biggest concern (101/129, 78.3%) and the biggest barrier (76/129, 58.9%) to implementing telemedicine. Conclusions: Telemedicine is not yet universally available for all health care needs and has not been used frequently by physicians in this study. However, the willingness of physicians to use telemedicine was high. Telemedicine still has many problems to overcome. %M 33945493 %R 10.2196/26463 %U https://medinform.jmir.org/2021/6/e26463 %U https://doi.org/10.2196/26463 %U http://www.ncbi.nlm.nih.gov/pubmed/33945493 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 6 %P e26784 %T Risk Assessment of Importation and Local Transmission of COVID-19 in South Korea: Statistical Modeling Approach %A Lee,Hyojung %A Kim,Yeahwon %A Kim,Eunsu %A ‍Lee,Sunmi %+ Kyung Hee University, 1732 Deogyeong-daero, Giheung-gu, Yongin-si, 17104, Republic of Korea, 82 312012409, sunmilee@khu.ac.kr %K COVID-19 %K transmission dynamics %K South Korea %K international travels %K imported and local transmission %K basic reproduction number %K effective reproduction number %K mitigation intervention strategies %K risk %K assessment %K transmission %K mitigation %K strategy %K travel %K mobility %K spread %K intervention %K diagnosis %K monitoring %K testing %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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 α=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. %M 33819165 %R 10.2196/26784 %U https://publichealth.jmir.org/2021/6/e26784 %U https://doi.org/10.2196/26784 %U http://www.ncbi.nlm.nih.gov/pubmed/33819165 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 6 %P e23630 %T Health Perceptions and Adopted Lifestyle Behaviors During the COVID-19 Pandemic: Cross-National Survey %A Manjunath,Nandi Krishnamurthy %A Majumdar,Vijaya %A Rozzi,Antonietta %A Huiru,Wang %A Mishra,Avinash %A Kimura,Keishin %A Nagarathna,Raghuram %A Nagendra,Hongasandra Ramarao %+ Swami Vivekananda Yoga Anusandhana Samsthana University, #19, Eknath Bhavan, Gavipuram Circle, KG Naga, Bengaluru, 560019, India, 91 08026995163, vijaya.majumdar@svyasa.edu.in %K health behavior %K self-report %K cross-national survey %K COVID-19 %K behavior %K perception %K lifestyle %K nutrition %K real-time %D 2021 %7 1.6.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Social isolation measures are requisites to control viral spread during the COVID-19 pandemic. However, if these measures are implemented for a long period of time, they can result in adverse modification of people’s health perceptions and lifestyle behaviors. Objective: The aim of this cross-national survey was to address the lack of adequate real-time data on the public response to changes in lifestyle behavior during the crisis of the COVID-19 pandemic. Methods: A cross-national web-based survey was administered using Google Forms during the month of April 2020. The settings were China, Japan, Italy, and India. There were two primary outcomes: (1) response to the health scale, defined as perceived health status, a combined score of health-related survey items; and (2) adoption of healthy lifestyle choices, defined as the engagement of the respondent in any two of three healthy lifestyle choices (healthy eating habits, engagement in physical activity or exercise, and reduced substance use). Statistical associations were assessed with linear and logistic regression analyses. Results: We received 3371 responses; 1342 were from India (39.8%), 983 from China (29.2%), 669 from Italy (19.8%), and 377 (11.2%) from Japan. A differential countrywise response was observed toward perceived health status; the highest scores were obtained for Indian respondents (9.43, SD 2.43), and the lowest were obtained for Japanese respondents (6.81, SD 3.44). Similarly, countrywise differences in the magnitude of the influence of perceptions on health status were observed; perception of interpersonal relationships was most pronounced in the comparatively old Italian and Japanese respondents (β=.68 and .60, respectively), and the fear response was most pronounced in Chinese respondents (β=.71). Overall, 78.4% of the respondents adopted at least two healthy lifestyle choices amid the COVID-19 pandemic. Unlike health status, the influence of perception of interpersonal relationships on the adoption of lifestyle choices was not unanimous, and it was absent in the Italian respondents (odds ratio 1.93, 95% CI 0.65-5.79). The influence of perceived health status was a significant predictor of lifestyle change across all the countries, most prominently by approximately 6-fold in China and Italy. Conclusions: The overall consistent positive influence of increased interpersonal relationships on health perceptions and adopted lifestyle behaviors during the pandemic is the key real-time finding of the survey. Favorable behavioral changes should be bolstered through regular virtual interpersonal interactions, particularly in countries with an overall middle-aged or older population. Further, controlling the fear response of the public through counseling could also help improve health perceptions and lifestyle behavior. However, the observed human behavior needs to be viewed within the purview of cultural disparities, self-perceptions, demographic variances, and the influence of countrywise phase variations of the pandemic. The observations derived from a short lockdown period are preliminary, and real insight could only be obtained from a longer follow-up. %M 33900928 %R 10.2196/23630 %U https://formative.jmir.org/2021/6/e23630 %U https://doi.org/10.2196/23630 %U http://www.ncbi.nlm.nih.gov/pubmed/33900928 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e28961 %T Factors Influencing the Adoption of Contact Tracing Applications: Protocol for a Systematic Review %A Oyibo,Kiemute %A Sahu,Kirti Sundar %A Oetomo,Arlene %A Morita,Plinio Pelegrini %+ School of Public Health Sciences, Faculty of Health, University of Waterloo, 200 University Avenue West, Waterloo, ON, N2L 3G1, Canada, 1 5198884567 ext 41372, plinio.morita@uwaterloo.ca %K contact tracing app %K technology acceptance %K user perception %K adoption %K COVID-19 %K review %K perception %K barrier %K challenge %K effective %K usability %D 2021 %7 1.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Following the onset of the COVID-19 pandemic, digital contact tracing apps have become prevalent worldwide in a coordinated effort to curb the spread of COVID-19. However, their uptake has been low and slow due to privacy concerns, the lack of trust and motivational affordances, and their minimalist design. Objective: The objective of this article is to present a protocol for a systematic review of the main factors, including facilitators and barriers, that influence the adoption of contact tracing apps. Methods: We searched seven databases, namely, Scopus, CINAHL, PubMed (MEDLINE), IEEE Xplore Digital Library, Association for Computing Machinery (ACM) Digital Library, Web of Science, and Google Scholar, for relevant publications between October 30, 2020, and January 31, 2021. Three authors were involved in removing duplicates, screening, and selection of relevant articles according to the PRISMA-P (Preferred Reporting Items for Systematic Review and Meta-analysis Protocols) guidelines. Results: Altogether, we retrieved 777 articles from the seven databases. As of May 14, 2021, we have completed the screening process and arrived at 13 eligible articles to be included in the systematic review. We hope to elicit, summarize, and report the main findings in the systematic review article by the end of August 2021. We expect to uncover facilitators and barriers related to app utility, data security, ease of use, and persuasive design that are deemed important to adoption of contact tracing apps. Conclusions: The findings of the systematic review will help researchers to uncover the gaps in the adoption of contact tracing apps, and decision makers and designers to focus on the principal adoption factors necessary to create better and more effective contact tracing apps. International Registered Report Identifier (IRRID): DERR1-10.2196/28961 %M 33974551 %R 10.2196/28961 %U https://www.researchprotocols.org/2021/6/e28961 %U https://doi.org/10.2196/28961 %U http://www.ncbi.nlm.nih.gov/pubmed/33974551 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 6 %P e25271 %T The GIMEMA-ALLIANCE Digital Health Platform for Patients With Hematologic Malignancies in the COVID-19 Pandemic and Postpandemic Era: Protocol for a Multicenter, Prospective, Observational Study %A Efficace,Fabio %A Breccia,Massimo %A Fazi,Paola %A Cottone,Francesco %A Holzner,Bernhard %A Vignetti,Marco %+ Data Center and Health Outcomes Research Unit, Italian Group for Adult Haematologic Diseases (GIMEMA), via Casilina 5, Rome, 00182, Italy, 39 06441639831, f.efficace@gimema.it %K digital health %K hematology %K leukemia %K lymphoma %K multiple myeloma %K patient-reported outcomes %K quality of life %K symptoms %K COVID-19 %D 2021 %7 1.6.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has raised unprecedented challenges in the management of patients with cancer and has increased the demands for digital health tools that, for example, could facilitate remote monitoring of patients. Based on this, the Gruppo Italiano Malattie Ematologiche dell’Adulto (GIMEMA) has recently developed a digital health tool dedicated to patients with hematologic malignancies: the GIMEMA-ALLIANCE platform. Objective: The main objectives of this web-based platform are to generate relevant data to better understand quality of life, symptoms, and medication adherence during the COVID-19 pandemic and postpandemic era; to develop a prospective real-life registry on outcomes of patients with hematologic cancer, with or without a diagnosis of COVID-19; and to facilitate patient-centered care in routine practice. Methods: The platform consists of physician- and patient-secure portals and enables electronic patient-reported outcome (ePRO) assessments with real-time graphical presentation to physicians of individual patient symptoms and quality-of-life outcomes. Automated alerts are sent to treating hematologists based on the following predetermined criteria: presence of clinically important problems and symptoms, problems with adherence to therapy, and risk of COVID-19 diagnosis. The platform also allows physicians to set up video consultations. Clinical information regarding disease and treatment as well as clinical and survival outcomes are also prospectively collected. Results: Recruitment of participants started in December 2020. As of April 2021, a total of 116 patients have been enrolled in this study. Use of this platform may help to improve patient-physician communication and help hematologists in the early recognition of clinically important problems and symptoms of their patients. More than 20 community and university-based hospitals have currently agreed to participate. In addition to patient-reported outcome data, the prospective collection of disease- and treatment-related information, as well as data on possible COVID-19 diagnosis and COVID-19 vaccination, will allow the development of a large database to also identify subgroups of patients at risk of poor outcomes. Conclusions: Data generated via this platform will help to answer clinically relevant questions for patients with hematologic malignancies during the COVID-19 pandemic and postpandemic era. The use of the GIMEMA-ALLIANCE platform in routine practice may also contribute to enhancing patient-centered care. Trial Registration: ClinicalTrials.gov NCT04581187; https://clinicaltrials.gov/ct2/show/NCT04581187 International Registered Report Identifier (IRRID): PRR1-10.2196/25271 %M 33890580 %R 10.2196/25271 %U https://www.researchprotocols.org/2021/6/e25271 %U https://doi.org/10.2196/25271 %U http://www.ncbi.nlm.nih.gov/pubmed/33890580 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26282 %T Perceptions of Mobile Health Apps and Features to Support Psychosocial Well-being Among Frontline Health Care Workers Involved in the COVID-19 Pandemic Response: Qualitative Study %A Yoon,Sungwon %A Goh,Hendra %A Nadarajan,Gayathri Devi %A Sung,Sharon %A Teo,Irene %A Lee,Jungup %A Ong,Marcus E H %A Graves,Nicholas %A Teo,Tess Lin %+ Health Services and Systems Research, Duke-NUS Medical School, 8 College Rd, Singapore 169857, Singapore, , Singapore, 65 66013198, sungwon.yoon@duke-nus.edu.sg %K COVID-19 %K frontline health care workers %K mHealth %K well-being %K psychosocial %D 2021 %7 31.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Frontline health care workers are experiencing a myriad of physical and psychosocial challenges amid the COVID-19 pandemic. There is growing recognition that digital technologies have the potential to improve the well-being of frontline workers. However, there has been limited development of wellness interventions using mobile health (mHealth) technology. More importantly, little research has been conducted on how frontline workers perceive mHealth-based support to promote their well-being. Objective: This study aimed to explore frontline workers’ experience of conventional psychological wellness programs and their perceptions of the usefulness of mHealth apps and features for promoting well-being. It also sought to identify factors that could potentially influence uptake and retention of an mHealth-based wellness program. Methods: We conducted semistructured interviews using purposive sampling with frontline workers involved in the COVID-19 response. Various visual materials, collated from existing mHealth app features, were presented to facilitate discussion. Interviews were audio-recorded and transcribed verbatim. Thematic analysis based on grounded theory was undertaken. Themes were subsequently mapped to key nudge strategies—those commonly used for mHealth development—to assess participants’ preferences for particular features and their reasoning. Results: A total of 42 frontline workers participated in 12 one-on-one interviews or focus group discussions. Frontline workers generally had a limited ability to identify their own psychological problems and liked the reminders functionality of the app to track their mood over time. A personalized goal-setting feature (ie, tailoring) and in-app resources were generally valued, while frequent coaching and messages (ie, framing) were seen as a distraction. The majority of participants desired a built-in chat function with a counselor (ie, guidance) for reasons of accessibility and protection of privacy. Very few participants appreciated a gamification function. Frontline workers commonly reported the need for ongoing social support and desired access to an in-app peer support community (ie, social influence). There were, however, concerns regarding potential risks from virtual peer interactions. Intrinsic motivational factors, mHealth app technicality, and tangible rewards were identified as critical for uptake and retention. Conclusions: Our study highlights the potential of mHealth apps with relevant features to be used as wellness tools by frontline health care workers. Future work should focus on developing a nonintrusive and personalized mHealth app with in-app counseling, peer support to improve well-being, and tangible and extrinsic rewards to foster continued use. %M 33979296 %R 10.2196/26282 %U https://www.jmir.org/2021/5/e26282 %U https://doi.org/10.2196/26282 %U http://www.ncbi.nlm.nih.gov/pubmed/33979296 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e19544 %T Age-Stratified Infection Probabilities Combined With a Quarantine-Modified Model for COVID-19 Needs Assessments: Model Development Study %A Bongolan,Vena Pearl %A Minoza,Jose Marie Antonio %A de Castro,Romulo %A Sevilleja,Jesus Emmanuel %+ Department of Computer Science, University of the Philippines Diliman, UP AECH Bldg, Velasquez St, Quezon City, 1101, Philippines, 63 915 877 2298, bongolan@up.edu.ph %K COVID-19 %K epidemic modeling %K age stratification theory %K infection probability %K SEIR %K mathematical modelling %D 2021 %7 31.5.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33900929 %R 10.2196/19544 %U https://www.jmir.org/2021/5/e19544 %U https://doi.org/10.2196/19544 %U http://www.ncbi.nlm.nih.gov/pubmed/33900929 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25713 %T Use of eHealth Platforms and Apps to Support Monitoring and Management of Home-Quarantined Patients With COVID-19 in the Province of Trento, Italy: App Development and Implementation %A Gios,Lorenzo %A Crema Falceri,Giulia %A Micocci,Stefano %A Patil,Luigi %A Testa,Sara %A Sforzin,Simona %A Turra,Ettore %A Conforti,Diego %A Malfatti,Giulia %A Moz,Monica %A Nicolini,Andrea %A Guarda,Paolo %A Bacchiega,Alessandro %A Mion,Carlo %A Marchesoni,Michele %A Maimone,Rosa %A Molini,Pietro Benedetto %A Zanella,Alberto %A Osmani,Venet %A Mayora-Ibarra,Oscar %A Forti,Stefano %+ TrentinoSalute4.0 – Competence Center for Digital Health of the Province of Trento, Via Sommarive, 18. I-38123 POVO (TN), Trento, Italy, 39 3408340665, gios.lorenzo@gmail.com %K telemedicine %K telemonitoring %K quarantine management %K COVID-19 %K connected care %D 2021 %7 31.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Italy was the first country to largely experience the COVID-19 epidemic among other Western countries during the so-called first wave of the COVID-19 pandemic. Proper management of an increasing number of home-quarantined individuals created a significant challenge for health care authorities and professionals. This was especially true when considering the importance of remote surveillance to detect signs of disease progression and consequently regulate access to hospitals and intensive care units on a priority basis. Objective: In this paper, we report on an initiative promoted to cope with the first wave of the COVID-19 epidemic in the Spring/Summer of 2020, in the Autonomous Province of Trento, Italy. A purposefully built app named TreCovid19 was designed to provide dedicated health care staff with a ready-to-use tool for remotely monitoring patients with progressive symptoms of COVID-19, who were home-quarantined during the first wave of the epidemic, and to focus on those patients who, based on their self-reported clinical data, required a quick response from health care professionals. Methods: TreCovid19 was rapidly developed to facilitate the monitoring of a selected number of home-quarantined patients with COVID-19 during the very first epidemic wave. The app was built on top of an existing eHealth platform, already in use by the local health authority to provide home care, with the following functionalities: (1) to securely collect and link demographic and clinical information related to the patients and (2) to provide a two-way communication between a multidisciplinary health care team and home-quarantined patients. The system supported patients to self-assess their condition and update the multidisciplinary team on their health status. The system was used between March and June 2020 in the province of Trento. Results: A dedicated multidisciplinary group of health care professionals adopted the platform over a period of approximately 3 months (from March-end to June 2020) to monitor a total of 170 patients with confirmed COVID-19 during home quarantine. All patients used the system until the end of the initiative. The TreCovid19 system has provided useful insights of possible viability and impact of a technological–organizational asset to manage a potentially critical workload for the health care staff involved in the periodic monitoring of a relevant number of quarantined patients, notwithstanding its limitations given the rapid implementation of the whole initiative. Conclusions: The technological and organizational model adopted in response to the COVID-19 pandemic was developed and finalized in a relatively short period during the initial few weeks of the epidemic. The system successfully supported the health care staff involved in the periodic monitoring of an increasing number of home-quarantined patients and provided valuable data in terms of disease surveillance. %M 33909586 %R 10.2196/25713 %U https://formative.jmir.org/2021/5/e25713 %U https://doi.org/10.2196/25713 %U http://www.ncbi.nlm.nih.gov/pubmed/33909586 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e29058 %T A Machine Learning Approach for Mortality Prediction in COVID-19 Pneumonia: Development and Evaluation of the Piacenza Score %A Halasz,Geza %A Sperti,Michela %A Villani,Matteo %A Michelucci,Umberto %A Agostoni,Piergiuseppe %A Biagi,Andrea %A Rossi,Luca %A Botti,Andrea %A Mari,Chiara %A Maccarini,Marco %A Pura,Filippo %A Roveda,Loris %A Nardecchia,Alessia %A Mottola,Emanuele %A Nolli,Massimo %A Salvioni,Elisabetta %A Mapelli,Massimo %A Deriu,Marco Agostino %A Piga,Dario %A Piepoli,Massimo %+ Department of Cardiology, Guglielmo Da Saliceto Hospital, Via Taverna 49,, Piacenza, 29121, Italy, 39 3517489495, geza.halasz@gmail.com %K artificial intelligence %K prognostic score %K COVID-19 %K pneumonia %K mortality %K prediction %K machine learning %K modeling %D 2021 %7 31.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Several models have been developed to predict mortality in patients with COVID-19 pneumonia, but only a few have demonstrated enough discriminatory capacity. Machine learning algorithms represent a novel approach for the data-driven prediction of clinical outcomes with advantages over statistical modeling. Objective: We aimed to develop a machine learning–based score—the Piacenza score—for 30-day mortality prediction in patients with COVID-19 pneumonia. Methods: The study comprised 852 patients with COVID-19 pneumonia, admitted to the Guglielmo da Saliceto Hospital in Italy from February to November 2020. Patients’ medical history, demographics, and clinical data were collected using an electronic health record. The overall patient data set was randomly split into derivation and test cohorts. The score was obtained through the naïve Bayes classifier and externally validated on 86 patients admitted to Centro Cardiologico Monzino (Italy) in February 2020. Using a forward-search algorithm, 6 features were identified: age, mean corpuscular hemoglobin concentration, PaO2/FiO2 ratio, temperature, previous stroke, and gender. The Brier index was used to evaluate the ability of the machine learning model to stratify and predict the observed outcomes. A user-friendly website was designed and developed to enable fast and easy use of the tool by physicians. Regarding the customization properties of the Piacenza score, we added a tailored version of the algorithm to the website, which enables an optimized computation of the mortality risk score for a patient when some of the variables used by the Piacenza score are not available. In this case, the naïve Bayes classifier is retrained over the same derivation cohort but using a different set of patient characteristics. We also compared the Piacenza score with the 4C score and with a naïve Bayes algorithm with 14 features chosen a priori. Results: The Piacenza score exhibited an area under the receiver operating characteristic curve (AUC) of 0.78 (95% CI 0.74-0.84, Brier score=0.19) in the internal validation cohort and 0.79 (95% CI 0.68-0.89, Brier score=0.16) in the external validation cohort, showing a comparable accuracy with respect to the 4C score and to the naïve Bayes model with a priori chosen features; this achieved an AUC of 0.78 (95% CI 0.73-0.83, Brier score=0.26) and 0.80 (95% CI 0.75-0.86, Brier score=0.17), respectively. Conclusions: Our findings demonstrated that a customizable machine learning–based score with a purely data-driven selection of features is feasible and effective for the prediction of mortality among patients with COVID-19 pneumonia. %M 33999838 %R 10.2196/29058 %U https://www.jmir.org/2021/5/e29058 %U https://doi.org/10.2196/29058 %U http://www.ncbi.nlm.nih.gov/pubmed/33999838 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e24811 %T Self-Sampling for SARS-CoV-2 Diagnostic Testing by Using Nasal and Saliva Specimens: Protocol for Usability and Clinical Evaluation %A Majam,Mohammed %A Msolomba,Vanessa %A Scott,Lesley %A Stevens,Wendy %A Marange,Fadzai %A Kahamba,Trish %A Venter,Francois %A Conserve,Donaldson Fadael %+ Ezintsha, Wits Health Consortium, University of the Witwatersrand, 31 Princess of Wales, Johannesburg, South Africa, 27 82 826 0180, mmajam@ezintsha.org %K SARS-CoV-2 %K SARS-CoV-2SS %K testing %K COVID-19 %K South Africa %K usabillity %K self-sampling %K diagnostic %K sensitivity %K specificity %D 2021 %7 28.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33882023 %R 10.2196/24811 %U https://www.researchprotocols.org/2021/5/e24811 %U https://doi.org/10.2196/24811 %U http://www.ncbi.nlm.nih.gov/pubmed/33882023 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e28673 %T Pool Testing as a Strategy for Prevention of SARS-CoV-2 Outbreaks in Schools: Protocol for a Feasibility Study %A Sweeney-Reed,Catherine M %A Wolff,Doreen %A Niggel,Jakob %A Kabesch,Michael %A Apfelbacher,Christian %+ Neurocybernetics and Rehabilitation, Department of Neurology, Otto von Guericke University Magdeburg, Leipziger Str. 44, Magdeburg, , Germany, 49 (0)391 6728224, catherine.sweeney-reed@med.ovgu.de %K SARS-CoV-2 %K COVID-19 %K schools %K pool testing %K gargle test %K test strategy %K monitoring %K surveillance %K PCR %D 2021 %7 28.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: School closures are a widely implemented strategy for limiting infection spread in the current COVID-19 pandemic. The negative impact of school closures on children and young people is increasingly apparent, however. Objective: We aim to evaluate the feasibility of an infection monitoring program in schools to enable targeted quarantining to replace school closures. The program is currently being implemented in two model schools in Magdeburg, Germany, within the framework of the Study of Coronavirus Outbreak Prevention in Magdeburg Schools (Studie zur Ausbruchsvermeidung von Corona an Magdeburger Schulen [STACAMA]). Methods: Five pupils per class are pseudorandomly selected twice a week and asked to provide a gargle sample over a 16-week evaluation period. RNA is extracted from each sample individually in a laboratory and pooled according to school class for real-time reverse transcription polymerase chain reaction (rRT-PCR) analysis. Immediate individual sample testing will be carried out in the case of a positive pool test. Individual RNA extraction prior to pooling and application of rRT-PCR result in high test sensitivity. Testing will be performed in strict adherence to data protection standards. All participating pupils will receive a 16-digit study code, which they will be able to use to access their test Results: When the study commenced on December 2, 2020, 520 (52%) pupils and their families or guardians had consented to study participation. The study was suspended after four test rounds due to renewed school closures resulting from rising regional infection incidence. Testing resumed when schools reopened on March 8, 2021, at which time consent to participation was provided for 54% of pupils. We will quantitatively and qualitatively evaluate the logistics and acceptability of the program. Conclusions: The findings from this study should inform the design of infection surveillance programs in schools based on gargle samples and a PCR-based pool testing procedure, enabling the identification of aspects that may require adaptation before large-scale implementation. Our focus on each step of the logistics and on the experiences of families should enable a robust assessment of the feasibility of such an approach. International Registered Report Identifier (IRRID): DERR1-10.2196/28673 %M 33979297 %R 10.2196/28673 %U https://www.researchprotocols.org/2021/5/e28673 %U https://doi.org/10.2196/28673 %U http://www.ncbi.nlm.nih.gov/pubmed/33979297 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25988 %T Using Unsupervised Machine Learning to Identify Age- and Sex-Independent Severity Subgroups Among Patients with COVID-19: Observational Longitudinal Study %A Benito-León,Julián %A del Castillo,Mª Dolores %A Estirado,Alberto %A Ghosh,Ritwik %A Dubey,Souvik %A Serrano,J Ignacio %+ Department of Neurology, University Hospital “12 de Octubre”, Avenida de Córdoba s/n, Madrid, 28041, Spain, 34 639154069, jbenitol67@gmail.com %K COVID-19 %K machine learning %K outcome %K severity %K subgroup %K emergency %K detection %K intervention %K testing %K data set %K characterization %D 2021 %7 27.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Early detection and intervention are the key factors for improving outcomes in patients with COVID-19. Objective: The objective of this observational longitudinal study was to identify nonoverlapping severity subgroups (ie, clusters) among patients with COVID-19, based exclusively on clinical data and standard laboratory tests obtained during patient assessment in the emergency department. Methods: We applied unsupervised machine learning to a data set of 853 patients with COVID-19 from the HM group of hospitals (HM Hospitales) in Madrid, Spain. Age and sex were not considered while building the clusters, as these variables could introduce biases in machine learning algorithms and raise ethical implications or enable discrimination in triage protocols. Results: From 850 clinical and laboratory variables, four tests—the serum levels of aspartate transaminase (AST), lactate dehydrogenase (LDH), C-reactive protein (CRP), and the number of neutrophils—were enough to segregate the entire patient pool into three separate clusters. Further, the percentage of monocytes and lymphocytes and the levels of alanine transaminase (ALT) distinguished cluster 3 patients from the other two clusters. The highest proportion of deceased patients; the highest levels of AST, ALT, LDH, and CRP; the highest number of neutrophils; and the lowest percentages of monocytes and lymphocytes characterized cluster 1. Cluster 2 included a lower proportion of deceased patients and intermediate levels of the previous laboratory tests. The lowest proportion of deceased patients; the lowest levels of AST, ALT, LDH, and CRP; the lowest number of neutrophils; and the highest percentages of monocytes and lymphocytes characterized cluster 3. Conclusions: A few standard laboratory tests, deemed available in all emergency departments, have shown good discriminative power for the characterization of severity subgroups among patients with COVID-19. %M 33872186 %R 10.2196/25988 %U https://www.jmir.org/2021/5/e25988 %U https://doi.org/10.2196/25988 %U http://www.ncbi.nlm.nih.gov/pubmed/33872186 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e29298 %T Increases in Naloxone Administrations by Emergency Medical Services Providers During the COVID-19 Pandemic: Retrospective Time Series Study %A Khoury,Dalia %A Preiss,Alexander %A Geiger,Paul %A Anwar,Mohd %A Conway,Kevin Paul %+ Research Triangle Institute International, 3040 East Cornwallis Road, Research Triangle Park, NC, 27709, United States, 1 9195411227, dkhoury@rti.org %K opioids %K naloxone %K EMS %K emergency medical services %K COVID-19 %K pandemic %K medical services %K overdose %K outcomes %K opioid crisis %K public health %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The opioid crisis in the United States may be exacerbated by the COVID-19 pandemic. Increases in opioid use, emergency medical services (EMS) runs for opioid-related overdoses, and opioid overdose deaths have been reported. No study has examined changes in multiple naloxone administrations, an indicator of overdose severity, during the COVID-19 pandemic. Objective: This study examines changes in the occurrence of naloxone administrations and multiple naloxone administrations during EMS runs for opioid-related overdoses during the COVID-19 pandemic in Guilford County, North Carolina (NC). Methods: Using a period-over-period approach, we compared the occurrence of opioid-related EMS runs, naloxone administrations, and multiple naloxone administrations during the 29-week period before (September 1, 2019, to March 9, 2020) and after NC’s COVID-19 state of emergency declaration (ie, the COVID-19 period of March 10 to September 30, 2020). Furthermore, historical data were used to generate a quasi-control distribution of period-over-period changes to compare the occurrence of each outcome during the COVID-19 period to each 29-week period back to January 1, 2014. Results: All outcomes increased during the COVID-19 period. Compared to the previous 29 weeks, the COVID-19 period experienced increases in the weekly mean number of opioid-related EMS runs (25.6, SD 5.6 vs 18.6, SD 6.6; P<.001), naloxone administrations (22.3, SD 6.2 vs 14.1, SD 6.0; P<.001), and multiple naloxone administrations (5.0, SD 1.9 vs 2.7, SD 1.9; P<.001), corresponding to proportional increases of 37.4%, 57.8%, and 84.8%, respectively. Additionally, the increases during the COVID-19 period were greater than 91% of all historical 29-week periods analyzed. Conclusions: The occurrence of EMS runs for opioid-related overdoses, naloxone administrations, and multiple naloxone administrations during EMS runs increased during the COVID-19 pandemic in Guilford County, NC. For a host of reasons that need to be explored, the COVID-19 pandemic appears to have exacerbated the opioid crisis. %M 33999828 %R 10.2196/29298 %U https://publichealth.jmir.org/2021/5/e29298 %U https://doi.org/10.2196/29298 %U http://www.ncbi.nlm.nih.gov/pubmed/33999828 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e28594 %T An Overview of the Treatment Options Used for the Management of COVID-19 in Pakistan: Retrospective Observational Study %A Akhtar,Hashaam %A Akhtar,Samar %A Rahman,Fazal-Ul %A Afridi,Maham %A Khalid,Sundas %A Ali,Sabahat %A Akhtar,Nasim %A Khader,Yousef S %A Ahmad,Hamaad %A Khan,Muhammad Mujeeb %+ Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Zaraj Housing Society, Opposite DHA Phase 2 Gate III, Main GT Road, Islamabad, 44000, Pakistan, 92 515709447, hashaamakhtar@gmail.com %K COVID-19 %K antibiotics %K Pakistan %K multidrug resistant infections %K antibiotic resistance %K first wave %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the first reports of COVID-19 infection, the foremost requirement has been to identify a treatment regimen that not only fights the causative agent but also controls the associated complications of the infection. Due to the time-consuming process of drug discovery, physicians have used readily available drugs and therapies for treatment of infections to minimize the death toll. Objective: The aim of this study is to provide a snapshot analysis of the major drugs used in a cohort of 1562 Pakistani patients during the period from May to July 2020, when the first wave of COVID-19 peaked in Pakistan. Methods: A retrospective observational study was performed to provide an overview of the major drugs used in a cohort of 1562 patients with COVID-19 admitted to the four major tertiary-care hospitals in the Rawalpindi-Islamabad region of Pakistan during the peak of the first wave of COVID-19 in the country (May-July 2020). Results: Antibiotics were the most common choice out of all the therapies employed, and they were used as first line of treatment for COVID-19. Azithromycin was the most prescribed drug for treatment. No monthly trend was observed in the choice of antibiotics, and these drugs appeared to be a random but favored choice throughout the months of the study. It was also noted that even antibiotics used for multidrug resistant infections were prescribed irrespective of the severity or progression of the infection. The results of the analysis are alarming, as this approach may lead to antibiotic resistance and complications in immunocompromised patients with COVID-19. A total of 1562 patients (1064 male, 68.1%, and 498 female, 31.9%) with a mean age of 47.35 years (SD 17.03) were included in the study. The highest frequency of patient hospitalizations occurred in June (846/1562, 54.2%). Conclusions: Guidelines for a targeted treatment regime are needed to control related complications and to limit the misuse of antibiotics in the management of COVID-19. %M 33945498 %R 10.2196/28594 %U https://publichealth.jmir.org/2021/5/e28594 %U https://doi.org/10.2196/28594 %U http://www.ncbi.nlm.nih.gov/pubmed/33945498 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e23461 %T Digital Phenotypes for Understanding Individuals' Compliance With COVID-19 Policies and Personalized Nudges: Longitudinal Observational Study %A Ibrahim,Ahmed %A Zhang,Heng %A Clinch,Sarah %A Poliakoff,Ellen %A Parsia,Bijan %A Harper,Simon %+ Department of Computer Science, The University of Manchester, LF7, Kilburn Building, Kilburn Buidling, Manchester, M13 9PL, United Kingdom, 44 7427630668, heng.zhang@manchester.ac.uk %K behavior %K compliance %K COVID-19 %K digital phenotyping %K nudges %K personalization %K policy %K sensor %K smartphone %D 2021 %7 27.5.2021 %9 Original Paper %J JMIR Form Res %G English %X 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. %M 33999832 %R 10.2196/23461 %U https://formative.jmir.org/2021/5/e23461 %U https://doi.org/10.2196/23461 %U http://www.ncbi.nlm.nih.gov/pubmed/33999832 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e26372 %T The Influence of the COVID-19 Epidemic on Prevention and Vaccination Behaviors Among Chinese Children and Adolescents: Cross-sectional Online Survey Study %A Hou,Zhiyuan %A Song,Suhang %A Du,Fanxing %A Shi,Lu %A Zhang,Donglan %A Lin,Leesa %A Yu,Hongjie %+ School of Public Health, Fudan University, Mailbox 250, 138# Yixueyuan Road, Xuhui District, Shanghai, 200030, China, 86 2133563935, zyhou@fudan.edu.cn %K COVID-19 %K prevention %K vaccination %K behavior %K children %K China %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 33882450 %R 10.2196/26372 %U https://publichealth.jmir.org/2021/5/e26372 %U https://doi.org/10.2196/26372 %U http://www.ncbi.nlm.nih.gov/pubmed/33882450 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e27473 %T Digitalizing a Brief Intervention to Reduce Intrusive Memories of Psychological Trauma for Health Care Staff Working During COVID-19: Exploratory Pilot Study With Nurses %A Singh,Laura %A Kanstrup,Marie %A Depa,Katherine %A Falk,Ann-Charlotte %A Lindström,Veronica %A Dahl,Oili %A Göransson,Katarina E %A Rudman,Ann %A Holmes,Emily A %+ Department of Psychology, Uppsala University, Box 1225, Uppsala, 75142, Sweden, 46 018 471 2118, laura.singh@psyk.uu.se %K intrusive memories %K psychological trauma %K prevention %K pilot trial %K COVID-19 %K digital intervention %K remote delivery %K cognitive science %K person-based approach %K mixed methods %K co-design %K health care staff %D 2021 %7 26.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has accelerated the worldwide need for simple remotely delivered (digital) scalable interventions that can also be used preventatively to protect the mental health of health care staff exposed to psychologically traumatic events during their COVID-19–related work. We have developed a brief behavioral intervention that aims to reduce the number of intrusive memories of traumatic events but has only been delivered face-to-face so far. After digitalizing the intervention materials, the intervention was delivered digitally to target users (health care staff) for the first time. The adaption for staff’s working context in a hospital setting used a co-design approach. Objective: The aims of this mixed method exploratory pilot study with health care staff who experienced working in the pandemic were to pilot the intervention that we have digitalized (for remote delivery and with remote support) and adapted for this target population (health care staff working clinically during a pandemic) to explore its ability to reduce the number of intrusive memories of traumatic events and improve related symptoms (eg, posttraumatic stress) and participant’s perception of their functioning, and to explore the feasibility and acceptability of both the digitalized intervention and digitalized data collection. Methods: We worked closely with target users with lived experience of working clinically during the COVID-19 pandemic in a hospital context (registered nurses who experienced intrusive memories from traumatic events at work; N=3). We used a mixed method design and exploratory quantitative and qualitative analysis. Results: After completing the digitalized intervention once with remote researcher support (approximately 25 minutes) and a brief follow-up check-in, participants learned to use the intervention independently. All 3 participants reported zero intrusive memories during week 5 (primary outcome: 100% digital data capture). Prior to study inclusion, two or more intrusions in the week were reported preintervention (assessed retrospectively). There was a general pattern of symptom reduction and improvement in perceived functioning (eg, concentration) at follow-up. The digitalized intervention and data collection were perceived as feasible and rated as acceptable (eg, all 3 participants would recommend it to a colleague). Participants were positive toward the digital intervention as a useful tool that could readily be incorporated into work life and repeated in the face of ongoing or repeated trauma exposure. Conclusions: The intervention when delivered remotely and adapted for this population during the pandemic was well received by participants. Since it could be tailored around work and daily life and used preventatively, the intervention may hold promise for health care staff pending future evaluations of efficacy. Limitations include the small sample size, lack of daily intrusion frequency data in the week before the intervention, and lack of a control condition. Following this co-design process in adapting and improving intervention delivery and evaluation, the next step is to investigate the efficacy of the digitalized intervention in a randomized controlled trial. %M 33886490 %R 10.2196/27473 %U https://formative.jmir.org/2021/5/e27473 %U https://doi.org/10.2196/27473 %U http://www.ncbi.nlm.nih.gov/pubmed/33886490 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26630 %T 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” %A Du,Li %A Raposo,Vera Lúcia %A Wang,Meng %+ Faculty of Law, University of Macau, Avenida da Universidade, Taipa, Macau, 999078, China, 853 88224733, stephendu@um.edu.mo %K COVID-19 %K contact tracing %K data protection %K privacy %K interoperability %K global health %K public health %D 2021 %7 26.5.2021 %9 Letter to the Editor %J JMIR Mhealth Uhealth %G English %X %M 33852409 %R 10.2196/26630 %U https://mhealth.jmir.org/2021/5/e26630 %U https://doi.org/10.2196/26630 %U http://www.ncbi.nlm.nih.gov/pubmed/33852409 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e26218 %T 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” %A Crutzen,Rik %+ Department of Health Promotion, Care and Public Health Research Institute, Maastricht University, PO Box 616, Maastricht, 6200 MD, Netherlands, 31 433882828, rik.crutzen@maastrichtuniversity.nl %K COVID-19 %K contact tracing %K data protection %K privacy %K interoperability %K global health %K public health %D 2021 %7 26.5.2021 %9 Letter to the Editor %J JMIR Mhealth Uhealth %G English %X %M 33848974 %R 10.2196/26218 %U https://mhealth.jmir.org/2021/5/e26218 %U https://doi.org/10.2196/26218 %U http://www.ncbi.nlm.nih.gov/pubmed/33848974 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e27271 %T Personalized Analytics and a Wearable Biosensor Platform for Early Detection of COVID-19 Decompensation (DeCODe): Protocol for the Development of the COVID-19 Decompensation Index %A Larimer,Karen %A Wegerich,Stephan %A Splan,Joel %A Chestek,David %A Prendergast,Heather %A Vanden Hoek,Terry %+ physIQ, Inc, 200 W Jackson Street Suite 550, Chicago, IL, 60606, United States, 1 7736126205, karen.larimer@physiq.com %K analytic %K artificial intelligence %K biomarker %K cloud %K COVID-19 %K decompensation %K detection %K development %K index %K monitoring %K outcome %K remote monitoring %K symptom validation %K wearable %D 2021 %7 26.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the COVID-19 pandemic, novel digital health technologies have the potential to improve our understanding of SARS-CoV-2 and COVID-19, improve care delivery, and produce better health outcomes. The National Institutes of Health called on digital health leaders to contribute to a high-quality data repository that will support researchers to make discoveries that are otherwise not possible with small, limited data sets. Objective: To this end, we seek to develop a COVID-19 digital biomarker for early detection of physiological exacerbation or decompensation. We propose the development and validation of a COVID-19 decompensation Index (CDI) in a 2-phase study that builds on existing wearable biosensor-derived analytics generated by physIQ’s end-to-end cloud platform for continuous physiological monitoring with wearable biosensors. This effort serves to achieve two primary objectives: (1) to collect adequate data to help develop the CDI and (2) to collect rich deidentified clinical data correlating with outcomes and symptoms related to COVID-19 progression. Our secondary objectives include evaluation of the feasibility and usability of pinpointIQ, a digital platform through which data are gathered, analyzed, and displayed. Methods: This is a prospective, nonrandomized, open-label, 2-phase study. Phase I will involve data collection for the digital data hub of the National Institutes of Health as well as data to support the preliminary development of the CDI. Phase II will involve data collection for the hub and contribute to continued refinement and validation of the CDI. While this study will focus on the development of a CDI, the digital platform will also be evaluated for feasibility and usability while clinicians deliver care to continuously monitored patients enrolled in the study. Results: Our target CDI will be a binary classifier trained to distinguish participants with and those without decompensation. The primary performance metric for CDI will be the area under the receiver operating characteristic curve with a minimum performance criterion of ≥0.75 (α=.05; power [1–β]=0.80). Furthermore, we will determine the sex or gender and race or ethnicity of the participants, which would account for differences in the CDI performance, as well as the lead time—time to predict decompensation—and its relationship with the ultimate disease severity based on the World Health Organization COVID-19 ordinal scale. Conclusions: Using machine learning techniques on a large data set of patients with COVID-19 could provide valuable insights into the pathophysiology of COVID-19 and a digital biomarker for COVID-19 decompensation. Through this study, we intend to develop a tool that can uniquely reflect physiological data of a diverse population and contribute to high-quality data that will help researchers better understand COVID-19. Trial Registration: ClinicalTrials.gov NCT04575532; https://www.clinicaltrials.gov/ct2/show/NCT04575532 International Registered Report Identifier (IRRID): DERR1-10.2196/27271 %M 33949966 %R 10.2196/27271 %U https://www.researchprotocols.org/2021/5/e27271 %U https://doi.org/10.2196/27271 %U http://www.ncbi.nlm.nih.gov/pubmed/33949966 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25556 %T COVID-19 Rehabilitation With Herbal Medicine and Cardiorespiratory Exercise: Protocol for a Clinical Study %A Gao,Yang %A Zhong,Linda L D %A Quach,Binh %A Davies,Bruce %A Ash,Garrett I %A Lin,Zhi-Xiu %A Feng,Yibin %A Lau,Benson W M %A Wagner,Peter D %A Yang,Xian %A Guo,Yike %A Jia,Wei %A Bian,Zhaoxiang %A Baker,Julien S %+ Centre for Health and Exercise Science Research, Hong Kong Baptist University, Room AAB 926, 9/F, Academic and Administration Building, Baptist University Road Campus, Kowloon, Hong Kong, 852 34118032, jsbaker@hkbu.edu.hk %K COVID-19 %K rehabilitation %K cardiorespiratory exercise %K Chinese medicine %D 2021 %7 26.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Recent studies have revealed that many discharged patients with COVID-19 experience ongoing symptoms months later. Rehabilitation interventions can help address the consequences of COVID-19, including medical, physical, cognitive, and psychological problems. To our knowledge, no studies have investigated the effects of rehabilitation following discharge from hospital for patients with COVID-19. Objective: The specific aims of this project are to investigate the effects of a 12-week exercise program on pulmonary fibrosis in patients recovering from COVID-19. A further aim will be to examine how Chinese herbal medicines as well as the gut microbiome and its metabolites regulate immune function and possibly autoimmune deficiency in the rehabilitation process. Methods: In this triple-blinded, randomized, parallel-group, controlled clinical trial, we will recruit adult patients with COVID-19 who have been discharged from hospital in Hong Kong and are experiencing impaired lung function and pulmonary function. A total of 172 eligible patients will be randomized into four equal groups: (1) cardiorespiratory exercise plus Chinese herbal medicines group, (2) cardiorespiratory exercise only group, (3) Chinese herbal medicines only group, and (4) waiting list group (in which participants will receive Chinese herbal medicines after 24 weeks). These treatments will be administered for 12 weeks, with a 12-week follow-up period. Primary outcomes include dyspnea, fatigue, lung function, pulmonary function, blood oxygen levels, immune function, blood coagulation, and related blood biochemistry. Measurements will be recorded prior to initiating the above treatments and repeated at the 13th and 25th weeks of the study. The primary analysis is aimed at comparing the outcomes between groups throughout the study period with an α level of .05 (two-tailed). Results: The trial has been approved by the university ethics committee following the Declaration of Helsinki (approval number: REC/19-20/0504) in 2020. The trial has been recruiting patients. The data collection will be completed in 24 months, from January 1, 2021, to December 31, 2022. Conclusions: Given that COVID-19 and its sequelae would persist in human populations, important findings from this study would provide valuable insights into the mechanisms and processes of COVID-19 rehabilitation. Trial Registration: ClinicalTrials.gov NCT04572360; https://clinicaltrials.gov/ct2/show/NCT04572360 International Registered Report Identifier (IRRID): PRR1-10.2196/25556 %M 33970864 %R 10.2196/25556 %U https://www.researchprotocols.org/2021/5/e25556 %U https://doi.org/10.2196/25556 %U http://www.ncbi.nlm.nih.gov/pubmed/33970864 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e27059 %T Mining and Validating Social Media Data for COVID-19–Related Human Behaviors Between January and July 2020: Infodemiology Study %A Daughton,Ashlynn R %A Shelley,Courtney D %A Barnard,Martha %A Gerts,Dax %A Watson Ross,Chrysm %A Crooker,Isabel %A Nadiga,Gopal %A Mukundan,Nilesh %A Vaquera Chavez,Nidia Yadira %A Parikh,Nidhi %A Pitts,Travis %A Fairchild,Geoffrey %+ Analytics, Intelligence, and Technology, Los Alamos National Laboratory, P.O. Box 1663, Los Alamos, NM, 87545, United States, 1 505 664 0062, adaughton@lanl.gov %K Twitter %K social media %K human behavior %K infectious disease %K COVID-19 %K coronavirus %K infodemiology %K infoveillance %K social distancing %K shelter-in-place %K mobility %K COVID-19 intervention %D 2021 %7 25.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Health authorities can minimize the impact of an emergent infectious disease outbreak through effective and timely risk communication, which can build trust and adherence to subsequent behavioral messaging. Monitoring the psychological impacts of an outbreak, as well as public adherence to such messaging, is also important for minimizing long-term effects of an outbreak. Objective: We used social media data from Twitter to identify human behaviors relevant to COVID-19 transmission, as well as the perceived impacts of COVID-19 on individuals, as a first step toward real-time monitoring of public perceptions to inform public health communications. Methods: We developed a coding schema for 6 categories and 11 subcategories, which included both a wide number of behaviors as well codes focused on the impacts of the pandemic (eg, economic and mental health impacts). We used this to develop training data and develop supervised learning classifiers for classes with sufficient labels. Classifiers that performed adequately were applied to our remaining corpus, and temporal and geospatial trends were assessed. We compared the classified patterns to ground truth mobility data and actual COVID-19 confirmed cases to assess the signal achieved here. Results: We applied our labeling schema to approximately 7200 tweets. The worst-performing classifiers had F1 scores of only 0.18 to 0.28 when trying to identify tweets about monitoring symptoms and testing. Classifiers about social distancing, however, were much stronger, with F1 scores of 0.64 to 0.66. We applied the social distancing classifiers to over 228 million tweets. We showed temporal patterns consistent with real-world events, and we showed correlations of up to –0.5 between social distancing signals on Twitter and ground truth mobility throughout the United States. Conclusions: Behaviors discussed on Twitter are exceptionally varied. Twitter can provide useful information for parameterizing models that incorporate human behavior, as well as for informing public health communication strategies by describing awareness of and compliance with suggested behaviors. %M 33882015 %R 10.2196/27059 %U https://www.jmir.org/2021/5/e27059 %U https://doi.org/10.2196/27059 %U http://www.ncbi.nlm.nih.gov/pubmed/33882015 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e29072 %T Predicting Risk of Hospital Admission in Patients With Suspected COVID-19 in a Community Setting: Protocol for Development and Validation of a Multivariate Risk Prediction Tool %A Espinosa-Gonzalez,Ana Belen %A Neves,Ana Luisa %A Fiorentino,Francesca %A Prociuk,Denys %A Husain,Laiba %A Ramtale,Sonny Christian %A Mi,Emma %A Mi,Ella %A Macartney,Jack %A Anand,Sneha N %A Sherlock,Julian %A Saravanakumar,Kavitha %A Mayer,Erik %A de Lusignan,Simon %A Greenhalgh,Trisha %A Delaney,Brendan C %+ Department of Surgery and Cancer, Imperial College London, St Mary's Hospital, Praed St, London, W2 1NY, United Kingdom, 44 747 203 5868, a.espinosa-gonzalez15@imperial.ac.uk %K COVID-19 severity %K risk prediction tool %K early warning score %K hospital admission %K primary care %K electronic health records %D 2021 %7 25.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: During the pandemic, remote consultations have become the norm for assessing patients with signs and symptoms of COVID-19 to decrease the risk of transmission. This has intensified the clinical uncertainty already experienced by primary care clinicians when assessing patients with suspected COVID-19 and has prompted the use of risk prediction scores, such as the National Early Warning Score (NEWS2), to assess severity and guide treatment. However, the risk prediction tools available have not been validated in a community setting and are not designed to capture the idiosyncrasies of COVID-19 infection. Objective: The objective of this study is to produce a multivariate risk prediction tool, RECAP-V1 (Remote COVID-19 Assessment in Primary Care), to support primary care clinicians in the identification of those patients with COVID-19 that are at higher risk of deterioration and facilitate the early escalation of their treatment with the aim of improving patient outcomes. Methods: The study follows a prospective cohort observational design, whereby patients presenting in primary care with signs and symptoms suggestive of COVID-19 will be followed and their data linked to hospital outcomes (hospital admission and death). Data collection will be carried out by primary care clinicians in four arms: North West London Clinical Commissioning Groups (NWL CCGs), Oxford-Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC), Covid Clinical Assessment Service (CCAS), and South East London CCGs (Doctaly platform). The study involves the use of an electronic template that incorporates a list of items (known as RECAP-V0) thought to be associated with disease outcome according to previous qualitative work. Data collected will be linked to patient outcomes in highly secure environments. We will then use multivariate logistic regression analyses for model development and validation. Results: Recruitment of participants started in October 2020. Initially, only the NWL CCGs and RCGP RSC arms were active. As of March 24, 2021, we have recruited a combined sample of 3827 participants in these two arms. CCAS and Doctaly joined the study in February 2021, with CCAS starting the recruitment process on March 15, 2021. The first part of the analysis (RECAP-V1 model development) is planned to start in April 2021 using the first half of the NWL CCGs and RCGP RSC combined data set. Posteriorly, the model will be validated with the rest of the NWL CCGs and RCGP RSC data as well as the CCAS and Doctaly data sets. The study was approved by the Research Ethics Committee on May 27, 2020 (Integrated Research Application System number: 283024, Research Ethics Committee reference number: 20/NW/0266) and badged as National Institute of Health Research Urgent Public Health Study on October 14, 2020. Conclusions: We believe the validated RECAP-V1 early warning score will be a valuable tool for the assessment of severity in patients with suspected COVID-19 in the community, either in face-to-face or remote consultations, and will facilitate the timely escalation of treatment with the potential to improve patient outcomes. Trial Registration: ISRCTN registry ISRCTN13953727; https://www.isrctn.com/ISRCTN13953727 International Registered Report Identifier (IRRID): DERR1-10.2196/29072 %M 33939619 %R 10.2196/29072 %U https://www.researchprotocols.org/2021/5/e29072 %U https://doi.org/10.2196/29072 %U http://www.ncbi.nlm.nih.gov/pubmed/33939619 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 5 %P e23305 %T Effective Training Data Extraction Method to Improve Influenza Outbreak Prediction from Online News Articles: Deep Learning Model Study %A Jang,Beakcheol %A Kim,Inhwan %A Kim,Jong Wook %+ Department of Computer Science, Sangmyung Univerisity, 20, Hongjimun 2-gil, Jongno-gu, Seoul, 03016, Republic of Korea, 82 027817590, jkim@smu.ac.kr %K influenza %K training data extraction %K keyword %K sorting %K word embedding %K Pearson correlation coefficient %K long short-term memory %K surveillance %K infodemiology %K infoveillance %K model %D 2021 %7 25.5.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Each year, influenza affects 3 to 5 million people and causes 290,000 to 650,000 fatalities worldwide. To reduce the fatalities caused by influenza, several countries have established influenza surveillance systems to collect early warning data. However, proper and timely warnings are hindered by a 1- to 2-week delay between the actual disease outbreaks and the publication of surveillance data. To address the issue, novel methods for influenza surveillance and prediction using real-time internet data (such as search queries, microblogging, and news) have been proposed. Some of the currently popular approaches extract online data and use machine learning to predict influenza occurrences in a classification mode. However, many of these methods extract training data subjectively, and it is difficult to capture the latent characteristics of the data correctly. There is a critical need to devise new approaches that focus on extracting training data by reflecting the latent characteristics of the data. Objective: In this paper, we propose an effective method to extract training data in a manner that reflects the hidden features and improves the performance by filtering and selecting only the keywords related to influenza before the prediction. Methods: Although word embedding provides a distributed representation of words by encoding the hidden relationships between various tokens, we enhanced the word embeddings by selecting keywords related to the influenza outbreak and sorting the extracted keywords using the Pearson correlation coefficient in order to solely keep the tokens with high correlation with the actual influenza outbreak. The keyword extraction process was followed by a predictive model based on long short-term memory that predicts the influenza outbreak. To assess the performance of the proposed predictive model, we used and compared a variety of word embedding techniques. Results: Word embedding without our proposed sorting process showed 0.8705 prediction accuracy when 50.2 keywords were selected on average. Conversely, word embedding using our proposed sorting process showed 0.8868 prediction accuracy and an improvement in prediction accuracy of 12.6%, although smaller amounts of training data were selected, with only 20.6 keywords on average. Conclusions: The sorting stage empowers the embedding process, which improves the feature extraction process because it acts as a knowledge base for the prediction component. The model outperformed other current approaches that use flat extraction before prediction. %M 34032577 %R 10.2196/23305 %U https://medinform.jmir.org/2021/5/e23305 %U https://doi.org/10.2196/23305 %U http://www.ncbi.nlm.nih.gov/pubmed/34032577 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25016 %T Communication Intervention Using Digital Technology to Facilitate Informed Choices at Childbirth in the Context of the COVID-19 Pandemic: Protocol for a Randomized Controlled Trial %A Diniz,Carmen Simone Grilo %A Franzon,Ana Carolina Arruda %A Fioretti-Foschi,Beatriz %A Niy,Denise Yoshie %A Pedrilio,Livia Sanches %A Amaro Jr,Edson %A Sato,João Ricardo %+ Gender and Evidence on Maternity and Health Study Group, School of Public Health, University of Sao Paulo, Av Dr Arnaldo, 715, Sao Paulo, 01246-904, Brazil, 55 1130617124, denise.niy@gmail.com %K app %K childbirth %K communication %K COVID-19 %K health literacy %K informatics %K internet %K intervention %K maternal health %K neonatal health %K neonate public health %K society %K technology %K women %D 2021 %7 21.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: In Brazil and other low- and middle-income countries, excess interventions in childbirth are associated with an increase in preterm and early-term births, contributing to stagnant morbidity and mortality of mothers and neonates. The fact that women often report a negative experience with vaginal childbirth, with physical pain and feelings of unsafety, neglect, or abuse, may explain the high acceptability of elective cesarean sections. The recognition of information needs and of the right to informed choice during childbirth can help change this reality. The internet has been the main source of health information, but its quality is highly variable. Objective: This study aimed to develop and evaluate an information and communication strategy through a smartphone app with respect to childbirth, to facilitate informed choices for access to safer and evidence-based care in the context of the COVID-19 pandemic. Methods: A randomized controlled trial, with 2 arms (intervention and control) and a closed, blind, parallel design, will be conducted with a smartphone app designed for behavior and opinion research in Brazil, with women of reproductive age previously registered on the app. After completing an entry questionnaire to verify the eligibility criteria and obtaining ethical consent, approximately 20,000 participants will be randomly allocated to the intervention and control groups at a 1:1 ratio. Participants allocated to the intervention group will be invited to engage in a digital information and communication strategy, which is designed to expand evidence-based knowledge on the advantages and disadvantages of options for labor and childbirth and the safety of the care processes. The information is based on the guidelines of the Ministry of Health and the World Health Organization for a positive childbirth experience and has been updated to include the new challenges and disruptions in maternity care within the context of the COVID-19 pandemic. The control group will receive information regarding disposable and reusable diapers as a placebo intervention. The groups will be compared in their responses in generating the birth plan and the entry and exit questionnaires, regarding responses less or more aligned with the guidelines for a positive childbirth experience. A qualitative component to map information needs is included. Results: The digital trial started recruiting participants in late October 2020, and data collection has been projected to be complete by December 2020. Conclusions: This study will evaluate an innovative intervention that has the potential to promote better communication between women and providers, such that they can make better choices using an approach suitable for use during the COVID-19 pandemic. Trial Registration: The Brazilian Clinical Trials Registry U1111-1255-8683; http://www.ensaiosclinicos.gov.br/rg/RBR-3g5f9f/ International Registered Report Identifier (IRRID): PRR1-10.2196/25016 %M 33945496 %R 10.2196/25016 %U https://www.researchprotocols.org/2021/5/e25016 %U https://doi.org/10.2196/25016 %U http://www.ncbi.nlm.nih.gov/pubmed/33945496 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e27818 %T The Impact of the COVID-19 Pandemic on Physical and Mental Health in China and Spain: Cross-sectional Study %A Wang,Cuiyan %A López-Núñez,María Inmaculada %A Pan,Riyu %A Wan,Xiaoyang %A Tan,Yilin %A Xu,Linkang %A Choo,Faith %A Ho,Roger %A Ho,Cyrus %A Aparicio García,Marta E %+ Department of Psychological Medicine, Institute of Health Innovation and Technology, National University of Singapore, Level 9, NUHS Tower Block, 1E Kent Ridge Road, Singapore, 119228, Singapore, 65 97321097, pcmrhcm@nus.edu.sg %K anxiety %K China %K coronavirus %K COVID-19 %K depression %K developing countries %K knowledge %K masks %K pandemic %K physical %K precaution %K psychological impact %K Spain %K stress %D 2021 %7 21.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Differences in physical and mental health impact across continents during the COVID-19 pandemic are unknown. Objective: This study compared the levels of impact of COVID-19 on mental health among people from Spain and China and correlated mental health parameters with variables relating to symptoms similar to COVID-19, COVID-19 knowledge, and precautionary measures. Methods: We collected information on demographic data, physical symptoms, contact history with persons with a confirmed COVID-19 diagnosis, COVID-19 knowledge, and precautionary measures. Participants completed the Impact of Event Scale-Revised (IES-R) and the Depression, Anxiety and Stress Scale–21 Items (DASS-21). To analyze the differences in the mental health parameters, the mean scores between Chinese and Spanish respondents were compared using the independent samples t test. The differences in categorical variables between the two samples were analyzed by the chi-square test. Linear regression was used to calculate the univariate associations between the independent variables and mental health parameters for both groups separately, with adjustments made for age, gender, and education. Results: A total of 1528 participants (Spain: n=687; China: n=841) were recruited. The mean age of the Chinese respondents was 24.73 years (SD 7.60; range 18-65 years), and the mean age of the Spanish respondents was 43.06 years (SD 11.95; range 18-76 years). Spanish participants reported significantly more symptoms similar to COVID-19 infection (eg, fever, sore throat, and breathing difficulties), contact history with COVID-19, higher perceived risk of contracting COVID-19, frequent use of medical services, and less confidence in medical services compared with their Chinese counterparts (P<.001). Spanish participants reported significantly higher DASS-21 stress and depression scores, while Chinese participants reported significantly higher IES-R scores (P<.001). Chinese participants encountered more discrimination from other countries (P<.001). Significantly more Chinese participants reported using face masks than Spanish ones (P<.001). More exposure to health information was associated with adverse mental health in Spain (depression: P=.02; anxiety: P=.02; stress: P=.001). Conclusions: Our study found that Spanish respondents reported higher levels of stress and depression as well as more symptoms and use of medical services. In preparation for the next pandemic, Spain needs to establish a prompt policy to implement rapid response and enhance medical services to safeguard physical and mental health. %M 33900933 %R 10.2196/27818 %U https://formative.jmir.org/2021/5/e27818 %U https://doi.org/10.2196/27818 %U http://www.ncbi.nlm.nih.gov/pubmed/33900933 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26543 %T Authors’ Reply to: Screening Tools: Their Intended Audiences and Purposes. Comment on “Diagnostic Accuracy of Web-Based COVID-19 Symptom Checkers: Comparison Study” %A Munsch,Nicolas %A Martin,Alistair %A Gruarin,Stefanie %A Nateqi,Jama %A Abdarahmane,Isselmou %A Weingartner-Ortner,Rafael %A Knapp,Bernhard %+ Data Science Department, Symptoma, Kundmanngasse 21, Vienna, 1030, Austria, 43 662458206, science@symptoma.com %K COVID-19 %K symptom checkers %K benchmark %K digital health %K symptom %K chatbot %K accuracy %D 2021 %7 21.5.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33989162 %R 10.2196/26543 %U https://www.jmir.org/2021/5/e26543 %U https://doi.org/10.2196/26543 %U http://www.ncbi.nlm.nih.gov/pubmed/33989162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26148 %T Screening Tools: Their Intended Audiences and Purposes. Comment on “Diagnostic Accuracy of Web-Based COVID-19 Symptom Checkers: Comparison Study” %A Millen,Elizabeth %A Gilsdorf,Andreas %A Fenech,Matthew %A Gilbert,Stephen %+ Ada Health, Karl-Liebknecht-Str 1, Berlin, 10178, Germany, 49 01520713083, elizabeth.millen@ada.com %K COVID-19 %K symptom checkers %K benchmark %K digital health %K symptom %K chatbot %K accuracy %D 2021 %7 21.5.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33989169 %R 10.2196/26148 %U https://www.jmir.org/2021/5/e26148 %U https://doi.org/10.2196/26148 %U http://www.ncbi.nlm.nih.gov/pubmed/33989169 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e29145 %T Authors’ Reply to: Methodological Clarifications and Generalizing From Weibo Data. Comment on “Nature and Diffusion of COVID-19–related Oral Health Information on Chinese Social Media: Analysis of Tweets on Weibo” %A Tao,Zhuo-Ying %A Su,Yu-Xiong %+ Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Sai Ying Pun, Hong Kong, Hong Kong (China), 852 2859 0267, richsu@hku.hk %K COVID-19 %K dentistry %K oral health %K dental health %K online health %K social media %K tweet %K Weibo %K China %K health information %D 2021 %7 21.5.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33989166 %R 10.2196/29145 %U https://www.jmir.org/2021/5/e29145 %U https://doi.org/10.2196/29145 %U http://www.ncbi.nlm.nih.gov/pubmed/33989166 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26255 %T Methodological Clarifications and Generalizing From Weibo Data. Comment on “Nature and Diffusion of COVID-19–related Oral Health Information on Chinese Social Media: Analysis of Tweets on Weibo” %A Yadav,Om Prakash %+ Division of Community Health and Humanities, Memorial University of Newfoundland, 230 Elizabeth Ave, St John's, NL, A1C 5S7, Canada, 1 7097706592, opyadav@mun.ca %K COVID-19 %K dentistry %K oral health %K dental health %K online health %K social media %K tweet %K Weibo %K China %K health information %D 2021 %7 21.5.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33989161 %R 10.2196/26255 %U https://www.jmir.org/2021/5/e26255 %U https://doi.org/10.2196/26255 %U http://www.ncbi.nlm.nih.gov/pubmed/33989161 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e27806 %T A COVID-19 Pandemic Artificial Intelligence–Based System With Deep Learning Forecasting and Automatic Statistical Data Acquisition: Development and Implementation Study %A Yu,Cheng-Sheng %A Chang,Shy-Shin %A Chang,Tzu-Hao %A Wu,Jenny L %A Lin,Yu-Jiun %A Chien,Hsiung-Fei %A Chen,Ray-Jade %+ Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, No.250, Wuxing St.,, Taipei, 11031, Taiwan, 886 227372181 ext 3966, rayjchen@tmu.edu.tw %K COVID-19 %K artificial intelligence %K time series %K deep learning %K machine learning %K statistical analysis %K pandemic %K data visualization %D 2021 %7 20.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: More than 79.2 million confirmed COVID-19 cases and 1.7 million deaths were caused by SARS-CoV-2; the disease was named COVID-19 by the World Health Organization. Control of the COVID-19 epidemic has become a crucial issue around the globe, but there are limited studies that investigate the global trend of the COVID-19 pandemic together with each country’s policy measures. Objective: We aimed to develop an online artificial intelligence (AI) system to analyze the dynamic trend of the COVID-19 pandemic, facilitate forecasting and predictive modeling, and produce a heat map visualization of policy measures in 171 countries. Methods: The COVID-19 Pandemic AI System (CPAIS) integrated two data sets: the data set from the Oxford COVID-19 Government Response Tracker from the Blavatnik School of Government, which is maintained by the University of Oxford, and the data set from the COVID-19 Data Repository, which was established by the Johns Hopkins University Center for Systems Science and Engineering. This study utilized four statistical and deep learning techniques for forecasting: autoregressive integrated moving average (ARIMA), feedforward neural network (FNN), multilayer perceptron (MLP) neural network, and long short-term memory (LSTM). With regard to 1-year records (ie, whole time series data), records from the last 14 days served as the validation set to evaluate the performance of the forecast, whereas earlier records served as the training set. Results: A total of 171 countries that featured in both databases were included in the online system. The CPAIS was developed to explore variations, trends, and forecasts related to the COVID-19 pandemic across several counties. For instance, the number of confirmed monthly cases in the United States reached a local peak in July 2020 and another peak of 6,368,591 in December 2020. A dynamic heat map with policy measures depicts changes in COVID-19 measures for each country. A total of 19 measures were embedded within the three sections presented on the website, and only 4 of the 19 measures were continuous measures related to financial support or investment. Deep learning models were used to enable COVID-19 forecasting; the performances of ARIMA, FNN, and the MLP neural network were not stable because their forecast accuracy was only better than LSTM for a few countries. LSTM demonstrated the best forecast accuracy for Canada, as the root mean square error (RMSE), mean absolute error (MAE), and mean absolute percentage error (MAPE) were 2272.551, 1501.248, and 0.2723075, respectively. ARIMA (RMSE=317.53169; MAPE=0.4641688) and FNN (RMSE=181.29894; MAPE=0.2708482) demonstrated better performance for South Korea. Conclusions: The CPAIS collects and summarizes information about the COVID-19 pandemic and offers data visualization and deep learning–based prediction. It might be a useful reference for predicting a serious outbreak or epidemic. Moreover, the system undergoes daily updates and includes the latest information on vaccination, which may change the dynamics of the pandemic. %M 33900932 %R 10.2196/27806 %U https://www.jmir.org/2021/5/e27806 %U https://doi.org/10.2196/27806 %U http://www.ncbi.nlm.nih.gov/pubmed/33900932 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25446 %T Characterizing Health Care Delays and Interruptions in the United States During the COVID-19 Pandemic: Internet-Based, Cross-sectional Survey Study %A Papautsky,Elizabeth Lerner %A Rice,Dylan R %A Ghoneima,Hana %A McKowen,Anna Laura W %A Anderson,Nicholas %A Wootton,Angie R %A Veldhuis,Cindy %+ Department of Biomedical & Health Information Sciences, College of Applied Health Sciences, University of Illinois at Chicago, 1919 W Taylor St, Chicago, IL, 60612, United States, 1 312 996 0357, elp@uic.edu %K COVID-19 %K health care delays %K internet survey %K preventive care %K delay %K interruption %K lockdown %K precaution %K prevention %K social media %K survey %D 2021 %7 19.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has broader geographic spread and potentially longer lasting effects than those of previous disasters. Necessary preventive precautions for the transmission of COVID-19 has resulted in delays for in-person health care services, especially at the outset of the pandemic. Objective: Among a US sample, we examined the rates of delays (defined as cancellations and postponements) in health care at the outset of the pandemic and characterized the reasons for such delays. Methods: As part of an internet-based survey that was distributed on social media in April 2020, we asked a US–based convenience sample of 2570 participants about delays in their health care resulting from the COVID-19 pandemic. Participant demographics and self-reported worries about general health and the COVID-19 pandemic were explored as potent determinants of health care delays. In addition to all delays, we focused on the following three main types of delays, which were the primary outcomes in this study: dental, preventive, and diagnostic care delays. For each outcome, we used bivariate statistical tests (t tests and chi-square tests) and multiple logistic regression models to determine which factors were associated with health care delays. Results: The top reported barrier to receiving health care was the fear of SARS-CoV-2 infection (126/374, 33.6%). Almost half (1227/2570, 47.7%) of the participants reported experiencing health care delays. Among those who experienced health care delays and further clarified the type of delay they experienced (921/1227, 75.1%), the top three reported types of care that were affected by delays included dental (351/921, 38.1%), preventive (269/921, 29.2%), and diagnostic (151/921, 16.4%) care. The logistic regression models showed that age (P<.001), gender identity (P<.001), education (P=.007), and self-reported worry about general health (P<.001) were significantly associated with experiencing health care delays. Self-reported worry about general health was negatively related to experiencing delays in dental care. However, this predictor was positively associated with delays in diagnostic testing based on the logistic regression model. Additionally, age was positively associated with delays in diagnostic testing. No factors remained significant in the multiple logistic regression for delays in preventive care, and although there was trend between race and delays (people of color experienced fewer delays than White participants), it was not significant (P=.06). Conclusions: The lessons learned from the initial surge of COVID-19 cases can inform systemic mitigation strategies for potential future disruptions. This study addresses the demand side of health care delays by exploring the determinants of such delays. More research on health care delays during the pandemic is needed, including research on their short- and long-term impacts on patient-level outcomes such as mortality, morbidity, mental health, people’s quality of life, and the experience of pain. %M 33886489 %R 10.2196/25446 %U https://www.jmir.org/2021/5/e25446 %U https://doi.org/10.2196/25446 %U http://www.ncbi.nlm.nih.gov/pubmed/33886489 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e27331 %T Sleep Disturbances in Frontline Health Care Workers During the COVID-19 Pandemic: Social Media Survey Study %A Stewart,Nancy H %A Koza,Anya %A Dhaon,Serena %A Shoushtari,Christiana %A Martinez,Maylyn %A Arora,Vineet M %+ Department of Medicine, University of Kansas Medical Center, 4000 Cambridge St., Mailstop 3007, Kansas City, KS, 66106, United States, 1 913 588 6045, nstewart5@kumc.edu %K social media %K sleep disorders %K frontline health care workers %K burnout %K insomnia %K sleep %K health care worker %K stress %K survey %K demographic %K outcome %K COVID-19 %D 2021 %7 19.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, health care workers are sharing their challenges, including sleep disturbances, on social media; however, no study has evaluated sleep in predominantly US frontline health care workers during the COVID-19 pandemic. Objective: The aim of this study was to assess sleep among a sample of predominantly US frontline health care workers during the COVID-19 pandemic using validated measures through a survey distributed on social media. Methods: A self-selection survey was distributed on Facebook, Twitter, and Instagram for 16 days (August 31 to September 15, 2020), targeting health care workers who were clinically active during the COVID-19 pandemic. Study participants completed the Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI), and they reported their demographic and career information. Poor sleep quality was defined as a PSQI score ≥5. Moderate-to-severe insomnia was defined as an ISI score >14. The Mini-Z Burnout Survey was used to measure burnout. Multivariate logistic regression tested associations between demographics, career characteristics, and sleep outcomes. Results: A total of 963 surveys were completed. Participants were predominantly White (894/963, 92.8%), female (707/963, 73.4%), aged 30-49 years (692/963, 71.9%), and physicians (620/963, 64.4%). Mean sleep duration was 6.1 hours (SD 1.2). Nearly 96% (920/963, 95.5%) of participants reported poor sleep (PSQI). One-third (288/963, 30%) reported moderate or severe insomnia. Many participants (554/910, 60.9%) experienced sleep disruptions due to device use or had nightmares at least once per week (420/929, 45.2%). Over 50% (525/932, 56.3%) reported burnout. In multivariable logistic regressions, nonphysician (odds ratio [OR] 2.4, 95% CI 1.7-3.4), caring for patients with COVID-19 (OR 1.8, 95% CI 1.2-2.8), Hispanic ethnicity (OR 2.2, 95% CI 1.4-3.5), female sex (OR 1.6, 95% CI 1.1-2.4), and having a sleep disorder (OR 4.3, 95% CI 2.7-6.9) were associated with increased odds of insomnia. In open-ended comments (n=310), poor sleep was mapped to four categories: children and family, work demands, personal health, and pandemic-related sleep disturbances. Conclusions: During the COVID-19 pandemic, nearly all the frontline health care workers surveyed on social media reported poor sleep, over one-third reported insomnia, and over half reported burnout. Many also reported sleep disruptions due to device use and nightmares. Sleep interventions for frontline health care workers are urgently needed. %M 33875414 %R 10.2196/27331 %U https://www.jmir.org/2021/5/e27331 %U https://doi.org/10.2196/27331 %U http://www.ncbi.nlm.nih.gov/pubmed/33875414 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26953 %T Tweet Topics and Sentiments Relating to COVID-19 Vaccination Among Australian Twitter Users: Machine Learning Analysis %A Kwok,Stephen Wai Hang %A Vadde,Sai Kumar %A Wang,Guanjin %+ Discipline of Information Technology, Media and Communications, Murdoch University, 90 South St, Perth, 6150, Australia, 61 0893607351, Guanjin.Wang@murdoch.edu.au %K COVID-19 %K vaccination %K public topics %K public sentiments %K Twitter %K infodemiology %K infoveillance %K social listening %K infodemic %K social media %K natural language processing %K machine learning %K latent Dirichlet allocation %D 2021 %7 19.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is one of the greatest threats to human beings in terms of health care, economy, and society in recent history. Up to this moment, there have been no signs of remission, and there is no proven effective cure. Vaccination is the primary biomedical preventive measure against the novel coronavirus. However, public bias or sentiments, as reflected on social media, may have a significant impact on the progression toward achieving herd immunity. Objective: This study aimed to use machine learning methods to extract topics and sentiments relating to COVID-19 vaccination on Twitter. Methods: We collected 31,100 English tweets containing COVID-19 vaccine–related keywords between January and October 2020 from Australian Twitter users. Specifically, we analyzed tweets by visualizing high-frequency word clouds and correlations between word tokens. We built a latent Dirichlet allocation (LDA) topic model to identify commonly discussed topics in a large sample of tweets. We also performed sentiment analysis to understand the overall sentiments and emotions related to COVID-19 vaccination in Australia. Results: Our analysis identified 3 LDA topics: (1) attitudes toward COVID-19 and its vaccination, (2) advocating infection control measures against COVID-19, and (3) misconceptions and complaints about COVID-19 control. Nearly two-thirds of the sentiments of all tweets expressed a positive public opinion about the COVID-19 vaccine; around one-third were negative. Among the 8 basic emotions, trust and anticipation were the two prominent positive emotions observed in the tweets, while fear was the top negative emotion. Conclusions: Our findings indicate that some Twitter users in Australia supported infection control measures against COVID-19 and refuted misinformation. However, those who underestimated the risks and severity of COVID-19 may have rationalized their position on COVID-19 vaccination with conspiracy theories. We also noticed that the level of positive sentiment among the public may not be sufficient to increase vaccination coverage to a level high enough to achieve vaccination-induced herd immunity. Governments should explore public opinion and sentiments toward COVID-19 and COVID-19 vaccination, and implement an effective vaccination promotion scheme in addition to supporting the development and clinical administration of COVID-19 vaccines. %M 33886492 %R 10.2196/26953 %U https://www.jmir.org/2021/5/e26953 %U https://doi.org/10.2196/26953 %U http://www.ncbi.nlm.nih.gov/pubmed/33886492 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25447 %T Utilizing Health Behavior Change and Technology Acceptance Models to Predict the Adoption of COVID-19 Contact Tracing Apps: Cross-sectional Survey Study %A Tomczyk,Samuel %A Barth,Simon %A Schmidt,Silke %A Muehlan,Holger %+ Department Health and Prevention, Institute of Psychology, University of Greifswald, Robert-Blum-Straße 13, Greifswald, , Germany, 49 3834 420 3806, samuel.tomczyk@uni-greifswald.de %K mHealth %K COVID-19 %K UTAUT1 %K UTAUT2 %K health behavior change %K theory of planned behavior %K contact tracing %K app %K model %K technology acceptance %K cross-sectional studies %K social norms %K health communication %K privacy %K anxiety %D 2021 %7 19.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: To combat the global COVID-19 pandemic, contact tracing apps have been discussed as digital health solutions to track infection chains and provide appropriate information. However, observational studies point to low acceptance in most countries, and few studies have yet examined theory-based predictors of app use in the general population to guide health communication efforts. Objective: This study utilizes established health behavior change and technology acceptance models to predict adoption intentions and frequency of current app use. Methods: We conducted a cross-sectional online survey between May and July 2020 in a German convenience sample (N=349; mean age 35.62 years; n=226, 65.3% female). To inspect the incremental validity of model constructs as well as additional variables (privacy concerns, personalization), hierarchical regression models were applied, controlling for covariates. Results: The theory of planned behavior and the unified theory of acceptance and use of technology predicted adoption intentions (R2=56%-63%) and frequency of current app use (R2=33%-37%). A combined model only marginally increased the predictive value by about 5%, but lower privacy concerns and higher threat appraisals (ie, anticipatory anxiety) significantly predicted app use when included as additional variables. Moreover, the impact of perceived usefulness was positive for adoption intentions but negative for frequency of current app use. Conclusions: This study identified several theory-based predictors of contact tracing app use. However, few constructs, such as social norms, have a consistent positive effect across models and outcomes. Further research is required to replicate these observations, and to examine the interconnectedness of these constructs and their impact throughout the pandemic. Nevertheless, the findings suggest that promulgating affirmative social norms and positive emotional effects of app use, as well as addressing health concerns, might be promising strategies to foster adoption intentions and app use in the general population. %M 33882016 %R 10.2196/25447 %U https://www.jmir.org/2021/5/e25447 %U https://doi.org/10.2196/25447 %U http://www.ncbi.nlm.nih.gov/pubmed/33882016 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e28845 %T The Impact of Inpatient Telemedicine on Personal Protective Equipment Savings During the COVID-19 Pandemic: Cross-sectional Study %A Halabi,Reem %A Smith,Geoffrey %A Sylwestrzak,Marc %A Clay,Brian %A Longhurst,Christopher A %A Lander,Lina %+ Department of Family Medicine, University of California, San Diego, 9500 Gilman Drive MC0606, La Jolla, CA, 92093-0606, United States, 1 8582601917, linalander@health.ucsd.edu %K inpatient telemedicine %K bedside iPad %K video visits %K personal protective equipment %K COVID-19 %K virtual visits %K pandemic %K telehealth %K telemedicine %K digital health %D 2021 %7 19.5.2021 %9 Viewpoint %J J Med Internet Res %G English %X With the emergence of the COVID-19 pandemic and shortage of adequate personal protective equipment (PPE), hospitals implemented inpatient telemedicine measures to ensure operational readiness and a safe working environment for clinicians. The utility and sustainability of inpatient telemedicine initiatives need to be evaluated as the number of COVID-19 inpatients is expected to continue declining. In this viewpoint, we describe the use of a rapidly deployed inpatient telemedicine workflow at a large academic medical center and discuss the potential impact on PPE savings. In early 2020, videoconferencing software was installed on patient bedside iPads at two academic medical center teaching hospitals. An internal website allowed providers to initiate video calls with patients in any patient room with an activated iPad, including both COVID-19 and non–COVID-19 patients. Patients were encouraged to use telemedicine technology to connect with loved ones via native apps or videoconferencing software. We evaluated the use of telemedicine technology on patients’ bedside iPads by monitoring traffic to the internal website. Between May 2020 and March 2021, there were a total of 1240 active users of the Video Visits website (mean 112.7, SD 49.0 connection events per month). Of these, 133 (10.7%) connections were made. Patients initiated 63 (47.4%) video calls with family or friends and sent 37 (27.8%) emails with videoconference connection instructions. Providers initiated a total of 33 (24.8%) video calls with the majority of calls initiated in August (n=22, 67%). There was a low level of adoption of inpatient telemedicine capability by providers and patients. With sufficient availability of PPE, inpatient providers did not find a frequent need to use the bedside telemedicine technology, despite a high census of patients with COVID-19. Compared to providers, patients used videoconferencing capabilities more frequently in September and October 2020. We did not find savings of PPE associated with the use of inpatient telemedicine. %M 33945494 %R 10.2196/28845 %U https://www.jmir.org/2021/5/e28845 %U https://doi.org/10.2196/28845 %U http://www.ncbi.nlm.nih.gov/pubmed/33945494 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e27609 %T Notes From the Field: The Combined Effects of Tocilizumab and Remdesivir in a Patient With Severe COVID-19 and Cytokine Release Syndrome %A Ali,Sabahat %A Khalid,Sundas %A Afridi,Maham %A Akhtar,Samar %A Khader,Yousef S %A Akhtar,Hashaam %+ Yusra Institute of Pharmaceutical Sciences, Zaraj Housing Society, Main GT Road, Islamabad, 44000, Pakistan, 92 3215272489, hashaamakhtar@gmail.com %K COVID-19 %K remdesivir %K treatment %K tocilizumab %D 2021 %7 19.5.2021 %9 Notes from the Field %J JMIR Public Health Surveill %G English %X SARS-CoV-2 is known to cause severe bilateral pneumonia and acute respiratory distress syndrome or COVID-19 in patients, which can be debilitating and even fatal. With no drugs or vaccines available yet, a wide range of treatment regimens used are being repurposed. The need of the hour is to analyze various currently available regimens and devise a treatment plan that is most effective for COVID-19. Here we describe the case of a 68-year-old man with hypertension and diabetes, exhibiting symptoms of cough and shortness of breath, who presented at the emergency department of our hospital. Chest computed tomography revealed bilateral ground glass opacities that were indicative of COVID-19, and a computed tomography score of 24 was indicative of severe pulmonary pneumonia. He tested positive for COVID-19. His treatment regimen included the use of convalescent plasma, oxygen therapy, steroids, high-dose antibiotics, broad-spectrum antiviral remdesivir, and anti–interleukin-6 monoclonal antibody (Tocilizumab) at various stages of the disease. Oxygen supplementation was required at the time of admission. The patient initially developed a cytokine release storm, and oxygen supplementation was initiated to manage his condition. Supportive care and multiple treatment regimens were used to successfully recover the patient’s health. With a rapid increase in number of confirmed cases worldwide, COVID-19 has become a major challenge to our health care system. With no available vaccines currently, the establishment of a combination of therapeutic drugs that effectively reduce disease progression is of utmost importance. %M 34009133 %R 10.2196/27609 %U https://publichealth.jmir.org/2021/5/e27609 %U https://doi.org/10.2196/27609 %U http://www.ncbi.nlm.nih.gov/pubmed/34009133 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e27638 %T Impact of the Protracted War in Yemen on the Acute Flaccid Paralysis Surveillance System: Retrospective Descriptive Analysis %A Al-Dubaiee,Riham %A AL Qassimi,Mutaher %A Al-Dar,Ahmed %A Al Serouri,Abdulwahed %A Khader,Yousef %+ Ministry of Public Health and Population, Al-Hasaba, Mazda street, Sana'a, Yemen, 967 776417333, rihamm10@yahoo.com %K acute flaccid paralysis %K surveillance indicators %K war %K Yemen %D 2021 %7 19.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Highly sensitive acute flaccid paralysis (AFP) surveillance, which includes immediate case investigation and specimen collection, is critical for achieving global polio eradication. In Yemen, the Acute Flaccid Paralysis Surveillance System (AFPSS) was launched in 1998 to achieve the polio eradication target. Although Yemen was certified as a polio-free country in 2009, the protracted war since 2015 has placed the country at risk for polio reemergence. Objective: The objectives of this analysis were to evaluate the performance of the Yemen AFPSS at both the national and governorate levels, and to assess the impact of the ongoing war on the performance. Methods: Retrospective descriptive analysis was performed on Yemen secondary AFP surveillance data for the years 2014 (before the war) and 2015-2017 (during the war). Data comprising all children <15 years old reported as having AFP were included in the analysis. AFP surveillance performance was evaluated using World Health Organization–specified AFP surveillance indicators. Results: At the national level, all indicators were met before and after the war except for “lab results received within ≤28 days,” which was unmet since the war erupted. Furthermore, the indicator “stool specimens arriving at a central level within ≤3 days” was unmet after the war but only in 2017. At the governorate level, although the indicators “adequacy” and “stool specimens arriving at the laboratory in good condition” were met before the war in all governorates, the former indicator was unmet in 9 (41%) governorates since the war erupted and the latter indicator was also unmet in 9 governorates (41%) but only in 2017. Conclusions: The findings show that some AFP surveillance indicators were negatively impacted by eruption of the war in Yemen due to closure of the Sana’a capital airport and postponement of sample shipment to the reference laboratory, which remained under long-term poor storage conditions. To ensure rapid detection of polio cases, improving specimen collection, storage, and transportation, together with proper and timely shipment of specimens to the reference laboratory should be considered. %M 34009132 %R 10.2196/27638 %U https://publichealth.jmir.org/2021/5/e27638 %U https://doi.org/10.2196/27638 %U http://www.ncbi.nlm.nih.gov/pubmed/34009132 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e28517 %T Pakistan’s Response to COVID-19: Overcoming National and International Hypes to Fight the Pandemic %A Akhtar,Hashaam %A Afridi,Maham %A Akhtar,Samar %A Ahmad,Hamaad %A Ali,Sabahat %A Khalid,Sundas %A Awan,Sajid Mahmood %A Jahangiri,Shahzaib %A Khader,Yousef Saleh %+ Yusra Institute of Pharmaceutical Sciences, Yusra Medical and Dental College, Zaraj Housing Society, Opposite DHA Phase 2 Gate III, Main GT Road, Islamabad, 44000, Pakistan, 92 3165163945, hashaamakhtar@gmail.com %K community health %K coronavirus %K COVID-19 %K epidemic %K epidemiology %K Pakistan %K pandemic %K public health emergency of international concern %D 2021 %7 19.5.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 outbreak started as pneumonia in December 2019 in Wuhan, China. The subsequent pandemic was declared as the sixth public health emergency of international concern on January 30, 2020, by the World Health Organization. Pakistan could be a potential hotspot for COVID-19 owing to its high population of 204.65 million and its struggling health care and economic systems. Pakistan was able to tackle the challenge with relatively mild repercussions. The present analysis has been conducted to highlight the situation of the disease in Pakistan in 2020 and the measures taken by various stakeholders coupled with support from the community to abate the risk of catastrophic spread of the virus. %M 33877048 %R 10.2196/28517 %U https://publichealth.jmir.org/2021/5/e28517 %U https://doi.org/10.2196/28517 %U http://www.ncbi.nlm.nih.gov/pubmed/33877048 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e22431 %T SARS-CoV-2: The Second Wave in Europe %A Fokas,Athanassios S %A Kastis,George A %+ Department of Applied Mathematics and Theoretical Physics, University of Cambridge, Wilberforce Rd, Cambridge, CB3 0WA, United Kingdom, 44 1223 339, tf227@cam.ac.uk %K mathematical modelling of epidemics %K COVID-19 %K SARS CoV-2 %K pandemic %K lockdown in Europe %D 2021 %7 18.5.2021 %9 Viewpoint %J J Med Internet Res %G English %X Although the SARS-CoV-2 virus has already undergone several mutations, the impact of these mutations on its infectivity and virulence remains controversial. In this viewpoint, we present arguments suggesting that SARS-CoV-2 mutants responsible for the second wave have less virulence but much higher infectivity. This suggestion is based on the results of the forecasting and mechanistic models developed by our study group. In particular, in May 2020, the analysis of our mechanistic model predicted that the easing of lockdown measures will lead to a dramatic second wave of the COVID-19 outbreak. However, after the lockdown was lifted in many European countries, the resulting number of reported infected cases and especially the number of deaths remained low for approximately two months. This raised the false hope that a substantial second wave will be avoided and that the COVID-19 epidemic in these European countries was nearing an end. Unfortunately, since the first week of August 2020, the number of reported infected cases increased dramatically. Furthermore, this was accompanied by an increasingly large number of deaths. The rate of reported infected cases in the second wave was much higher than that in the first wave, whereas the rate of deaths was lower. This trend is consistent with higher infectivity and lower virulence. Even if the mutated form of SARS-CoV-2 is less virulent, the very high number of reported infected cases implies that a large number of people will perish. %M 33939621 %R 10.2196/22431 %U https://www.jmir.org/2021/5/e22431 %U https://doi.org/10.2196/22431 %U http://www.ncbi.nlm.nih.gov/pubmed/33939621 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e26431 %T Cognitive Outcomes During COVID-19 Confinement Among Older People and Their Caregivers Using Technologies for Dementia: Protocol for an Observational Cohort Study %A Goodman-Casanova,Jessica Marian %A Dura-Perez,Elena %A Guerrero-Pertiñez,Gloria %A Barnestein-Fonseca,Pilar %A Guzman-Parra,Jose %A Vega-Nuñez,Amanda %A Varela-Moreno,Esperanza %A Cuesta-Vargas,Antonio %A Mayoral-Cleries,Fermin %+ Department of Mental Health, Regional University Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Plaza del Hospital Civil s/n, Málaga, 29009, Spain, 34 660901966, jmariangoodman@gmail.com %K caregiver %K cognition %K cognitive impairment %K cohort %K COVID-19 %K dementia %K older people %K informal caregivers %K information and communications technologies %K isolation %K older adults %K outcome %K quality of life %K social isolation %K stress %K technologies %D 2021 %7 18.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has led to worldwide implementation of unprecedented restrictions to control its rapid spread and mitigate its impact. The Spanish government has enforced social distancing, quarantine, and home confinement measures. Such restrictions on activities of daily life and separation from loved ones may lead to social isolation and loneliness with health-related consequences among community-dwelling older adults with mild cognitive impairment or mild dementia and their caregivers. Additionally, inadequate access to health care and social support services may aggravate chronic conditions. Home-based technological interventions have emerged for combating social isolation and loneliness, while simultaneously preventing the risk of virus exposure. Objective: The aim of this cohort study is to explore, analyze, and determine the impact of social isolation on (1) cognition, quality of life, mood, technophilia, and perceived stress among community-dwelling older adults with mild cognitive impairment or mild dementia and on the caregiver burden; (2) access to and utilization of health and social care services; and (3) cognitive, social, and entertainment-related uses of information and communication technologies. Methods: This study will be conducted in Málaga (Andalucía, Spain). In total 200 dyads, consisting of a person with mild cognitive impairment or mild dementia and his/her informal caregiver, will be contacted by telephone. Potential respondents will be participants of the following clinical trials: support, monitoring, and reminder technology for mild dementia (n=100) and television-based assistive integrated service to support European adults living with mild dementia or mild cognitive impairment (n=100). Results: As of May 2021, a total of 153 participants have been enrolled and assessed during COVID-19 confinement, of whom 67 have been assessed at 6 months of enrollment. Changes in the mean values of the variables will be analyzed relative to baseline findings of previous studies with those during and after confinement, using repeated-measures analysis of variance or the nonparametric Friedman test, as appropriate. The performance of multivariate analysis of covariance (ANCOVA) to introduce potential covariates will also be considered. Values of 95% CI will be used. Conclusions: If our hypothesis is accepted, these findings will demonstrate the negative impact of social isolation owing to COVID-19 confinement on cognition, quality of life, mood, and perceived stress among community-dwelling older adults with mild cognitive impairment and mild dementia, the impact on technophilia, caregiver burden, the access to and utilization of health and social care services, and the cognitive, social, and entertainment-related use of information and communication technologies during and after COVID-19 confinement. Trial Registration: ClinicalTrials.gov NCT04385797; https://clinicaltrials.gov/ct2/show/NCT04385797 International Registered Report Identifier (IRRID): DERR1-10.2196/26431 %M 33909588 %R 10.2196/26431 %U https://www.researchprotocols.org/2021/5/e26431 %U https://doi.org/10.2196/26431 %U http://www.ncbi.nlm.nih.gov/pubmed/33909588 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26618 %T Understanding Public Perceptions of COVID-19 Contact Tracing Apps: Artificial Intelligence–Enabled Social Media Analysis %A Cresswell,Kathrin %A Tahir,Ahsen %A Sheikh,Zakariya %A Hussain,Zain %A Domínguez Hernández,Andrés %A Harrison,Ewen %A Williams,Robin %A Sheikh,Aziz %A Hussain,Amir %+ Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh, EH8 9AG, United Kingdom, 44 (0)131 651 4151, kathrin.cresswell@ed.ac.uk %K artificial intelligence %K sentiment analysis %K COVID-19 %K contact tracing %K social media %K perception %K app %K exploratory %K suitability %K AI %K Facebook %K Twitter %K United Kingdom %K sentiment %K attitude %K infodemiology %K infoveillance %D 2021 %7 17.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of SARS-CoV-2 in late 2019 and its subsequent spread worldwide continues to be a global health crisis. Many governments consider contact tracing of citizens through apps installed on mobile phones as a key mechanism to contain the spread of SARS-CoV-2. Objective: In this study, we sought to explore the suitability of artificial intelligence (AI)–enabled social media analyses using Facebook and Twitter to understand public perceptions of COVID-19 contact tracing apps in the United Kingdom. Methods: We extracted and analyzed over 10,000 relevant social media posts across an 8-month period, from March 1 to October 31, 2020. We used an initial filter with COVID-19–related keywords, which were predefined as part of an open Twitter-based COVID-19 dataset. We then applied a second filter using contract tracing app–related keywords and a geographical filter. We developed and utilized a hybrid, rule-based ensemble model, combining state-of-the-art lexicon rule-based and deep learning–based approaches. Results: Overall, we observed 76% positive and 12% negative sentiments, with the majority of negative sentiments reported in the North of England. These sentiments varied over time, likely influenced by ongoing public debates around implementing app-based contact tracing by using a centralized model where data would be shared with the health service, compared with decentralized contact-tracing technology. Conclusions: Variations in sentiments corroborate with ongoing debates surrounding the information governance of health-related information. AI-enabled social media analysis of public attitudes in health care can help facilitate the implementation of effective public health campaigns. %M 33939622 %R 10.2196/26618 %U https://www.jmir.org/2021/5/e26618 %U https://doi.org/10.2196/26618 %U http://www.ncbi.nlm.nih.gov/pubmed/33939622 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e24412 %T Factors Influencing Anxiety Among WeChat Users During the Early Stages of the COVID-19 Pandemic in Mainland China: Cross-sectional Survey Study %A Zou,Changqing %A Zhang,Weiyu %A Sznajder,Kristin %A Yang,Fengzhi %A Jia,Yajing %A Ma,Ruqing %A Cui,Can %A Yang,Xiaoshi %+ Department of Social Medicine, School of Public Health, China Medical University, No 77 Puhe Road, Shenyang North New Area, Liaoning Province, Shenyang, 110122, China, 86 18900910796, xsyang@cmu.edu.cn %K anxiety %K COVID-19 %K information seeking behavior %K positive psychological response %K health information %K public health emergency %K mental health %K online survey %K China %K cross-sectional study %D 2021 %7 17.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The rapid outbreak of COVID-19 around the world has adversely affected the mental health of the public. The prevalence of anxiety among the public has increased dramatically during the COVID-19 pandemic. However, there are few studies evaluating the effects of positive psychological responses and information-seeking behaviors on anxiety experienced among social media users during the COVID-19 pandemic. Objective: This study evaluated the prevalence of anxiety and its associated factors among WeChat users in mainland China during the early stages of the COVID-19 pandemic. Methods: From February 10 to February 24, 2020, a nationwide, web-based cross-sectional survey study was carried out using convenience sampling. Participants’ levels of anxiety, positive psychological responses, and information-seeking behaviors were assessed. The survey was distributed among WeChat users via the WeChat smartphone platform. Chi-square tests and multivariable logistic regression analyses were performed to examine the factors associated with anxiety. Results: This study found that the prevalence of anxiety (Generalized Anxiety Disorder 7-item [GAD-7] scale score ≥7) among WeChat users in China was 17.96% (446/2483) during the early stages of the COVID-19 pandemic. Results of multivariable logistic regression analysis showed that information-seeking behaviors such as cannot stop searching for information on COVID-19, being concerned about the COVID-19 pandemic, and spending more than 1 hour per day consuming information about the pandemic were found to be associated with increased levels of anxiety. Additionally, participants who chose social media and commercial media as the primary sources to obtain information about the COVID-19 pandemic were found more likely to report anxiety. Conversely, participants who were confident or rational about the COVID-19 pandemic were less likely to report anxiety. Conclusions: This study found that positive psychological responses and information-seeking behaviors were closely associated with anxiety among WeChat users during the COVID-19 pandemic in China. It might be paramount to enhance mental well-being by helping people respond to the COVID-19 pandemic more rationally and positively in order to decrease symptoms of anxiety. %M 33878025 %R 10.2196/24412 %U https://www.jmir.org/2021/5/e24412 %U https://doi.org/10.2196/24412 %U http://www.ncbi.nlm.nih.gov/pubmed/33878025 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e27268 %T Morbidity and Mortality Associated with Typhoid Fever Among Hospitalized Patients in Hyderabad District, Pakistan, 2017-2018: Retrospective Record Review %A Fatima,Munaza %A Kumar,Santosh %A Hussain,Mudassar %A Memon,Naveed Masood %A Vighio,Anum %A Syed,Muhammad Asif %A Chaudhry,Ambreen %A Hussain,Zakir %A Baig,Zeeshan Iqbal %A Baig,Mirza Amir %A Asghar,Rana Jawad %A Ikram,Aamer %A Khader,Yousef %+ National Institute of Health Pakistan, Park Road, Chak Shehzad, Islamabad, 44000, Pakistan, 92 519255302, ambr.chaudhry@gmail.com %K antimicrobial resistance %K complications %K control drug resistance %K extensive drug resistance %K hospitalization %K Hyderabad %K ileal perforation %K medical records %K microbiological %K morbidity %K mortality %K Pakistan %K prevention %K typhoid %D 2021 %7 17.5.2021 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: Hyderabad, Pakistan, was the first city to witness an outbreak of extensively drug resistant (XDR) typhoid fever. The outbreak strain is resistant to ampicillin, chloramphenicol, trimethoprim-sulfamethoxazole, fluoroquinolones, and third-generation cephalosporin, thus greatly limiting treatment options. However, despite over 5000 documented cases, information on mortality and morbidity has been limited. Objective: To address the existing knowledge gap, this study aimed to assess the morbidity and mortality associated with XDR and non-XDR Salmonella serovar Typhi infections in Pakistan. Methods: We reviewed the medical records of culture-confirmed typhoid cases in 5 hospitals in Hyderabad from October 1, 2016, to September 30, 2018. We recorded data on age, gender, onset of fever, physical examination, serological and microbiological test results, treatment before and during hospitalization, duration of hospitalization, complications, and deaths. Results: A total of 1452 culture-confirmed typhoid cases, including 947 (66%) XDR typhoid cases and 505 (34%) non-XDR typhoid cases, were identified. Overall, ≥1 complications were reported in 360 (38%) patients with XDR typhoid and 89 (18%) patients with non-XDR typhoid (P<.001). Ileal perforation was the most commonly reported complication in both patients with XDR typhoid (n=210, 23%) and patients with non-XDR typhoid (n=71, 14%) (P<.001). Overall, mortality was documented among 17 (1.8%) patients with XDR S Typhi infections and 3 (0.6%) patients with non-XDR S Typhi infections (P=.06). Conclusions: As this first XDR typhoid outbreak continues to spread, the increased duration of illness before hospitalization and increased rate of complications have important implications for clinical care and medical costs and heighten the importance of prevention and control measures. %M 33999000 %R 10.2196/27268 %U https://publichealth.jmir.org/2021/5/e27268 %U https://doi.org/10.2196/27268 %U http://www.ncbi.nlm.nih.gov/pubmed/33999000 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e25273 %T Changes in Perceptions and Use of Mobile Technology and Health Communication in South Africa During the COVID-19 Lockdown: Cross-sectional Survey Study %A Fischer,Alex Emilio %A Van Tonder,Tanya %A Gumede,Siphamandla B %A Lalla-Edward,Samanta T %+ Ezintsha, Faculty of Health Sciences, University of Witwatersrand, Sunnyside Office Park, 31 Princess of Wales Terrace Parktown, Johannesburg, 2193, South Africa, 27 073 776 2705, fischermHealth@gmail.com %K coronavirus %K SARS-CoV-2 %K COVID-19 %K technology %K mHealth %K app %D 2021 %7 17.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In late March 2020, South Africa implemented a 5-stage COVID-19 Risk Adjusted Strategy, which included a lockdown that required all residents to remain home to prevent the spread of COVID-19. Due to this lockdown, individuals have been forced to find and use alternatives for accomplishing tasks including shopping, socializing, working, and finding information, and many have turned to the internet and their mobile devices. Objective: This study aimed to describe how South Africans consume and internalize information surrounding the COVID-19 outbreak in order to determine whether the COVID-19 lockdown and social isolation have influenced technology behavior, particularly in terms of health communication and information. Methods: From June 24 to August 24, 2020, people in South Africa were invited to complete a survey through the Upinion mobile app, an online data collection resource. The survey collected information on demographics, and technology use during the lockdown, and COVID-19 knowledge. Results: There were 405 participants, of which 296 (73.06%) were female. A total of 320 (79.01%) participants had a tertiary school education, 242 (59.75%) were single, and 173 (42.72%) had full-time employment. The lockdown forced 363 (89.63%) participants to use more technology, especially for work (n=140, 24.05%) and social media/communication (n=133, 22.85%). Security or privacy issues (n=46, 38.98%) and unfamiliarity with technology (n=32, 27.12%) were identified as the most common issues faced by the 127 (31.36%) participants who were unsure about using technology prior to the lockdown. Almost all participants (n=392, 96.79%) stated that they would continue using technology after the lockdown. Multimedia (n=215, 53.09%), mobile phone content (n=99, 24.44%), and health organizations and professionals (n=91, 22.47%) were the main sources of COVID-19 information. Most participants (n=282, 69.63%) felt that they had enough information. Two-thirds (n=275, 67.90%) of participants stated that they had used their mobile phones for health information before the lockdown, with web searches (n=109, 26.91%), social media (n=58, 14.32%), and government and institutional websites (n=52; 12.84%) serving as their main sources of information. Overall, the mean COVID-19 knowledge score was 8.8 (out of 10), and 335 (82.72%) had adequate knowledge (scored ≥8). Males were less likely to identify the correct transmission routes, and single participants were less likely to identify the signs and symptoms of the coronavirus. Tertiary school graduates were 4 times more likely to correctly identify the routes and 2 times more likely to identify how to stop the spread of the virus. People aged 43-56 years were 4 times more likely to identify how the coronavirus can be prevented, and participants ≥57 years were 2.6 times more likely to obtain a knowledge score of 10 when compared to those under 29 years of age. Conclusions: This study has shown that the COVID-19 lockdown has forced people to increase technology use, and people plan to continue using technology after the lockdown is lifted. Increased technology use was seen across a variety of fields; however, barriers including privacy, unfamiliarity, and data costs were identified. This population showed high COVID-19 knowledge, although the use of web searches and social media, instead of government and institutional websites, increases the potential for health misinformation to be spread. %M 33956640 %R 10.2196/25273 %U https://formative.jmir.org/2021/5/e25273 %U https://doi.org/10.2196/25273 %U http://www.ncbi.nlm.nih.gov/pubmed/33956640 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e26948 %T Suicide Prevention Among College Students Before and During the COVID-19 Pandemic: Protocol for a Systematic Review and Meta-analysis %A Xiao,Yunyu %A Hinrichs,Rachel %A Johnson,Nina %A McKinley,Amanda %A Carlson,Joan %A Agley,Jon %A Yip,Paul Siu Fai %+ School of Social Work, Indiana University–Purdue University Indianapolis, 902 W New York St, 4F, Education/Social Work Building, ES 4119, Indianapolis, IN, 46202, United States, 1 201 253 7264, yx18@iu.edu %K suicide %K suicidal prevention %K college %K university %K health disparities %K equity %K suicidal ideation %K suicide attempt %K COVID-19 %K college student %K young adult %K disparity %K review %D 2021 %7 17.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Suicide is the second leading cause of death for college-aged individuals worldwide and in the United States. Recent studies have identified preliminary evidence of widening disparities in suicidal behaviors across sex, sexual orientation, race/ethnicity, age, and socioeconomic status among college students. Few systematic reviews and meta-analyses offer a comprehensive understanding of on-campus and off-campus suicide interventions, nor is collated information available for different types of screening, assessment, treatment, and postvention plans. Further challenges have been identified since the COVID-19 pandemic, calling for cost-effective and innovative interventions to address increased rates of suicidal behaviors among college students facing unprecedented stressors. Objective: This research protocol describes the first systematic review and meta-analysis to identify the most effective and cost-effective intervention components for universal and targeted (indicated and selected) suicide prevention among college students in a global context. Special attention will be placed on disparities in suicide prevention across sociodemographic subgroups, inclusive interventions beyond campus, global context, and intervention responses to the COVID-19 pandemic. Methods: A sensitive search strategy will be executed across MEDLINE (Ovid), EMBASE, PsycINFO (EBSCO), ERIC (EBSCO), Cochrane Library, Dissertations and Theses Global (ProQuest), Scopus, Global Index Medicus, SciELO, African Journals Online, Global Health (CABI), and Google Scholar. Data extraction and evaluation will be conducted by three independent researchers. Risk of bias will be assessed. A multilevel meta-regression model and subgroup analysis will be used to analyze the data and estimate effect sizes. Results: The initial search was completed in December 2020 and updated with additional other-language studies in March 2020. We expect the results to be submitted for publication in mid-2021. Conclusions: Despite increasing rates of suicidal behaviors among college students, few preventative efforts have targeted this population, and fewer focus on factors that might place specific demographic groups at heightened risk. The impact of COVID-19 on suicidal behaviors among college students highlights and exacerbates the urgent need for rapid and effective interventions that might differ from traditional approaches. This equity-focused study will address these gaps and provide a valuable analysis of the effectiveness of suicide prevention programs and interventions. Findings will inform clinicians, researchers, policy makers, families, and organizations about evidence-based interventions for reducing the gaps in the suicide crisis among college students from different sociodemographic groups. Trial Registration: PROSPERO CRD42020225429; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=225429 International Registered Report Identifier (IRRID): DERR1-10.2196/26948 %M 33878016 %R 10.2196/26948 %U https://www.researchprotocols.org/2021/5/e26948 %U https://doi.org/10.2196/26948 %U http://www.ncbi.nlm.nih.gov/pubmed/33878016 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e27442 %T Cutaneous Leishmaniasis Outbreak Investigation in Hajjah Governorate, Yemen, in 2018: Case-Control Study %A Nassar,Abdulkareem Ali %A Abdelrazzaq,Mahmood Hasan %A Almahaqri,Ali Hamoud %A Al-Amad,Mohammed Abdullah %A Al Serouri,Abulwahed Abduljabbar %A Khader,Yousef Saleh %+ Sana'a City's Public Health and Population Office, Yemen Ministry of Public Health and Population, Al-Thawra District, Sana'a, Yemen, 967 777228977, abdulkareemnassar@gmail.com %K cutaneous leishmaniasis %K outbreak %K risk factors %K Yemen %K Field Epidemiology Training Program %D 2021 %7 14.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Cutaneous leishmaniasis (CL) is endemic in Yemen. About 4440 cases were reported in 2019. On July 23, 2018, a Hajjah governorate surveillance officer notified the Ministry of Public Health and Population about an increase in the number of CL cases in Bani-Oshb, Kuhlan district, Hajjah governorate. On July 24, 2018, Yemen Field Epidemiology Training Program sent a team to perform an investigation. Objective: We aimed to describe a CL outbreak in Hajjah governorate and determine its risk factors. Methods: A descriptive study and case-control study (1:1 ratio) were conducted. Cases included people who met the suspected or confirmed case definition of the World Health Organization and lived in Bani-Oshb subdistrict during the period from August 2017 to July 2018. Controls included people living for at least 1 year in Bani-Oshb without new or old skin lesions. Crude odds ratios (cORs) and adjusted odds ratios (aORs) with 95% CI were used to test the significance of associations. Results: We identified 30 CL cases. Among the 30 patients, 7 (23%) were younger than 5 years, 17 (57%) were 5 to 14 years, 17 (57%) were females, and 23 (77%) had one lesion. The attack rate was 7 per 1000 population in the age group <15 years and 1 per 1000 population in the age group ≥15 years. On bivariate analysis, the following factors were significantly associated with CL: female gender (cOR 5.2, 95% CI 1.7-16.5), malnutrition (cOR 5.2, 95% CI 1.7-16.5), not using a bed net (cOR 14.5, 95% CI 1.7-122.4), poor house lighting (cOR 6.4, 95% CI 2.1-19.7), poor house hygiene (cOR 11.2, 95% CI 3.1-40.7), poor sanitation (cOR 14.5, 95% CI 1.7-122.4), living in houses without window nets (cOR 5.2, 95% CI 1.3-21.2), plantation around the house (cOR 6.5, 95% CI 2.1-20.5), animal barn inside or close to the house (cOR 9.3, 95% CI 1.9-46.7), raising animals (cOR 8.1, 95% CI 1.6-40.7), and having animal dung in or near the house (cOR 6.8, 95% CI 1.7-27.7). The following risk factors remained significant on multivariate stepwise analysis: female gender (aOR 22.7, 95% CI 1.6-320.5), malnutrition (aOR 17.2, 95% CI 1.3-225.8), poor house hygiene (aOR 45.6, 95% CI 2.5-846.4), plantation around the house (aOR 43.8, 95% CI 1.9-1009.9), and raising animals (aOR 287.1, 95% CI 5.4-15205.6). Conclusions: CL was endemic in Hajjah governorate, and an increase in cases was confirmed. Many individual, housing, and animal related factors were shown to contribute to CL endemicity. Implementation of control measures directed toward altering the factors favoring contact among vectors, reservoirs, and susceptible humans is strongly recommended to control future outbreaks. %M 33988521 %R 10.2196/27442 %U https://publichealth.jmir.org/2021/5/e27442 %U https://doi.org/10.2196/27442 %U http://www.ncbi.nlm.nih.gov/pubmed/33988521 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e26073 %T Protective Behaviors and Secondary Harms Resulting From Nonpharmaceutical Interventions During the COVID-19 Epidemic in South Africa: Multisite, Prospective Longitudinal Study %A Harling,Guy %A Gómez-Olivé,Francesc Xavier %A Tlouyamma,Joseph %A Mutevedzi,Tinofa %A Kabudula,Chodziwadziwa Whiteson %A Mahlako,Ruth %A Singh,Urisha %A Ohene-Kwofie,Daniel %A Buckland,Rose %A Ndagurwa,Pedzisai %A Gareta,Dickman %A Gunda,Resign %A Mngomezulu,Thobeka %A Nxumalo,Siyabonga %A Wong,Emily B %A Kahn,Kathleen %A Siedner,Mark J %A Maimela,Eric %A Tollman,Stephen %A Collinson,Mark %A Herbst,Kobus %+ Africa Health Research Institute, P.O. Box 198, Mtubatuba 3935, KwaZulu-Natal, South Africa, 27 0355507500, guy.harling@ahri.org %K behaviour change %K COVID-19 %K economic well-being %K health care access %K health knowledge %K mental health %K South Africa %K surveillance %K nonpharmaceutical interventions %D 2021 %7 13.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 33827046 %R 10.2196/26073 %U https://publichealth.jmir.org/2021/5/e26073 %U https://doi.org/10.2196/26073 %U http://www.ncbi.nlm.nih.gov/pubmed/33827046 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e28118 %T Understanding Behavioral Intentions Toward COVID-19 Vaccines: Theory-Based Content Analysis of Tweets %A Liu,Siru %A Liu,Jialin %+ Department of Medical Informatics, West China Hospital, Sichuan University, No 37 Wainan Guoxuexiang Street, Chengdu, 610041, China, 86 28 85422306, dljl8@163.com %K vaccine %K COVID-19 %K behavior %K tweet %K intention %K content analysis %K Twitter %K social media %K acceptance %K threshold %K willing %K theory %K model %K infodemiology %K infoveillance %D 2021 %7 12.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Acceptance rates of COVID-19 vaccines have still not reached the required threshold to achieve herd immunity. Understanding why some people are willing to be vaccinated and others are not is a critical step to develop efficient implementation strategies to promote COVID-19 vaccines. Objective: We conducted a theory-based content analysis based on the capability, opportunity, motivation–behavior (COM-B) model to characterize the factors influencing behavioral intentions toward COVID-19 vaccines mentioned on the Twitter platform. Methods: We collected tweets posted in English from November 1-22, 2020, using a combination of relevant keywords and hashtags. After excluding retweets, we randomly selected 5000 tweets for manual coding and content analysis. We performed a content analysis informed by the adapted COM-B model. Results: Of the 5000 COVID-19 vaccine–related tweets that were coded, 4796 (95.9%) were posted by unique users. A total of 97 tweets carried positive behavioral intent, while 182 tweets contained negative behavioral intent. Of these, 28 tweets were mapped to capability factors, 155 tweets were related to motivation, 23 tweets were related to opportunities, and 74 tweets did not contain any useful information about the reasons for their behavioral intentions (κ=0.73). Some tweets mentioned two or more constructs at the same time. Tweets that were mapped to capability (P<.001), motivation (P<.001), and opportunity (P=.03) factors were more likely to indicate negative behavioral intentions. Conclusions: Most behavioral intentions regarding COVID-19 vaccines were related to the motivation construct. The themes identified in this study could be used to inform theory-based and evidence-based interventions to improve acceptance of COVID-19 vaccines. %M 33939625 %R 10.2196/28118 %U https://www.jmir.org/2021/5/e28118 %U https://doi.org/10.2196/28118 %U http://www.ncbi.nlm.nih.gov/pubmed/33939625 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e22973 %T Usability of Rapid Cholera Detection Device (OmniVis) for Water Quality Workers in Bangladesh: Iterative Convergent Mixed Methods Study %A Rager,Theresa L %A Koepfli,Cristian %A Khan,Wasif A %A Ahmed,Sabeena %A Mahmud,Zahid Hayat %A Clayton,Katherine N %+ OmniVis Inc, 280 Utah Ave Ste 200, South San Francisco, CA, , United States, 1 415 938 4300, kclayton@omnivistech.com %K cholera %K environmental surveillance %K mHealth %K usability %D 2021 %7 12.5.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33978590 %R 10.2196/22973 %U https://www.jmir.org/2021/5/e22973 %U https://doi.org/10.2196/22973 %U http://www.ncbi.nlm.nih.gov/pubmed/33978590 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e29562 %T Monitoring Health Care Workers at Risk for COVID-19 Using Wearable Sensors and Smartphone Technology: Protocol for an Observational mHealth Study %A Clingan,Caroline A %A Dittakavi,Manasa %A Rozwadowski,Michelle %A Gilley,Kristen N %A Cislo,Christine R %A Barabas,Jenny %A Sandford,Erin %A Olesnavich,Mary %A Flora,Christopher %A Tyler,Jonathan %A Mayer,Caleb %A Stoneman,Emily %A Braun,Thomas %A Forger,Daniel B %A Tewari,Muneesh %A Choi,Sung Won %+ Division of Pediatric Hematology/Oncology, Department of Pediatrics, University of Michigan, 1500 E Medical Center Dr, D4118 Medical Professional Building, Ann Arbor, MI, 48109, United States, 1 734 615 5707, sungchoi@med.umich.edu %K mobile health %K app %K mHealth %K wearable %K sensor %K COVID-19 %K health care worker %K frontline worker %K smartphone %K digital health %D 2021 %7 12.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care workers (HCWs) have been working on the front lines of the COVID-19 pandemic with high risks of viral exposure, infection, and transmission. Standard COVID-19 testing is insufficient to protect HCWs from these risks and prevent the spread of disease. Continuous monitoring of physiological data with wearable sensors, self-monitoring of symptoms, and asymptomatic COVID-19 testing may aid in the early detection of COVID-19 in HCWs and may help reduce further transmission among HCWs, patients, and families. Objective: By using wearable sensors, smartphone-based symptom logging, and biospecimens, this project aims to assist HCWs in self-monitoring COVID-19. Methods: We conducted a prospective, longitudinal study of HCWs at a single institution. The study duration was 1 year, wherein participants were instructed on the continuous use of two wearable sensors (Fitbit Charge 3 smartwatch and TempTraq temperature patches) for up to 30 days. Participants consented to provide biospecimens (ie, nasal swabs, saliva swabs, and blood) for up to 1 year from study entry. Using a smartphone app called Roadmap 2.0, participants entered a daily mood score, submitted daily COVID-19 symptoms, and completed demographic and health-related quality of life surveys at study entry and 30 days later. Semistructured qualitative interviews were also conducted at the end of the 30-day period, following completion of daily mood and symptoms reporting as well as continuous wearable sensor use. Results: A total of 226 HCWs were enrolled between April 28 and December 7, 2020. The last participant completed the 30-day study procedures on January 16, 2021. Data collection will continue through January 2023, and data analyses are ongoing. Conclusions: Using wearable sensors, smartphone-based symptom logging and survey completion, and biospecimen collections, this study will potentially provide data on the prevalence of COVID-19 infection among HCWs at a single institution. The study will also assess the feasibility of leveraging wearable sensors and self-monitoring of symptoms in an HCW population. Trial Registration: ClinicalTrials.gov NCT04756869; https://clinicaltrials.gov/ct2/show/NCT04756869 International Registered Report Identifier (IRRID): DERR1-10.2196/29562 %M 33945497 %R 10.2196/29562 %U https://www.researchprotocols.org/2021/5/e29562 %U https://doi.org/10.2196/29562 %U http://www.ncbi.nlm.nih.gov/pubmed/33945497 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 5 %P e27342 %T On-site Dining in Tokyo During the COVID-19 Pandemic: Time Series Analysis Using Mobile Phone Location Data %A Nakanishi,Miharu %A Shibasaki,Ryosuke %A Yamasaki,Syudo %A Miyazawa,Satoshi %A Usami,Satoshi %A Nishiura,Hiroshi %A Nishida,Atsushi %+ Research Center for Social Science & Medicine, Tokyo Metopolitan Institute of Medical Science, 2-1-6 Kamikitazawa, Setagaya-ku, Tokyo, 156-8506, Japan, 81 3 6834 2292, mnakanishi-tky@umin.ac.jp %K COVID-19 %K mobility data %K on-site dining %K public health and social measures %K public health %K mobile phone %K mobility %K protection %K time series %K location %K infectious disease %K transmission %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 33886486 %R 10.2196/27342 %U https://mhealth.jmir.org/2021/5/e27342 %U https://doi.org/10.2196/27342 %U http://www.ncbi.nlm.nih.gov/pubmed/33886486 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e27276 %T Risk Factors of Extensively Drug Resistant Typhoid Fever Among Children in Karachi: Case-Control Study %A Vighio,Anum %A Syed,Muhammad Asif %A Hussain,Ishfaque %A Zia,Syed Masroor %A Fatima,Munaza %A Masood,Naveed %A Chaudry,Ambreen %A Hussain,Zakir %A Iqbal Baig,Mirza Zeeshan %A Baig,Mirza Amir %A Ikram,Aamer %A S Khader,Yousef %+ Field Epidemiology and Laboratory Training Program Pakistan, National Institute of Health, Park Road, Chak Shahzad, Islamabad, 44000, Pakistan, 92 519255307, anumvighio@gmail.com %K case-control study %K drug resistance %K extensively drug resistant typhoid fever %K risk factors %K typhoid fever %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 33973861 %R 10.2196/27276 %U https://publichealth.jmir.org/2021/5/e27276 %U https://doi.org/10.2196/27276 %U http://www.ncbi.nlm.nih.gov/pubmed/33973861 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e23009 %T Learning From the Experiences of COVID-19 Survivors: Web-Based Survey Study %A Prioleau,Temiloluwa %+ Dartmouth College, 9 Maynard Street, Hanover, NH, 03755, United States, 1 6036468730, tprioleau@dartmouth.edu %K patient-reported outcomes %K coronavirus %K COVID-19 %K outcome %K crowdsourcing %K social media %K internet %K survivor %K experience %D 2021 %7 11.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: There are still many unanswered questions about the novel coronavirus; however, a largely underutilized source of knowledge is the millions of people who have recovered after contracting the virus. This includes a majority of undocumented cases of COVID-19, which were classified as mild or moderate and received little to no clinical care during the course of illness. Objective: This study aims to document and glean insights from the experiences of individuals with a first-hand experience in dealing with COVID-19, especially the so-called mild-to-moderate cases that self-resolved while in isolation. Methods: This web-based survey study called C19 Insider Scoop recruited adult participants aged 18 years or older who reside in the United States and had tested positive for COVID-19 or antibodies. Participants were recruited through various methods, including online support groups for COVID-19 survivors, advertisement in local news outlets, as well as through professional and other networks. The main outcomes measured in this study included knowledge of contraction or transmission of the virus, symptoms, and personal experiences on the road to recovery. Results: A total of 72 participants (female, n=53; male, n=19; age range: 18-73 years; mean age: 41 [SD 14] years) from 22 US states were enrolled in this study. The top known source of how people contracted SARS-CoV-2, the virus known to cause COVID-19, was through a family or household member (26/72, 35%). This was followed by essential workers contracting the virus through the workplace (13/72, 18%). Participants reported up to 27 less-documented symptoms that they experienced during their illness, such as brain or memory fog, palpitations, ear pain or discomfort, and neurological problems. In addition, 47 of 72 (65%) participants reported that their symptoms lasted longer than the commonly cited 2-week period even for mild cases of COVID-19. The mean recovery time of the study participants was 4.5 weeks, and exactly one-half of participants (50%) still experienced lingering symptoms of COVID-19 after an average of 65 days following illness onset. Additionally, 37 (51%) participants reported that they experienced stigma associated with contracting COVID-19. Conclusions: This study presents preliminary findings suggesting that emphasis on family or household spread of COVID-19 may be lacking and that there is a general underestimation of the recovery time even for mild cases of illness with the virus. Although a larger study is needed to validate these results, it is important to note that as more people experience COVID-19, insights from COVID-19 survivors can enable a more informed public, pave the way for others who may be affected by the virus, and guide further research. %M 33878012 %R 10.2196/23009 %U https://formative.jmir.org/2021/5/e23009 %U https://doi.org/10.2196/23009 %U http://www.ncbi.nlm.nih.gov/pubmed/33878012 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e25753 %T SARS-CoV-2 Surveillance System in Canada: Longitudinal Trend Analysis %A Post,Lori %A Boctor,Michael J %A Issa,Tariq Z %A Moss,Charles B %A Murphy,Robert Leo %A Achenbach,Chad J %A Ison,Michael G %A Resnick,Danielle %A Singh,Lauren %A White,Janine %A Welch,Sarah B %A Oehmke,James F %+ Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K global COVID surveillance %K COVID-19 %K COVID-21 %K new COVID strains %K Canada Public Health Surveillance %K Great COVID Shutdown %K Canadian COVID-19 %K surveillance metrics %K wave 2 Canada COVID-19 %K dynamic panel data %K generalized method of the moments %K Canadian econometrics %K Canada SARS-CoV-2 %K Canadian COVID-19 surveillance system %K Canadian COVID transmission speed %K Canadian COVID transmission acceleration %K COVID transmission deceleration %K COVID transmission jerk %K COVID 7-day lag %K Alberta %K British Columbia %K Manitoba %K New Brunswick %K Newfoundland and Labrador %K Northwest Territories %K Nova Scotia %K Nunavut %K Ontario %K Prince Edward Island %K Quebec %K Saskatchewan %K Yukon %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 global pandemic has disrupted structures and communities across the globe. Numerous regions of the world have had varying responses in their attempts to contain the spread of the virus. Factors such as public health policies, governance, and sociopolitical climate have led to differential levels of success at controlling the spread of SARS-CoV-2. Ultimately, a more advanced surveillance metric for COVID-19 transmission is necessary to help government systems and national leaders understand which responses have been effective and gauge where outbreaks occur. Objective: The goal of this study is to provide advanced COVID-19 surveillance metrics for Canada at the country, province, and territory level that account for shifts in the pandemic including speed, acceleration, jerk, and persistence. Enhanced surveillance identifies risks for explosive growth and regions that have controlled outbreaks successfully. Methods: Using a longitudinal trend analysis study design, we extracted 62 days of COVID-19 data from Canadian public health registries for 13 provinces and territories. We used an empirical difference equation to measure the daily number of cases in Canada as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: We compare the week of February 7-13, 2021, with the week of February 14-20, 2021. Canada, as a whole, had a decrease in speed from 8.4 daily new cases per 100,000 population to 7.5 daily new cases per 100,000 population. The persistence of new cases during the week of February 14-20 reported 7.5 cases that are a result of COVID-19 transmissions 7 days earlier. The two most populous provinces of Ontario and Quebec both experienced decreases in speed from 7.9 and 11.5 daily new cases per 100,000 population for the week of February 7-13 to speeds of 6.9 and 9.3 for the week of February 14-20, respectively. Nunavut experienced a significant increase in speed during this time, from 3.3 daily new cases per 100,000 population to 10.9 daily new cases per 100,000 population. Conclusions: Canada excelled at COVID-19 control early on in the pandemic, especially during the first COVID-19 shutdown. The second wave at the end of 2020 resulted in a resurgence of the outbreak, which has since been controlled. Enhanced surveillance identifies outbreaks and where there is the potential for explosive growth, which informs proactive health policy. %M 33852410 %R 10.2196/25753 %U https://publichealth.jmir.org/2021/5/e25753 %U https://doi.org/10.2196/25753 %U http://www.ncbi.nlm.nih.gov/pubmed/33852410 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e19502 %T Development of an Index for the Inspection of Aedes aegypti Breeding Sites in Brazil: Multi-criteria Analysis %A Lima,Yuri %A Pinheiro,Wallace %A Barbosa,Carlos Eduardo %A Magalhães,Matheus %A Chaves,Miriam %A de Souza,Jano Moreira %A Rodrigues,Sérgio %A Xexéo,Geraldo %+ Graduate School of Engineering (COPPE), Federal University of Rio de Janeiro (UFRJ), Rua Horácio Macedo, Bloco G, 2030 - 101 - Cidade Universitária da Universidade Federal do Rio de Janeiro, Rio de Janeiro, 21941-450, Brazil, 55 21995716204, yuriodelima@cos.ufrj.br %K multi-criteria analysis %K public health %K human sensors %K vector surveillance %K tropical diseases %D 2021 %7 10.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Aedes aegypti is a vector for the transmission of diseases such as dengue fever, chikungunya, Zika fever, and yellow fever. In 2016, over 1 million cases of these diseases were reported in Brazil, which is an alarming public health issue. One of the ways of controlling this disease is by inspecting and neutralizing the places where A. aegypti lays its eggs. The Ministry of Planning, Development, and Administration of Brazil maintains the inspection statistics. Objective: We propose a multi-criteria analysis to create an index for A. aegypti inspections reported through the Ministry of Planning, Development, and Administration system of Brazil. Methods: Based on the repository from urban cleaning services combined with data on inspections conducted by government agencies in several Brazilian cities and municipalities, we selected and combined metrics, which we further ranked using the analytic hierarchy process methodology. We also developed risk maps based on the analytic hierarchy process ranking of the A. aegypti breeding sites. Results: Based on our analysis and the available data, the priority for inspections should consider the number of sick people (weight 0.350), medical evaluations (weight 0.239), inspections (weight 0.201), mosquito breeding sites (weight 0.126), and days of absence from work (weight 0.096). Conclusions: The proposed index could aid public health practitioners in preventing the appearance of new A. aegypti breeding sites. This information technology application can help solve such public health challenges. %M 33970118 %R 10.2196/19502 %U https://publichealth.jmir.org/2021/5/e19502 %U https://doi.org/10.2196/19502 %U http://www.ncbi.nlm.nih.gov/pubmed/33970118 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e27412 %T 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 %A Abu El Sood,Hanaa %A Abu Kamer,Shimaa Ali %A Kamel,Reham %A Magdy,Hesham %A Osman,Fatma S %A Fahim,Manal %A Mohsen,Amira %A AbdelFatah,Mohamad %A Hassany,Mohamed %A Afifi,Salma %A Eid,Alaa %+ Department of Epidemiology and Surveillance, Preventive Sector, Ministry of Health and Population, 3 Magles Elshaab St, Cairo, , Egypt, 20 01282833078 ext 002, hanaaabuelsood@hotmail.com %K pandemic preparedness %K Egypt %K ARI %K epidemic mitigation %K COVID-19 %D 2021 %7 7.5.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X This article briefly describes Egypt’s acute respiratory infection (ARI) epidemic preparedness and containment plan and illustrates the impact of implementation of the plan on combating the early stage of the COVID-19 epidemic in Egypt. Pillars of the plan include crisis management, enhancing surveillance systems and contact tracing, case and hospital management, raising community awareness, and quarantine and entry points. To identify the impact of the implementation of the plan on epidemic mitigation, a literature review was performed of studies published from Egypt in the early stage of the pandemic. In addition, data for patients with COVID-19 from February to July 2020 were obtained from the National Egyptian Surveillance system and studied to describe the situation in the early stage of the epidemic in Egypt. The lessons learned indicated that the single most important key to success in early-stage epidemic containment is the commitment of all partners to a predeveloped and agreed-upon preparedness plan. This information could be useful for other countries in the region and worldwide in mitigating future anticipated ARI epidemics and pandemics. Postepidemic evaluation is needed to better assess Egypt’s national response to the COVID-19 epidemic. %M 33830932 %R 10.2196/27412 %U https://publichealth.jmir.org/2021/5/e27412 %U https://doi.org/10.2196/27412 %U http://www.ncbi.nlm.nih.gov/pubmed/33830932 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 2 %P e25703 %T Mobile App–Reported Use of Traditional Medicine for Maintenance of Health in India During the COVID-19 Pandemic: Cross-sectional Questionnaire Study %A Srikanth,N %A Rana,Rakesh %A Singhal,Richa %A Jameela,Sophia %A Singh,Rajeshwari %A Khanduri,Shruti %A Tripathi,Arunabh %A Goel,Sumeet %A Chhatre,Leena %A Chandra,Ashwin %A Rao,B C S %A Dhiman,K S %+ Central Council for Research in Ayurvedic Sciences, Ministry of AYUSH, Janakpuri, Delhi, 110058, India, 91 9818478514, rkrana2000@gmail.com %K AYUSH Sanjivani app %K COVID-19 %K traditional medicine %K Ayurveda %K Siddha %K Unani %K homeopathy %D 2021 %7 7.5.2021 %9 Original Paper %J JMIRx Med %G English %X Background: India follows a pluralistic system for strategic and focused health care delivery in which traditional systems of medicine such as Ayurveda, yoga and naturopathy, Unani, Siddha, Sowa Rigpa, and homoeopathy (AYUSH) coexist with contemporary medicine, and this system functions under the Ministry of AYUSH (MoA). The MoA developed a mobile app, called AYUSH Sanjivani, to document the trends of the use of AYUSH-based traditional and holistic measures by the public across India. Analysis of the data generated through this app can help monitor the extent of the use of AYUSH measures for maintenance of health during the COVID-19 pandemic and aid effective health promotion and communication efforts focused on targeted health care delivery during the pandemic. Objective: The purpose of the study was to determine the extent of use of AYUSH measures by the public in India for maintenance of health during the COVID-19 pandemic as reported through the AYUSH Sanjivani mobile app. Methods: Cross-sectional analysis of the data generated through the Ayush Sanjivani app from May 4 to July 31, 2020, was performed to study the pattern and extent of the use of AYUSH-based measures by the Indian population. The responses of the respondents in terms of demographic profile, use pattern, and benefits obtained; the association between the use of AYUSH-based measures and symptomatic status; and the association between the duration of use of AYUSH-based measures and the outcome of COVID-19 testing were evaluated based on bivariate and multivariate logistic regression analysis. Results: Data from 723,459 respondents were used for the analysis, among whom 616,295 (85.2%) reported that they had been using AYUSH measures for maintenance of health during the COVID-19 pandemic. Among these 616,295 users, 553,801 (89.8%) either strongly or moderately agreed to have benefitted from AYUSH measures. Ayurveda and homeopathic measures and interventions were the most preferred by the respondents across India. Among the 359,785 AYUSH users who described their overall improvement in general health, 144,927 (40.3%) rated it as good, 30,848 (8.6%) as moderate, and 133,046 (40.3%) as slight. Respondents who had been using AYUSH measures for less than 30 days were more likely to be COVID-19–positive among those who were tested (odds ratio 1.52, 95% CI 1.44-1.60). The odds of nonusers of AYUSH measures being symptomatic if they tested positive were greater than those of AYUSH users (odds ratio 4.01, 95% CI 3.61-4.59). Conclusions: The findings of this cross-sectional analysis assert that a large proportion of the representative population practiced AYUSH measures across different geographic locations of the country during the COVID-19 pandemic and benefitted considerably in terms of general well-being, with a possible impact on their quality of life and specific domains of health. %M 34032815 %R 10.2196/25703 %U https://xmed.jmir.org/2021/2/e25703 %U https://doi.org/10.2196/25703 %U http://www.ncbi.nlm.nih.gov/pubmed/34032815 %0 Journal Article %@ 2562-0959 %I JMIR Publications %V 4 %N 1 %P e22789 %T Does Wearing a Face Mask During the COVID-19 Pandemic Increase the Incidence of Dermatological Conditions in Health Care Workers? Narrative Literature Review %A Wilcha,Robyn-Jenia %+ Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester, M13 9PL, United Kingdom, 44 (0)161 306 021, robynwilcha05@gmail.com %K COVID-19 %K dermatology %K face masks %K health care worker %K incidence %K literature %K mask %K N95 mask %K review %K skin %D 2021 %7 6.5.2021 %9 Review %J JMIR Dermatol %G English %X 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. %M 34028470 %R 10.2196/22789 %U https://derma.jmir.org/2021/1/e22789 %U https://doi.org/10.2196/22789 %U http://www.ncbi.nlm.nih.gov/pubmed/34028470 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e25600 %T Associations Between Health Literacy, eHealth Literacy, and COVID-19–Related Health Behaviors Among Chinese College Students: Cross-sectional Online Study %A Li,Shaojie %A Cui,Guanghui %A Kaminga,Atipatsa Chiwanda %A Cheng,Sixiang %A Xu,Huilan %+ Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 238 Shangmayuanling Lane, Changsha, 410078, China, 86 13637480958, xhl_csu@163.com %K COVID-19 %K health literacy %K eHealth literacy %K COVID-19–related health behavior questionnaire %K Chinese college students %D 2021 %7 6.5.2021 %9 Original Paper %J J Med Internet Res %G English %X 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 α=.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 (βhealth literacy=.149, βeHealth literacy=.368; P<.001) and conventional health behaviors (βhealth literacy=.219, βeHealth 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. %M 33822734 %R 10.2196/25600 %U https://www.jmir.org/2021/5/e25600 %U https://doi.org/10.2196/25600 %U http://www.ncbi.nlm.nih.gov/pubmed/33822734 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e23251 %T Survival Analysis of Patients With COVID-19 in India by Demographic Factors: Quantitative Study %A Kundu,Sampurna %A Chauhan,Kirti %A Mandal,Debarghya %+ Department of Mathematical Demography and Statistics, International Institute for Population Sciences, Govandi Station Road, Mumbai, 400088, India, 91 9073111858, sampurna34@gmail.com %K survival analysis %K COVID-19 %K patient data %K Kaplan-Meier %K hazard model %K modeling %K survival %K mortality %K demographic %K India %K transmission %D 2021 %7 6.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Studies of the transmission dynamics of COVID-19 have depicted the rate, patterns, and predictions of cases of this pandemic disease. To combat transmission of the disease in India, the government declared a lockdown on March 25, 2020. Even after this strict lockdown was enacted nationwide, the number of COVID-19 cases increased and surpassed 450,000. A positive point to note is that the number of recovered cases began to slowly exceed that of active cases. The survival of patients, taking death as the event that varies by age group and sex, is noteworthy. Objective: The aim of this study was to conduct a survival analysis to establish the variability in survivorship of patients with COVID-19 in India by age group and sex at different levels, that is, the national, state, and district levels. Methods: The study period was taken from the date of the first reported case of COVID-19 in India, which was January 30, 2020, up to June 30, 2020. Due to the amount of underreported data and removal of missing columns, a total sample of 26,815 patients was considered. Kaplan-Meier survival estimation, the Cox proportional hazard model, and the multilevel survival model were used to perform the survival analysis. Results: The Kaplan-Meier survival function showed that the probability of survival of patients with COVID-19 declined during the study period of 5 months, which was supplemented by the log rank test (P<.001) and Wilcoxon test (P<.001) to compare the survival functions. Significant variability was observed in the age groups, as evident from all the survival estimates; with increasing age, the risk of dying of COVID-19 increased. The Cox proportional hazard model reiterated that male patients with COVID-19 had a 1.14 times higher risk of dying than female patients (hazard ratio 1.14; SE 0.11; 95% CI 0.93-1.38). Western and Central India showed decreasing survival rates in the framed time period, while Eastern, North Eastern, and Southern India showed slightly better results in terms of survival. Conclusions: This study depicts a grave scenario of decreasing survival rates in various regions of India and shows variability in these rates by age and sex. In essence, we can safely conclude that the critical appraisal of the survival rate and thorough analysis of patient data in this study equipped us to identify risk groups and perform comparative studies of various segments in India. International Registered Report Identifier (IRRID): RR2-10.1101/2020.08.01.20162115 %M 33882017 %R 10.2196/23251 %U https://formative.jmir.org/2021/5/e23251 %U https://doi.org/10.2196/23251 %U http://www.ncbi.nlm.nih.gov/pubmed/33882017 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 5 %P e25207 %T 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 %A Griswold,Dylan %A Gempeler,Andrés %A Rosseau,Gail %A Kaseje,Neema %A Johnson,Walter D %A Kolias,Angelos %A Hutchinson,Peter J %A Rubiano,Andres M %+ Neuroscience Institute, INUB-MEDITECH Research Group, El Bosque University, Av Cra 9 No 131 A - 02, Bogota, 110121, Colombia, 57 3006154775, rubianoam@gmail.com %K systematic review %K broad-evidence synthesis %K COVID-19 %K global health %K trauma surgery %K evidence-based practice %K chest CT %K rapid testing %K testing %K diagnosis %K scan %K computed tomography %K review %K antigen %K immune system %K health care worker %K surgery %K emergency %K protocol %D 2021 %7 6.5.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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·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 %M 33878019 %R 10.2196/25207 %U https://www.researchprotocols.org/2021/5/e25207 %U https://doi.org/10.2196/25207 %U http://www.ncbi.nlm.nih.gov/pubmed/33878019 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e28352 %T YouTube Videos and Informed Decision-Making About COVID-19 Vaccination: Successive Sampling Study %A Basch,Charles E %A Basch,Corey H %A Hillyer,Grace C %A Meleo-Erwin,Zoe C %A Zagnit,Emily A %+ Teachers College, Columbia University, 525 W 120th St, New York, NY, 10027, United States, 1 212 678 3983, ceb35@columbia.edu %K YouTube %K vaccination %K COVID-19 %K social media %K communication %K misinformation %K disinformation %K adverse reactions %D 2021 %7 6.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media platforms such as YouTube are used by many people to seek and share health-related information that may influence their decision-making about COVID-19 vaccination. Objective: The purpose of this study was to improve the understanding about the sources and content of widely viewed YouTube videos on COVID-19 vaccination. Methods: Using the keywords “coronavirus vaccination,” we searched for relevant YouTube videos, sorted them by view count, and selected two successive samples (with replacement) of the 100 most widely viewed videos in July and December 2020, respectively. Content related to COVID-19 vaccines were coded by two observers, and inter-rater reliability was demonstrated. Results: The videos observed in this study were viewed over 55 million times cumulatively. The number of videos that addressed fear increased from 6 in July to 20 in December 2020, and the cumulative views correspondingly increased from 2.6% (1,449,915 views) to 16.6% (9,553,368 views). There was also a large increase in the number of videos and cumulative views with respect to concerns about vaccine effectiveness, from 6 videos with approximately 6 million views in July to 25 videos with over 12 million views in December 2020. The number of videos and total cumulative views covering adverse reactions almost tripled, from 11 videos with approximately 6.5 million (11.7% of cumulative views) in July to 31 videos with almost 15.7 million views (27.2% of cumulative views) in December 2020. Conclusions: Our data show the potentially inaccurate and negative influence social media can have on population-wide vaccine uptake, which should be urgently addressed by agencies of the United States Public Health Service as well as its global counterparts. %M 33886487 %R 10.2196/28352 %U https://publichealth.jmir.org/2021/5/e28352 %U https://doi.org/10.2196/28352 %U http://www.ncbi.nlm.nih.gov/pubmed/33886487 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 5 %P e26590 %T A Resilience-Building App to Support the Mental Health of Health Care Workers in the COVID-19 Era: Design Process, Distribution, and Evaluation %A Golden,Eddye A %A Zweig,Micol %A Danieletto,Matteo %A Landell,Kyle %A Nadkarni,Girish %A Bottinger,Erwin %A Katz,Lindsay %A Somarriba,Ricardo %A Sharma,Vansh %A Katz,Craig L %A Marin,Deborah B %A DePierro,Jonathan %A Charney,Dennis S %+ Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Avenue, 14th Fl, New York, NY, 10065, United States, 1 4014398798, eddye.golden@mssm.edu %K mHealth %K resilience %K mental health %K COVID-19 %K HCWs %K digital health %K health app %K mental health platform %K mobile phone %D 2021 %7 5.5.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has resulted in increased strain on health care systems and negative psychological effects on health care workers (HCWs). This is anticipated to result in long-term negative mental health effects on the population, with HCWs representing a particularly vulnerable group. The scope of the COVID-19 pandemic necessitates the development of a scalable mental health platform to provide services to large numbers of at-risk or affected individuals. The Mount Sinai Health System in New York City was at the epicenter of the pandemic in the United States. Objective: The Center for Stress, Resilience, and Personal Growth (CSRPG) was created to address the current and anticipated psychological impact of the pandemic on the HCWs in the health system. The mission of the Center is to support the resilience and mental health of employees through educational offerings, outreach, and clinical care. Our aim was to build a mobile app to support the newly founded Center in its mission. Methods: We built the app as a standalone digital platform that hosts a suite of tools that users can interact with on a daily basis. With consideration for the Center’s aims, we determined the overall vision, initiatives, and goals for the Wellness Hub app, followed by specific milestone tasks and deliverables for development. We defined the app’s primary features based on the mental health assessment and needs of HCWs. Feature definition was informed by the results of a resilience survey widely distributed to Mount Sinai HCWs and by the resources offered at CSRPG, including workshop content. Results: We launched our app over the course of two phases, the first phase being a “soft” launch and the second being a broader launch to all of Mount Sinai. Of the 231 HCWs who downloaded the app, 173 (74.9%) completed our baseline assessment of all mental health screeners in the app. Results from the baseline assessment show that more than half of the users demonstrate a need for support in at least one psychological area. As of 3 months after the Phase 2 launch, approximately 55% of users re-entered the app after their first opening to explore additional features, with an average of 4 app openings per person. Conclusions: To address the mental health needs of HCWs during the COVID-19 pandemic, the Wellness Hub app was built and deployed throughout the Mount Sinai Health System. To our knowledge, this is the first resilience app of its kind. The Wellness Hub app is a promising proof of concept, with room to grow, for those who wish to build a secure mobile health app to support their employees, communities, or others in managing and improving mental and physical well-being. It is a novel tool offering mental health support broadly. %M 33872189 %R 10.2196/26590 %U https://formative.jmir.org/2021/5/e26590 %U https://doi.org/10.2196/26590 %U http://www.ncbi.nlm.nih.gov/pubmed/33872189 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e26932 %T Analysis of COVID-19 Transmission Sources in France by Self-Assessment Before and After the Partial Lockdown: Observational Study %A Denis,Fabrice %A Septans,Anne-Lise %A Le Goff,Florian %A Jeanneau,Stephan %A Lescure,François-Xavier %+ Inter-regional Cancer Institut Jean Bernard - ELSAN, 9 Rue Beauverger, Le Mans, , France, 33 0684190480, fabrice.denis.home@gmail.com %K COVID-19 %K web application %K digital health %K analysis %K transmission %K France %K self-assessment %K lockdown %K observational %K survey %K impact %K public health %D 2021 %7 4.5.2021 %9 Original Paper %J J Med Internet Res %G English %X 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 %M 33878018 %R 10.2196/26932 %U https://www.jmir.org/2021/5/e26932 %U https://doi.org/10.2196/26932 %U http://www.ncbi.nlm.nih.gov/pubmed/33878018 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 5 %P e27606 %T Performance of the Neonatal Tetanus Surveillance System (NTSS) in Sana'a, Yemen: Evaluation Study %A Al-Jamrah,Khaled Mohammed %A Al Nabehi,Basheer Abdulgalil %A Almoayed,Khaled Abdullah %A Anam,Labiba Saeed %A Khader,Yousef S %+ Yemen Field Epidemiology Training Program, Ministry of Public Health and Population, Alhasabah Area, Althawrah District, Sana'a, Yemen, 967 777 950 053, khjamrah2010@gmail.com %K neonatal tetanus %K evaluation %K surveillance %K CDC guidelines %K Yemen %D 2021 %7 4.5.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Neonatal Tetanus Surveillance System (NTSS) in Yemen was established in 2009 to identify high-risk areas, determine trends, and evaluate elimination activities. Since its launch, the NTSS had never been evaluated. Objective: This study aimed to assess the performance of NTSS and determine its strengths and weaknesses to recommend improvements. Methods: The US Centers for Disease Control and Prevention (CDC) guidelines were used for evaluating the NTSS. Stakeholders at the central, district, and facility levels were interviewed to rate the attributes of the NTSS. The percentage scores for attributes were ranked as poor (<60%), average (≥60% to <80%) and good (≥80%). Results: The overall usefulness score percentage was 38%, which indicates a poor performance. The performance of the NTSS was rated as average on flexibility (score percent: 68%) and acceptability (score percent: 64%) attributes and poor on stability (score percentage: 33%), simplicity (score percentage: 57%), and representativeness (score percentage: 39%) attributes. About 65% of investigation forms were completed within 48 hours of notification date. Data quality was poor, as 41% of the core variables were missing. Conclusions: The overall performance of the NTSS was poor. Most of the system attributes require improvement, including stability, simplicity, quality of data, and completeness of investigation. To improve the performance of NTSS, the following are recommended: capacity building of staff (focal points), strengthening NTSS through technical support and government funding to ensure its sustainability, establishing electronic investigation forms for improving the system data quality, and expansion of NTSS coverage to include all private health care facilities. %M 33944794 %R 10.2196/27606 %U https://publichealth.jmir.org/2021/5/e27606 %U https://doi.org/10.2196/27606 %U http://www.ncbi.nlm.nih.gov/pubmed/33944794 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 5 %P e22933 %T Information-Seeking Patterns During the COVID-19 Pandemic Across the United States: Longitudinal Analysis of Google Trends Data %A Mangono,Tichakunda %A Smittenaar,Peter %A Caplan,Yael %A Huang,Vincent S %A Sutermaster,Staci %A Kemp,Hannah %A Sgaier,Sema K %+ Surgo Ventures, 1701 Rhode Island Ave NW, Washington, DC, 20036, United States, 1 8579397670, tichmangono@surgoventures.org %K Google Trends %K coronavirus %K COVID-19 %K principal component analysis %K information-seeking trends %K information retrieval %K trend %K infodemiology %K infoveillance %K virus %K public health %K information seeking %K online health information %D 2021 %7 3.5.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has impacted people’s lives at unprecedented speed and scale, including how they eat and work, what they are concerned about, how much they move, and how much they can earn. Traditional surveys in the area of public health can be expensive and time-consuming, and they can rapidly become outdated. The analysis of big data sets (such as electronic patient records and surveillance systems) is very complex. Google Trends is an alternative approach that has been used in the past to analyze health behaviors; however, most existing studies on COVID-19 using these data examine a single issue or a limited geographic area. This paper explores Google Trends as a proxy for what people are thinking, needing, and planning in real time across the United States. Objective: We aimed to use Google Trends to provide both insights into and potential indicators of important changes in information-seeking patterns during pandemics such as COVID-19. We asked four questions: (1) How has information seeking changed over time? (2) How does information seeking vary between regions and states? (3) Do states have particular and distinct patterns in information seeking? (4) Do search data correlate with—or precede—real-life events? Methods: We analyzed searches on 38 terms related to COVID-19, falling into six themes: social and travel; care seeking; government programs; health programs; news and influence; and outlook and concerns. We generated data sets at the national level (covering January 1, 2016, to April 15, 2020) and state level (covering January 1 to April 15, 2020). Methods used include trend analysis of US search data; geographic analyses of the differences in search popularity across US states from March 1 to April 15, 2020; and principal component analysis to extract search patterns across states. Results: The data showed high demand for information, corresponding with increasing searches for coronavirus linked to news sources regardless of the ideological leaning of the news source. Changes in information seeking often occurred well in advance of action by the federal government. The popularity of searches for unemployment claims predicted the actual spike in weekly claims. The increase in searches for information on COVID-19 care was paralleled by a decrease in searches related to other health behaviors, such as urgent care, doctor’s appointments, health insurance, Medicare, and Medicaid. Finally, concerns varied across the country; some search terms were more popular in some regions than in others. Conclusions: COVID-19 is unlikely to be the last pandemic faced by the United States. Our research holds important lessons for both state and federal governments in a fast-evolving situation that requires a finger on the pulse of public sentiment. We suggest strategic shifts for policy makers to improve the precision and effectiveness of non-pharmaceutical interventions and recommend the development of a real-time dashboard as a decision-making tool. %M 33878015 %R 10.2196/22933 %U https://www.jmir.org/2021/5/e22933 %U https://doi.org/10.2196/22933 %U http://www.ncbi.nlm.nih.gov/pubmed/33878015 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27341 %T Emotions of COVID-19: Content Analysis of Self-Reported Information Using Artificial Intelligence %A Adikari,Achini %A Nawaratne,Rashmika %A De Silva,Daswin %A Ranasinghe,Sajani %A Alahakoon,Oshadi %A Alahakoon,Damminda %+ Research Centre for Data Analytics and Cognition, La Trobe University, Kingsbury Drive, Melbourne, Australia, 61 394793109, A.Adikari@latrobe.edu.au %K COVID-19 %K pandemic %K lockdown %K human emotions %K affective computing %K human-centric artificial intelligence %K artificial intelligence %K AI %K machine learning %K natural language processing %K language modeling %K infodemiology %K infoveillance %D 2021 %7 30.4.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33819167 %R 10.2196/27341 %U https://www.jmir.org/2021/4/e27341 %U https://doi.org/10.2196/27341 %U http://www.ncbi.nlm.nih.gov/pubmed/33819167 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e27013 %T Collect Once, Use Many Times: Attaining Unified Metrics for Tuberculosis Preventive Treatment for People Living With HIV %A Fukunaga,Rena %A Lowrance,David %A MacNeil,Adam %A Al-Samarrai,Teeb %A Cavanaugh,Joseph %A Baddeley,Annabel %A Nichols,Catherine %A Peterson,Meaghan %A Ahmedov,Sevim %A Singh,Vindi %A Edwards,Celeste Gracia %A Jain,Suman %A Date,Anand %A Maloney,Susan A %+ Centers for Disease Control and Prevention, 1600 Clifton Rd, Atlanta, GA, 30333, United States, 1 404 639 3311, lxi9@cdc.gov %K tuberculosis preventive treatment %K monitoring and evaluation %K people living with HIV %K HIV %K TB %K infectious disease %K preventative treatment %D 2021 %7 30.4.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The World Health Organization (WHO) recommends providing tuberculosis preventive treatment (TPT) to all persons living with HIV and to all household contacts of persons with bacteriologically confirmed pulmonary tuberculosis disease. Regrettably, the absence of a harmonized data collection and management approach to TPT indicators has contributed to programmatic challenges at local, national, and global levels. However, in April 2020, the WHO launched the Consolidated HIV Strategic Information Guidelines, with an updated set of priority indicators. These guidelines recommend that Ministries of Health collect, report, and use data on TPT completion in addition to TPT initiation. Both indicators are reflected in the WHO’s list of 15 core indicators for program management and are also required by the US President’s Emergency Plan for AIDS Relief’s Monitoring, Evaluation, and Reporting (MER) guidance. Although not perfectly harmonized, both frameworks now share essential indicator characteristics. Aligned indicators are necessary for robust strategic and operational planning, resource allocation, and data communication. “Collect once, use many times” is a best practice for strategic information management. Building harmonized and sustainable health systems will enable countries to successfully maintain essential HIV, tuberculosis, and other health services while combatting new health threats. %M 33929335 %R 10.2196/27013 %U https://publichealth.jmir.org/2021/4/e27013 %U https://doi.org/10.2196/27013 %U http://www.ncbi.nlm.nih.gov/pubmed/33929335 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e25075 %T Use of a Telemedicine Risk Assessment Tool to Predict the Risk of Hospitalization of 496 Outpatients With COVID-19: Retrospective Analysis %A O'Keefe,James B %A Tong,Elizabeth J %A Taylor Jr,Thomas H %A O’Keefe,Ghazala A Datoo %A Tong,David C %+ Division of General Internal Medicine, Department of Medicine, Emory University School of Medicine, 1365 Clifton Rd NE, Building A, Atlanta, GA, 30322, United States, 1 4047780480, jbokeef@emory.edu %K COVID-19 %K SARS-CoV-2 %K nonhospitalized %K risk assessment %K outpatient %K outcomes %K telemedicine %D 2021 %7 30.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Risk assessment of patients with acute COVID-19 in a telemedicine context is not well described. In settings of large numbers of patients, a risk assessment tool may guide resource allocation not only for patient care but also for maximum health care and public health benefit. Objective: The goal of this study was to determine whether a COVID-19 telemedicine risk assessment tool accurately predicts hospitalizations. Methods: We conducted a retrospective study of a COVID-19 telemedicine home monitoring program serving health care workers and the community in Atlanta, Georgia, with enrollment from March 24 to May 26, 2020; the final call range was from March 27 to June 19, 2020. All patients were assessed by medical providers using an institutional COVID-19 risk assessment tool designating patients as Tier 1 (low risk for hospitalization), Tier 2 (intermediate risk for hospitalization), or Tier 3 (high risk for hospitalization). Patients were followed with regular telephone calls to an endpoint of improvement or hospitalization. Using survival analysis by Cox regression with days to hospitalization as the metric, we analyzed the performance of the risk tiers and explored individual patient factors associated with risk of hospitalization. Results: Providers using the risk assessment rubric assigned 496 outpatients to tiers: Tier 1, 237 out of 496 (47.8%); Tier 2, 185 out of 496 (37.3%); and Tier 3, 74 out of 496 (14.9%). Subsequent hospitalizations numbered 3 out of 237 (1.3%) for Tier 1, 15 out of 185 (8.1%) for Tier 2, and 17 out of 74 (23%) for Tier 3. From a Cox regression model with age of 60 years or older, gender, and reported obesity as covariates, the adjusted hazard ratios for hospitalization using Tier 1 as reference were 3.74 (95% CI 1.06-13.27; P=.04) for Tier 2 and 10.87 (95% CI 3.09-38.27; P<.001) for Tier 3. Conclusions: A telemedicine risk assessment tool prospectively applied to an outpatient population with COVID-19 identified populations with low, intermediate, and high risk of hospitalization. %M 33667174 %R 10.2196/25075 %U https://publichealth.jmir.org/2021/4/e25075 %U https://doi.org/10.2196/25075 %U http://www.ncbi.nlm.nih.gov/pubmed/33667174 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e25541 %T Transitioning to Remote Clinic Visits in a Smoking Cessation Trial During the COVID-19 Pandemic: Mixed Methods Evaluation %A Mahoney,Martin Christopher %A Park,Eunhee %A Schlienz,Nicolas J %A Duerr,CeCe %A Hawk,Larry W %+ Roswell Park Cancer Institute, Elm & Carlton Streets, Buffalo, NY, 14263, United States, 1 7168453099, martin.mahoney@roswellpark.org %K smoking %K cessation %K clinical trial %K telehealth %K COVID-19 %K coronavirus %K telemedicine %K conferencing %K mixed methods %K experience %K patient %D 2021 %7 30.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The pandemic of SARS-CoV-2, which causes COVID-19, has caused disruptions in ongoing clinical trials and is expected to accelerate interest in conducting research studies remotely. Objective: A quasi-experimental, mixed methods approach was used to examine the rates of visit completion as well as the opinions and experiences of participants enrolled in an ongoing clinical trial of smoking cessation who were required to change from in-person clinic visits to remote visits using video or telephone conferencing due to the COVID-19 pandemic. Methods: For quantitative comparisons, we used a quasi-experimental design, comparing a cohort of participants followed during the pandemic (n=23, COVID-19 cohort) to a comparable cohort of participants followed over a similar time period in the calendar years 2018 and 2019 (n=51, pre–COVID-19 cohort) to examine the rates of completion of scheduled visits and biospecimen collection. For the qualitative component, interviews were conducted with participants who experienced the transition from in-person to remote visits. Results: Participants in the COVID-19 cohort completed an average of 83.6% of remote clinic visits (95% CI 73.1%-91.2%), which was not significantly different than the in-person completion rate of 89.8% in the pre–COVID-19 cohort. Participants in the COVID-19 cohort returned an average of 93.2% (95% CI 83.5%-98.1%) of saliva specimens for remote clinic visits completed, which was not significantly different than the in-person saliva specimen completion rate of 100% in the pre–COVID-19 cohort. Two broad themes emerged from the qualitative data: (1) the benefits of remote visits and (2) the challenges of remote counseling compared to in-person counseling. Despite limited experience with telehealth prior to this transition, most participants expressed a willingness to engage in remote visits in the future. Conclusions: Even in the context of a rapid transition from in-person to remote visits necessitated by the COVID-19 pandemic, rates of visit completion and return of biospecimens remained high. Participants were generally accepting of the transition. Further research is needed to identify the optimal mix of in-person and remote visits beyond the pandemic context and to better understand how these changes may impact study outcomes. Trial Registration: ClinicalTrials.gov NCT03262662; https://clinicaltrials.gov/ct2/show/study/NCT03262662 %M 33878020 %R 10.2196/25541 %U https://formative.jmir.org/2021/4/e25541 %U https://doi.org/10.2196/25541 %U http://www.ncbi.nlm.nih.gov/pubmed/33878020 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e25410 %T SARS-CoV-2 Infection in Health Care Personnel and Their Household Contacts at a Tertiary Academic Medical Center: Protocol for a Longitudinal Cohort Study %A Ciccone,Emily J %A Zivich,Paul N %A Lodge,Evans K %A Zhu,Deanna %A Law,Elle %A Miller,Elyse %A Taylor,Jasmine L %A Chung,Suemin %A Xu,Jason %A Volfovsky,Alexander %A Beatty,Cherese %A Abernathy,Haley %A King,Elise %A Garrett,Haley E %A Markmann,Alena J %A Rebuli,Meghan E %A Sellers,Subhashini %A Weber,David J %A Reyes,Raquel %A Alavian,Naseem %A Juliano,Jonathan J %A Boyce,Ross M %A Aiello,Allison E %+ Division of Infectious Diseases, School of Medicine, University of North Carolina, 111 Mason Farm Road, MBRB 2341C, CB #7036, Chapel Hill, NC, 27599, United States, 1 919 445 1138, ciccone@med.unc.edu %K SARS-CoV-2 %K COVID-19 %K health personnel %K cohort studies %K Bluetooth contact tracking %K survey-based research %K occupational health %K seroprevalence %K mobile phone %D 2021 %7 30.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Health care personnel (HCP) are at high risk for exposure to the SARS-CoV-2 virus. While personal protective equipment (PPE) may mitigate this risk, prospective data collection on its use and other risk factors for seroconversion in this population is needed. Objective: The primary objectives of this study are to (1) determine the incidence of, and risk factors for, SARS-CoV-2 infection among HCP at a tertiary care medical center and (2) actively monitor PPE use, interactions between study participants via electronic sensors, secondary cases in households, and participant mental health and well-being. Methods: To achieve these objectives, we designed a prospective, observational study of SARS-CoV-2 infection among HCP and their household contacts at an academic tertiary care medical center in North Carolina, USA. Enrolled HCP completed frequent surveys on symptoms and work activities and provided serum and nasal samples for SARS-CoV-2 testing every 2 weeks. Additionally, interactions between participants and their movement within the clinical environment were captured with a smartphone app and Bluetooth sensors. Finally, a subset of participants’ households was randomly selected every 2 weeks for further investigation, and enrolled households provided serum and nasal samples via at-home collection kits. Results: As of December 31, 2020, 211 HCP and 53 household participants have been enrolled. Recruitment and follow-up are ongoing and expected to continue through September 2021. Conclusions: Much remains to be learned regarding the risk of SARS-CoV-2 infection among HCP and their household contacts. Through the use of a multifaceted prospective study design and a well-characterized cohort, we will collect critical information regarding SARS-CoV-2 transmission risks in the health care setting and its linkage to the community. International Registered Report Identifier (IRRID): DERR1-10.2196/25410 %M 33769944 %R 10.2196/25410 %U https://www.researchprotocols.org/2021/4/e25410 %U https://doi.org/10.2196/25410 %U http://www.ncbi.nlm.nih.gov/pubmed/33769944 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e28973 %T People’s Willingness to Vaccinate Against COVID-19 Despite Their Safety Concerns: Twitter Poll Analysis %A Eibensteiner,Fabian %A Ritschl,Valentin %A Nawaz,Faisal A %A Fazel,Sajjad S %A Tsagkaris,Christos %A Kulnik,Stefan Tino %A Crutzen,Rik %A Klager,Elisabeth %A Völkl-Kernstock,Sabine %A Schaden,Eva %A Kletecka-Pulker,Maria %A Willschke,Harald %A Atanasov,Atanas G %+ Ludwig Boltzmann Institute for Digital Health and Patient Safety, Medical University of Vienna, Spitalgasse 23, Vienna, 1090, Austria, 43 6641929852, Atanas.Atanasov@dhps.lbg.ac.at %K COVID-19 %K SARS-CoV-2 %K vaccine %K vaccination %K Twitter %K survey %K vaccination willingness %K vaccination hesitancy %K coronavirus %K vaccine confidence %K willingness %K hesitancy %K social media %K safety %K concern %K public health %K opinion %K perception %D 2021 %7 29.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: On January 30, 2020, the World Health Organization’s Emergency Committee declared the rapid, worldwide spread of COVID-19 a global health emergency. Since then, tireless efforts have been made to mitigate the spread of the disease and its impact, and these efforts have mostly relied on nonpharmaceutical interventions. By December 2020, the safety and efficacy of the first COVID-19 vaccines were demonstrated. The large social media platform Twitter has been used by medical researchers for the analysis of important public health topics, such as the public’s perception on antibiotic use and misuse and human papillomavirus vaccination. The analysis of Twitter-generated data can be further facilitated by using Twitter’s built-in, anonymous polling tool to gain insight into public health issues and obtain rapid feedback on an international scale. During the fast-paced course of the COVID-19 pandemic, the Twitter polling system has provided a viable method for gaining rapid, large-scale, international public health insights on highly relevant and timely SARS-CoV-2–related topics. Objective: The purpose of this study was to understand the public’s perception on the safety and acceptance of COVID-19 vaccines in real time by using Twitter polls. Methods: We developed 2 Twitter polls to explore the public’s views on available COVID-19 vaccines. The surveys were pinned to the Digital Health and Patient Safety Platform Twitter timeline for 1 week in mid-February 2021, and Twitter users and influencers were asked to participate in and retweet the polls to reach the largest possible audience. Results: The adequacy of COVID-19 vaccine safety (ie, the safety of currently available vaccines; poll 1) was agreed upon by 1579 out of 3439 (45.9%) Twitter users. In contrast, almost as many Twitter users (1434/3439, 41.7%) were unsure about the safety of COVID-19 vaccines. Only 5.2% (179/3439) of Twitter users rated the available COVID-19 vaccines as generally unsafe. Poll 2, which addressed the question of whether users would undergo vaccination, was answered affirmatively by 82.8% (2862/3457) of Twitter users, and only 8% (277/3457) categorically rejected vaccination at the time of polling. Conclusions: In contrast to the perceived high level of uncertainty about the safety of the available COVID-19 vaccines, we observed an elevated willingness to undergo vaccination among our study sample. Since people's perceptions and views are strongly influenced by social media, the snapshots provided by these media platforms represent a static image of a moving target. Thus, the results of this study need to be followed up by long-term surveys to maintain their validity. This is especially relevant due to the circumstances of the fast-paced pandemic and the need to not miss sudden rises in the incidence of vaccine hesitancy, which may have detrimental effects on the pandemic’s course. %M 33872185 %R 10.2196/28973 %U https://www.jmir.org/2021/4/e28973 %U https://doi.org/10.2196/28973 %U http://www.ncbi.nlm.nih.gov/pubmed/33872185 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e27419 %T Returning to a Normal Life via COVID-19 Vaccines in the United States: A Large-scale Agent-Based Simulation Study %A Li,Junjiang %A Giabbanelli,Philippe %+ Department of Computer Science & Software Engineering, Miami University, 205 Benton Hall, Oxford, OH, 45056, United States, 1 513 529 0147, aqualonne@free.fr %K agent-based model %K cloud-based simulations %K COVID-19 %K large-scale simulations %K vaccine %K model %K simulation %K United States %K agent-based %K effective %K willingness %K capacity %K plan %K strategy %K outcome %K interaction %K intervention %K scenario %K impact %D 2021 %7 29.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: In 2020, COVID-19 has claimed more than 300,000 deaths in the United States alone. Although nonpharmaceutical interventions were implemented by federal and state governments in the United States, these efforts have failed to contain the virus. Following the Food and Drug Administration's approval of two COVID-19 vaccines, however, the hope for the return to normalcy has been renewed. This hope rests on an unprecedented nationwide vaccine campaign, which faces many logistical challenges and is also contingent on several factors whose values are currently unknown. Objective: We study the effectiveness of a nationwide vaccine campaign in response to different vaccine efficacies, the willingness of the population to be vaccinated, and the daily vaccine capacity under two different federal plans. To characterize the possible outcomes most accurately, we also account for the interactions between nonpharmaceutical interventions and vaccines through 6 scenarios that capture a range of possible impacts from nonpharmaceutical interventions. Methods: We used large-scale, cloud-based, agent-based simulations by implementing the vaccination campaign using COVASIM, an open-source agent-based model for COVID-19 that has been used in several peer-reviewed studies and accounts for individual heterogeneity and a multiplicity of contact networks. Several modifications to the parameters and simulation logic were made to better align the model with current evidence. We chose 6 nonpharmaceutical intervention scenarios and applied the vaccination intervention following both the plan proposed by Operation Warp Speed (former Trump administration) and the plan of one million vaccines per day, proposed by the Biden administration. We accounted for unknowns in vaccine efficacies and levels of population compliance by varying both parameters. For each experiment, the cumulative infection growth was fitted to a logistic growth model, and the carrying capacities and the growth rates were recorded. Results: For both vaccination plans and all nonpharmaceutical intervention scenarios, the presence of the vaccine intervention considerably lowers the total number of infections when life returns to normal, even when the population compliance to vaccines is as low as 20%. We noted an unintended consequence; given the vaccine availability estimates under both federal plans and the focus on vaccinating individuals by age categories, a significant reduction in nonpharmaceutical interventions results in a counterintuitive situation in which higher vaccine compliance then leads to more total infections. Conclusions: Although potent, vaccines alone cannot effectively end the pandemic given the current availability estimates and the adopted vaccination strategy. Nonpharmaceutical interventions need to continue and be enforced to ensure high compliance so that the rate of immunity established by vaccination outpaces that induced by infections. %M 33872188 %R 10.2196/27419 %U https://medinform.jmir.org/2021/4/e27419 %U https://doi.org/10.2196/27419 %U http://www.ncbi.nlm.nih.gov/pubmed/33872188 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25987 %T Evaluation of an Intrahospital Telemedicine Program for Patients Admitted With COVID-19: Mixed Methods Study %A Legler,Sean %A Diehl,Matthew %A Hilliard,Brian %A Olson,Andrew %A Markowitz,Rebecca %A Tignanelli,Christopher %A Melton,Genevieve B %A Broccard,Alain %A Kirsch,Jonathan %A Usher,Michael %+ Division of General Internal Medicine, Department of Medicine, University of Minnesota Medical School, 420 Delaware St SE, MMC 741, Minneapolis, MN, 55455, United States, 1 734 223 3450, mgusher@umn.edu %K telemedicine %K hospital medicine %K COVID-19 %K telehealth %K hospital %K mixed methods %K evaluation %K impact %K exposure %K risk %K communication %D 2021 %7 29.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The increasing incidence of COVID-19 infection has challenged health care systems to increase capacity while conserving personal protective equipment (PPE) supplies and minimizing nosocomial spread. Telemedicine shows promise to address these challenges but lacks comprehensive evaluation in the inpatient environment. Objective: The aim of this study is to evaluate an intrahospital telemedicine program (virtual care), along with its impact on exposure risk and communication. Methods: We conducted a natural experiment of virtual care on patients admitted for COVID-19. The primary exposure variable was documented use of virtual care. Patient characteristics, PPE use rates, and their association with virtual care use were assessed. In parallel, we conducted surveys with patients and clinicians to capture satisfaction with virtual care along the domains of communication, medical treatment, and exposure risk. Results: Of 137 total patients in our primary analysis, 43 patients used virtual care. In total, there were 82 inpatient days of use and 401 inpatient days without use. Hospital utilization and illness severity were similar in patients who opted in versus opted out. Virtual care was associated with a significant reduction in PPE use and physical exam rate. Surveys of 41 patients and clinicians showed high rates of recommendation for further use, and subjective improvements in communication. However, providers and patients expressed limitations in usability, medical assessment, and empathetic communication. Conclusions: In this pilot natural experiment, only a subset of patients used inpatient virtual care. When used, virtual care was associated with reductions in PPE use, reductions in exposure risk, and patient and provider satisfaction. %M 33872187 %R 10.2196/25987 %U https://www.jmir.org/2021/4/e25987 %U https://doi.org/10.2196/25987 %U http://www.ncbi.nlm.nih.gov/pubmed/33872187 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26940 %T Knowledge About COVID-19 Among Adults in China: Cross-sectional Online Survey %A Yu,Fengyun %A Geldsetzer,Pascal %A Meierkord,Anne %A Yang,Juntao %A Chen,Qiushi %A Jiao,Lirui %A Abou-Arraj,Nadeem E %A Pan,An %A Wang,Chen %A Bärnighausen,Till %A Chen,Simiao %+ Heidelberg Institute of Global Health, Faculty of Medicine and University Hospital, Heidelberg University, Im Neuenheimer Feld 130.3, Heidelberg, Germany, 49 15207926273, simiao.chen@uni-heidelberg.de %K COVID-19 %K knowledge %K perception %K risk %K public health %K China %K cross-sectional %K survey %D 2021 %7 29.4.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33844637 %R 10.2196/26940 %U https://www.jmir.org/2021/4/e26940 %U https://doi.org/10.2196/26940 %U http://www.ncbi.nlm.nih.gov/pubmed/33844637 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26558 %T Impact of the COVID-19 Pandemic on Health Care Utilization in a Large Integrated Health Care System: Retrospective Cohort Study %A Xu,Stanley %A Glenn,Sungching %A Sy,Lina %A Qian,Lei %A Hong,Vennis %A Ryan,Denison S %A Jacobsen,Steven %+ Department of Research & Evaluation, Kaiser Permanente Southern California, 100 S Los Robles Ave, 5th Floor, Pasadena, CA, 91101, United States, 1 6263726807, stan.xu@kp.org %K cohort %K COVID-19 %K difference-in-difference analysis %K health care utilization %K health care worker %K impact %K knowledge %K pandemic %K policy %K retrospective %K telehealth %K telemedicine %K usage %K utilization %D 2021 %7 29.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has caused an abrupt reduction in the use of in-person health care, accompanied by a corresponding surge in the use of telehealth services. However, the extent and nature of changes in health care utilization during the pandemic may differ by care setting. Knowledge of the impact of the pandemic on health care utilization is important to health care organizations and policy makers. Objective: The aims of this study are (1) to evaluate changes in in-person health care utilization and telehealth visits during the COVID-19 pandemic and (2) to assess the difference in changes in health care utilization between the pandemic year 2020 and the prepandemic year 2019. Methods: We retrospectively assembled a cohort consisting of members of a large integrated health care organization, who were enrolled between January 6 and November 2, 2019 (prepandemic year), and between January 5 and October 31, 2020 (pandemic year). The rates of visits were calculated weekly for four settings: inpatient, emergency department (ED), outpatient, and telehealth. Using Poisson models, we assessed the impact of the pandemic on health care utilization during the early days of the pandemic and conducted difference-in-deference (DID) analyses to measure the changes in health care utilization, adjusting for the trend of health care utilization in the prepandemic year. Results: In the early days of the pandemic, we observed significant reductions in inpatient, ED, and outpatient utilization (by 30.2%, 37.0%, and 80.9%, respectively). By contrast, there was a 4-fold increase in telehealth visits between weeks 8 (February 23) and 12 (March 22) in 2020. DID analyses revealed that after adjusting for prepandemic secular trends, the reductions in inpatient, ED, and outpatient visit rates in the early days of the pandemic were 1.6, 8.9, and 367.2 visits per 100 person-years (P<.001), respectively, while the increase in telehealth visits was 272.9 visits per 100 person-years (P<.001). Further analyses suggested that the increase in telehealth visits offset the reduction in outpatient visits by week 26 (June 28, 2020). Conclusions: In-person health care utilization decreased drastically during the early period of the pandemic, but there was a corresponding increase in telehealth visits during the same period. By end-June 2020, the combined outpatient and telehealth visits had recovered to prepandemic levels. %M 33882020 %R 10.2196/26558 %U https://www.jmir.org/2021/4/e26558 %U https://doi.org/10.2196/26558 %U http://www.ncbi.nlm.nih.gov/pubmed/33882020 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e21394 %T Application of Artificial Intelligence for Screening COVID-19 Patients Using Digital Images: Meta-analysis %A Poly,Tahmina Nasrin %A Islam,Md Mohaimenul %A Li,Yu-Chuan Jack %A Alsinglawi,Belal %A Hsu,Min-Huei %A Jian,Wen Shan %A Yang,Hsuan-Chia %+ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 15 Floor, No. 172-1, Section: 2, Keelung Road, Daan District, Taipei, 106, Taiwan, 886 (02)66382736 ext 1507, itpharmacist@gmail.com %K COVID-19 %K SARS-CoV-2 %K pneumonia %K artificial intelligence %K deep learning %D 2021 %7 29.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 outbreak has spread rapidly and hospitals are overwhelmed with COVID-19 patients. While analysis of nasal and throat swabs from patients is the main way to detect COVID-19, analyzing chest images could offer an alternative method to hospitals, where health care personnel and testing kits are scarce. Deep learning (DL), in particular, has shown impressive levels of performance when analyzing medical images, including those related to COVID-19 pneumonia. Objective: The goal of this study was to perform a systematic review with a meta-analysis of relevant studies to quantify the performance of DL algorithms in the automatic stratification of COVID-19 patients using chest images. Methods: A search strategy for use in PubMed, Scopus, Google Scholar, and Web of Science was developed, where we searched for articles published between January 1 and April 25, 2020. We used the key terms “COVID-19,” or “coronavirus,” or “SARS-CoV-2,” or “novel corona,” or “2019-ncov,” and “deep learning,” or “artificial intelligence,” or “automatic detection.” Two authors independently extracted data on study characteristics, methods, risk of bias, and outcomes. Any disagreement between them was resolved by consensus. Results: A total of 16 studies were included in the meta-analysis, which included 5896 chest images from COVID-19 patients. The pooled sensitivity and specificity of the DL models in detecting COVID-19 were 0.95 (95% CI 0.94-0.95) and 0.96 (95% CI 0.96-0.97), respectively, with an area under the receiver operating characteristic curve of 0.98. The positive likelihood, negative likelihood, and diagnostic odds ratio were 19.02 (95% CI 12.83-28.19), 0.06 (95% CI 0.04-0.10), and 368.07 (95% CI 162.30-834.75), respectively. The pooled sensitivity and specificity for distinguishing other types of pneumonia from COVID-19 were 0.93 (95% CI 0.92-0.94) and 0.95 (95% CI 0.94-0.95), respectively. The performance of radiologists in detecting COVID-19 was lower than that of the DL models; however, the performance of junior radiologists was improved when they used DL-based prediction tools. Conclusions: Our study findings show that DL models have immense potential in accurately stratifying COVID-19 patients and in correctly differentiating them from patients with other types of pneumonia and normal patients. Implementation of DL-based tools can assist radiologists in correctly and quickly detecting COVID-19 and, consequently, in combating the COVID-19 pandemic. %M 33764884 %R 10.2196/21394 %U https://medinform.jmir.org/2021/4/e21394 %U https://doi.org/10.2196/21394 %U http://www.ncbi.nlm.nih.gov/pubmed/33764884 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e23446 %T Telemanagement of Home-Isolated COVID-19 Patients Using Oxygen Therapy With Noninvasive Positive Pressure Ventilation and Physical Therapy Techniques: Randomized Clinical Trial %A Adly,Aya Sedky %A Adly,Mahmoud Sedky %A Adly,Afnan Sedky %+ Faculty of Engineering and Technology, Badr University in Cairo (BUC), Cairo Suez Road, Badr City, Cairo, Egypt, 20 1145559778, aya.sedky@gmail.com %K telemedicine %K oxygen therapy %K noninvasive positive airway pressure %K BiPAP %K osteopathic medicine %K physical therapy %K SARS-CoV-2 %K COVID-19 %K teletherapy %K telemanagement %D 2021 %7 28.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: With the growing stress on hospitals caused by the COVID-19 pandemic, the need for home-based solutions has become a necessity to support these overwhelmed hospitals. Objective: The goal of this study was to compare two nonpharmacological respiratory treatment methods for home-isolated COVID-19 patients using a newly developed telemanagement health care system. Methods: In this single-blinded randomized clinical trial, 60 patients with stage 1 pneumonia caused by SARS-CoV-2 infection were treated. Group A (n=30) received oxygen therapy with bilevel positive airway pressure (BiPAP) ventilation, and Group B (n=30) received osteopathic manipulative respiratory and physical therapy techniques. Arterial blood gases of PaO2 and PaCO2, pH, vital signs (ie, temperature, respiratory rate, oxygen saturation, heart rate, and blood pressure), and chest computed tomography scans were used for follow-up and for assessment of the course and duration of recovery. Results: Analysis of the results showed a significant difference between the two groups (P<.05), with Group A showing shorter recovery periods than Group B (mean 14.9, SD 1.7 days, and mean 23.9, SD 2.3 days, respectively). Significant differences were also observed between baseline and final readings in all of the outcome measures in both groups (P<.05). Regarding posttreatment satisfaction with our proposed telemanagement health care system, positive responses were given by most of the patients in both groups. Conclusions: It was found that home-based oxygen therapy with BiPAP can be a more effective prophylactic treatment approach than osteopathic manipulative respiratory and physical therapy techniques, as it can impede exacerbation of early-stage COVID-19 pneumonia. Telemanagement health care systems are promising methods to help in the pandemic-related shortage of hospital beds, as they showed reasonable effectiveness and reliability in the monitoring and management of patients with early-stage COVID-19 pneumonia. Trial Registration: ClinicalTrials.gov NCT04368923; https://clinicaltrials.gov/ct2/show/NCT04368923 %M 33819166 %R 10.2196/23446 %U https://www.jmir.org/2021/4/e23446 %U https://doi.org/10.2196/23446 %U http://www.ncbi.nlm.nih.gov/pubmed/33819166 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e25695 %T Surveillance of the Second Wave of COVID-19 in Europe: Longitudinal Trend Analyses %A Post,Lori %A Culler,Kasen %A Moss,Charles B %A Murphy,Robert L %A Achenbach,Chad J %A Ison,Michael G %A Resnick,Danielle %A Singh,Lauren Nadya %A White,Janine %A Boctor,Michael J %A Welch,Sarah B %A Oehmke,James Francis %+ Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K SARS-CoV-2 surveillance %K wave two %K second wave %K global COVID surveillance %K Europe Public Health Surveillance %K Europe COVID %K Europe surveillance metrics %K dynamic panel data %K generalized method of the moments %K Europe econometrics %K Europe SARS-CoV-2 %K Europe COVID surveillance system %K European COVID transmission speed %K European COVID transmission acceleration %K COVID transmission deceleration %K COVID transmission jerk %K COVID 7-day lag %K SARS-CoV-2 %K Arellano-Bond estimator %K GMM %K Albania %K Andorra %K Austria %K Belarus %K Belgium %K Bosnia and Herzegovina %K Bulgaria %K Croatia %K Czech Republic %K Denmark %K Estonia %K Finland %K France %K Germany %K Greece %K Greenland %K Hungary %K Iceland %K Ireland %K Isle of Man %K Italy %K Latvia %K Liechtenstein %K Lithuania %K Luxembourg %K Moldova %K Monaco %K Montenegro %K Netherlands %K Norway %K Poland %K Portugal %K Romania %K San Marino %K Serbia %K Slovakia %K Slovenia %K Spain %K Sweden %K Switzerland %K Ukraine %K United Kingdom %K Vatican City %D 2021 %7 28.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has severely impacted Europe, resulting in a high caseload and deaths that varied by country. The second wave of the COVID-19 pandemic has breached the borders of Europe. Public health surveillance is necessary to inform policy and guide leaders. Objective: This study aimed to provide advanced surveillance metrics for COVID-19 transmission that account for weekly shifts in the pandemic, speed, acceleration, jerk, and persistence, to better understand countries at risk for explosive growth and those that are managing the pandemic effectively. Methods: We performed a longitudinal trend analysis and extracted 62 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in Europe as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: New COVID-19 cases slightly decreased from 158,741 (week 1, January 4-10, 2021) to 152,064 (week 2, January 11-17, 2021), and cumulative cases increased from 22,507,271 (week 1) to 23,890,761 (week 2), with a weekly increase of 1,383,490 between January 10 and January 17. France, Germany, Italy, Spain, and the United Kingdom had the largest 7-day moving averages for new cases during week 1. During week 2, the 7-day moving average for France and Spain increased. From week 1 to week 2, the speed decreased (37.72 to 33.02 per 100,000), acceleration decreased (0.39 to –0.16 per 100,000), and jerk increased (–1.30 to 1.37 per 100,000). Conclusions: The United Kingdom, Spain, and Portugal, in particular, are at risk for a rapid expansion in COVID-19 transmission. An examination of the European region suggests that there was a decrease in the COVID-19 caseload between January 4 and January 17, 2021. Unfortunately, the rates of jerk, which were negative for Europe at the beginning of the month, reversed course and became positive, despite decreases in speed and acceleration. Finally, the 7-day persistence rate was higher during week 2 than during week 1. These measures indicate that the second wave of the pandemic may be subsiding, but some countries remain at risk for new outbreaks and increased transmission in the absence of rapid policy responses. %M 33818391 %R 10.2196/25695 %U https://publichealth.jmir.org/2021/4/e25695 %U https://doi.org/10.2196/25695 %U http://www.ncbi.nlm.nih.gov/pubmed/33818391 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26075 %T Predictability of COVID-19 Hospitalizations, Intensive Care Unit Admissions, and Respiratory Assistance in Portugal: Longitudinal Cohort Study %A Patrício,André %A Costa,Rafael S %A Henriques,Rui %+ LAQV-REQUIMTE, NOVA School of Science and Technology, Universidade NOVA de Lisboa, Campus Caparica, 2829-516, Caparica, 2829-516, Portugal, 351 21 294 8351, rs.costa@fct.unl.pt %K COVID-19 %K machine learning %K intensive care admissions %K respiratory assistance %K predictive models %K data modeling %K clinical informatics %D 2021 %7 28.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In the face of the current COVID-19 pandemic, the timely prediction of upcoming medical needs for infected individuals enables better and quicker care provision when necessary and management decisions within health care systems. Objective: This work aims to predict the medical needs (hospitalizations, intensive care unit admissions, and respiratory assistance) and survivability of individuals testing positive for SARS-CoV-2 infection in Portugal. Methods: A retrospective cohort of 38,545 infected individuals during 2020 was used. Predictions of medical needs were performed using state-of-the-art machine learning approaches at various stages of a patient’s cycle, namely, at testing (prehospitalization), at posthospitalization, and during postintensive care. A thorough optimization of state-of-the-art predictors was undertaken to assess the ability to anticipate medical needs and infection outcomes using demographic and comorbidity variables, as well as dates associated with symptom onset, testing, and hospitalization. Results: For the target cohort, 75% of hospitalization needs could be identified at the time of testing for SARS-CoV-2 infection. Over 60% of respiratory needs could be identified at the time of hospitalization. Both predictions had >50% precision. Conclusions: The conducted study pinpoints the relevance of the proposed predictive models as good candidates to support medical decisions in the Portuguese population, including both monitoring and in-hospital care decisions. A clinical decision support system is further provided to this end. %M 33835931 %R 10.2196/26075 %U https://www.jmir.org/2021/4/e26075 %U https://doi.org/10.2196/26075 %U http://www.ncbi.nlm.nih.gov/pubmed/33835931 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e24277 %T Effects of Age, Gender, Health Status, and Political Party on COVID-19–Related Concerns and Prevention Behaviors: Results of a Large, Longitudinal Cross-sectional Survey %A Naeim,Arash %A Baxter-King,Ryan %A Wenger,Neil %A Stanton,Annette L %A Sepucha,Karen %A Vavreck,Lynn %+ Center for SMART Health, Departments of Medicine and Bioengineering, David Geffen School of Medicine at UCLA and Samueli School of Engineering and Applied Science, 10911 Weyburn Avenue, Los Angeles, CA, 90095, United States, 1 3103670148, anaeim@mednet.ucla.edu %K COVID-19 %K prevention %K behavior %K advice %K health care provider %K economy %K health information %K concern %K survey %D 2021 %7 28.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: With conflicting information about COVID-19, the general public may be uncertain about how to proceed in terms of precautionary behavior and decisions about whether to return to activity. Objective: The aim of this study is to determine the factors associated with COVID-19–related concerns, precautionary behaviors, and willingness to return to activity. Methods: National survey data were obtained from the Democracy Fund + UCLA Nationscape Project, an ongoing cross-sectional weekly survey. The sample was provided by Lucid, a web-based market research platform. Three outcomes were evaluated: (1) COVID-19–related concerns, (2) precautionary behaviors, and (3) willingness to return to activity. Key independent variables included age, gender, race or ethnicity, education, household income, political party support, religion, news consumption, number of medication prescriptions, perceived COVID-19 status, and timing of peak COVID-19 infections by state. Results: The data included 125,508 responses from web-based surveys conducted over 20 consecutive weeks during the COVID-19 pandemic (comprising approximately 6250 adults per week), between March 19 and August 5, 2020, approved by the University of California, Los Angeles (UCLA) Institutional Review Board for analysis. A substantial number of participants were not willing to return to activity even after the restrictions were lifted. Weighted multivariate logistic regressions indicated the following groups had different outcomes (all P<.001): individuals aged ≥65 years (COVID-19–related concerns: OR 2.05, 95% CI 1.93-2.18; precautionary behaviors: OR 2.38, 95% CI 2.02-2.80; return to activity: OR 0.41, 95% CI 0.37-0.46 vs 18-40 years); men (COVID-19–related concerns: OR 0.73, 95% CI 0.70-0.75; precautionary behaviors: OR 0.74, 95% CI 0.67-0.81; return to activity: OR 2.00, 95% CI 1.88-2.12 vs women); taking ≥4 medications (COVID-19–related concerns: OR 1.47, 95% CI 1.40-1.54; precautionary behaviors: OR 1.36, 95% CI 1.20-1.555; return to activity: OR 0.75, 95% CI 0.69-0.81 vs <3 medications); Republicans (COVID-19–related concerns: OR 0.40, 95% CI 0.38-0.42; precautionary behaviors: OR 0.45, 95% CI 0.40-0.50; return to activity: OR 2.22, 95% CI 2.09-2.36 vs Democrats); and adults who reported having COVID-19 (COVID-19–related concerns: OR 1.24, 95% CI 1.12-1.39; precautionary behaviors: OR 0.65, 95% CI 0.52-0.81; return to activity: OR 3.99, 95% CI 3.48-4.58 vs those who did not). Conclusions: Participants’ age, party affiliation, and perceived COVID-19 status were strongly associated with their COVID-19–related concerns, precautionary behaviors, and willingness to return to activity. Future studies need to develop and test targeted messaging approaches and consider political partisanship to encourage preventative behaviors and willingness to return to activities. %M 33908887 %R 10.2196/24277 %U https://publichealth.jmir.org/2021/4/e24277 %U https://doi.org/10.2196/24277 %U http://www.ncbi.nlm.nih.gov/pubmed/33908887 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e27433 %T Coinfection With SARS-CoV-2 and Influenza A(H1N1) in a Patient Seen at an Influenza-like Illness Surveillance Site in Egypt: Case Report %A Fahim,Manal %A Ghonim,Hanaa Abu El Sood %A Roshdy,Wael H %A Naguib,Amel %A Elguindy,Nancy %A AbdelFatah,Mohamad %A Hassany,Mohamed %A Mohsen,Amira %A Afifi,Salma %A Eid,Alaa %+ Department of Surveillance and Epidemiology, Ministry of Health and Population, 3 Magles El Shab Street, Cairo, , Egypt, 20 01222598200 ext 202, fahimmanal@yahoo.com %K influenza-like Illness %K pandemic %K SARS-CoV-2 %K COVID-19 %K influenza %K virus %K case study %K Egypt %K flu %K coinfection %K infectious disease %K surveillance %K outcome %K demographic %D 2021 %7 28.4.2021 %9 Short Paper %J JMIR Public Health Surveill %G English %X 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 °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. %M 33784634 %R 10.2196/27433 %U https://publichealth.jmir.org/2021/4/e27433 %U https://doi.org/10.2196/27433 %U http://www.ncbi.nlm.nih.gov/pubmed/33784634 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e27091 %T Association Between Smoking and SARS-CoV-2 Infection: Cross-sectional Study of the EPICOVID19 Internet-Based Survey %A Prinelli,Federica %A Bianchi,Fabrizio %A Drago,Gaspare %A Ruggieri,Silvia %A Sojic,Aleksandra %A Jesuthasan,Nithiya %A Molinaro,Sabrina %A Bastiani,Luca %A Maggi,Stefania %A Noale,Marianna %A Galli,Massimo %A Giacomelli,Andrea %A Antonelli Incalzi,Raffaele %A Adorni,Fulvio %A Cibella,Fabio %A , %+ Institute of Biomedical Technologies, National Research Council, Via Fratelli 93, Segrate (MI), 20090, Italy, 39 0226422629, federica.prinelli@cnr.it %K SARS-CoV-2 %K COVID-19 %K smoking habit %K dose-response relationship %K nasopharyngeal swab testing %K infection severity %K web-based survey %K self-reported %K cross-sectional design %D 2021 %7 28.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Several studies have reported a low prevalence of current smoking among hospitalized COVID-19 cases; however, no definitive conclusions can be drawn. Objective: We investigated the association of tobacco smoke exposure with nasopharyngeal swab (NPS) test results for SARS-CoV-2 infection and disease severity accounting for possible confounders. Methods: The nationwide, self-administered, cross-sectional web-based Italian National Epidemiological Survey on COVID-19 (EPICOVID19) was administered to an Italian population of 198,822 adult volunteers who filled in an online questionnaire between April 13 and June 2, 2020. For this study, we analyzed 6857 individuals with known NPS test results. The associations of smoking status and the dose-response relationship with a positive NPS test result and infection severity were calculated as odds ratios (ORs) with 95% CIs by means of logistic and multinomial regression models adjusting for sociodemographic, clinical, and behavioral characteristics. Results: Out of the 6857 individuals (mean age 47.9 years, SD 14.1; 4516/6857, 65.9% female), 63.2% (4334/6857) had never smoked, 21.3% (1463/6857) were former smokers, and 15.5% (1060/6857) were current smokers. Compared to nonsmokers, current smokers were younger, were more educated, were less affected by chronic diseases, reported COVID-19–like symptoms less frequently, were less frequently hospitalized, and less frequently tested positive for COVID-19. In multivariate analysis, current smokers had almost half the odds of a positive NPS test result (OR 0.54, 95% CI 0.45-0.65) compared to nonsmokers. We also found a dose-dependent relationship with tobacco smoke: mild smokers (adjusted OR [aOR] 0.76, 95% CI 0.55-1.05), moderate smokers (aOR 0.56, 95% CI 0.42-0.73), and heavy smokers (aOR 0.38, 95% CI 0.27-0.53). This inverse association also persisted when considering the severity of the infection. Current smokers had a statistically significantly lower probability of having asymptomatic (aOR 0.50, 95% CI 0.27-0.92), mild (aOR 0.65, 95% CI 0.53-0.81), and severe infections (aOR 0.27, 95% CI 0.17-0.42) compared to those who never smoked. Conclusions: Current smoking was negatively associated with SARS-CoV-2 infection with a dose-dependent relationship. Ad hoc experimental studies are needed to elucidate the mechanisms underlying this association. Trial Registration: ClinicalTrials.gov NCT04471701; https://clinicaltrials.gov/ct2/show/NCT04471701 %M 33668011 %R 10.2196/27091 %U https://publichealth.jmir.org/2021/4/e27091 %U https://doi.org/10.2196/27091 %U http://www.ncbi.nlm.nih.gov/pubmed/33668011 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e25407 %T Protocol for the Pregnancy During the COVID-19 Pandemic (PdP) Study: A Longitudinal Cohort Study of Mental Health Among Pregnant Canadians During the COVID-19 Pandemic and Developmental Outcomes in Their Children %A Giesbrecht,Gerald F %A Bagshawe,Mercedes %A van Sloten,Melinda %A MacKinnon,Anna L %A Dhillon,Ashley %A van de Wouw,Marcel %A Vaghef-Mehrabany,Elnaz %A Rojas,Laura %A Cattani,Danielle %A Lebel,Catherine %A Tomfohr-Madsen,Lianne %+ Department of Pediatrics, University of Calgary, 2500 University Drive, Calgary, AB, T2N 1N4, Canada, 1 403 441 8469, ggiesbre@ucalgary.ca %K pregnancy %K anxiety %K depression %K stress %K social support %K resilience %K COVID-19 %K infant development %K pandemic %D 2021 %7 28.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic and countermeasures implemented by governments around the world have led to dramatically increased symptoms of depression and anxiety. Pregnant individuals may be particularly vulnerable to the negative psychological effects of COVID-19 public health measures because they represent a demographic that is most affected by disasters and because pregnancy itself entails significant life changes that require major psychosocial and emotional adjustments. Objective: The PdP study was designed to investigate the associations among exposure to objective hardship caused by the pandemic, perceived stress and psychological distress in pregnant individuals, and developmental outcomes in their offspring. Methods: The PdP study comprises a prospective longitudinal cohort of individuals who were pregnant at enrollment, with repeated follow-ups during pregnancy and the postpartum period. Participants were eligible if they were pregnant, ≥17 years old, at ≤35 weeks of gestation at study enrollment, living in Canada, and able to read and write in English or French. At enrollment, participants completed an initial survey that assessed demographic and socioeconomic characteristics, previous pregnancies and births, prepregnancy health, health conditions during pregnancy, medications, psychological distress, social support, and hardships experienced because of the COVID-19 pandemic (eg, lost employment or a loved one dying). For the first three months following the initial survey, participants received a monthly email link to complete a follow-up survey that asked about their experiences since the previous survey. After three months, follow-up surveys were sent every other month to reduce participant burden. For each of these surveys, participants were first asked if they were still pregnant and then routed either to the next prenatal survey or to the delivery survey. In the postpartum period, surveys were sent at 3, 6, and 12 months of infant age to assess maternal stress, psychological distress, and infant development. Results: Participant recruitment via social media (Facebook and Instagram) began on April 5, 2020, and is ongoing. As of April 2021, more than 11,000 individuals have started the initial survey. Follow-up data collection is ongoing. Conclusions: This longitudinal investigation seeks to elucidate the associations among hardships, maternal psychological distress, child development during the COVID-19 pandemic, and risk and resilience factors that amplify or ameliorate these associations. The findings of this study are intended to generate knowledge about the psychological consequences of pandemics on pregnant individuals and point toward prevention and intervention targets. International Registered Report Identifier (IRRID): DERR1-10.2196/25407 %M 33848971 %R 10.2196/25407 %U https://www.researchprotocols.org/2021/4/e25407 %U https://doi.org/10.2196/25407 %U http://www.ncbi.nlm.nih.gov/pubmed/33848971 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25215 %T Patterns of Media Use, Strength of Belief in COVID-19 Conspiracy Theories, and the Prevention of COVID-19 From March to July 2020 in the United States: Survey Study %A Romer,Daniel %A Jamieson,Kathleen Hall %+ Annnenberg Public Policy Center, University of Pennsylvania, 202 S 36th St, Philadelphia, PA, 19104, United States, 1 610 202 7315, dan.romer@appc.upenn.edu %K COVID-19 %K conspiracy beliefs %K social media %K print news media %K broadcast news media %K conservative media %K vaccination %K mask wearing %K belief %K misinformation %K infodemic %K United States %K intention %K prevention %D 2021 %7 27.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Holding conspiracy beliefs regarding the COVID-19 pandemic in the United States has been associated with reductions in both actions to prevent the spread of the infection (eg, mask wearing) and intentions to accept a vaccine when one becomes available. Patterns of media use have also been associated with acceptance of COVID-19 conspiracy beliefs. Here we ask whether the type of media on which a person relies increased, decreased, or had no additional effect on that person’s COVID-19 conspiracy beliefs over a 4-month period. Objective: We used panel data to explore whether use of conservative and social media in the United States, which were previously found to be positively related to holding conspiracy beliefs about the origins and prevention of COVID-19, were associated with a net increase in the strength of those beliefs from March to July of 2020. We also asked whether mainstream news sources, which were previously found to be negatively related to belief in pandemic-related conspiracies, were associated with a net decrease in the strength of such beliefs over the study period. Additionally, we asked whether subsequent changes in pandemic conspiracy beliefs related to the use of media were also related to subsequent mask wearing and vaccination intentions. Methods: A survey that we conducted with a national US probability sample in March of 2020 and again in July with the same 840 respondents assessed belief in pandemic-related conspiracies, use of various types of media information sources, actions taken to prevent the spread of the disease and intentions to vaccinate, and various demographic characteristics. Change across the two waves was analyzed using path analytic techniques. Results: We found that conservative media use predicted an increase in conspiracy beliefs (β=.17, 99% CI .10-.25) and that reliance on mainstream print predicted a decrease in their belief (β=–.08, 99% CI –.14 to –.02). Although many social media platforms reported downgrading or removing false or misleading content, ongoing use of such platforms by respondents predicted growth in conspiracy beliefs as well (β=.072, 99% CI .018-.123). Importantly, conspiracy belief changes related to media use between the two waves of the study were associated with the uptake of mask wearing and changes in vaccination intentions in July. Unlike other media, use of mainstream broadcast television predicted greater mask wearing (β=.17, 99% CI .09-.26) and vaccination intention (β=.08, 95% CI .02-.14), independent of conspiracy beliefs. Conclusions: The findings point to the need for greater efforts on the part of commentators, reporters, and guests on conservative media to report verifiable information about the pandemic. The results also suggest that social media platforms need to be more aggressive in downgrading, blocking, and counteracting claims about COVID-19 vaccines, claims about mask wearing, and conspiracy beliefs that have been judged problematic by public health authorities. %M 33857008 %R 10.2196/25215 %U https://www.jmir.org/2021/4/e25215 %U https://doi.org/10.2196/25215 %U http://www.ncbi.nlm.nih.gov/pubmed/33857008 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e25728 %T Latin America and the Caribbean SARS-CoV-2 Surveillance: Longitudinal Trend Analysis %A Post,Lori %A Ohiomoba,Ramael O %A Maras,Ashley %A Watts,Sean J %A Moss,Charles B %A Murphy,Robert Leo %A Ison,Michael G %A Achenbach,Chad J %A Resnick,Danielle %A Singh,Lauren Nadya %A White,Janine %A Chaudhury,Azraa S %A Boctor,Michael J %A Welch,Sarah B %A Oehmke,James Francis %+ Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K 7-day persistence %K acceleration %K Arellano–Bond estimator %K COVID-19 surveillance system %K COVID-19 %K dynamic panel data %K econometrics %K economic %K generalized method of moments %K global COVID-19 surveillance %K Latin America and the Caribbean %K longitudinal %K metric %K persistence %K policy %K public health surveillance %K SARS-CoV-2 %K second wave %K surveillance metrics %K transmission deceleration %K transmission jerk %K transmission speed %K trend analysis %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has placed unprecedented stress on economies, food systems, and health care resources in Latin America and the Caribbean (LAC). Existing surveillance provides a proxy of the COVID-19 caseload and mortalities; however, these measures make it difficult to identify the dynamics of the pandemic and places where outbreaks are likely to occur. Moreover, existing surveillance techniques have failed to measure the dynamics of the pandemic. Objective: This study aimed to provide additional surveillance metrics for COVID-19 transmission to track changes in the speed, acceleration, jerk, and persistence in the transmission of the pandemic more accurately than existing metrics. Methods: Through a longitudinal trend analysis, we extracted COVID-19 data over 45 days from public health registries. We used an empirical difference equation to monitor the daily number of cases in the LAC as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano–Bond estimator in R. COVID-19 transmission rates were tracked for the LAC between September 30 and October 6, 2020, and between October 7 and 13, 2020. Results: The LAC saw a reduction in the speed, acceleration, and jerk for the week of October 13, 2020, compared to the week of October 6, 2020, accompanied by reductions in new cases and the 7-day moving average. For the week of October 6, 2020, Belize reported the highest acceleration and jerk, at 1.7 and 1.8, respectively, which is particularly concerning, given its high mortality rate. The Bahamas also had a high acceleration at 1.5. In total, 11 countries had a positive acceleration during the week of October 6, 2020, whereas only 6 countries had a positive acceleration for the week of October 13, 2020. The TAC displayed an overall positive trend, with a speed of 10.40, acceleration of 0.27, and jerk of –0.31, all of which decreased in the subsequent week to 9.04, –0.81, and –0.03, respectively. Conclusions: Metrics such as new cases, cumulative cases, deaths, and 7-day moving averages provide a static view of the pandemic but fail to identify where and the speed at which SARS-CoV-2 infects new individuals, the rate of acceleration or deceleration of the pandemic, and weekly comparison of the rate of acceleration of the pandemic indicate impending explosive growth or control of the pandemic. Enhanced surveillance will inform policymakers and leaders in the LAC about COVID-19 outbreaks. %M 33852413 %R 10.2196/25728 %U https://publichealth.jmir.org/2021/4/e25728 %U https://doi.org/10.2196/25728 %U http://www.ncbi.nlm.nih.gov/pubmed/33852413 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e26955 %T Estimating the Proportion of COVID-19 Contacts Among Households Based on Individuals With Myocardial Infarction History: Cross-sectional Telephone Survey %A Fraticelli,Laurie %A Freyssenge,Julie %A Claustre,Clément %A Martinez,Mikaël %A Redjaline,Abdesslam %A Serre,Patrice %A Bochaton,Thomas %A El Khoury,Carlos %+ RESCUe-RESUVal, Lucien Hussel Hospital, Montée du Docteur Maurice Chapuis, Vienne, 38200, France, 33 4 37 02 10 59, l.fraticelli@resuval.fr %K COVID-19 %K survey %K myocardial infarction %K cases %K contacts %K household %K estimate %K cross-sectional %K cardiovascular %K risk %K symptom %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adults with cardiovascular diseases were disproportionately associated with an increased risk of a severe form of COVID-19 and all-cause mortality. Objective: The aims of this study are to report the associated symptoms for COVID-19 cases, to estimate the proportion of contacts, and to describe the clinical signs and behaviors among individuals with and without myocardial infarction history among cases and contacts. Methods: A 2-week cross-sectional telephone survey was conducted during the first lockdown period in France, from May 4 to 15, 2020. A total of 668 households participated, representing 703 individuals with pre-existing cardiovascular disease in the past 2 years and 849 individuals without myocardial infarction history. Results: High rates of compliance with health measures were self-reported, regardless of age or risk factors. There were 4 confirmed COVID-19 cases that were registered from 4 different households. Based on deductive assumptions of the 1552 individuals, 9.73% (n=151) were identified as contacts, of whom 71.52% (108/151) were asymptomatic. Among individuals with a myocardial infarction history, 2 were COVID-19 cases, and the estimated proportion of contacts was 8.68% (61/703), of whom 68.85% (42/61) were asymptomatic. The cases and contacts presented different symptoms, with more respiratory signs in those with a myocardial infarction history. Conclusions: The telephone survey could be a relevant tool for reporting the number of contacts during a limited period and in a limited territory based on the presence of associated symptoms and COVID-19 cases in the households. This study advanced our knowledge to better prepare for future crises. %M 33855968 %R 10.2196/26955 %U https://formative.jmir.org/2021/4/e26955 %U https://doi.org/10.2196/26955 %U http://www.ncbi.nlm.nih.gov/pubmed/33855968 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e24760 %T Psychological and Coping Strategies Related to Home Isolation and Social Distancing in Children and Adolescents During the COVID-19 Pandemic: Cross-sectional Study %A Zainel,Abduljaleel Abdullatif %A Qotba,Hamda %A Al-Maadeed,Alyaa %A Al-Kohji,Sadriya %A Al Mujalli,Hanan %A Ali,Atif %A Al Mannai,Lolwa %A Aladab,Aisha %A AlSaadi,Hamda %A AlKarbi,Khalid Ali %A Al-Baghdadi,Tholfakhar %+ Primary Health Care Corporation, PO Box 55772, Doha, Qatar, 974 55087676, azainel@phcc.gov.qa %K COVID-19 %K coronavirus %K pandemic %K psychological %K coping strategies %K children %K adolescents %K Qatar %D 2021 %7 27.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: In December 2019, a novel coronavirus called SARS-CoV-2 was identified as the cause of a cluster of pneumonia cases in Wuhan, China. It rapidly spread due to human-to-human transmission, resulting in a global pandemic. Nearly every country, including Qatar, has established guidelines and regulations to limit the spread of the virus and to preserve public health. However, these procedures have been associated with negative effects on the psychological and intellectual well-being of individuals, including children and adolescents. Objective: The objective of this study was to determine the psychological influence of home isolation and social distancing on children and adolescents during the COVID-19 pandemic in Qatar, and the strategies used to cope with these measures. Methods: This cross-sectional study was undertaken using an online questionnaire administered through SMS text messaging. All home-isolated children and adolescents registered at the Primary Health Care Corporation aged 7-18 years were invited to participate in the study. Children and adolescents with intellectual disadvantages were excluded. A P value of .05 (two-tailed) was considered statistically significant. Results: Data were collected from 6608 participants from June 23 to July 18, 2020. Nearly all participants adhered to the official regulations during the period of home isolation and social distancing; however, 69.1% (n=4568) of parents believed their children were vulnerable to the virus compared to 25% (n=1652) who expressed they were not vulnerable at all. Higher levels of anger, depression, and general anxiety were prevalent among 1.3% (n=84), 3.9% (n=260), and 1.6% (n=104) of participants, respectively. The mean score for the emotional constructs anger and depression decreased with increased compliance with regulations (P=.04 and P=.11, respectively). The differences in mean score for all psychological and coping strategies used among participants across the 3 levels of vulnerability to SARS-CoV-2 were statistically significant. The mean score varied little with increasing reported vulnerability to the virus. This mild variation can make a difference when the sample size is large, as is the case in this study. Conclusions: Screening for psychological and social disruptions is important for the development of strategies by schools and health care providers to assess and monitor behavioral changes and negative psychological impact during post–COVID-19 reintegration. Participants experiencing higher levels of anxiety should be given more attention during reintegration and transitional phases in schools. Although electronic devices and social media platforms may have lowered anxiety levels in some cases, it is important to address how they are used and how content is tailored to children and adolescents. It is also important to maintain an active lifestyle for children and young persons, and encourage them not to neglect their physical health, as this promotes a better psychological state of mind. %M 33851577 %R 10.2196/24760 %U https://formative.jmir.org/2021/4/e24760 %U https://doi.org/10.2196/24760 %U http://www.ncbi.nlm.nih.gov/pubmed/33851577 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27468 %T Deep Convolutional Neural Network–Based Computer-Aided Detection System for COVID-19 Using Multiple Lung Scans: Design and Implementation Study %A Ghaderzadeh,Mustafa %A Asadi,Farkhondeh %A Jafari,Ramezan %A Bashash,Davood %A Abolghasemi,Hassan %A Aria,Mehrad %+ Department of Health Information Technology and Management, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Darband St, Ghods Square, Tehran, Iran, 98 9123187253, Asadifar@sbmu.ac.ir %K artificial intelligence %K classification %K computer-aided detection %K computed tomography scan %K convolutional neural network %K coronavirus %K COVID-19 %K deep learning %K machine learning %K machine vision %K model %K pandemic %D 2021 %7 26.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Owing to the COVID-19 pandemic and the imminent collapse of health care systems following the exhaustion of financial, hospital, and medicinal resources, the World Health Organization changed the alert level of the COVID-19 pandemic from high to very high. Meanwhile, more cost-effective and precise COVID-19 detection methods are being preferred worldwide. Objective: Machine vision–based COVID-19 detection methods, especially deep learning as a diagnostic method in the early stages of the pandemic, have been assigned great importance during the pandemic. This study aimed to design a highly efficient computer-aided detection (CAD) system for COVID-19 by using a neural search architecture network (NASNet)–based algorithm. Methods: NASNet, a state-of-the-art pretrained convolutional neural network for image feature extraction, was adopted to identify patients with COVID-19 in their early stages of the disease. A local data set, comprising 10,153 computed tomography scans of 190 patients with and 59 without COVID-19 was used. Results: After fitting on the training data set, hyperparameter tuning, and topological alterations of the classifier block, the proposed NASNet-based model was evaluated on the test data set and yielded remarkable results. The proposed model's performance achieved a detection sensitivity, specificity, and accuracy of 0.999, 0.986, and 0.996, respectively. Conclusions: The proposed model achieved acceptable results in the categorization of 2 data classes. Therefore, a CAD system was designed on the basis of this model for COVID-19 detection using multiple lung computed tomography scans. The system differentiated all COVID-19 cases from non–COVID-19 ones without any error in the application phase. Overall, the proposed deep learning–based CAD system can greatly help radiologists detect COVID-19 in its early stages. During the COVID-19 pandemic, the use of a CAD system as a screening tool would accelerate disease detection and prevent the loss of health care resources. %M 33848973 %R 10.2196/27468 %U https://www.jmir.org/2021/4/e27468 %U https://doi.org/10.2196/27468 %U http://www.ncbi.nlm.nih.gov/pubmed/33848973 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e26720 %T Texas Public Agencies’ Tweets and Public Engagement During the COVID-19 Pandemic: Natural Language Processing Approach %A Tang,Lu %A Liu,Wenlin %A Thomas,Benjamin %A Tran,Hong Thoai Nga %A Zou,Wenxue %A Zhang,Xueying %A Zhi,Degui %+ Department of Communication, Texas A&M University, 456 Ross Street, College Station, TX, 77840-77845, United States, 1 12136754090, ltang@tamu.edu %K COVID-19 %K public health agencies %K natural language processing %K Twitter %K health belief model %K public engagement %K social media %K belief %K public health %K engagement %K communication %K strategy %K content analysis %K dissemination %D 2021 %7 26.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The ongoing COVID-19 pandemic is characterized by different morbidity and mortality rates across different states, cities, rural areas, and diverse neighborhoods. The absence of a national strategy for battling the pandemic also leaves state and local governments responsible for creating their own response strategies and policies. Objective: This study examines the content of COVID-19–related tweets posted by public health agencies in Texas and how content characteristics can predict the level of public engagement. Methods: All COVID-19–related tweets (N=7269) posted by Texas public agencies during the first 6 months of 2020 were classified in terms of each tweet’s functions (whether the tweet provides information, promotes action, or builds community), the preventative measures mentioned, and the health beliefs discussed, by using natural language processing. Hierarchical linear regressions were conducted to explore how tweet content predicted public engagement. Results: The information function was the most prominent function, followed by the action or community functions. Beliefs regarding susceptibility, severity, and benefits were the most frequently covered health beliefs. Tweets that served the information or action functions were more likely to be retweeted, while tweets that served the action and community functions were more likely to be liked. Tweets that provided susceptibility information resulted in the most public engagement in terms of the number of retweets and likes. Conclusions: Public health agencies should continue to use Twitter to disseminate information, promote action, and build communities. They need to improve their strategies for designing social media messages about the benefits of disease prevention behaviors and audiences’ self-efficacy. %M 33847587 %R 10.2196/26720 %U https://publichealth.jmir.org/2021/4/e26720 %U https://doi.org/10.2196/26720 %U http://www.ncbi.nlm.nih.gov/pubmed/33847587 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e24180 %T Mobile Sensing Apps and Self-management of Mental Health During the COVID-19 Pandemic: Web-Based Survey %A Suruliraj,Banuchitra %A Bessenyei,Kitti %A Bagnell,Alexa %A McGrath,Patrick %A Wozney,Lori %A Orji,Rita %A Meier,Sandra %+ Department of Psychiatry, Dalhousie University, 5850/5980 University Avenue, PO Box 970, Halifax, NS, B3K 6R8, Canada, 1 782 414 8054, sandra.m.meier@gmail.com %K app %K awareness %K behavior %K COVID-19 %K helpfulness %K mobile health %K mobile sensing %K self-management %K sensing %K web-based survey %D 2021 %7 26.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, people had to adapt their daily life routines to the currently implemented public health measures, which is likely to have resulted in a lack of in-person social interactions, physical activity, or sleep. Such changes can have a significant impact on mental health. Mobile sensing apps can passively record the daily life routines of people, thus making them aware of maladaptive behavioral adjustments to the pandemic. Objective: This study aimed to explore the views of people on mobile sensing apps that passively record behaviors and their potential to increase awareness and helpfulness for self-managing mental health during the pandemic. Methods: We conducted an anonymous web-based survey including people with and those without mental disorders, asking them to rate the helpfulness of mobile sensing apps for the self-management of mental health during the COVID-19 pandemic. The survey was conducted in May 2020. Results: The majority of participants, particularly those with a mental disorder (n=106/148, 72%), perceived mobile sensing apps as very or extremely helpful for managing their mental health by becoming aware of maladaptive behaviors. The perceived helpfulness of mobile sensing apps was also higher among people who experienced a stronger health impact of the COVID-19 pandemic (β=.24; 95% CI 0.16-0.33; P<.001), had a better understanding of technology (β=.17; 95% CI 0.08-0.25; P<.001), and had a higher education (β=.1; 95% CI 0.02-0.19; P=.02). Conclusions: Our findings highlight the potential of mobile sensing apps to assist in mental health care during the pandemic. %M 33872181 %R 10.2196/24180 %U https://formative.jmir.org/2021/4/e24180 %U https://doi.org/10.2196/24180 %U http://www.ncbi.nlm.nih.gov/pubmed/33872181 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26628 %T 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 %A Yeung,Arnold YS %A Roewer-Despres,Francois %A Rosella,Laura %A Rudzicz,Frank %+ Department of Computer Science, University of Toronto, 27 King's College Cir, Toronto, ON, M5S 3H7, Canada, 1 416 978 2011, arnoldyeung@cs.toronto.edu %K COVID-19 %K machine learning %K nonpharmaceutical interventions %K cultural dimensions %K random forest %K AdaBoost %K forecast %K informatics %K epidemiology %K artificial intelligence %D 2021 %7 23.4.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33844636 %R 10.2196/26628 %U https://www.jmir.org/2021/4/e26628 %U https://doi.org/10.2196/26628 %U http://www.ncbi.nlm.nih.gov/pubmed/33844636 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e28589 %T Patient Satisfaction and Trust in Telemedicine During the COVID-19 Pandemic: Retrospective Observational Study %A Orrange,Sharon %A Patel,Arpna %A Mack,Wendy Jean %A Cassetta,Julia %+ Keck School of Medicine of USC, University of Southern California, 1975 Zonal Avenue, Los Angeles, CA, 90033, United States, 1 323 442 5100, sharon.orrange@med.usc.edu %K telemedicine %K patient satisfaction %K COVID-19 %K health services research %K health policy %K health care delivery %K physicians %K medicine %D 2021 %7 22.4.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Los Angeles County is a hub for COVID-19 cases in the United States. Academic health centers rapidly deployed and leveraged telemedicine to permit uninterrupted care of patients. Telemedicine enjoys high patient satisfaction, yet little is known about the level of satisfaction during a crisis and to what extent patient- or visit-related factors and trust play when in-person visits are eliminated. Objective: The aim of this study is to examine correlates of patients’ satisfaction with a telemedicine visit. Methods: In this retrospective observational study conducted in our single-institution, urban, academic medical center in Los Angeles, internal medicine patients aged ≥18 years who completed a telemedicine visit between March 10th and April 17th, 2020, were invited for a survey (n=1624). Measures included patient demographics, degree of interpersonal trust in patient-physician relationships (using the Trust in Physician Scale), and visit-related concerns. Statistical analysis used descriptive statistics, Spearman rank-order correlation, and linear and ordinal logistic regression. Results: Of 1624 telemedicine visits conducted during this period, 368 (22.7%) patients participated in the survey. Across the study, respondents were very satisfied (173/365, 47.4%) or satisfied (n=129, 35.3%) with their telemedicine visit. Higher physician trust was associated with higher patient satisfaction (Spearman correlation r=0.51, P<.001). Visit-related factors with statistically significant correlation with Trust in Physician score were technical issues with the telemedicine visit (r=–0.16), concerns about privacy (r=–0.19), concerns about cost (r=–0.23), satisfaction with telemedicine convenience (r=0.41), and amount of time spent (r=0.47; all P<.01). Visit-related factors associated with patients’ satisfaction included fewer technical issues (P<.001), less concern about privacy (P<.001) or cost (P=.02), and successful face-to-face video (P<.001). The only patient variable with a significant positive association was income and level of trust in physician (r=0.18, P<.001). Younger age was associated with higher satisfaction with the telemedicine visit (P=.005). Conclusions: There have been calls for redesigning primary care after the COVID-19 pandemic and for the widespread adoption of telemedicine. Patients’ satisfaction with telemedicine during the COVID-19 pandemic is high. Their satisfaction is shaped by the degree of trust in physician and visit-related factors more so than patient factors. This has widespread implications for outpatient practices and further research into visit-related factors and the patient-provider connection over telemedicine is needed. %M 33822736 %R 10.2196/28589 %U https://humanfactors.jmir.org/2021/2/e28589 %U https://doi.org/10.2196/28589 %U http://www.ncbi.nlm.nih.gov/pubmed/33822736 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27832 %T Communicating Scientific Uncertainty About the COVID-19 Pandemic: Online Experimental Study of an Uncertainty-Normalizing Strategy %A Han,Paul K J %A Scharnetzki,Elizabeth %A Scherer,Aaron M %A Thorpe,Alistair %A Lary,Christine %A Waterston,Leo B %A Fagerlin,Angela %A Dieckmann,Nathan F %+ Center for Outcomes Research and Evaluation, Maine Medical Center Research Institute, 509 Forest Avenue, Portland, ME, 04101, United States, 1 207 661 7619, hanp@mmc.org %K uncertainty %K communication %K ambiguity %K vaccination %K COVID-19 %D 2021 %7 22.4.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33769947 %R 10.2196/27832 %U https://www.jmir.org/2021/4/e27832 %U https://doi.org/10.2196/27832 %U http://www.ncbi.nlm.nih.gov/pubmed/33769947 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27214 %T Google Trends for Pain Search Terms in the World’s Most Populated Regions Before and After the First Recorded COVID-19 Case: Infodemiological Study %A Szilagyi,Istvan-Szilard %A Ullrich,Torsten %A Lang-Illievich,Kordula %A Klivinyi,Christoph %A Schittek,Gregor Alexander %A Simonis,Holger %A Bornemann-Cimenti,Helmar %+ Department of Anesthesiology and Intensive Care Medicine, Medical University of Graz, Auenbruggerplatz 5/5, Graz, 8036, Austria, 1 316 385, helmar.bornemann@medunigraz.at %K COVID-19 %K data mining %K Google Trends %K incidence %K internet %K interest %K pain %K research %K trend %D 2021 %7 22.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Web-based analysis of search queries has become a very useful method in various academic fields for understanding timely and regional differences in the public interest in certain terms and concepts. Particularly in health and medical research, Google Trends has been increasingly used over the last decade. Objective: This study aimed to assess the search activity of pain-related parameters on Google Trends from among the most populated regions worldwide over a 3-year period from before the report of the first confirmed COVID-19 cases in these regions (January 2018) until December 2020. Methods: Search terms from the following regions were used for the analysis: India, China, Europe, the United States, Brazil, Pakistan, and Indonesia. In total, 24 expressions of pain location were assessed. Search terms were extracted using the local language of the respective country. Python scripts were used for data mining. All statistical calculations were performed through exploratory data analysis and nonparametric Mann–Whitney U tests. Results: Although the overall search activity for pain-related terms increased, apart from pain entities such as headache, chest pain, and sore throat, we observed discordant search activity. Among the most populous regions, pain-related search parameters for shoulder, abdominal, and chest pain, headache, and toothache differed significantly before and after the first officially confirmed COVID-19 cases (for all, P<.001). In addition, we observed a heterogenous, marked increase or reduction in pain-related search parameters among the most populated regions. Conclusions: As internet searches are a surrogate for public interest, we assume that our data are indicative of an increased incidence of pain after the onset of the COVID-19 pandemic. However, as these increased incidences vary across geographical and anatomical locations, our findings could potentially facilitate the development of specific strategies to support the most affected groups. %M 33844638 %R 10.2196/27214 %U https://www.jmir.org/2021/4/e27214 %U https://doi.org/10.2196/27214 %U http://www.ncbi.nlm.nih.gov/pubmed/33844638 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26459 %T Loss of Smell and Taste in Patients With Suspected COVID-19: Analyses of Patients’ Reports on Social Media %A Koyama,Sachiko %A Ueha,Rumi %A Kondo,Kenji %+ Department of Chemistry, Indiana University, 800 E Kirkwood Ave, Bloomington, IN, 47405-7102, United States, 1 812 345 6155, apodemusmice@gmail.com %K COVID-19 %K anosmia %K ageusia %K free reports on social media %K symptomatic %K asymptomatic %K recovery of senses %K symptom %K social media %K smell %K taste %K senses %K patient-reported %K benefit %K limit %K diagnosis %D 2021 %7 22.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The year 2020 was the year of the global COVID-19 pandemic. The severity of the situation has become so substantial that many or even most of the patients with mild to moderate symptoms had to self-isolate without specific medical treatments or even without being tested for COVID-19. Many patients joined internet membership groups to exchange information and support each other. Objective: Our goal is to determine the benefits and limits of using social media to understand the symptoms of patients with suspected COVID-19 with mild to moderate symptoms and, in particular, their symptoms of anosmia (loss of the sense of smell) and ageusia (loss of the sense of taste). The voluntary reports on an internet website of a membership group will be the platform of the analyses. Methods: Posts and comments of members of an internet group known as COVID-19 Smell and Taste Loss, founded on March 24, 2020, to support patients with suspected COVID-19 were collected and analyzed daily. Demographic data were collected using the software mechanism called Group Insights on the membership group website. Results: Membership groups on social media have become rare sources of support for patients with suspected COVID-19 with mild to moderate symptoms. These groups provided mental support to their members and became resources for information on COVID-19 tests and medicines or supplements. However, the membership was voluntary, and often the members leave without notification. It is hard to be precise from the free voluntary reports. The number of women in the group (6995/9227, 75.38% as of October 12, 2020) was about three times more than men (2272/9227, 24.62% as of October 12, 2020), and the peak age of members was between 20-40 years in both men and women. Patients who were asymptomatic other than the senses comprised 14.93% (53/355) of the total patients. Recovery of the senses was higher in the patients who were asymptomatic besides having anosmia and ageusia. Most (112/123, 91.06%) patients experienced other symptoms first and then lost their senses, on average, 4.2 days later. Patients without other symptoms tended to recover earlier (P=.02). Patients with anosmia and ageusia occasionally reported distorted smell and taste (parosmia and dysgeusia) as well as experiencing or perceiving the smell and taste without the sources of the smell or taste (phantosmia and phantogeusia). Conclusions: Our analysis of the social media database of suspected COVID-19 patients’ voices demonstrated that, although accurate diagnosis of patients is not always obtained with social media–based analyses, it may be a useful tool to collect a large amount of data on symptoms and the clinical course of worldwide rapidly growing infectious diseases. %M 33788699 %R 10.2196/26459 %U https://www.jmir.org/2021/4/e26459 %U https://doi.org/10.2196/26459 %U http://www.ncbi.nlm.nih.gov/pubmed/33788699 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e25128 %T Digital Health Intervention to Increase Health Knowledge Related to Diseases of High Public Health Concern in Iringa, Tanzania: Protocol for a Mixed Methods Study %A Holst,Christine %A Sukums,Felix %A Ngowi,Bernard %A Diep,Lien My %A Kebede,Tewodros Aragie %A Noll,Josef %A Winkler,Andrea Sylvia %+ Centre for Global Health, Department of Community Medicine and Global Health, Institute of Health and Society, University of Oslo, Postboks 1130 Blindern, Oslo, 0318, Norway, 47 48234044, christine.holst@medisin.uio.no %K digital health %K eHealth %K mHealth %K DigI %K Tanzania %K digital health messages %K digital health promotion %K digital health education %K HIV/AIDS %K tuberculosis %D 2021 %7 22.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Traditionally, health promotion and health education have been provided to communities in the global south in the form of leaflets or orally by health care workers. Digital health interventions (DHIs) such as digital health messages accessed by smartphones have the potential to reach more people at a lower cost and to contribute to strengthening of health care systems. The DHI in this study focuses on disseminating digital health education regarding 3 disease complexes of high public health concern: HIV/AIDS, tuberculosis, and Taenia solium (neuro)cysticercosis or taeniasis, a parasitic zoonotic disease that requires a One Health approach. The DHI presents the participants with animated health videos (animations) and provides access to information spots (InfoSpots) with a free-of-charge digital health platform containing messages about health to rural Tanzanian communities. Objective: The objective of this study is to measure the effect of the DHI on health knowledge uptake and retention over time in the rural communities. Methods: This is a mixed methods study including a nonrandomized controlled trial and qualitative interviews conducted in rural Tanzania. A health platform containing digital health messages for the communities was developed prior to the study. The health messages consist of text, pictures, quizzes, and animations of everyday stories, aimed at disease prevention and early treatment. The baseline and immediate postintervention assessments were completed in Iringa, Tanzania in May 2019. The participants were interviewed by enumerators and completed questionnaires regarding health knowledge. Participants in the intervention group were exposed to 3 different health animations once on a tablet device. The participants’ health knowledge was assessed again immediately after the exposure. The first follow-up survey was undertaken in August 2019. The InfoSpots with the digital health platform were thereafter launched in the intervention villages in November 2019. Qualitative interviews were undertaken in February 2020. The second follow-up was completed in June 2020. Results: A total of 600 participants have been enrolled in the trial. We will assess (1) the difference in knowledge scores between baseline and the immediate postintervention assessments in the intervention group and (2) the difference in knowledge scores between the intervention and control groups at baseline, 3 and 6 months post-DHI rollout. Since a randomized design did not prove feasible, potential confounders (eg, age, gender, education, and time of exposure) may be introduced, and results will be adjusted. Data analysis for the 35 qualitative interviews is currently ongoing, and perspectives and experiences related to use and nonuse of the InfoSpots are being explored. Conclusions: The data have been collected, and the analysis is ongoing in this digital health study, aimed at evaluating the effects of a DHI based on relevant health messages. The publications of results can be expected this year. Trial Registration: ClinicalTrials.gov NCT03808597; https://clinicaltrials.gov/ct2/show/NCT03808597 International Registered Report Identifier (IRRID): RR1-10.2196/25128 %M 33885369 %R 10.2196/25128 %U https://www.researchprotocols.org/2021/4/e25128 %U https://doi.org/10.2196/25128 %U http://www.ncbi.nlm.nih.gov/pubmed/33885369 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e28945 %T One Year of Pandemic Learning Response: Benefits of Massive Online Delivery of the World Health Organization’s Technical Guidance %A Utunen,Heini %A Van Kerkhove,Maria D %A Tokar,Anna %A O'Connell,Gillian %A Gamhewage,Gaya M %A Fall,Ibrahima Socé %+ Health Emergencies Programme, World Health Organization, 20 Avenue Appia, Geneva, 1211, Switzerland, 41 795933476, utunenh@who.int %K COVID-19 %K e-learning %K massive open web-based courses %K OpenWHO %K pandemic %K public health %K web-based learning %K World Health Organization %D 2021 %7 21.4.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The World Health Organization (WHO) launched the first web-based learning course on COVID-19 on January 26, 2020, four days before the director general of the WHO declared a public health emergency of international concern. The WHO is expanding access to web-based learning for COVID-19 through its open-learning platform for health emergencies, OpenWHO. Throughout the pandemic, OpenWHO has continued to publish learning offerings based on the WHO’s emerging evidence-based knowledge for managing the COVID-19 pandemic. This study presents the various findings derived from the analysis of the performance of the OpenWHO platform during the pandemic, along with the core benefits of massive web-based learning formats. %M 33881404 %R 10.2196/28945 %U https://publichealth.jmir.org/2021/4/e28945 %U https://doi.org/10.2196/28945 %U http://www.ncbi.nlm.nih.gov/pubmed/33881404 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e25066 %T Predicting Intensive Care Transfers and Other Unforeseen Events: Analytic Model Validation Study and Comparison to Existing Methods %A Cummings,Brandon C %A Ansari,Sardar %A Motyka,Jonathan R %A Wang,Guan %A Medlin Jr,Richard P %A Kronick,Steven L %A Singh,Karandeep %A Park,Pauline K %A Napolitano,Lena M %A Dickson,Robert P %A Mathis,Michael R %A Sjoding,Michael W %A Admon,Andrew J %A Blank,Ross %A McSparron,Jakob I %A Ward,Kevin R %A Gillies,Christopher E %+ Michigan Center for Integrative Research In Critical Care, Department of Emergency Medicine, University of Michigan, 2800 N Plymouth Road, NCRC 10-A112, Ann Arbor, MI, 48109, United States, 1 (734) 647 7436, cummingb@med.umich.edu %K COVID-19 %K biomedical informatics %K critical care %K machine learning %K deterioration %K predictive analytics %K informatics %K prediction %K intensive care unit %K ICU %K mortality %D 2021 %7 21.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: COVID-19 has led to an unprecedented strain on health care facilities across the United States. Accurately identifying patients at an increased risk of deterioration may help hospitals manage their resources while improving the quality of patient care. Here, we present the results of an analytical model, Predicting Intensive Care Transfers and Other Unforeseen Events (PICTURE), to identify patients at high risk for imminent intensive care unit transfer, respiratory failure, or death, with the intention to improve the prediction of deterioration due to COVID-19. Objective: This study aims to validate the PICTURE model’s ability to predict unexpected deterioration in general ward and COVID-19 patients, and to compare its performance with the Epic Deterioration Index (EDI), an existing model that has recently been assessed for use in patients with COVID-19. Methods: The PICTURE model was trained and validated on a cohort of hospitalized non–COVID-19 patients using electronic health record data from 2014 to 2018. It was then applied to two holdout test sets: non–COVID-19 patients from 2019 and patients testing positive for COVID-19 in 2020. PICTURE results were aligned to EDI and NEWS scores for head-to-head comparison via area under the receiver operating characteristic curve (AUROC) and area under the precision-recall curve. We compared the models’ ability to predict an adverse event (defined as intensive care unit transfer, mechanical ventilation use, or death). Shapley values were used to provide explanations for PICTURE predictions. Results: In non–COVID-19 general ward patients, PICTURE achieved an AUROC of 0.819 (95% CI 0.805-0.834) per observation, compared to the EDI’s AUROC of 0.763 (95% CI 0.746-0.781; n=21,740; P<.001). In patients testing positive for COVID-19, PICTURE again outperformed the EDI with an AUROC of 0.849 (95% CI 0.820-0.878) compared to the EDI’s AUROC of 0.803 (95% CI 0.772-0.838; n=607; P<.001). The most important variables influencing PICTURE predictions in the COVID-19 cohort were a rapid respiratory rate, a high level of oxygen support, low oxygen saturation, and impaired mental status (Glasgow Coma Scale). Conclusions: The PICTURE model is more accurate in predicting adverse patient outcomes for both general ward patients and COVID-19 positive patients in our cohorts compared to the EDI. The ability to consistently anticipate these events may be especially valuable when considering potential incipient waves of COVID-19 infections. The generalizability of the model will require testing in other health care systems for validation. %M 33818393 %R 10.2196/25066 %U https://medinform.jmir.org/2021/4/e25066 %U https://doi.org/10.2196/25066 %U http://www.ncbi.nlm.nih.gov/pubmed/33818393 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e24330 %T Web-Based Apps for Responding to Acute Infectious Disease Outbreaks in the Community: Systematic Review %A Quinn,Emma %A Hsiao,Kai Hsun %A Maitland-Scott,Isis %A Gomez,Maria %A Baysari,Melissa T %A Najjar,Zeina %A Gupta,Leena %+ Sydney Local Health District, Camperdown Public Health Unit, Royal Prince Alfred Hospital Campus, Missenden Road, Camperdown, Sydney, NSW, 2050, Australia, 61 2 9515 9420, Leena.Gupta@health.nsw.gov.au %K software %K mHealth %K infectious diseases %K outbreaks %K mobile apps %K mobile phone %K eHealth %D 2021 %7 21.4.2021 %9 Review %J JMIR Public Health Surveill %G English %X Background: Web-based technology has dramatically improved our ability to detect communicable disease outbreaks, with the potential to reduce morbidity and mortality because of swift public health action. Apps accessible through the internet and on mobile devices create an opportunity to enhance our traditional indicator-based surveillance systems, which have high specificity but issues with timeliness. Objective: The aim of this study is to describe the literature on web-based apps for indicator-based surveillance and response to acute communicable disease outbreaks in the community with regard to their design, implementation, and evaluation. Methods: We conducted a systematic search of the published literature across four databases (MEDLINE via OVID, Web of Science Core Collection, ProQuest Science, and Google Scholar) for peer-reviewed journal papers from January 1998 to October 2019 using a keyword search. Papers with the full text available were extracted for review, and exclusion criteria were applied to identify eligible papers. Results: Of the 6649 retrieved papers, 23 remained, describing 15 web-based apps. Apps were primarily designed to improve the early detection of disease outbreaks, targeted government settings, and comprised either complex algorithmic or statistical outbreak detection mechanisms or both. We identified a need for these apps to have more features to support secure information exchange and outbreak response actions, with a focus on outbreak verification processes and staff and resources to support app operations. Evaluation studies (6 out of 15 apps) were mostly cross-sectional, with some evidence of reduction in time to notification of outbreak; however, studies lacked user-based needs assessments and evaluation of implementation. Conclusions: Public health officials designing new or improving existing disease outbreak web-based apps should ensure that outbreak detection is automatic and signals are verified by users, the app is easy to use, and staff and resources are available to support the operations of the app and conduct rigorous and holistic evaluations. %M 33881406 %R 10.2196/24330 %U https://publichealth.jmir.org/2021/4/e24330 %U https://doi.org/10.2196/24330 %U http://www.ncbi.nlm.nih.gov/pubmed/33881406 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e20699 %T The Impact of COVID-19 Management Policies Tailored to Airborne SARS-CoV-2 Transmission: Policy Analysis %A Telles,Charles Roberto %A Roy,Archisman %A Ajmal,Mohammad Rehan %A Mustafa,Syed Khalid %A Ahmad,Mohammad Ayaz %A de la Serna,Juan Moises %A Frigo,Elisandro Pires %A Rosales,Manuel Hernández %+ Internal Control Center, Secretary of State for Education and Sport of Paraná, Av Água Verde, 2140, Curitiba, 80240-900, Brazil, 55 41996056321, charlestelles@seed.pr.gov.br %K social distancing policies %K COVID-19 %K airborne transmission %K convergence and stability properties %D 2021 %7 21.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 33729168 %R 10.2196/20699 %U https://publichealth.jmir.org/2021/4/e20699 %U https://doi.org/10.2196/20699 %U http://www.ncbi.nlm.nih.gov/pubmed/33729168 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 2 %P e21269 %T Impact of COVID-19 Testing Strategies and Lockdowns on Disease Management Across Europe, South America, and the United States: Analysis Using Skew-Normal Distributions %A De Leo,Stefano %+ Department of Applied Mathematics, State University of Campinas, Rua Sérgio Buarque de Holanda, 651, Campinas, 13083-859, Brazil, 55 1935215958, deleo@ime.unicamp.br %K COVID-19 %K testing strategy %K skew-normal distributions %K lockdown %K forecast %K modeling %K outbreak %K infectious disease %K prediction %D 2021 %7 21.4.2021 %9 Original Paper %J JMIRx Med %G English %X 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. %M 34032814 %R 10.2196/21269 %U https://xmed.jmir.org/2021/2/e21269 %U https://doi.org/10.2196/21269 %U http://www.ncbi.nlm.nih.gov/pubmed/34032814 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e23488 %T Novel Predictors of COVID-19 Protective Behaviors Among US Adults: Cross-sectional Survey %A Resnicow,Ken %A Bacon,Elizabeth %A Yang,Penny %A Hawley,Sarah %A Van Horn,M Lee %A An,Lawrence %+ Department of Health Behavior & Health Education, School of Public Health, University of Michigan, 109 Observatory Street, Room 3867 SPH I, Ann Arbor, MI, 48109, United States, 1 734 764 9494, kresnic@umich.edu %K COVID-19 %K protective behavior %K psychological predictors %K reactance %K conspiracy beliefs %K public health %K health communication %K communication %K protection %K behavior %K psychology %D 2021 %7 20.4.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33835930 %R 10.2196/23488 %U https://www.jmir.org/2021/4/e23488 %U https://doi.org/10.2196/23488 %U http://www.ncbi.nlm.nih.gov/pubmed/33835930 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e23311 %T The Uncounted Casualties of a Hidden COVID-19 Epidemic in China: Cross-sectional Study on Deaths Related to Overwork %A Wang,Zhicheng %A Lin,Leesa %A Guo,Yan %A Xiong,Huayi %A Tang,Kun %+ Vanke School of Public Health, Tsinghua University, No. 30, Shuangqing Road, Haidian District, Beijing, China, 86 13671129425, tangk@mail.tsinghua.edu.cn %K nonpharmaceutical interventions %K on-duty deaths %K COVID-19 %K overwork death %K crowdsourced data %K intervention %K mortality %K casualty %K cross-sectional %K overwork %K stress %D 2021 %7 20.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 response, nonclinical essential workers usually worked overtime and experienced significant work stress, which subsequently increased their risk of mortality due to cardiovascular diseases, stroke, and pre-existing conditions. Deaths on duty, including deaths due to overwork, during the COVID-19 response were usually reported on web-based platforms for public recognition and solidarity. Although no official statistics are available for these casualties, a list of on-duty deaths has been made publicly available on the web by crowdsourcing. Objective: This study aims to understand the trends and characteristics of deaths related to overwork among the frontline nonclinical essential workers participating in nonpharmaceutical interventions during the first wave of COVID-19 in China. Methods: Based on a web-based crowdsourced list of deaths on duty during the first wave of the COVID-19 response in China, we manually verified all overwork-related death records against the full-text web reports from credible sources. After excluding deaths caused by COVID-19 infection and accidents, a total of 340 deaths related to overwork among nonclinical essential workers were attributed to combatting the COVID-19 crisis. We coded the key characteristics of the deceased workers, including sex, age at death, location, causes of death, date of incidence, date of death, containment duties, working area, and occupation. The temporal and spatial correlations between deaths from overwork and COVID-19 cases in China were also examined using Pearson correlation coefficient. Results: From January 20 to April 26, 2020, at least 340 nonclinical frontline workers in China were reported to have died as a result of overwork while combatting COVID-19. The weekly overwork mortality was positively correlated with weekly COVID-19 cases (r=0.79, P<.001). Two-thirds of deceased workers (230/340, 67.6%) were under 55 years old, and two major causes of deaths related to overwork were cardiovascular diseases (138/340, 40.6%) and cerebrovascular diseases (73/340, 21.5%). Outside of Hubei province, there were almost 2.5 times as many deaths caused by COVID-19–related overwork (308/340, 90.6%) than by COVID-19 itself (n=120). Conclusions: The high number of deaths related to overwork among nonclinical essential workers at the frontline of the COVID-19 epidemic is alarming. Policies for occupational health protection against work hazards should therefore be prioritized and enforced. %M 33822735 %R 10.2196/23311 %U https://www.jmir.org/2021/4/e23311 %U https://doi.org/10.2196/23311 %U http://www.ncbi.nlm.nih.gov/pubmed/33822735 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 8 %N 4 %P e25097 %T Learning the Mental Health Impact of COVID-19 in the United States With Explainable Artificial Intelligence: Observational Study %A Jha,Indra Prakash %A Awasthi,Raghav %A Kumar,Ajit %A Kumar,Vibhor %A Sethi,Tavpritesh %+ Indraprastha Institute of Information Technology, Room 309, R and D Building, IIIT Campus, Okhla Phase 3, New Delhi, India, 91 01126907533, tavpriteshsethi@iiitd.ac.in %K COVID-19 %K mental health %K Bayesian network %K machine learning %K artificial intelligence %K disorder %K susceptibility %K well-being %K explainable artificial intelligence %D 2021 %7 20.4.2021 %9 Original Paper %J JMIR Ment Health %G English %X Background: The COVID-19 pandemic has affected the health, economic, and social fabric of many nations worldwide. Identification of individual-level susceptibility factors may help people in identifying and managing their emotional, psychological, and social well-being. Objective: This study is focused on learning a ranked list of factors that could indicate a predisposition to a mental disorder during the COVID-19 pandemic. Methods: In this study, we have used a survey of 17,764 adults in the United States from different age groups, genders, and socioeconomic statuses. Through initial statistical analysis and Bayesian network inference, we have identified key factors affecting mental health during the COVID-19 pandemic. Integrating Bayesian networks with classical machine learning approaches led to effective modeling of the level of mental health prevalence. Results: Overall, females were more stressed than males, and people in the age group 18-29 years were more vulnerable to anxiety than other age groups. Using the Bayesian network model, we found that people with a chronic mental illness were more prone to mental disorders during the COVID-19 pandemic. The new realities of working from home; homeschooling; and lack of communication with family, friends, and neighbors induces mental pressure. Financial assistance from social security helps in reducing mental stress during the COVID-19–generated economic crises. Finally, using supervised machine learning models, we predicted the most mentally vulnerable people with ~80% accuracy. Conclusions: Multiple factors such as social isolation, digital communication, and working and schooling from home were identified as factors of mental illness during the COVID-19 pandemic. Regular in-person communication with friends and family, a healthy social life, and social security were key factors, and taking care of people with a history of mental disease appears to be even more important during this time. %M 33877051 %R 10.2196/25097 %U https://mental.jmir.org/2021/4/e25097 %U https://doi.org/10.2196/25097 %U http://www.ncbi.nlm.nih.gov/pubmed/33877051 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e26477 %T Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection (PROUDEST Trial): Protocol for a Multicenter, Prospective Cohort Study %A Fernandes,Geraldo Magela %A Motta,Felipe %A Sasaki,Lizandra Moura Paravidine %A Silva,Ângelo Pereira Da %A Miranda,Andreza Monforte %A Carvalho,Aleida Oliveira De %A Gomides,Ana Paula Monteiro %A Soares,Alexandre Anderson De Sousa Munhoz %A Santos Jr,Agenor De Castro Moreira Dos %A Alves,Caroline De Oliveira %A Gomes,Ciro Martins %A Siracusa,Clara Correia De %A Araújo Jr,David Alves De %A Mendonça-Silva,Dayde Lane %A Jesus,José Alfredo Lacerda De %A Costa,Karina Nascimento %A Castro,Maria Eduarda Canellas De %A Kurizky,Patricia Shu %A França,Paulo Sérgio %A Tristão,Rosana %A Pereira,Yacara Ribeiro %A Castro,Luiz Claudio Gonçalves De %A Zaconeta,Alberto Moreno %A Albuquerque,Cleandro Pires De %A Mota,Licia Maria Henrique Da %+ Faculty of Medicine, University of Brasília, Campus Universitário Darcy Ribeiro, UNB Área 1 - Asa Norte, Brasília - DF, 70910-900, Brazil, 55 61981070071, geraldomafer@gmail.com %K SARS-CoV-2 %K COVID-19 %K pregnancy %K neonate %K children %K outcome %K development %K prospective %K cohort %K women %K fetus %K baby %K implication %D 2021 %7 20.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: A growing body of evidence suggests that SARS-COV-2 infection during pregnancy may affect maternal-fetal outcomes and possibly result in implications for the long-term development of SARS-CoV-2–exposed children. Objective: The PROUDEST (Pregnancy Outcomes and Child Development Effects of SARS-CoV-2 Infection Study) is a multicenter, prospective cohort study designed to elucidate the repercussions of COVID-19 for the global health of mothers and their children. Methods: The PROUDEST trial comprises 2 prospective, sequential substudies. The PREGNANT substudy will clinically assess the effects of SARS-CoV-2 infection on pregnancy, childbirth, and puerperium from a mechanistic standpoint to elucidate the pregnancy-related inflammatory and immunological phenomena underlying COVID-19. Pregnant women aged 18-40 years who have been exposed (proven with laboratory tests) to SARS-CoV-2 (group A; n=300) will be compared to control subjects with no laboratory evidence of in-pregnancy exposure to the virus (group B; n=300). Subjects exposed to other infections during pregnancy will be excluded. The BORN substudy is a long-term follow-up study that will assess the offspring of women who enrolled in the prior substudy. It will describe the effects of SARS-CoV-2 exposure during pregnancy on children’s growth, neurodevelopment, and metabolism from birth up to 5 years of age. It includes two comparison groups; group A (exposed; n=300) comprises children born from SARS-CoV-2–exposed pregnancies, and group B (controls; n=300) comprises children born from nonexposed mothers. Results: Recruitment began in July 2020, and as of January 2021, 260 pregnant women who were infected with SARS-CoV-2 during pregnancy and 160 newborns have been included in the study. Data analysis is scheduled to start after all data are collected. Conclusions: Upon completion of the study, we expect to have comprehensive data that will provide a better understanding of the effects of SARS-CoV-2 infection and related inflammatory and immunological processes on pregnancy, puerperium, and infancy. Our findings will inform clinical decisions regarding the care of SARS-CoV-2–exposed mothers and children and support the development of evidence-based public health policies. Trial Registration: Brazilian Register of Clinical Trials RBR65QXS2; https://ensaiosclinicos.gov.br/rg/RBR-65qxs2 International Registered Report Identifier (IRRID): DERR1-10.2196/26477 %M 33793409 %R 10.2196/26477 %U https://www.researchprotocols.org/2021/4/e26477 %U https://doi.org/10.2196/26477 %U http://www.ncbi.nlm.nih.gov/pubmed/33793409 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27060 %T Prediction and Feature Importance Analysis for Severity of COVID-19 in South Korea Using Artificial Intelligence: Model Development and Validation %A Chung,Heewon %A Ko,Hoon %A Kang,Wu Seong %A Kim,Kyung Won %A Lee,Hooseok %A Park,Chul %A Song,Hyun-Ok %A Choi,Tae-Young %A Seo,Jae Ho %A Lee,Jinseok %+ Department of Artificial Intelligence, The Catholic University of Korea, 43 Jibong-ro, Bucheon, 14662, Republic of Korea, 82 2 2164 5523, gonasago@catholic.ac.kr %K COVID-19 %K artificial intelligence %K blood samples %K mortality prediction %D 2021 %7 19.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of deaths from COVID-19 continues to surge worldwide. In particular, if a patient’s condition is sufficiently severe to require invasive ventilation, it is more likely to lead to death than to recovery. Objective: The goal of our study was to analyze the factors related to COVID-19 severity in patients and to develop an artificial intelligence (AI) model to predict the severity of COVID-19 at an early stage. Methods: We developed an AI model that predicts severity based on data from 5601 COVID-19 patients from all national and regional hospitals across South Korea as of April 2020. The clinical severity of COVID-19 was divided into two categories: low and high severity. The condition of patients in the low-severity group corresponded to no limit of activity, oxygen support with nasal prong or facial mask, and noninvasive ventilation. The condition of patients in the high-severity group corresponded to invasive ventilation, multi-organ failure with extracorporeal membrane oxygenation required, and death. For the AI model input, we used 37 variables from the medical records, including basic patient information, a physical index, initial examination findings, clinical findings, comorbid diseases, and general blood test results at an early stage. Feature importance analysis was performed with AdaBoost, random forest, and eXtreme Gradient Boosting (XGBoost); the AI model for predicting COVID-19 severity among patients was developed with a 5-layer deep neural network (DNN) with the 20 most important features, which were selected based on ranked feature importance analysis of 37 features from the comprehensive data set. The selection procedure was performed using sensitivity, specificity, accuracy, balanced accuracy, and area under the curve (AUC). Results: We found that age was the most important factor for predicting disease severity, followed by lymphocyte level, platelet count, and shortness of breath or dyspnea. Our proposed 5-layer DNN with the 20 most important features provided high sensitivity (90.2%), specificity (90.4%), accuracy (90.4%), balanced accuracy (90.3%), and AUC (0.96). Conclusions: Our proposed AI model with the selected features was able to predict the severity of COVID-19 accurately. We also made a web application so that anyone can access the model. We believe that sharing the AI model with the public will be helpful in validating and improving its performance. %M 33764883 %R 10.2196/27060 %U https://www.jmir.org/2021/4/e27060 %U https://doi.org/10.2196/27060 %U http://www.ncbi.nlm.nih.gov/pubmed/33764883 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e21468 %T A Recursive Model of the Spread of COVID-19: Modelling Study %A Ilyin,Sergey O %+ AV Topchiev Institute of Petrochemical Synthesis, Russian Academy of Sciences, 29 Leninsky prospekt, Moscow, 119991, Russian Federation, 7 9168276852, s.o.ilyin@gmail.com %K epidemiology %K COVID-19 %K model %K modelling %K prediction %K spread %K infection %K effective %K contagious %K transmission %D 2021 %7 19.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 33871381 %R 10.2196/21468 %U https://publichealth.jmir.org/2021/4/e21468 %U https://doi.org/10.2196/21468 %U http://www.ncbi.nlm.nih.gov/pubmed/33871381 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26645 %T Evolving Epidemiological Characteristics of COVID-19 in Hong Kong From January to August 2020: Retrospective Study %A Kwok,Kin On %A Wei,Wan In %A Huang,Ying %A Kam,Kai Man %A Chan,Emily Ying Yang %A Riley,Steven %A Chan,Ho Hin Henry %A Hui,David Shu Cheong %A Wong,Samuel Yeung Shan %A Yeoh,Eng Kiong %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 419, 4/F, School of Public Health Building, Prince of Wales Hospital, Shatin, NT, Hong Kong, China (Hong Kong), 852 22528405, kkokwok@cuhk.edu.hk %K SARS-CoV-2 %K COVID-19 %K evolving epidemiology %K containment delay %K serial interval %K Hong Kong %K epidemiology %K public health %K transmission %K China %K intervention %K case study %D 2021 %7 16.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has plagued the globe, with multiple SARS-CoV-2 clusters hinting at its evolving epidemiology. Since the disease course is governed by important epidemiological parameters, including containment delays (time between symptom onset and mandatory isolation) and serial intervals (time between symptom onsets of infector-infectee pairs), understanding their temporal changes helps to guide interventions. Objective: This study aims to characterize the epidemiology of the first two epidemic waves of COVID-19 in Hong Kong by doing the following: (1) estimating the containment delays, serial intervals, effective reproductive number (Rt), and proportion of asymptomatic cases; (2) identifying factors associated with the temporal changes of the containment delays and serial intervals; and (3) depicting COVID-19 transmission by age assortativity and types of social settings. Methods: We retrieved the official case series and the Apple mobility data of Hong Kong from January-August 2020. The empirical containment delays and serial intervals were fitted to theoretical distributions, and factors associated with their temporal changes were quantified in terms of percentage contribution (the percentage change in the predicted outcome from multivariable regression models relative to a predefined comparator). Rt was estimated with the best fitted distribution for serial intervals. Results: The two epidemic waves were characterized by imported cases and clusters of local cases, respectively. Rt peaked at 2.39 (wave 1) and 3.04 (wave 2). The proportion of asymptomatic cases decreased from 34.9% (0-9 years) to 12.9% (≥80 years). Log-normal distribution best fitted the 1574 containment delays (mean 5.18 [SD 3.04] days) and the 558 serial intervals (17 negative; mean 4.74 [SD 4.24] days). Containment delays decreased with involvement in a cluster (percentage contribution: 10.08%-20.73%) and case detection in the public health care sector (percentage contribution: 27.56%, 95% CI 22.52%-32.33%). Serial intervals decreased over time (6.70 days in wave 1 versus 4.35 days in wave 2) and with tertiary transmission or beyond (percentage contribution: –50.75% to –17.31%), but were lengthened by mobility (percentage contribution: 0.83%). Transmission within the same age band was high (18.1%). Households (69.9%) and social settings (20.3%) were where transmission commonly occurred. Conclusions: First, the factors associated with reduced containment delays suggested government-enacted interventions were useful for achieving outbreak control and should be further encouraged. Second, the shorter serial intervals associated with the composite mobility index calls for empirical surveys to disentangle the role of different contact dimensions in disease transmission. Third, the presymptomatic transmission and asymptomatic cases underscore the importance of remaining vigilant about COVID-19. Fourth, the time-varying epidemiological parameters suggest the need to incorporate their temporal variations when depicting the epidemic trajectory. Fifth, the high proportion of transmission events occurring within the same age group supports the ban on gatherings outside of households, and underscores the need for residence-centered preventive measures. %M 33750740 %R 10.2196/26645 %U https://www.jmir.org/2021/4/e26645 %U https://doi.org/10.2196/26645 %U http://www.ncbi.nlm.nih.gov/pubmed/33750740 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e25852 %T Prediction Models for the Clinical Severity of Patients With COVID-19 in Korea: Retrospective Multicenter Cohort Study %A Oh,Bumjo %A Hwangbo,Suhyun %A Jung,Taeyeong %A Min,Kyungha %A Lee,Chanhee %A Apio,Catherine %A Lee,Hyejin %A Lee,Seungyeoun %A Moon,Min Kyong %A Kim,Shin-Woo %A Park,Taesung %+ Department of Statistics, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 2 880 8924, tspark@stats.snu.ac.kr %K clinical decision support system %K clinical characteristics %K COVID-19 %K SARS-CoV-2 %K prognostic tool %K severity %D 2021 %7 16.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Limited information is available about the present characteristics and dynamic clinical changes that occur in patients with COVID-19 during the early phase of the illness. Objective: This study aimed to develop and validate machine learning models based on clinical features to assess the risk of severe disease and triage for COVID-19 patients upon hospital admission. Methods: This retrospective multicenter cohort study included patients with COVID-19 who were released from quarantine until April 30, 2020, in Korea. A total of 5628 patients were included in the training and testing cohorts to train and validate the models that predict clinical severity and the duration of hospitalization, and the clinical severity score was defined at four levels: mild, moderate, severe, and critical. Results: Out of a total of 5601 patients, 4455 (79.5%), 330 (5.9%), 512 (9.1%), and 301 (5.4%) were included in the mild, moderate, severe, and critical levels, respectively. As risk factors for predicting critical patients, we selected older age, shortness of breath, a high white blood cell count, low hemoglobin levels, a low lymphocyte count, and a low platelet count. We developed 3 prediction models to classify clinical severity levels. For example, the prediction model with 6 variables yielded a predictive power of >0.93 for the area under the receiver operating characteristic curve. We developed a web-based nomogram, using these models. Conclusions: Our prediction models, along with the web-based nomogram, are expected to be useful for the assessment of the onset of severe and critical illness among patients with COVID-19 and triage patients upon hospital admission. %M 33822738 %R 10.2196/25852 %U https://www.jmir.org/2021/4/e25852 %U https://doi.org/10.2196/25852 %U http://www.ncbi.nlm.nih.gov/pubmed/33822738 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e26734 %T The Impact of the COVID-19 Pandemic on the Uptake of Influenza Vaccine: UK-Wide Observational Study %A Bachtiger,Patrik %A Adamson,Alexander %A Chow,Ji-Jian %A Sisodia,Rupa %A Quint,Jennifer K %A Peters,Nicholas S %+ National Heart & Lung Institute, Imperial College London, 4th Floor ICTEM Building, Hammersmith Campus, Du Cane Road, London, W12 0NN, United Kingdom, 44 020 7589 5111, n.peters@imperial.ac.uk %K COVID-19 %K influenza %K vaccination %K COVID %K Pandemic %K National Health Service %K Health Service %K flu %K virus %K vaccine %K impact %K uptake %K observational %K United Kingdom %K public health %K intention %K electronic health record %D 2021 %7 14.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 33651708 %R 10.2196/26734 %U https://publichealth.jmir.org/2021/4/e26734 %U https://doi.org/10.2196/26734 %U http://www.ncbi.nlm.nih.gov/pubmed/33651708 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26211 %T Machine Learning Applied to Clinical Laboratory Data in Spain for COVID-19 Outcome Prediction: Model Development and Validation %A Domínguez-Olmedo,Juan L %A Gragera-Martínez,Álvaro %A Mata,Jacinto %A Pachón Álvarez,Victoria %+ Higher Technical School of Engineering, University of Huelva, Fuerzas Armadas Ave, Huelva, 21007, Spain, 34 959217371, juan.dominguez@dti.uhu.es %K COVID-19 %K electronic health record %K machine learning %K mortality %K prediction %D 2021 %7 14.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic is probably the greatest health catastrophe of the modern era. Spain’s health care system has been exposed to uncontrollable numbers of patients over a short period, causing the system to collapse. Given that diagnosis is not immediate, and there is no effective treatment for COVID-19, other tools have had to be developed to identify patients at the risk of severe disease complications and thus optimize material and human resources in health care. There are no tools to identify patients who have a worse prognosis than others. Objective: This study aimed to process a sample of electronic health records of patients with COVID-19 in order to develop a machine learning model to predict the severity of infection and mortality from among clinical laboratory parameters. Early patient classification can help optimize material and human resources, and analysis of the most important features of the model could provide more detailed insights into the disease. Methods: After an initial performance evaluation based on a comparison with several other well-known methods, the extreme gradient boosting algorithm was selected as the predictive method for this study. In addition, Shapley Additive Explanations was used to analyze the importance of the features of the resulting model. Results: After data preprocessing, 1823 confirmed patients with COVID-19 and 32 predictor features were selected. On bootstrap validation, the extreme gradient boosting classifier yielded a value of 0.97 (95% CI 0.96-0.98) for the area under the receiver operator characteristic curve, 0.86 (95% CI 0.80-0.91) for the area under the precision-recall curve, 0.94 (95% CI 0.92-0.95) for accuracy, 0.77 (95% CI 0.72-0.83) for the F-score, 0.93 (95% CI 0.89-0.98) for sensitivity, and 0.91 (95% CI 0.86-0.96) for specificity. The 4 most relevant features for model prediction were lactate dehydrogenase activity, C-reactive protein levels, neutrophil counts, and urea levels. Conclusions: Our predictive model yielded excellent results in the differentiating among patients who died of COVID-19, primarily from among laboratory parameter values. Analysis of the resulting model identified a set of features with the most significant impact on the prediction, thus relating them to a higher risk of mortality. %M 33793407 %R 10.2196/26211 %U https://www.jmir.org/2021/4/e26211 %U https://doi.org/10.2196/26211 %U http://www.ncbi.nlm.nih.gov/pubmed/33793407 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24577 %T Socioeconomic Disparities in eHealth Literacy and Preventive Behaviors During the COVID-19 Pandemic in Hong Kong: Cross-sectional Study %A Guo,Ziqiu %A Zhao,Sheng Zhi %A Guo,Ningyuan %A Wu,Yongda %A Weng,Xue %A Wong,Janet Yuen-Ha %A Lam,Tai Hing %A Wang,Man Ping %+ School of Nursing, University of Hong Kong, 21 Sassoon Road, Hong Kong, China (Hong Kong), 852 3917 6636, mpwang@hku.hk %K COVID-19 %K eHealth literacy %K preventive behaviors %K socioeconomic disparities %K web-based information seeking %D 2021 %7 14.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: eHealth literacy can potentially facilitate web-based information seeking and taking informed measures. Objective: This study aimed to evaluate socioeconomic disparities in eHealth literacy and seeking of web-based information on COVID-19, and their associations with COVID-19 preventive behaviors. Methods: The COVID-19 Health Information Survey (CoVHIns), using telephonic (n=500) and web-based surveys (n=1001), was conducted among adults in Hong Kong in April 2020. The Chinese eHealth literacy scale (eHEALS; score range 8-40) was used to measure eHealth literacy. COVID-19 preventive behaviors included wearing surgical masks, wearing fabric masks, washing hands, social distancing, and adding water or bleach to the household drainage system. Adjusted beta coefficients and the slope indices of inequality for the eHEALS score by socioeconomic status, adjusted odds ratios (aORs) for seeking of web-based information on COVID-19 by socioeconomic status, and aORs for the high adherence to preventive behaviors by the eHEALS score and seeking of web-based information on COVID-19 were calculated. Results: The mean eHEALS score was 26.10 (SD 7.70). Age was inversely associated with the eHEALS score, but education and personal income were positively associated with the eHEALS score and seeking of web-based information on COVID-19 (for all, P for trend<.05). Participants who sought web-based information on COVID-19 showed high adherence to the practice of wearing surgical masks (aOR 1.56, 95% CI 1.15-2.13), washing hands (aOR 1.33, 95% CI 1.05-1.71), social distancing (aOR 1.48, 95% CI 1.14-1.93), and adding water or bleach to the household drainage system (aOR 1.67, 95% CI 1.28-2.18). Those with the highest eHEALS score displayed high adherence to the practice of wearing surgical masks (aOR 3.84, 95% CI 1.63-9.05), washing hands (aOR 4.14, 95% CI 2.46-6.96), social distancing (aOR 2.25, 95% CI 1.39-3.65), and adding water or bleach to the household drainage system (aOR 1.94, 95% CI 1.19-3.16), compared to those with the lowest eHEALS score. Conclusions: Chinese adults with a higher socioeconomic status had higher eHealth literacy and sought more web-based information on COVID-19; both these factors were associated with a high adherence to the guidelines for preventive behaviors during the COVID-19 pandemic. %M 33784240 %R 10.2196/24577 %U https://www.jmir.org/2021/4/e24577 %U https://doi.org/10.2196/24577 %U http://www.ncbi.nlm.nih.gov/pubmed/33784240 %0 Journal Article %@ 2561-9128 %I JMIR Publications %V 4 %N 1 %P e26316 %T An Online Calculator to Better Understand the Impact of False-Negative COVID-19 Polymerase Chain Reaction Test Results in the Context of Anesthesia Providers %A Runnels,Sean %A Pearson,John Frederick %A Samuels,Jon Dean %A Panchamia,Rohan Kirit %+ Department of Anesthesiology, Weill Cornell Medical College, 525 E 68th St, New York, NY, 10065, United States, 1 2127462755, rkp9004@med.cornell.edu %K COVID-19 %K testing %K false-negative rate %K calculator %K provider exposure %K airway management %K anesthesia %K exposure %K false negative %K risk %K transmission %K infectious disease %D 2021 %7 14.4.2021 %9 Viewpoint %J JMIR Perioper Med %G English %X What does the COVID-19 false-negative exposure problem mean in the context of a local anesthesia practice? We present a customizable online calculator designed to quantify and better understand individual and aggregate provider exposure risk. %M 33851930 %R 10.2196/26316 %U https://periop.jmir.org/2021/1/e26316 %U https://doi.org/10.2196/26316 %U http://www.ncbi.nlm.nih.gov/pubmed/33851930 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27045 %T Spatial-Temporal Relationship Between Population Mobility and COVID-19 Outbreaks in South Carolina: Time Series Forecasting Analysis %A Zeng,Chengbo %A Zhang,Jiajia %A Li,Zhenlong %A Sun,Xiaowen %A Olatosi,Bankole %A Weissman,Sharon %A Li,Xiaoming %+ South Carolina SmartState Center for Healthcare Quality, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, United States, 1 8034775298, czeng@email.sc.edu %K COVID-19 %K mobility %K incidence %K South Carolina %D 2021 %7 13.4.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33784239 %R 10.2196/27045 %U https://www.jmir.org/2021/4/e27045 %U https://doi.org/10.2196/27045 %U http://www.ncbi.nlm.nih.gov/pubmed/33784239 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26874 %T COVID-19 Vaccine Hesitancy in Canada: Content Analysis of Tweets Using the Theoretical Domains Framework %A Griffith,Janessa %A Marani,Husayn %A Monkman,Helen %+ Women's College Hospital Institute for Health Systems Solutions and Virtual Care, Women’s College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 6479650943, janessa.griffith@wchospital.ca %K vaccine hesitancy %K vaccine %K COVID-19 %K immunization %K Twitter %K infodemiology %K infoveillance %K social media %K behavioral science %K behavior %K Canada %K content analysis %K framework %K hesitancy %D 2021 %7 13.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: With the approval of two COVID-19 vaccines in Canada, many people feel a sense of relief, as hope is on the horizon. However, only about 75% of people in Canada plan to receive one of the vaccines. Objective: The purpose of this study is to determine the reasons why people in Canada feel hesitant toward receiving a COVID-19 vaccine. Methods: We screened 3915 tweets from public Twitter profiles in Canada by using the search words “vaccine” and “COVID.” The tweets that met the inclusion criteria (ie, those about COVID-19 vaccine hesitancy) were coded via content analysis. Codes were then organized into themes and interpreted by using the Theoretical Domains Framework. Results: Overall, 605 tweets were identified as those about COVID-19 vaccine hesitancy. Vaccine hesitancy stemmed from the following themes: concerns over safety, suspicion about political or economic forces driving the COVID-19 pandemic or vaccine development, a lack of knowledge about the vaccine, antivaccine or confusing messages from authority figures, and a lack of legal liability from vaccine companies. This study also examined mistrust toward the medical industry not due to hesitancy, but due to the legacy of communities marginalized by health care institutions. These themes were categorized into the following five Theoretical Domains Framework constructs: knowledge, beliefs about consequences, environmental context and resources, social influence, and emotion. Conclusions: With the World Health Organization stating that one of the worst threats to global health is vaccine hesitancy, it is important to have a comprehensive understanding of the reasons behind this reluctance. By using a behavioral science framework, this study adds to the emerging knowledge about vaccine hesitancy in relation to COVID-19 vaccines by analyzing public discourse in tweets in real time. Health care leaders and clinicians may use this knowledge to develop public health interventions that are responsive to the concerns of people who are hesitant to receive vaccines. %M 33769946 %R 10.2196/26874 %U https://www.jmir.org/2021/4/e26874 %U https://doi.org/10.2196/26874 %U http://www.ncbi.nlm.nih.gov/pubmed/33769946 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e25884 %T Machine Learning Approach to Predicting COVID-19 Disease Severity Based on Clinical Blood Test Data: Statistical Analysis and Model Development %A Aktar,Sakifa %A Ahamad,Md Martuza %A Rashed-Al-Mahfuz,Md %A Azad,AKM %A Uddin,Shahadat %A Kamal,AHM %A Alyami,Salem A %A Lin,Ping-I %A Islam,Sheikh Mohammed Shariful %A Quinn,Julian MW %A Eapen,Valsamma %A Moni,Mohammad Ali %+ WHO Collaborating Centre on eHealth, UNSW Digital Health, School of Public Health and Community Medicine, Faculty of Medicine, University of New South Wales, Kensington, Sydney, NSW 2052, Australia, 61 414701759, m.moni@unsw.edu.au %K COVID-19 %K blood samples %K machine learning %K statistical analysis %K prediction %K severity %K mortality %K morbidity %K risk %K blood %K testing %K outcome %K data set %D 2021 %7 13.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Accurate prediction of the disease severity of patients with COVID-19 would greatly improve care delivery and resource allocation and thereby reduce mortality risks, especially in less developed countries. Many patient-related factors, such as pre-existing comorbidities, affect disease severity and can be used to aid this prediction. Objective: Because rapid automated profiling of peripheral blood samples is widely available, we aimed to investigate how data from the peripheral blood of patients with COVID-19 can be used to predict clinical outcomes. Methods: We investigated clinical data sets of patients with COVID-19 with known outcomes by combining statistical comparison and correlation methods with machine learning algorithms; the latter included decision tree, random forest, variants of gradient boosting machine, support vector machine, k-nearest neighbor, and deep learning methods. Results: Our work revealed that several clinical parameters that are measurable in blood samples are factors that can discriminate between healthy people and COVID-19–positive patients, and we showed the value of these parameters in predicting later severity of COVID-19 symptoms. We developed a number of analytical methods that showed accuracy and precision scores >90% for disease severity prediction. Conclusions: We developed methodologies to analyze routine patient clinical data that enable more accurate prediction of COVID-19 patient outcomes. With this approach, data from standard hospital laboratory analyses of patient blood could be used to identify patients with COVID-19 who are at high risk of mortality, thus enabling optimization of hospital facilities for COVID-19 treatment. %M 33779565 %R 10.2196/25884 %U https://medinform.jmir.org/2021/4/e25884 %U https://doi.org/10.2196/25884 %U http://www.ncbi.nlm.nih.gov/pubmed/33779565 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 2 %P e27254 %T Mass Testing With Contact Tracing Compared to Test and Trace for the Effective Suppression of COVID-19 in the United Kingdom: Systematic Review %A Mbwogge,Mathew %+ London School of Hygiene & Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 07424409211, mathew.ngime@alumni.lshtm.ac.uk %K COVID-19 %K SARS-CoV-2 %K test and trace %K universal testing %K mass testing %K contact tracing %K infection surveillance %K prevention and control %K review %D 2021 %7 12.4.2021 %9 Review %J JMIRx Med %G English %X Background: Making testing available to everyone and tracing contacts might be the gold standard to control COVID-19. Many countries including the United Kingdom have relied on the symptom-based test and trace strategy in bringing the COVID-19 pandemic under control. The effectiveness of a test and trace strategy based on symptoms has been questionable and has failed to meet testing and tracing needs. This is further exacerbated by it not being delivered at the point of care, leading to rising cases and deaths. Increases in COVID-19 cases and deaths in the United Kingdom despite performing the highest number of tests in Europe suggest that symptom-based testing and contact tracing might not be effective as a control strategy. An alternative strategy is making testing available to all. Objective: The primary objective of this review was to compare mass testing and contact tracing with the conventional test and trace method in the suppression of SARS-CoV-2 infections. The secondary objective was to determine the proportion of asymptomatic COVID-19 cases reported during mass testing interventions. Methods: Literature in English was searched from September through December 2020 in Google Scholar, ScienceDirect, Mendeley, and PubMed. Search terms included “mass testing,” “test and trace,” “contact tracing,” “COVID-19,” “SARS-CoV-2,” “effectiveness,” “asymptomatic,” “symptomatic,” “community screening,” “UK,” and “2020.” Search results were synthesized without meta-analysis using the direction of effect as the standardized metric and vote counting as the synthesis metric. A statistical synthesis was performed using Stata 14.2. Tabular and graphical methods were used to present findings. Results: The literature search yielded 286 articles from Google Scholar, 20 from ScienceDirect, 14 from Mendeley, 27 from PubMed, and 15 through manual search. A total of 35 articles were included in the review, with a sample size of nearly 1 million participants. We found a 76.9% (10/13, 95% CI 46.2%-95.0%; P=.09) majority vote in favor of the intervention under the primary objective. The overall proportion of asymptomatic cases among those who tested positive and in the tested sample populations under the secondary objective was 40.7% (1084/2661, 95% CI 38.9%-42.6%) and 0.0% (1084/9,942,878, 95% CI 0.0%-0.0%), respectively. Conclusions: There was low-level but promising evidence that mass testing and contact tracing could be more effective in bringing the virus under control and even more effective if combined with social distancing and face coverings. The conventional test and trace method should be superseded by decentralized and regular mass rapid testing and contact tracing, championed by general practitioner surgeries and low-cost community services. %M 33857269 %R 10.2196/27254 %U https://xmed.jmir.org/2021/2/e27254 %U https://doi.org/10.2196/27254 %U http://www.ncbi.nlm.nih.gov/pubmed/33857269 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 2 %P e26474 %T Impact of the COVID-19 Pandemic on Older Adults: Rapid Review %A Lebrasseur,Audrey %A Fortin-Bédard,Noémie %A Lettre,Josiane %A Raymond,Emilie %A Bussières,Eve-Line %A Lapierre,Nolwenn %A Faieta,Julie %A Vincent,Claude %A Duchesne,Louise %A Ouellet,Marie-Christine %A Gagnon,Eric %A Tourigny,André %A Lamontagne,Marie-Ève %A Routhier,François %+ Centre for Interdisciplinary Research in Rehabilitation and Social Integration, Centre intégré universitaire de santé et de services sociaux de la Capitale-Nationale, 525 Hamel est, Québec, QC, G1M 2S8, Canada, 1 4185299141 ext 6256, francois.routhier@rea.ulaval.ca %K COVID-19 %K impact %K rapid review %K older adults %K aged individuals %K review %D 2021 %7 12.4.2021 %9 Review %J JMIR Aging %G English %X Background: The COVID-19 pandemic has drastically changed the lives of countless members of the general population. Older adults are known to experience loneliness, age discrimination, and excessive worry. It is therefore reasonable to anticipate that they would experience greater negative outcomes related to the COVID-19 pandemic given their increased isolation and risk for complications than younger adults. Objective: This study aims to synthesize the existing research on the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults. The secondary objective is to investigate the impact of the COVID-19 pandemic, and associated isolation and protective measures, on older adults with Alzheimer disease and related dementias. Methods: A rapid review of the published literature was conducted on October 6, 2020, through a search of 6 online databases to synthesize results from published original studies regarding the impact of the COVID-19 pandemic on older adults. The Human Development Model conceptual framework–Disability Creation Process was used to describe and understand interactions between personal factors, environmental factors, and life habits. Methods and results are reported following the Preferred Reporting Items for Systematic Reviews and Meta-analyses Statement. Results: A total of 135 records were included from the initial search strategy of 13,452 individual studies. Of these, 113 (83.7%) studies were determined to be of level 4 according to the levels of evidence classification by the Centre for Evidence-Based Medicine. The presence of psychological symptoms, exacerbation of ageism, and physical deterioration of aged populations were reported in the included studies. Decreased social life and fewer in-person social interactions reported during the COVID-19 pandemic were occasionally associated with reduced quality of life and increased depression. Difficulties accessing services, sleep disturbances, and a reduction of physical activity were also noted. Conclusions: Our results highlight the need for adequate isolation and protective measures. Older adults represent a heterogeneous group, which could explain the contradictory results found in the literature. Individual, organizational, and institutional strategies should be established to ensure that older adults are able to maintain social contacts, preserve family ties, and maintain the ability to give or receive help during the current pandemic. Future studies should focus on specific consequences and needs of more at-risk older adults to ensure their inclusion, both in public health recommendations and considerations made by policy makers. %M 33720839 %R 10.2196/26474 %U https://aging.jmir.org/2021/2/e26474 %U https://doi.org/10.2196/26474 %U http://www.ncbi.nlm.nih.gov/pubmed/33720839 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24053 %T Association of Perceived Threat, Negative Emotions, and Self-Efficacy With Mental Health and Personal Protective Behavior Among Chinese Pregnant Women During the COVID-19 Pandemic: Cross-sectional Survey Study %A Mo,Phoenix Kit Han %A Fong,Vivian Wai In %A Song,Bo %A Di,Jiangli %A Wang,Qian %A Wang,Linhong %+ National Center for Women and Children's Health, Chinese Center for Disease Control and Prevention, No 12 Dahuisi Road, Haidian District, Beijing, 100081, China, 86 010 62170970, qianawang@chinawch.org.cn %K COVID-19 %K pregnant women %K depression %K anxiety %K self-efficacy %K mental health %K survey %K threat %K emotion %D 2021 %7 12.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is an emerging infectious disease that has created health care challenges worldwide. Pregnant women are particularly affected by this disease. Objective: The aims of this study are to assess the levels of perceived threat (susceptibility, severity, impact), negative emotions (fear, worry), and self-efficacy of pregnant women in China related to COVID-19 and to examine their associations with mental health (depression and anxiety) and personal protective behavior (wearing a face mask). Methods: A total of 4087 pregnant women from China completed a cross-sectional web-based survey between March 3 and 10, 2020. Results: The prevalence of probable depression and anxiety was 48.7% (1989/4087) and 33.0% (1347/4087), respectively; 23.8% participants (974/4087) reported always wearing a face mask when going out. Of the 4087 participants, 32.1% (1313) and 36.4% (1490) perceived themselves or their family members to be susceptible to COVID-19 infection, respectively; 3216-3518 (78.7%-86.1%) agreed the disease would have various severe consequences. Additionally, 2275 of the 4087 participants (55.7%) showed self-efficacy in protecting themselves from contracting COVID-19, and 2232 (54.6%) showed efficacy in protecting their family members; 1303 (31.9%) reported a high level of fear of the disease, and 2780-3056 (68.0%-74.8%) expressed worry about various aspects of COVID-19. The results of the multivariate multinominal logistic regression analyses showed that perceived severity, perceived impact, fear, and worry were risk factors for probable depression and anxiety, while self-efficacy was a protective factor. The results of the multivariate logistic regression analysis showed that perceived susceptibility was associated with always wearing a face mask. Conclusions: Chinese pregnant women showed high levels of mental distress but low levels of personal protective behavior during the COVID-19 pandemic. Interventions are needed to promote the mental health and health behavior of pregnant women during the pandemic. %M 33729983 %R 10.2196/24053 %U https://www.jmir.org/2021/4/e24053 %U https://doi.org/10.2196/24053 %U http://www.ncbi.nlm.nih.gov/pubmed/33729983 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e23238 %T A Patient Journey Map to Improve the Home Isolation Experience of Persons With Mild COVID-19: Design Research for Service Touchpoints of Artificial Intelligence in eHealth %A He,Qian %A Du,Fei %A Simonse,Lianne W L %+ Department of Design Organisation & Strategy, Faculty of Industrial Design Engineering, Delft University of Technology, Landbergstraat 15, Delft, 2628CE, Netherlands, 31 15 27 ext 89054, L.W.L.Simonse@tudelft.nl %K COVID-19 %K design %K eHealth %K artificial intelligence %K service design %K patient journey map %K user-centered design %K digital service solutions in health %K home isolation %K AI %K touchpoint %D 2021 %7 12.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: In the context of the COVID-19 outbreak, 80% of the persons who are infected have mild symptoms and are required to self-recover at home. They have a strong demand for remote health care that, despite the great potential of artificial intelligence (AI), is not met by the current services of eHealth. Understanding the real needs of these persons is lacking. Objective: The aim of this paper is to contribute a fine-grained understanding of the home isolation experience of persons with mild COVID-19 symptoms to enhance AI in eHealth services. Methods: A design research method with a qualitative approach was used to map the patient journey. Data on the home isolation experiences of persons with mild COVID-19 symptoms was collected from the top-viewed personal video stories on YouTube and their comment threads. For the analysis, this data was transcribed, coded, and mapped into the patient journey map. Results: The key findings on the home isolation experience of persons with mild COVID-19 symptoms concerned (1) an awareness period before testing positive, (2) less typical and more personal symptoms, (3) a negative mood experience curve, (5) inadequate home health care service support for patients, and (6) benefits and drawbacks of social media support. Conclusions: The design of the patient journey map and underlying insights on the home isolation experience of persons with mild COVID-19 symptoms serves health and information technology professionals in more effectively applying AI technology into eHealth services, for which three main service concepts are proposed: (1) trustworthy public health information to relieve stress, (2) personal COVID-19 health monitoring, and (3) community support. %M 33444156 %R 10.2196/23238 %U https://medinform.jmir.org/2021/4/e23238 %U https://doi.org/10.2196/23238 %U http://www.ncbi.nlm.nih.gov/pubmed/33444156 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e24617 %T Effects of Participating in a Research Project During the COVID-19 Pandemic on Medical Students’ Educational Routines and Mental Health: Protocol for a Web-Based Survey Study %A Calderaro,Débora Cerqueira %A Kahlow,Barbara Stadler %A Munhoz,Gabriela Araújo %A Dias,Samuel Elias Basualto %A Lopes,João Vitor Ziroldo %A Borges,Aline Rizzo %A Mariz,Henrique De Ataíde %A Gomes,Kirla Wagner Poti %A Valadares,Lilian David De Azevedo %A Araújo,Nafice Costa %A Ribeiro,Sandra Lucia Euzébio %A Kakehasi,Adriana Maria %A Reis,Ana Paula Monteiro Gomides %A Marques,Cláudia %A Reis-Neto,Edgard Torres %A Paiva,Eduardo Dos Santos %A Pileggi,Gecilmara Salviato %A Ferreira,Gilda Aparecida %A Provenza,José Roberto %A Mota,Licia Maria Henrique %A Xavier,Ricardo Machado %A Teodoro,Maycoln Leôni Martins %A Pinheiro,Marcelo De Medeiros %A , %+ Universidade Federal de Minas Gerais, 190 Professor Alfredo Balena Avenue, Belo Horizonte, 30130-100, Brazil, 55 3134099757, dccalderaro@gmail.com %K SARS-CoV-2 %K COVID-19 %K medical education %K observational %K cross-sectional %K case-control study %K voluntary %K mental health %K rheumatic disease %K medical student %K protocol %K survey %D 2021 %7 9.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has resulted in social isolation, which has a potential negative impact on the educational routines (eg, the suspension of face-to-face appointments) and mental health of medical students. The Mario Pinotti II (MPII) study is a 24-week observational study that conducted scheduled telephone calls every 2 weeks to verify the occurrence of COVID-19 in patients with rheumatic diseases on chronic hydroxychloroquine therapy (from March 29, 2020, to September 30, 2020). The effects of voluntarily participating in a research project (ie, one that involves interactions via telephone contact with patients, professors, rheumatologists, and colleagues) on the daily lives and mental health of medical students requires evaluation. Objective: As medical students are professionals in training and have a high level of responsibility in terms of handling the emotional and physical aspects of several diseases, this study aims to evaluate the impacts of the COVID-19 pandemic and participation in the MPII study on the educational routines and mental health of medical students. Methods: A web-based survey was carried out to perform a cross-sectional comparative assessment of medical students who participated in the MPII study and their colleagues who were not involved in the MPII study. Participants from both groups were matched based on sex, age, and medical school. The web questionnaire was developed by a panel composed of graduate medical students, rheumatologists, medical school professors, and a psychology professor. The questionnaire included details on demographic and life habits data and evaluated participants' impressions of the MPII study and the impact of the COVID-19 pandemic on their educational routines and medical training. In addition, depression, anxiety, and stress were evaluated using the Brazilian version of the Depression, Anxiety, and Stress Scale (DASS)-21, and currently, the DASS-21 scores are grouped as those that indicate a low, moderate, or high risk of mental distress. This project was approved by the Federal University of São Paulo Ethics Committee (CAAE: 34034620.0.0000.5505). Results: Data were collected from both medical student groups from July 20 to August 31, 2020. Data extraction was completed in September 2020. The data analysis is ongoing. We expect the results to be published in the first semester of 2021. Conclusions: This study will provide insight into the effects of participating in a research project on depression, anxiety, and stress, which will be determined by applying the DASS-21 to a large sample of Brazilian undergraduate medical students. We will also evaluate the impact of the COVID-19 pandemic on medical students’ educational routines and medical training. International Registered Report Identifier (IRRID): DERR1-10.2196/24617 %M 33735094 %R 10.2196/24617 %U https://www.researchprotocols.org/2021/4/e24617 %U https://doi.org/10.2196/24617 %U http://www.ncbi.nlm.nih.gov/pubmed/33735094 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 2 %P e24860 %T Identifying Barriers to and Opportunities for Telehealth Implementation Amidst the COVID-19 Pandemic by Using a Human Factors Approach: A Leap Into the Future of Health Care Delivery? %A Zhang,Tianyi %A Mosier,Jarrod %A Subbian,Vignesh %+ Department of Systems and Industrial Engineering, College of Engineering, The University of Arizona, 1127 E James E Rogers Way, Tucson, AZ, 85721-0020, United States, 1 6088863936, tianyi@email.arizona.edu %K telehealth %K healthcare system %K COVID-19 %K human factors %K implementation %K SEIPS %D 2021 %7 9.4.2021 %9 Viewpoint %J JMIR Hum Factors %G English %X The extensive uptake of telehealth has considerably transformed health care delivery since the beginning of the COVID-19 pandemic and has imposed tremendous challenges to its large-scale implementation and adaptation. Given the shift in paradigm from telehealth as an alternative mechanism of care delivery to telehealth as an integral part of the health system, it is imperative to take a systematic approach to identifying barriers to, opportunities for, and the overall impact of telehealth implementation amidst the current pandemic. In this work, we apply a human factors framework, the Systems Engineering Initiative for Patient Safety model, to guide our holistic analysis and discussion of telehealth implementation, encompassing the health care work system, care processes, and outcomes. %M 33779566 %R 10.2196/24860 %U https://humanfactors.jmir.org/2021/2/e24860 %U https://doi.org/10.2196/24860 %U http://www.ncbi.nlm.nih.gov/pubmed/33779566 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 4 %P e23545 %T Epidemiology of Malaria in East Nusa Tenggara Province in Indonesia: Protocol for a Cross-sectional Study %A Guntur,Robertus Dole %A Kingsley,Jonathan %A Islam,Fakir M Amirul %+ Department of Health Science and Biostatistics, School of Health Sciences, Swinburne University of Technology, John St, Hawthorn, Melbourne, 3122, Australia, 61 451361478, rguntur@swin.edu.au %K malaria %K rural population %K awareness %K risk factors %K health policy %K World Health Organization %D 2021 %7 9.4.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Malaria is a global pandemic that results in approximately 228 million cases globally; 3.5% of these cases are in Southeast Asian countries, including Indonesia. Following the World Health Organization (WHO) initiative, Indonesia is in the process of achieving malaria-free zone status by 2030. However, the eastern part of Indonesia, including the East Nusa Tenggara Province (ENTP), still has a disproportionately high rate of malaria. Objective: The aims of this cross-sectional study are to determine the awareness and knowledge, attitude, and practice toward various aspects of malaria among rural adults and their associated factors, including sociodemographic factors and ethnicities; assess the gap between coverage of, access to, and use of long-lasting insecticide-treated nets (LLINs) among the households; estimate the prevalence of and factors associated with malaria in rural adults; and develop a risk prediction model for malaria. Methods: A multistage cluster sampling procedure with a systematic random sampling procedure at cluster level 4 was applied to recruit 1503 adults aged 18 years or older from the ENTP. Each participant participated in a face-to-face interview to assess their awareness and knowledge, attitude, and practice toward aspects of malaria, practices of sleeping under LLINs, and history of malaria. Information on sociodemographic, environmental, and lifestyle factors was also documented. The proportion of knowledge, attitude, and practice toward aspects of malaria and their variations across different sociodemographic and ethnic groups will be analyzed using descriptive statistics and chi-square tests. Coverage and access to LLINs will be evaluated based on the WHO recommendations. Malaria risk factors will be analyzed using logistic regression. Multilevel logistic regression will be applied to estimate the risk score for malaria. Results: Of the total participants, 99.46% (1495/1503) of rural adults from 49 villages in the ENTP participated in a face-to-face interview from October to December 2019. The study results are expected to be published in peer-reviewed journals. Conclusions: The best malaria risk prediction model will be developed in this study. In this protocol, we developed a methodology to provide new evidence to guide health policy in supporting the ENTP government’s expectation to achieve the malaria-free rating by 2030. International Registered Report Identifier (IRRID): DERR1-10.2196/23545 %M 33835037 %R 10.2196/23545 %U https://www.researchprotocols.org/2021/4/e23545 %U https://doi.org/10.2196/23545 %U http://www.ncbi.nlm.nih.gov/pubmed/33835037 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e27293 %T Classification Models for COVID-19 Test Prioritization in Brazil: Machine Learning Approach %A Viana dos Santos Santana,Íris %A CM da Silveira,Andressa %A Sobrinho,Álvaro %A Chaves e Silva,Lenardo %A Dias da Silva,Leandro %A Santos,Danilo F S %A Gurjão,Edmar C %A Perkusich,Angelo %+ Federal University of the Agreste of Pernambuco, Av. Bom Pastor, s/n - Boa Vista, Garanhuns, 55292-270, Brazil, 55 87981493955, alvaro.alvares@ufape.edu.br %K COVID-19 %K test prioritization %K classification models %K medical diagnosis %D 2021 %7 8.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Controlling the COVID-19 outbreak in Brazil is a challenge due to the population’s size and urban density, inefficient maintenance of social distancing and testing strategies, and limited availability of testing resources. Objective: The purpose of this study is to effectively prioritize patients who are symptomatic for testing to assist early COVID-19 detection in Brazil, addressing problems related to inefficient testing and control strategies. Methods: Raw data from 55,676 Brazilians were preprocessed, and the chi-square test was used to confirm the relevance of the following features: gender, health professional, fever, sore throat, dyspnea, olfactory disorders, cough, coryza, taste disorders, and headache. Classification models were implemented relying on preprocessed data sets; supervised learning; and the algorithms multilayer perceptron (MLP), gradient boosting machine (GBM), decision tree (DT), random forest (RF), extreme gradient boosting (XGBoost), k-nearest neighbors (KNN), support vector machine (SVM), and logistic regression (LR). The models’ performances were analyzed using 10-fold cross-validation, classification metrics, and the Friedman and Nemenyi statistical tests. The permutation feature importance method was applied for ranking the features used by the classification models with the highest performances. Results: Gender, fever, and dyspnea were among the highest-ranked features used by the classification models. The comparative analysis presents MLP, GBM, DT, RF, XGBoost, and SVM as the highest performance models with similar results. KNN and LR were outperformed by the other algorithms. Applying the easy interpretability as an additional comparison criterion, the DT was considered the most suitable model. Conclusions: The DT classification model can effectively (with a mean accuracy≥89.12%) assist COVID-19 test prioritization in Brazil. The model can be applied to recommend the prioritizing of a patient who is symptomatic for COVID-19 testing. %M 33750734 %R 10.2196/27293 %U https://www.jmir.org/2021/4/e27293 %U https://doi.org/10.2196/27293 %U http://www.ncbi.nlm.nih.gov/pubmed/33750734 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e24389 %T Adaptive Susceptible-Infectious-Removed Model for Continuous Estimation of the COVID-19 Infection Rate and Reproduction Number in the United States: Modeling Study %A Shapiro,Mark B %A Karim,Fazle %A Muscioni,Guido %A Augustine,Abel Saju %+ Anthem, Inc, 220 Virginia Avenue, Indianapolis, IN, 46204, United States, 1 708 295 8150, mark.shapiro@anthem.com %K compartmental models %K COVID-19 %K decision-making %K estimate %K infection rate %K infectious disease %K modeling %K pandemic %K prediction %K reproduction number %K SARS-CoV-2 %K United States %D 2021 %7 7.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The dynamics of the COVID-19 pandemic vary owing to local population density and policy measures. During decision-making, policymakers consider an estimate of the effective reproduction number Rt, which is the expected number of secondary infections spread by a single infected individual. Objective: We propose a simple method for estimating the time-varying infection rate and the Rt. Methods: We used a sliding window approach with a Susceptible-Infectious-Removed (SIR) model. We estimated the infection rate from the reported cases over a 7-day window to obtain a continuous estimation of Rt. A proposed adaptive SIR (aSIR) model was applied to analyze the data at the state and county levels. Results: The aSIR model showed an excellent fit for the number of reported COVID-19 cases, and the 1-day forecast mean absolute prediction error was <2.6% across all states. However, the 7-day forecast mean absolute prediction error approached 16.2% and strongly overestimated the number of cases when the Rt was rapidly decreasing. The maximal Rt displayed a wide range of 2.0 to 4.5 across all states, with the highest values for New York (4.4) and Michigan (4.5). We found that the aSIR model can rapidly adapt to an increase in the number of tests and an associated increase in the reported cases of infection. Our results also suggest that intensive testing may be an effective method of reducing Rt. Conclusions: The aSIR model provides a simple and accurate computational tool for continuous Rt estimation and evaluation of the efficacy of mitigation measures. %M 33755577 %R 10.2196/24389 %U https://www.jmir.org/2021/4/e24389 %U https://doi.org/10.2196/24389 %U http://www.ncbi.nlm.nih.gov/pubmed/33755577 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e23948 %T A Multimodality Machine Learning Approach to Differentiate Severe and Nonsevere COVID-19: Model Development and Validation %A Chen,Yuanfang %A Ouyang,Liu %A Bao,Forrest S %A Li,Qian %A Han,Lei %A Zhang,Hengdong %A Zhu,Baoli %A Ge,Yaorong %A Robinson,Patrick %A Xu,Ming %A Liu,Jie %A Chen,Shi %+ Department of Occupational Disease Prevention, Jiangsu Provincial Center for Disease Control and Prevention, 172 Jiangsu Road, Nanjing, 210009, China, 86 85393210, sosolou@126.com %K COVID-19 %K clinical type %K multimodality %K classification %K machine learning %K machine learning %K diagnosis %K prediction %K reliable %K decision support %D 2021 %7 7.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Effectively and efficiently diagnosing patients who have COVID-19 with the accurate clinical type of the disease is essential to achieve optimal outcomes for the patients as well as to reduce the risk of overloading the health care system. Currently, severe and nonsevere COVID-19 types are differentiated by only a few features, which do not comprehensively characterize the complicated pathological, physiological, and immunological responses to SARS-CoV-2 infection in the different disease types. In addition, these type-defining features may not be readily testable at the time of diagnosis. Objective: In this study, we aimed to use a machine learning approach to understand COVID-19 more comprehensively, accurately differentiate severe and nonsevere COVID-19 clinical types based on multiple medical features, and provide reliable predictions of the clinical type of the disease. Methods: For this study, we recruited 214 confirmed patients with nonsevere COVID-19 and 148 patients with severe COVID-19. The clinical characteristics (26 features) and laboratory test results (26 features) upon admission were acquired as two input modalities. Exploratory analyses demonstrated that these features differed substantially between two clinical types. Machine learning random forest models based on all the features in each modality as well as on the top 5 features in each modality combined were developed and validated to differentiate COVID-19 clinical types. Results: Using clinical and laboratory results independently as input, the random forest models achieved >90% and >95% predictive accuracy, respectively. The importance scores of the input features were further evaluated, and the top 5 features from each modality were identified (age, hypertension, cardiovascular disease, gender, and diabetes for the clinical features modality, and dimerized plasmin fragment D, high sensitivity troponin I, absolute neutrophil count, interleukin 6, and lactate dehydrogenase for the laboratory testing modality, in descending order). Using these top 10 multimodal features as the only input instead of all 52 features combined, the random forest model was able to achieve 97% predictive accuracy. Conclusions: Our findings shed light on how the human body reacts to SARS-CoV-2 infection as a unit and provide insights on effectively evaluating the disease severity of patients with COVID-19 based on more common medical features when gold standard features are not available. We suggest that clinical information can be used as an initial screening tool for self-evaluation and triage, while laboratory test results should be applied when accuracy is the priority. %M 33714935 %R 10.2196/23948 %U https://www.jmir.org/2021/4/e23948 %U https://doi.org/10.2196/23948 %U http://www.ncbi.nlm.nih.gov/pubmed/33714935 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e24292 %T Community and Campus COVID-19 Risk Uncertainty Under University Reopening Scenarios: Model-Based Analysis %A Benneyan,James %A Gehrke,Christopher %A Ilies,Iulian %A Nehls,Nicole %+ Healthcare Systems Engineering Institute, Northeastern University, 360 Huntington Avenue 177H, Boston, MA, 02115, United States, 1 617 373 6450, j.benneyan@northeastern.edu %K COVID-19 %K university reopening %K community impact %K epidemic model %K model %K community %K university %K safety %K strategy %K risk %K infectious disease %D 2021 %7 7.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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 × 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. %M 33667173 %R 10.2196/24292 %U https://publichealth.jmir.org/2021/4/e24292 %U https://doi.org/10.2196/24292 %U http://www.ncbi.nlm.nih.gov/pubmed/33667173 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e24192 %T An Agent-Based Model of the Local Spread of SARS-CoV-2: Modeling Study %A Staffini,Alessio %A Svensson,Akiko Kishi %A Chung,Ung-Il %A Svensson,Thomas %+ Precision Health, Department of Bioengineering, Graduate School of Engineering, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, 113-8655, Japan, 81 080 7058 1309, alessio.staffini@bocconialumni.it %K computational epidemiology %K COVID-19 %K SARS-CoV-2 %K agent-based modeling %K public health %K computational models %K modeling %K agent %K spread %K computation %K epidemiology %K policy %D 2021 %7 6.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The spread of SARS-CoV-2, originating in Wuhan, China, was classified as a pandemic by the World Health Organization on March 11, 2020. The governments of affected countries have implemented various measures to limit the spread of the virus. The starting point of this paper is the different government approaches, in terms of promulgating new legislative regulations to limit the virus diffusion and to contain negative effects on the populations. Objective: This paper aims to study how the spread of SARS-CoV-2 is linked to government policies and to analyze how different policies have produced different results on public health. Methods: Considering the official data provided by 4 countries (Italy, Germany, Sweden, and Brazil) and from the measures implemented by each government, we built an agent-based model to study the effects that these measures will have over time on different variables such as the total number of COVID-19 cases, intensive care unit (ICU) bed occupancy rates, and recovery and case-fatality rates. The model we implemented provides the possibility of modifying some starting variables, and it was thus possible to study the effects that some policies (eg, keeping the national borders closed or increasing the ICU beds) would have had on the spread of the infection. Results: The 4 considered countries have adopted different containment measures for COVID-19, and the forecasts provided by the model for the considered variables have given different results. Italy and Germany seem to be able to limit the spread of the infection and any eventual second wave, while Sweden and Brazil do not seem to have the situation under control. This situation is also reflected in the forecasts of pressure on the National Health Services, which see Sweden and Brazil with a high occupancy rate of ICU beds in the coming months, with a consequent high number of deaths. Conclusions: In line with what we expected, the obtained results showed that the countries that have taken restrictive measures in terms of limiting the population mobility have managed more successfully than others to contain the spread of COVID-19. Moreover, the model demonstrated that herd immunity cannot be reached even in countries that have relied on a strategy without strict containment measures. %M 33750735 %R 10.2196/24192 %U https://medinform.jmir.org/2021/4/e24192 %U https://doi.org/10.2196/24192 %U http://www.ncbi.nlm.nih.gov/pubmed/33750735 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e22880 %T The Causality Inference of Public Interest in Restaurants and Bars on Daily COVID-19 Cases in the United States: Google Trends Analysis %A Asgari Mehrabadi,Milad %A Dutt,Nikil %A Rahmani,Amir M %+ Department of Electrical Engineering and Computer Science, University of California Irvine, Berk Hall, 1st Floor, Irvine, CA, 92617, United States, 1 949 506 8187, masgarim@uci.edu %K bars %K coronavirus %K COVID-19 %K deep learning %K infodemiology %K infoveillance %K Google Trends %K LSTM %K machine learning %K restaurants %D 2021 %7 6.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 33690143 %R 10.2196/22880 %U https://publichealth.jmir.org/2021/4/e22880 %U https://doi.org/10.2196/22880 %U http://www.ncbi.nlm.nih.gov/pubmed/33690143 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e24288 %T Reporting and Availability of COVID-19 Demographic Data by US Health Departments (April to October 2020): Observational Study %A Ossom-Williamson,Peace %A Williams,Isaac Maximilian %A Kim,Kukhyoung %A Kindratt,Tiffany B %+ Public Health Program, Department of Kinesiology, College of Nursing and Health Innovation, University of Texas at Arlington, 500 W Nedderman Drive, Arlington, TX, 75919, United States, 1 817 272 7917, tiffany.kindratt@uta.edu %K coronavirus disease 2019 %K COVID-19 %K SARS-CoV-2 %K race %K ethnicity %K age %K sex %K health equity %K open data %K dashboards %D 2021 %7 6.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There is an urgent need for consistent collection of demographic data on COVID-19 morbidity and mortality and sharing it with the public in open and accessible ways. Due to the lack of consistency in data reporting during the initial spread of COVID-19, the Equitable Data Collection and Disclosure on COVID-19 Act was introduced into the Congress that mandates collection and reporting of demographic COVID-19 data on testing, treatments, and deaths by age, sex, race and ethnicity, primary language, socioeconomic status, disability, and county. To our knowledge, no studies have evaluated how COVID-19 demographic data have been collected before and after the introduction of this legislation. Objective: This study aimed to evaluate differences in reporting and public availability of COVID-19 demographic data by US state health departments and Washington, District of Columbia (DC) before (pre-Act), immediately after (post-Act), and 6 months after (6-month follow-up) the introduction of the Equitable Data Collection and Disclosure on COVID-19 Act in the Congress on April 21, 2020. Methods: We reviewed health department websites of all 50 US states and Washington, DC (N=51). We evaluated how each state reported age, sex, and race and ethnicity data for all confirmed COVID-19 cases and deaths and how they made this data available (ie, charts and tables only or combined with dashboards and machine-actionable downloadable formats) at the three timepoints. Results: We found statistically significant increases in the number of health departments reporting age-specific data for COVID-19 cases (P=.045) and resulting deaths (P=.002), sex-specific data for COVID-19 deaths (P=.003), and race- and ethnicity-specific data for confirmed cases (P=.003) and deaths (P=.005) post-Act and at the 6-month follow-up (P<.05 for all). The largest increases were race and ethnicity state data for confirmed cases (pre-Act: 18/51, 35%; post-Act: 31/51, 61%; 6-month follow-up: 46/51, 90%) and deaths due to COVID-19 (pre-Act: 13/51, 25%; post-Act: 25/51, 49%; and 6-month follow-up: 39/51, 76%). Although more health departments reported race and ethnicity data based on federal requirements (P<.001), over half (29/51, 56.9%) still did not report all racial and ethnic groups as per the Office of Management and Budget guidelines (pre-Act: 5/51, 10%; post-Act: 21/51, 41%; and 6-month follow-up: 27/51, 53%). The number of health departments that made COVID-19 data available for download significantly increased from 7 to 23 (P<.001) from our initial data collection (April 2020) to the 6-month follow-up, (October 2020). Conclusions: Although the increased demand for disaggregation has improved public reporting of demographics across health departments, an urgent need persists for the introduced legislation to be passed by the Congress for the US states to consistently collect and make characteristics of COVID-19 cases, deaths, and vaccinations available in order to allocate resources to mitigate disease spread. %M 33821804 %R 10.2196/24288 %U https://publichealth.jmir.org/2021/4/e24288 %U https://doi.org/10.2196/24288 %U http://www.ncbi.nlm.nih.gov/pubmed/33821804 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e23914 %T Prescribing Phones to Address Health Equity Needs in the COVID-19 Era: The PHONE-CONNECT Program %A Kazevman,Gill %A Mercado,Marck %A Hulme,Jennifer %A Somers,Andrea %+ Department of Emergency Medicine, University Health Network, 200 Elizabeth St, RFE-GS-480, Toronto, ON, M5G 2C4, Canada, 1 416 340 3856, Andrea.Somers@uhn.ca %K digital health equity %K health inequity %K digital determinants of health %K emergency medicine %K COVID-19 %K public health %K health policy %K primary care %K cell phone %D 2021 %7 6.4.2021 %9 Viewpoint %J J Med Internet Res %G English %X Vulnerable populations have been identified as having higher infection rates and poorer COVID-19–related outcomes, likely due to their inability to readily access primary care, follow public health directives, and adhere to self-isolation guidelines. As a response to the COVID-19 pandemic, many health care services have adopted new digital solutions, which rely on phone and internet connectivity. However, persons who are digitally inaccessible, such as those experiencing poverty or homelessness, are often unable to use these services. In response to this newly highlighted social disparity known as “digital health inequity,” emergency physicians at the University Health Network in Toronto, Canada, initiated a program called PHONE-CONNECT (Phones for Healthier Ontarians iN EDs – COvid NEeds met by Cellular Telephone). This novel approach attempts to improve patients’ access to health care, information, and social services, as well as improve their ability to adhere to public health directives (social isolation and contact tracing). Although similar programs addressing the same emerging issues have been recently described in the media, this is the first time phones have been provided as a health care intervention in an emergency department. This innovative emergency department point-of-care intervention may have a significant impact on improving health outcomes for vulnerable people during the COVID-19 pandemic and beyond. %M 33760753 %R 10.2196/23914 %U https://www.jmir.org/2021/4/e23914 %U https://doi.org/10.2196/23914 %U http://www.ncbi.nlm.nih.gov/pubmed/33760753 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 9 %N 2 %P e26216 %T How Gameful Experience Affects Public Knowledge, Attitudes, and Practices Regarding COVID-19 Among the Taiwanese Public: Cross-sectional Study %A Peng,Li-Hsun %A Bai,Ming-Han %+ Graduate School of Design, National Yunlin University of Science and Technology, 123 University Road, Section 3, Douliou, Yunlin, 640301, Taiwan, 886 961055900, minghan.bai@gmail.com %K COVID-19 %K knowledge %K attitude %K practice %K serious game %K gameful experience %D 2021 %7 6.4.2021 %9 Original Paper %J JMIR Serious Games %G English %X 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 (ρ=.127, P=.04) and dominance (ρ=.122, P=.04) in attitude. Finally, there was a significant correlation between creative thinking (ρ=.126, P<.001) and dominance (ρ=.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. %M 33737262 %R 10.2196/26216 %U https://games.jmir.org/2021/2/e26216 %U https://doi.org/10.2196/26216 %U http://www.ncbi.nlm.nih.gov/pubmed/33737262 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26960 %T Rural Telemedicine Use Before and During the COVID-19 Pandemic: Repeated Cross-sectional Study %A Chu,Cherry %A Cram,Peter %A Pang,Andrea %A Stamenova,Vess %A Tadrous,Mina %A Bhatia,R Sacha %+ Women's College Hospital Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville St, Toronto, ON, M5S 1B2, Canada, 1 416 312 9147, sacha.bhatia@wchospital.ca %K chronic disease %K chronic illness %K COVID-19 %K health care %K health services %K older adults %K remote %K rural %K pandemic %K population %K telemedicine %K virtual care %D 2021 %7 5.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has led to a notable increase in telemedicine adoption. However, the impact of the pandemic on telemedicine use at a population level in rural and remote settings remains unclear. Objective: This study aimed to evaluate changes in the rate of telemedicine use among rural populations and identify patient characteristics associated with telemedicine use prior to and during the pandemic. Methods: We conducted a repeated cross-sectional study on all monthly and quarterly rural telemedicine visits from January 2012 to June 2020, using administrative data from Ontario, Canada. We compared the changes in telemedicine use among residents of rural and urban regions of Ontario prior to and during the pandemic. Results: Before the pandemic, telemedicine use was steadily low in 2012-2019 for both rural and urban populations but slightly higher overall for rural patients (11 visits per 1000 patients vs 7 visits per 1000 patients in December 2019, P<.001). The rate of telemedicine visits among rural patients significantly increased to 147 visits per 1000 patients in June 2020. A similar but steeper increase (P=.15) was observed among urban patients (220 visits per 1000 urban patients). Telemedicine use increased across all age groups, with the highest rates reported among older adults aged ≥65 years (77 visits per 100 patients in 2020). The proportions of patients with at least 1 telemedicine visit were similar across the adult age groups (n=82,246/290,401, 28.3% for patients aged 18-49 years, n=79,339/290,401, 27.3% for patients aged 50-64 years, and n=80,833/290,401, 27.8% for patients aged 65-79 years), but lower among younger patients <18 years (n=23,699/290,401, 8.2%) and older patients ≥80 years (n=24,284/290,401, 8.4%) in 2020 (P<.001). There were more female users than male users of telemedicine (n=158,643/290,401, 54.6% vs n=131,758/290,401, 45.4%, respectively, in 2020; P<.001). There was a significantly higher proportion of telemedicine users residing in relatively less rural than in more rural regions (n=261,814/290,401, 90.2% vs n=28,587/290,401, 9.8%, respectively, in 2020; P<.001). Conclusions: Telemedicine adoption increased in rural and remote areas during the COVID-19 pandemic, but its use increased in urban and less rural populations. Future studies should investigate the potential barriers to telemedicine use among rural patients and the impact of rural telemedicine on patient health care utilization and outcomes. %M 33769942 %R 10.2196/26960 %U https://www.jmir.org/2021/4/e26960 %U https://doi.org/10.2196/26960 %U http://www.ncbi.nlm.nih.gov/pubmed/33769942 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 4 %P e26518 %T Comparison of Public Responses to Containment Measures During the Initial Outbreak and Resurgence of COVID-19 in China: Infodemiology Study %A Zhou,Xinyu %A Song,Yi %A Jiang,Hao %A Wang,Qian %A Qu,Zhiqiang %A Zhou,Xiaoyu %A Jit,Mark %A Hou,Zhiyuan %A Lin,Leesa %+ School of Public Health, Fudan University, Mailbox 250, 138# Yixueyuan Road, Xuhui District, Shanghai, 200032, China, 86 21 33563935, zyhou@fudan.edu.cn %K COVID-19 %K engagement %K latent Dirichlet allocation %K public response %K sentiment %K social media %K topic modeling %D 2021 %7 5.4.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 cases resurged worldwide in the second half of 2020. Not much is known about the changes in public responses to containment measures from the initial outbreak to resurgence. Monitoring public responses is crucial to inform policy measures to prepare for COVID-19 resurgence. Objective: This study aimed to assess and compare public responses to containment measures during the initial outbreak and resurgence of COVID-19 in China. Methods: We curated all COVID-19–related posts from Sina Weibo (China’s version of Twitter) during the initial outbreak and resurgence of COVID-19 in Beijing, China. With a Python script, we constructed subsets of Weibo posts focusing on 3 containment measures: lockdown, the test-trace-isolate strategy, and suspension of gatherings. The Baidu open-source sentiment analysis model and latent Dirichlet allocation topic modeling, a widely used machine learning algorithm, were used to assess public engagement, sentiments, and frequently discussed topics on each containment measure. Results: A total of 8,985,221 Weibo posts were curated. In China, the containment measures evolved from a complete lockdown for the general population during the initial outbreak to a more targeted response strategy for high-risk populations during COVID-19 resurgence. Between the initial outbreak and resurgence, the average daily proportion of Weibo posts with negative sentiments decreased from 57% to 47% for the lockdown, 56% to 51% for the test-trace-isolate strategy, and 55% to 48% for the suspension of gatherings. Among the top 3 frequently discussed topics on lockdown measures, discussions on containment measures accounted for approximately 32% in both periods, but those on the second-most frequently discussed topic shifted from the expression of negative emotions (11%) to its impacts on daily life or work (26%). The public expressed a high level of panic (21%) during the initial outbreak but almost no panic (1%) during resurgence. The more targeted test-trace-isolate measure received the most support (60%) among all 3 containment measures in the initial outbreak, and its support rate approached 90% during resurgence. Conclusions: Compared to the initial outbreak, the public expressed less engagement and less negative sentiments on containment measures and were more supportive toward containment measures during resurgence. Targeted test-trace-isolate strategies were more acceptable to the public. Our results indicate that when COVID-19 resurges, more targeted test-trace-isolate strategies for high-risk populations should be promoted to balance pandemic control and its impact on daily life and the economy. %M 33750739 %R 10.2196/26518 %U https://www.jmir.org/2021/4/e26518 %U https://doi.org/10.2196/26518 %U http://www.ncbi.nlm.nih.gov/pubmed/33750739 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 4 %P e21547 %T Implementation of the COVID-19 Vulnerability Index Across an International Network of Health Care Data Sets: Collaborative External Validation Study %A Reps,Jenna M %A Kim,Chungsoo %A Williams,Ross D %A Markus,Aniek F %A Yang,Cynthia %A Duarte-Salles,Talita %A Falconer,Thomas %A Jonnagaddala,Jitendra %A Williams,Andrew %A Fernández-Bertolín,Sergio %A DuVall,Scott L %A Kostka,Kristin %A Rao,Gowtham %A Shoaibi,Azza %A Ostropolets,Anna %A Spotnitz,Matthew E %A Zhang,Lin %A Casajust,Paula %A Steyerberg,Ewout W %A Nyberg,Fredrik %A Kaas-Hansen,Benjamin Skov %A Choi,Young Hwa %A Morales,Daniel %A Liaw,Siaw-Teng %A Abrahão,Maria Tereza Fernandes %A Areia,Carlos %A Matheny,Michael E %A Lynch,Kristine E %A Aragón,María %A Park,Rae Woong %A Hripcsak,George %A Reich,Christian G %A Suchard,Marc A %A You,Seng Chan %A Ryan,Patrick B %A Prieto-Alhambra,Daniel %A Rijnbeek,Peter R %+ Janssen Research & Development, 1125 Trenton Harbourton Rd, Titusville, NJ, United States, 1 732 715 6300, jreps@its.jnj.com %K external validation %K transportability %K COVID-19 %K prognostic model %K prediction %K C-19 %K modeling %K datasets %K observation %K hospitalization %K bias %K risk %K decision-making %D 2021 %7 5.4.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: SARS-CoV-2 is straining health care systems globally. The burden on hospitals during the pandemic could be reduced by implementing prediction models that can discriminate patients who require hospitalization from those who do not. The COVID-19 vulnerability (C-19) index, a model that predicts which patients will be admitted to hospital for treatment of pneumonia or pneumonia proxies, has been developed and proposed as a valuable tool for decision-making during the pandemic. However, the model is at high risk of bias according to the “prediction model risk of bias assessment” criteria, and it has not been externally validated. Objective: The aim of this study was to externally validate the C-19 index across a range of health care settings to determine how well it broadly predicts hospitalization due to pneumonia in COVID-19 cases. Methods: We followed the Observational Health Data Sciences and Informatics (OHDSI) framework for external validation to assess the reliability of the C-19 index. We evaluated the model on two different target populations, 41,381 patients who presented with SARS-CoV-2 at an outpatient or emergency department visit and 9,429,285 patients who presented with influenza or related symptoms during an outpatient or emergency department visit, to predict their risk of hospitalization with pneumonia during the following 0-30 days. In total, we validated the model across a network of 14 databases spanning the United States, Europe, Australia, and Asia. Results: The internal validation performance of the C-19 index had a C statistic of 0.73, and the calibration was not reported by the authors. When we externally validated it by transporting it to SARS-CoV-2 data, the model obtained C statistics of 0.36, 0.53 (0.473-0.584) and 0.56 (0.488-0.636) on Spanish, US, and South Korean data sets, respectively. The calibration was poor, with the model underestimating risk. When validated on 12 data sets containing influenza patients across the OHDSI network, the C statistics ranged between 0.40 and 0.68. Conclusions: Our results show that the discriminative performance of the C-19 index model is low for influenza cohorts and even worse among patients with COVID-19 in the United States, Spain, and South Korea. These results suggest that C-19 should not be used to aid decision-making during the COVID-19 pandemic. Our findings highlight the importance of performing external validation across a range of settings, especially when a prediction model is being extrapolated to a different population. In the field of prediction, extensive validation is required to create appropriate trust in a model. %M 33661754 %R 10.2196/21547 %U https://medinform.jmir.org/2021/4/e21547 %U https://doi.org/10.2196/21547 %U http://www.ncbi.nlm.nih.gov/pubmed/33661754 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 4 %P e26780 %T Public Discourse Against Masks in the COVID-19 Era: Infodemiology Study of Twitter Data %A Al-Ramahi,Mohammad %A Elnoshokaty,Ahmed %A El-Gayar,Omar %A Nasralah,Tareq %A Wahbeh,Abdullah %+ Supply Chain and Information Management Group, D’Amore-McKim School of Business, Northeastern University, 360 Huntington Ave, Boston, MA, 02115, United States, 1 617 373 4460, t.nasralah@northeastern.edu %K pandemic %K coronavirus %K masks %K social medial, opinion analysis %K COVID-19 %D 2021 %7 5.4.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 33720841 %R 10.2196/26780 %U https://publichealth.jmir.org/2021/4/e26780 %U https://doi.org/10.2196/26780 %U http://www.ncbi.nlm.nih.gov/pubmed/33720841 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e23593 %T Concerns Discussed on Chinese and French Social Media During the COVID-19 Lockdown: Comparative Infodemiology Study Based on Topic Modeling %A Schück,Stéphane %A Foulquié,Pierre %A Mebarki,Adel %A Faviez,Carole %A Khadhar,Mickaïl %A Texier,Nathalie %A Katsahian,Sandrine %A Burgun,Anita %A Chen,Xiaoyi %+ Centre de Recherche des Cordeliers, INSERM, Sorbonne Université, Université de Paris, 15 Rue de l'école de médecine, Paris, F-75006, France, 33 171196369, xiaoyi.chen@inserm.fr %K comparative analysis %K content analysis %K topic model %K social media %K COVID-19 %K lockdown %K China %K France %K impact %K population %D 2021 %7 5.4.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: During the COVID-19 pandemic, numerous countries, including China and France, have implemented lockdown measures that have been effective in controlling the epidemic. However, little is known about the impact of these measures on the population as expressed on social media from different cultural contexts. Objective: This study aims to assess and compare the evolution of the topics discussed on Chinese and French social media during the COVID-19 lockdown. Methods: We extracted posts containing COVID-19–related or lockdown-related keywords in the most commonly used microblogging social media platforms (ie, Weibo in China and Twitter in France) from 1 week before lockdown to the lifting of the lockdown. A topic model was applied independently for three periods (prelockdown, early lockdown, and mid to late lockdown) to assess the evolution of the topics discussed on Chinese and French social media. Results: A total of 6395; 23,422; and 141,643 Chinese Weibo messages, and 34,327; 119,919; and 282,965 French tweets were extracted in the prelockdown, early lockdown, and mid to late lockdown periods, respectively, in China and France. Four categories of topics were discussed in a continuously evolving way in all three periods: epidemic news and everyday life, scientific information, public measures, and solidarity and encouragement. The most represented category over all periods in both countries was epidemic news and everyday life. Scientific information was far more discussed on Weibo than in French tweets. Misinformation circulated through social media in both countries; however, it was more concerned with the virus and epidemic in China, whereas it was more concerned with the lockdown measures in France. Regarding public measures, more criticisms were identified in French tweets than on Weibo. Advantages and data privacy concerns regarding tracing apps were also addressed in French tweets. All these differences were explained by the different uses of social media, the different timelines of the epidemic, and the different cultural contexts in these two countries. Conclusions: This study is the first to compare the social media content in eastern and western countries during the unprecedented COVID-19 lockdown. Using general COVID-19–related social media data, our results describe common and different public reactions, behaviors, and concerns in China and France, even covering the topics identified in prior studies focusing on specific interests. We believe our study can help characterize country-specific public needs and appropriately address them during an outbreak. %M 33750736 %R 10.2196/23593 %U https://formative.jmir.org/2021/4/e23593 %U https://doi.org/10.2196/23593 %U http://www.ncbi.nlm.nih.gov/pubmed/33750736 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 4 %P e23233 %T Recommendations for Health Equity and Virtual Care Arising From the COVID-19 Pandemic: Narrative Review %A Shaw,James %A Brewer,LaPrincess C %A Veinot,Tiffany %+ Institute for Health System Solutions and Virtual Care, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada, 1 416 323 6400 ext 4224, jay.shaw@wchospital.ca %K virtual care %K health equity %K health disparities %K health informatics %K COVID-19 %K telemedicine %K telehealth %K digital health %D 2021 %7 5.4.2021 %9 Review %J JMIR Form Res %G English %X Background: The COVID-19 health crisis has disproportionately impacted populations who have been historically marginalized in health care and public health, including low-income and racial and ethnic minority groups. Members of marginalized communities experience undue barriers to accessing health care through virtual care technologies, which have become the primary mode of ambulatory health care delivery during the COVID-19 pandemic. Insights generated during the COVID-19 pandemic can inform strategies to promote health equity in virtual care now and in the future. Objective: The aim of this study is to generate insights arising from literature that was published in direct response to the widespread use of virtual care during the COVID-19 pandemic, and had a primary focus on providing recommendations for promoting health equity in the delivery of virtual care. Methods: We conducted a narrative review of literature on health equity and virtual care during the COVID-19 pandemic published in 2020, describing strategies that have been proposed in the literature at three levels: (1) policy and government, (2) organizations and health systems, and (3) communities and patients. Results: We highlight three strategies for promoting health equity through virtual care that have been underaddressed in this literature: (1) simplifying complex interfaces and workflows, (2) using supportive intermediaries, and (3) creating mechanisms through which marginalized community members can provide immediate input into the planning and delivery of virtual care. Conclusions: We conclude by outlining three areas of work that are required to ensure that virtual care is employed in ways that are equity enhancing in a post–COVID-19 reality. %M 33739931 %R 10.2196/23233 %U https://formative.jmir.org/2021/4/e23233 %U https://doi.org/10.2196/23233 %U http://www.ncbi.nlm.nih.gov/pubmed/33739931 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e22603 %T Online Tool for the Assessment of the Burden of COVID-19 in Patients: Development Study %A van Noort,Esther M J %A Claessens,Danny %A Moor,Catharina C %A Berg,Carlijn A L Van Den %A Kasteleyn,Marise J %A in 't Veen,Johannes C C M %A Van Schayck,Onno C P %A Chavannes,Niels H %+ Department of Public Health and Primary Care, Leiden University Medical Center, Albinusdreef 2, Leiden, 2333 ZA, Netherlands, 31 162520571, e.m.j.van_noort@lumc.nl %K COVID-19 %K patient-reported outcomes %K ABCoV tool %K monitoring %K patient outcome %K long-term impact %K tool %K assessment %K online patient platform %D 2021 %7 31.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The impact of COVID-19 has been felt worldwide, yet we are still unsure about its full impact. One of the gaps in our current knowledge relates to the long-term mental and physical impact of the infection on affected individuals. The COVID-19 pandemic hit the Netherlands at the end of February 2020, resulting in over 900,000 people testing positive for the virus, over 24,000 hospitalizations, and over 13,000 deaths by the end of January 2021. Although many patients recover from the acute phase of the disease, experience with other virus outbreaks has raised concerns regarding possible late sequelae of the infection. Objective: This study aims to develop an online tool to assess the long-term burden of COVID-19 in patients. Methods: In this paper, we describe the process of development, assessment, programming, implementation, and use of this new tool: the assessment of burden of COVID-19 (ABCoV) tool. This new tool is based on the well-validated assessment of burden of chronic obstructive pulmonary disease tool. Results: As of January 2021, the new ABCoV tool has been used in an online patient platform by more than 2100 self-registered patients and another 400 patients in a hospital setting, resulting in over 2500 patients. These patients have submitted the ABCoV questionnaire 3926 times. Among the self-registered patients who agreed to have their data analyzed (n=1898), the number of females was high (n=1153, 60.7%), many were medically diagnosed with COVID-19 (n=892, 47.0%), and many were relatively young with only 7.4% (n=141) being older than 60 years. Of all patients that actually used the tool (n=1517), almost one-quarter (n=356, 23.5%) used the tool twice, and only a small group (n=76, 5.0%) used the tool 6 times. Conclusions: This new ABCoV tool has been broadly and repeatedly used, and may provide insight into the perceived burden of disease, provide direction for personalized aftercare for people post COVID-19, and help us to be prepared for possible future recurrences. %M 33729982 %R 10.2196/22603 %U https://formative.jmir.org/2021/3/e22603 %U https://doi.org/10.2196/22603 %U http://www.ncbi.nlm.nih.gov/pubmed/33729982 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 1 %P e25610 %T The Psychological Impact of Hypertension During COVID-19 Restrictions: Retrospective Case-Control Study %A Bonner,Carissa %A Cvejic,Erin %A Ayre,Julie %A Isautier,Jennifer %A Semsarian,Christopher %A Nickel,Brooke %A Batcup,Carys %A Pickles,Kristen %A Dodd,Rachael %A Cornell,Samuel %A Copp,Tessa %A McCaffery,Kirsten J %+ Sydney Health Literacy Lab, School of Public Health, Faculty of Medicine and Health, The University of Sydney, Edward Ford Building A27, Rm 128A, Sydney, NSW 2006, Australia, 61 2 9351 7125, carissa.bonner@sydney.edu.au %K public health %K global health %K COVID-19 %K hypertension %K risk %K strategy %K mental health %K behavior %K response %K anxiety %K vaccine %K retrospective %K perception %K prevention %K intention %D 2021 %7 30.3.2021 %9 Original Paper %J JMIRx Med %G English %X Background: It is unclear how people with hypertension are responding to the COVID-19 pandemic given their increased risk, and whether targeted public health strategies are needed. Objective: This retrospective case-control study compared people with hypertension to matched healthy controls during the COVID-19 lockdown to determine whether they have higher risk perceptions, anxiety, and vaccination intentions. Methods: Baseline data from a national survey were collected in April 2020 during the COVID-19 lockdown in Australia. People who reported hypertension with no other chronic conditions were randomly matched to healthy controls of similar age, gender, education, and health literacy level. A subset including participants with hypertension was followed up at 2 months after restrictions were eased. Risk perceptions, anxiety, and vaccination intentions were measured in April and June. Results: Of the 4362 baseline participants, 466 (10.7%) reported hypertension with no other chronic conditions. A subset of 1369 people were followed up at 2 months, which included 147 (10.7%) participants with hypertension. At baseline, perceived seriousness was high for both hypertension and control groups. The hypertension group reported greater anxiety compared to the controls and were more willing to vaccinate against influenza, but COVID-19 vaccination intentions were similar. At follow-up, these differences were no longer present in the longitudinal subsample. Perceived seriousness and anxiety had decreased, but vaccination intentions for both influenza and COVID-19 remained high across groups (>80%). Conclusions: Anxiety was above normal levels during the COVID-19 lockdown. It was higher in the hypertension group, which also had higher vaccination intentions. Groups that are more vulnerable to COVID-19 may require targeted mental health screening during periods of greater risk. Despite a decrease in perceived risk and anxiety after 2 months of lockdown restrictions, vaccination intentions remained high, which is encouraging for the future prevention of COVID-19. %M 34076628 %R 10.2196/25610 %U https://xmed.jmir.org/2021/1/e25610 %U https://doi.org/10.2196/25610 %U http://www.ncbi.nlm.nih.gov/pubmed/34076628 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25042 %T Relationship Between Coronavirus-Related eHealth Literacy and COVID-19 Knowledge, Attitudes, and Practices among US Adults: Web-Based Survey Study %A An,Lawrence %A Bacon,Elizabeth %A Hawley,Sarah %A Yang,Penny %A Russell,Daniel %A Huffman,Scott %A Resnicow,Ken %+ Center for Health Communications Research, Rogel Cancer Center, University of Michigan, North Campus Research Complex, Building 16, 2800 Plymouth Rd, Ann Arbor, MI, 48109, United States, 1 734 763 6099, lcan@med.umich.edu %K internet %K digital health %K eHealth %K eHealth literacy %K coronavirus %K COVID-19 %K knowledge %K conspiracy beliefs %K protective behaviors %K social distancing %K survey %K health communication %K attitude %K behavior %D 2021 %7 29.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During a global pandemic, it is critical that the public is able to rapidly acquire new and accurate health information. The internet is a major source of health information. eHealth literacy is the ability of individuals to find, assess, and use health information available on the internet. Objective: The goals of this study were to assess coronavirus-related eHealth literacy and examine the relationship between eHealth literacy and COVID-19−related knowledge, attitudes, and practices (KAPs). Methods: We conducted a web-based survey of a representative sample of 1074 US adults. We adapted the 8-item eHealth Literacy Scale to develop the Coronavirus-Related eHealth Literacy Scale (CoV-eHEALS) to measure COVID-19−related knowledge, conspiracy beliefs, and adherence to protective behaviors (eg, wearing facial masks and social distancing). Our analyses identified sociodemographic associations with the participants’ CoV-eHEALS scores and an association between the CoV-eHEALS measure and COVID-19 KAPs. Results: The internal consistency of the adapted CoV-eHEALS measure was high (Cronbach α=.92). The mean score for the CoV-eHEALS was 29.0 (SD 6.1). A total of 29% (306/1074) of the survey participants were classified as having low coronavirus-related eHealth literacy (CoV-eHEALS score <26). Independent associations were found between CoV-eHEALS scores and ethnicity (standardized β=–.083, P=.016 for Black participants) and education level (standardized β=–.151, P=.001 for participants with high-school education or lower). Controlling for demographic characteristics, CoV-eHEALS scores demonstrated positive independent associations with knowledge (standardized β=.168, P<.001) and adherence to protective behaviors (standardized β=.241, P<.001) and a negative association with conspiracy beliefs (standardized β=–.082, P=.009). Conclusions: This study provides an estimate of coronavirus-related eHealth literacy among US adults. Our findings suggest that a substantial proportion of US adults have low coronavirus-related eHealth literacy and are thus at a greater risk of lower and less-protective COVID-19 KAPs. These findings highlight the need to assess and address eHealth literacy as part of COVID-19 control efforts. Potential strategies include improving the quality of health information about COVID-19 available on the internet, assisting or simplifying web-based search for information about COVID-19, and training to improve general or coronavirus-specific search skills. %M 33626015 %R 10.2196/25042 %U https://www.jmir.org/2021/3/e25042 %U https://doi.org/10.2196/25042 %U http://www.ncbi.nlm.nih.gov/pubmed/33626015 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e27317 %T Analyzing Cross-country Pandemic Connectedness During COVID-19 Using a Spatial-Temporal Database: Network Analysis %A Chu,Amanda MY %A Chan,Jacky NL %A Tsang,Jenny TY %A Tiwari,Agnes %A So,Mike KP %+ Department of Information Systems, Business Statistics and Operations Management, The Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong, China (Hong Kong), 852 23587726, immkpso@ust.hk %K air traffic %K coronavirus %K COVID-19 %K human mobility %K network analysis %K travel restrictions %D 2021 %7 29.3.2021 %9 Rapid Surveillance Report %J JMIR Public Health Surveill %G English %X Communicable diseases including COVID-19 pose a major threat to public health worldwide. To curb the spread of communicable diseases effectively, timely surveillance and prediction of the risk of pandemics are essential. The aim of this study is to analyze free and publicly available data to construct useful travel data records for network statistics other than common descriptive statistics. This study describes analytical findings of time-series plots and spatial-temporal maps to illustrate or visualize pandemic connectedness. We analyzed data retrieved from the web-based Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation dashboard, which contains up-to-date and comprehensive meta-information on civil flights from 193 national governments in accordance with the airport, country, city, latitude, and the longitude of flight origin and the destination. We used the database to visualize pandemic connectedness through the workflow of travel data collection, network construction, data aggregation, travel statistics calculation, and visualization with time-series plots and spatial-temporal maps. We observed similar patterns in the time-series plots of worldwide daily flights from January to early-March of 2019 and 2020. A sharp reduction in the number of daily flights recorded in mid-March 2020 was likely related to large-scale air travel restrictions owing to the COVID-19 pandemic. The levels of connectedness between places are strong indicators of the risk of a pandemic. Since the initial reports of COVID-19 cases worldwide, a high network density and reciprocity in early-March 2020 served as early signals of the COVID-19 pandemic and were associated with the rapid increase in COVID-19 cases in mid-March 2020. The spatial-temporal map of connectedness in Europe on March 13, 2020, shows the highest level of connectedness among European countries, which reflected severe outbreaks of COVID-19 in late March and early April of 2020. As a quality control measure, we used the aggregated numbers of international flights from April to October 2020 to compare the number of international flights officially reported by the International Civil Aviation Organization with the data collected from the Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation dashboard, and we observed high consistency between the 2 data sets. The flexible design of the database provides users access to network connectedness at different periods, places, and spatial levels through various network statistics calculation methods in accordance with their needs. The analysis can facilitate early recognition of the risk of a current communicable disease pandemic and newly emerging communicable diseases in the future. %M 33711799 %R 10.2196/27317 %U https://publichealth.jmir.org/2021/3/e27317 %U https://doi.org/10.2196/27317 %U http://www.ncbi.nlm.nih.gov/pubmed/33711799 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e26293 %T Changes in Workers’ Sedentary and Physical Activity Behaviors in Response to the COVID-19 Pandemic and Their Relationships With Fatigue: Longitudinal Online Study %A Koohsari,Mohammad Javad %A Nakaya,Tomoki %A McCormack,Gavin R %A Shibata,Ai %A Ishii,Kaori %A Oka,Koichiro %+ Faculty of Sport Sciences, Waseda University, 2-579-15 Mikajima, Tokorozawa, 359-1192, Japan, 81 4 2947 7189, javadkoohsari@aoni.waseda.jp %K COVID-19 %K physical inactivity %K sitting time %K mental health %K Japan %K prospective design %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Sedentary behaviors and physical activity are likely to be affected by the COVID-19 outbreak, and sedentary lifestyles can increase subjective fatigue. The nonpharmaceutical policies imposed as a result of the COVID-19 pandemic may also have adverse effects on fatigue. Objective: This study has two aims: to examine the changes in sedentary behaviors and physical activity of company workers in response to the COVID-19 pandemic in Japan and to examine relationships between changes in these sedentary behaviors and physical activity and changes in fatigue. Methods: Data from a nationwide prospective online survey conducted in 2019 and 2020 were used. On February 22, 2019, an email with a link to participate in the study was sent to 45,659 workers, aged 20 to 59 years, who were randomly selected from a database of approximately 1 million individuals. A total of 2466 and 1318 participants, who self-reported their occupation as company workers, answered the baseline and follow-up surveys, respectively. Surveys captured fatigue, workday and daily domain-specific sedentary behaviors and physical activity, and total sedentary behaviors and physical activity. We used multivariable linear regression models to estimate associations of changes in sedentary behaviors and physical activity with changes in fatigue. Results: Increases in public transportation sitting during workdays, other leisure sitting time during workdays, and other leisure sitting time were associated with an increase in the motivation aspect of fatigue (b=0.29, 95% CI 0-0.57, P=.048; b=0.40, 95% CI 0.18-0.62, P<.001; and b=0.26, 95% CI 0.07-0.45, P=.007, respectively). Increases in work-related sitting time during workdays, total sitting time during workdays, and total work-related sitting time were significantly associated with an increase in the physical activity aspect of fatigue (b=0.06, 95% CI 0-0.12, P=.03; b=0.05, 95% CI 0.01-0.09, P=.02; and b=0.07, 95% CI 0-0.14, P=.04, respectively). The motivation and physical activity aspects of fatigue increased by 0.06 for each 1-hour increase in total sitting time between baseline and follow-up (b=0.06, 95% CI 0-0.11, P=.045; and b=0.06, 95% CI 0.01-0.10, P=.009, respectively). Conclusions: Our findings demonstrated that sedentary and active behaviors among company workers in Japan were negatively affected during the COVID-19 outbreak. Increases in several domain-specific sedentary behaviors also contributed to unfavorable changes in workers’ fatigue. Social distancing and teleworking amid a pandemic may contribute to the sedentary lifestyle of company workers. Public health interventions are needed to mitigate the negative effects of the COVID-19 pandemic or future pandemics on sedentary and physical activity behaviors and fatigue among company workers. %M 33727211 %R 10.2196/26293 %U https://publichealth.jmir.org/2021/3/e26293 %U https://doi.org/10.2196/26293 %U http://www.ncbi.nlm.nih.gov/pubmed/33727211 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e27232 %T Analyzing the Essential Attributes of Nationally Issued COVID-19 Contact Tracing Apps: Open-Source Intelligence Approach and Content Analysis %A Weiß,Jan-Patrick %A Esdar,Moritz %A Hübner,Ursula %+ Health Informatics Research Group, Faculty of Business Management and Social Sciences, University of Applied Sciences Osnabrueck, Caprivistraße 30a, Osnabrück, , Germany, 49 5419692012, u.huebner@hs-osnabrueck.de %K COVID-19 %K contact tracing %K app %K protocol %K privacy %K assessment %K review %K surveillance %K monitoring %K design %K framework %K feature %K usage %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Contact tracing apps are potentially useful tools for supporting national COVID-19 containment strategies. Various national apps with different technical design features have been commissioned and issued by governments worldwide. Objective: Our goal was to develop and propose an item set that was suitable for describing and monitoring nationally issued COVID-19 contact tracing apps. This item set could provide a framework for describing the key technical features of such apps and monitoring their use based on widely available information. Methods: We used an open-source intelligence approach (OSINT) to access a multitude of publicly available sources and collect data and information regarding the development and use of contact tracing apps in different countries over several months (from June 2020 to January 2021). The collected documents were then iteratively analyzed via content analysis methods. During this process, an initial set of subject areas were refined into categories for evaluation (ie, coherent topics), which were then examined for individual features. These features were paraphrased as items in the form of questions and applied to information materials from a sample of countries (ie, Brazil, China, Finland, France, Germany, Italy, Singapore, South Korea, Spain, and the United Kingdom [England and Wales]). This sample was purposefully selected; our intention was to include the apps of different countries from around the world and to propose a valid item set that can be relatively easily applied by using an OSINT approach. Results: Our OSINT approach and subsequent analysis of the collected documents resulted in the definition of the following five main categories and associated subcategories: (1) background information (open-source code, public information, and collaborators); (2) purpose and workflow (secondary data use and warning process design); (3) technical information (protocol, tracing technology, exposure notification system, and interoperability); (4) privacy protection (the entity of trust and anonymity); and (5) availability and use (release date and the number of downloads). Based on this structure, a set of items that constituted the evaluation framework were specified. The application of these items to the 10 selected countries revealed differences, especially with regard to the centralization of the entity of trust and the overall transparency of the apps’ technical makeup. Conclusions: We provide a set of criteria for monitoring and evaluating COVID-19 tracing apps that can be easily applied to publicly issued information. The application of these criteria might help governments to identify design features that promote the successful, widespread adoption of COVID-19 tracing apps among target populations and across national boundaries. %M 33724920 %R 10.2196/27232 %U https://mhealth.jmir.org/2021/3/e27232 %U https://doi.org/10.2196/27232 %U http://www.ncbi.nlm.nih.gov/pubmed/33724920 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e27882 %T The Dutch COVID-19 Contact Tracing App (the CoronaMelder): Usability Study %A Bente,Britt Elise %A van 't Klooster,Jan Willem Jaap Roderick %A Schreijer,Maud Annemarie %A Berkemeier,Lea %A van Gend,Joris Elmar %A Slijkhuis,Peter Jan Hendrik %A Kelders,Saskia Marion %A van Gemert-Pijnen,Julia Elisabeth Wilhelmina Cornelia %+ Centre for eHealth and Wellbeing Research, Department of Psychology, Health and Technology, University of Twente, Drienerlolaan 5, Enschede, 7522 NB, Netherlands, 31 53 489 9660, b.e.bente@utwente.nl %K usability testing %K user evaluation %K user experience %K contact tracing apps %K CoronaMelder %K COVID-19 %K pandemic %K mobile apps %K mHealth %K public health %D 2021 %7 26.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Adoption and evaluation of contact tracing tools based on information and communications technology may expand the reach and efficacy of traditional contact tracing methods in fighting COVID-19. The Dutch Ministry of Health, Welfare and Sports initiated and developed CoronaMelder, a COVID-19 contact tracing app. This app is based on a Google/Apple Exposure Notification approach and aims to combat the spread of the coronavirus among individuals by notifying those who are at increased risk of infection due to proximity to someone who later tests positive for COVID-19. The app should support traditional contact tracing by faster tracing and greater reach compared to regular contact tracing procedures. Objective: The main goal of this study is to investigate whether the CoronaMelder is able to support traditional contact tracing employed by public health authorities. To achieve this, usability tests were conducted to answer the following question: is the CoronaMelder user-friendly, understandable, reliable and credible, and inclusive? Methods: Participants (N=44) of different backgrounds were recruited: youth with varying educational levels, youth with an intellectual disability, migrants, adults (aged 40-64 years), and older adults (aged >65 years) via convenience sampling in the region of Twente in the Netherlands. The app was evaluated with scenario-based, think-aloud usability tests and additional interviews. Findings were recorded via voice recordings, observation notes, and the Dutch User Experience Questionnaire, and some participants wore eye trackers to measure gaze behavior. Results: Our results showed that the app is easy to use, although problems occurred with understandability and accessibility. Older adults and youth with a lower education level did not understand why or under what circumstances they would receive notifications, why they must share their key (ie, their assigned identifier), and what happens after sharing. In particular, youth in the lower-education category did not trust or understand Bluetooth signals, or comprehend timing and follow-up activities after a risk exposure notification. Older adults had difficulties multitasking (speaking with a public health worker and simultaneously sharing the key in the app). Public health authorities appeared to be unprepared to receive support from the app during traditional contact tracing because their telephone conversation protocol lacks guidance, explanation, and empathy. Conclusions: The study indicated that the CoronaMelder app is easy to use, but participants experienced misunderstandings about its functioning. The perceived lack of clarity led to misconceptions about the app, mostly regarding its usefulness and privacy-preserving mechanisms. Tailored and targeted communication through, for example, public campaigns or social media, is necessary to provide correct information about the app to residents in the Netherlands. Additionally, the app should be presented as part of the national coronavirus measures instead of as a stand-alone app offered to the public. Public health workers should be trained to effectively and empathetically instruct users on how to use the CoronaMelder app. %M 33724198 %R 10.2196/27882 %U https://formative.jmir.org/2021/3/e27882 %U https://doi.org/10.2196/27882 %U http://www.ncbi.nlm.nih.gov/pubmed/33724198 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e23015 %T Phylogenetic and Mutational Analysis of Lassa Virus Strains Isolated in Nigeria: Proposal for an In Silico Study %A Kolawole,Daniel %A Raji,Hayatu %A Okeke,Malachy Ifeanyi %+ Department of Natural and Environmental Sciences, American University of Nigeria, Lamido Zubairu Way, Yola, , Nigeria, 234 8145545022, malachy.okeke@aun.edu.ng %K Arenavirus %K Bayesian phylogeny %K epidemic %K evolution %K Lassa virus %K Mammarenavirus %K marker gene %K molecular epidemiology %K mutations %K Nigeria %D 2021 %7 26.3.2021 %9 Proposal %J JMIR Res Protoc %G English %X Background: In 2018, the total number of Lassa fever cases in Nigeria was significantly higher than that observed in previous years. Hence, studies had attempted to determine the underlying cause. However, reports using phylogenetic methods to analyze this finding ruled out the emergence of potentially more transmissible Lassa virus strains or an increase in human-to-human viral transmission as the cause underlying the increase in cases. Two years later, the situation seems even worse as the number of confirmed cases has reached an all-time high according to situational reports released by the Nigerian Center for Disease Control. Objective: Considering the increasing trend of Lassa fever cases and related mortality, the major objective of this study is to map mutations within the genomes of Lassa virus isolates from 2018 and 2019 using the reference sequence available at the National Center for Biotechnology Information as a benchmark and compare them to the genomes of viruses isolated during 1969-2017. This study would also attempt to identify a viral marker gene for easier identification and grouping. Finally, the time-scaled evolution of Lassa virus in Nigeria will be reconstructed. Methods: After collecting the sequence data of Lassa virus isolates, Bayesian phylogenetic trees, a sequence identity matrix, and a single nucleotide polymorphism matrix will be generated using BEAST (version 2.6.2), Base-By-Base, and DIVEIN (a web-based tool for variant calling), respectively. Results: Mining and alignment of Lassa virus genome sequences have been completed, while mutational analysis and the reconstruction of time-scaled maximum clade credibility trees, congruence tests for inferred segments, and gene phylogeny analysis are ongoing. Conclusions: The findings of this study would further the current knowledge of the evolutionary history of the Lassa virus in Nigeria and would document the mutations in Nigerian isolates from 1969 to 2019. International Registered Report Identifier (IRRID): DERR1-10.2196/23015 %M 33769296 %R 10.2196/23015 %U https://www.researchprotocols.org/2021/3/e23015 %U https://doi.org/10.2196/23015 %U http://www.ncbi.nlm.nih.gov/pubmed/33769296 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e27443 %T Impact of a Serious Game (Escape COVID-19) on the Intention to Change COVID-19 Control Practices Among Employees of Long-term Care Facilities: Web-Based Randomized Controlled Trial %A Suppan,Mélanie %A Abbas,Mohamed %A Catho,Gaud %A Stuby,Loric %A Regard,Simon %A Achab,Sophia %A Harbarth,Stephan %A Suppan,Laurent %+ Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 223723311, melanie.suppan@hcuge.ch %K COVID-19 %K transmission %K serious game %K infection prevention %K health care worker %K SARS-CoV-2 %K nursing homes %K randomized controlled trial %K long-term care facilities %K impact %K game %K intention %K control %K elderly %D 2021 %7 25.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Most residents of long-term care facilities (LTCFs) are at high risk of complications and death following SARS-CoV-2 infection. In these facilities, viral transmission can be facilitated by shortages of human and material resources, which can lead to suboptimal application of infection prevention and control (IPC) procedures. To improve the dissemination of COVID-19 IPC guidelines, we developed a serious game called “Escape COVID-19” using Nicholson’s RECIPE for meaningful gamification, as engaging serious games have the potential to induce behavioral change. Objective: As the probability of executing an action is strongly linked to the intention of performing it, the objective of this study was to determine whether LTCF employees were willing to change their IPC practices after playing “Escape COVID-19.” Methods: This was a web-based, triple-blind, randomized controlled trial, which took place between November 5 and December 4, 2020. The health authorities of Geneva, Switzerland, asked the managers of all LTCFs under their jurisdiction to forward information regarding the study to all their employees, regardless of professional status. Participants were unaware that they would be randomly allocated to one of two different study paths upon registration. In the control group, participants filled in a first questionnaire designed to gather demographic data and assess baseline knowledge before accessing regular online IPC guidelines. They then answered a second questionnaire, which assessed their willingness to change their IPC practices and identified the reasons underlying their decision. They were then granted access to the serious game. Conversely, the serious game group played “Escape COVID-19” after answering the first questionnaire but before answering the second one. This group accessed the control material after answering the second set of questions. There was no time limit. The primary outcome was the proportion of LTCF employees willing to change their IPC practices. Secondary outcomes included the factors underlying participants’ decisions, the domains these changes would affect, changes in the use of protective equipment items, and attrition at each stage of the study. Results: A total of 295 answer sets were analyzed. Willingness to change behavior was higher in the serious game group (82% [119/145] versus 56% [84/150]; P<.001), with an odds ratio of 3.86 (95% CI 2.18-6.81; P<.001) after adjusting for professional category and baseline knowledge, using a mixed effects logistic regression model with LTCF as a random effect. For more than two-thirds (142/203) of the participants, the feeling of playing an important role against the epidemic was the most important factor explaining their willingness to change behavior. Most of the participants unwilling to change their behavior answered that they were already applying all the guidelines. Conclusions: The serious game “Escape COVID-19” was more successful than standard IPC material in convincing LTCF employees to adopt COVID-19–safe IPC behavior. International Registered Report Identifier (IRRID): RR2-10.2196/25595 %M 33685854 %R 10.2196/27443 %U https://www.jmir.org/2021/3/e27443 %U https://doi.org/10.2196/27443 %U http://www.ncbi.nlm.nih.gov/pubmed/33685854 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25696 %T Modeling Predictive Age-Dependent and Age-Independent Symptoms and Comorbidities of Patients Seeking Treatment for COVID-19: Model Development and Validation Study %A Huang,Yingxiang %A Radenkovic,Dina %A Perez,Kevin %A Nadeau,Kari %A Verdin,Eric %A Furman,David %+ Buck Institute for Research on Aging, 8001 Redwood Blvd, Novato, CA, 94945, United States, 1 (415) 209 2000, DFurman@buckinstitute.org %K clinical informatics %K predictive modeling %K COVID-19 %K app %K model %K prediction %K symptom %K informatics %K age %K morbidity %K hospital %D 2021 %7 25.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic continues to ravage and burden hospitals around the world. The epidemic started in Wuhan, China, and was subsequently recognized by the World Health Organization as an international public health emergency and declared a pandemic in March 2020. Since then, the disruptions caused by the COVID-19 pandemic have had an unparalleled effect on all aspects of life. Objective: With increasing total hospitalization and intensive care unit admissions, a better understanding of features related to patients with COVID-19 could help health care workers stratify patients based on the risk of developing a more severe case of COVID-19. Using predictive models, we strive to select the features that are most associated with more severe cases of COVID-19. Methods: Over 3 million participants reported their potential symptoms of COVID-19, along with their comorbidities and demographic information, on a smartphone-based app. Using data from the >10,000 individuals who indicated that they had tested positive for COVID-19 in the United Kingdom, we leveraged the Elastic Net regularized binary classifier to derive the predictors that are most correlated with users having a severe enough case of COVID-19 to seek treatment in a hospital setting. We then analyzed such features in relation to age and other demographics and their longitudinal trend. Results: The most predictive features found include fever, use of immunosuppressant medication, use of a mobility aid, shortness of breath, and severe fatigue. Such features are age-related, and some are disproportionally high in minority populations. Conclusions: Predictors selected from the predictive models can be used to stratify patients into groups based on how much medical attention they are expected to require. This could help health care workers devote valuable resources to prevent the escalation of the disease in vulnerable populations. %M 33621185 %R 10.2196/25696 %U https://www.jmir.org/2021/3/e25696 %U https://doi.org/10.2196/25696 %U http://www.ncbi.nlm.nih.gov/pubmed/33621185 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e26719 %T Automated Travel History Extraction From Clinical Notes for Informing the Detection of Emergent Infectious Disease Events: Algorithm Development and Validation %A Peterson,Kelly S %A Lewis,Julia %A Patterson,Olga V %A Chapman,Alec B %A Denhalter,Daniel W %A Lye,Patricia A %A Stevens,Vanessa W %A Gamage,Shantini D %A Roselle,Gary A %A Wallace,Katherine S %A Jones,Makoto %+ VA Salt Lake City Health Care System, US Department of Veterans Affairs, 500 Foothill Dr, Salt Lake City, UT, 84148, United States, 1 801 582 1565, kelly.peterson2@va.gov %K natural language processing %K machine learning %K travel history %K COVID-19 %K Zika %K infectious disease surveillance %K surveillance applications %K biosurveillance %K electronic health record %D 2021 %7 24.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Patient travel history can be crucial in evaluating evolving infectious disease events. Such information can be challenging to acquire in electronic health records, as it is often available only in unstructured text. Objective: This study aims to assess the feasibility of annotating and automatically extracting travel history mentions from unstructured clinical documents in the Department of Veterans Affairs across disparate health care facilities and among millions of patients. Information about travel exposure augments existing surveillance applications for increased preparedness in responding quickly to public health threats. Methods: Clinical documents related to arboviral disease were annotated following selection using a semiautomated bootstrapping process. Using annotated instances as training data, models were developed to extract from unstructured clinical text any mention of affirmed travel locations outside of the continental United States. Automated text processing models were evaluated, involving machine learning and neural language models for extraction accuracy. Results: Among 4584 annotated instances, 2659 (58%) contained an affirmed mention of travel history, while 347 (7.6%) were negated. Interannotator agreement resulted in a document-level Cohen kappa of 0.776. Automated text processing accuracy (F1 85.6, 95% CI 82.5-87.9) and computational burden were acceptable such that the system can provide a rapid screen for public health events. Conclusions: Automated extraction of patient travel history from clinical documents is feasible for enhanced passive surveillance public health systems. Without such a system, it would usually be necessary to manually review charts to identify recent travel or lack of travel, use an electronic health record that enforces travel history documentation, or ignore this potential source of information altogether. The development of this tool was initially motivated by emergent arboviral diseases. More recently, this system was used in the early phases of response to COVID-19 in the United States, although its utility was limited to a relatively brief window due to the rapid domestic spread of the virus. Such systems may aid future efforts to prevent and contain the spread of infectious diseases. %M 33759790 %R 10.2196/26719 %U https://publichealth.jmir.org/2021/3/e26719 %U https://doi.org/10.2196/26719 %U http://www.ncbi.nlm.nih.gov/pubmed/33759790 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24925 %T Short-Range Forecasting of COVID-19 During Early Onset at County, Health District, and State Geographic Levels Using Seven Methods: Comparative Forecasting Study %A Lynch,Christopher J %A Gore,Ross %+ Virginia Modeling, Analysis, and Simulation Center, Old Dominion University, 1030 University Blvd, Suffolk, VA, 23435, United States, 1 7576866248, cjlynch@odu.edu %K coronavirus disease 2019 %K COVID-19 %K infectious disease %K emerging outbreak %K forecasting %K modeling and simulation %K public health %K modeling disease outbreaks %D 2021 %7 23.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Forecasting methods rely on trends and averages of prior observations to forecast COVID-19 case counts. COVID-19 forecasts have received much media attention, and numerous platforms have been created to inform the public. However, forecasting effectiveness varies by geographic scope and is affected by changing assumptions in behaviors and preventative measures in response to the pandemic. Due to time requirements for developing a COVID-19 vaccine, evidence is needed to inform short-term forecasting method selection at county, health district, and state levels. Objective: COVID-19 forecasts keep the public informed and contribute to public policy. As such, proper understanding of forecasting purposes and outcomes is needed to advance knowledge of health statistics for policy makers and the public. Using publicly available real-time data provided online, we aimed to evaluate the performance of seven forecasting methods utilized to forecast cumulative COVID-19 case counts. Forecasts were evaluated based on how well they forecast 1, 3, and 7 days forward when utilizing 1-, 3-, 7-, or all prior–day cumulative case counts during early virus onset. This study provides an objective evaluation of the forecasting methods to identify forecasting model assumptions that contribute to lower error in forecasting COVID-19 cumulative case growth. This information benefits professionals, decision makers, and the public relying on the data provided by short-term case count estimates at varied geographic levels. Methods: We created 1-, 3-, and 7-day forecasts at the county, health district, and state levels using (1) a naïve approach, (2) Holt-Winters (HW) exponential smoothing, (3) a growth rate approach, (4) a moving average (MA) approach, (5) an autoregressive (AR) approach, (6) an autoregressive moving average (ARMA) approach, and (7) an autoregressive integrated moving average (ARIMA) approach. Forecasts relied on Virginia’s 3464 historical county-level cumulative case counts from March 7 to April 22, 2020, as reported by The New York Times. Statistically significant results were identified using 95% CIs of median absolute error (MdAE) and median absolute percentage error (MdAPE) metrics of the resulting 216,698 forecasts. Results: The next-day MA forecast with 3-day look-back length obtained the lowest MdAE (median 0.67, 95% CI 0.49-0.84, P<.001) and statistically significantly differed from 39 out of 59 alternatives (66%) to 53 out of 59 alternatives (90%) at each geographic level at a significance level of .01. For short-range forecasting, methods assuming stationary means of prior days’ counts outperformed methods with assumptions of weak stationarity or nonstationarity means. MdAPE results revealed statistically significant differences across geographic levels. Conclusions: For short-range COVID-19 cumulative case count forecasting at the county, health district, and state levels during early onset, the following were found: (1) the MA method was effective for forecasting 1-, 3-, and 7-day cumulative case counts; (2) exponential growth was not the best representation of case growth during early virus onset when the public was aware of the virus; and (3) geographic resolution was a factor in the selection of forecasting methods. %M 33621186 %R 10.2196/24925 %U https://www.jmir.org/2021/3/e24925 %U https://doi.org/10.2196/24925 %U http://www.ncbi.nlm.nih.gov/pubmed/33621186 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e22860 %T Revealing Opinions for COVID-19 Questions Using a Context Retriever, Opinion Aggregator, and Question-Answering Model: Model Development Study %A Lu,Zhao-Hua %A Wang,Jade Xiaoqing %A Li,Xintong %+ Department of Biostatistics, St. Jude Children’s Research Hospital, MS 768, Room R6006, 262 Danny Thomas Place, Memphis, TN, 38105-3678, United States, 1 901 595 2714, zhaohua.lu@stjude.org %K natural language processing %K question-answering systems %K language summarization %K machine learning %K life and medical sciences %K COVID-19 %K public health %K coronavirus literature %D 2021 %7 19.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has challenged global public health because it is highly contagious and can be lethal. Numerous ongoing and recently published studies about the disease have emerged. However, the research regarding COVID-19 is largely ongoing and inconclusive. Objective: A potential way to accelerate COVID-19 research is to use existing information gleaned from research into other viruses that belong to the coronavirus family. Our objective is to develop a natural language processing method for answering factoid questions related to COVID-19 using published articles as knowledge sources. Methods: Given a question, first, a BM25-based context retriever model is implemented to select the most relevant passages from previously published articles. Second, for each selected context passage, an answer is obtained using a pretrained bidirectional encoder representations from transformers (BERT) question-answering model. Third, an opinion aggregator, which is a combination of a biterm topic model and k-means clustering, is applied to the task of aggregating all answers into several opinions. Results: We applied the proposed pipeline to extract answers, opinions, and the most frequent words related to six questions from the COVID-19 Open Research Dataset Challenge. By showing the longitudinal distributions of the opinions, we uncovered the trends of opinions and popular words in the articles published in the five time periods assessed: before 1990, 1990-1999, 2000-2009, 2010-2018, and since 2019. The changes in opinions and popular words agree with several distinct characteristics and challenges of COVID-19, including a higher risk for senior people and people with pre-existing medical conditions; high contagion and rapid transmission; and a more urgent need for screening and testing. The opinions and popular words also provide additional insights for the COVID-19–related questions. Conclusions: Compared with other methods of literature retrieval and answer generation, opinion aggregation using our method leads to more interpretable, robust, and comprehensive question-specific literature reviews. The results demonstrate the usefulness of the proposed method in answering COVID-19–related questions with main opinions and capturing the trends of research about COVID-19 and other relevant strains of coronavirus in recent years. %M 33739287 %R 10.2196/22860 %U https://www.jmir.org/2021/3/e22860 %U https://doi.org/10.2196/22860 %U http://www.ncbi.nlm.nih.gov/pubmed/33739287 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e27078 %T Temporal Dynamics of Public Emotions During the COVID-19 Pandemic at the Epicenter of the Outbreak: Sentiment Analysis of Weibo Posts From Wuhan %A Yu,Shaobin %A Eisenman,David %A Han,Ziqiang %+ Department of Public Administration, School of Political Science and Public Administration, Shandong University, Binhai Road 72, Jimo, Qingdao, 266237, China, 86 13210178710, ziqiang.han@sdu.edu.cn %K public health emergencies %K emotion %K infodemiology %K temporal dynamics %K sentiment analysis %K COVID-19 %D 2021 %7 18.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The ongoing COVID-19 pandemic has led to an increase in anxiety, depression, posttraumatic stress disorder, and psychological stress experienced by the general public in various degrees worldwide. However, effective, tailored mental health services and interventions cannot be achieved until we understand the patterns of mental health issues emerging after a public health crisis, especially in the context of the rapid transmission of COVID-19. Understanding the public's emotions and needs and their distribution attributes are therefore critical for creating appropriate public policies and eventually responding to the health crisis effectively, efficiently, and equitably. Objective: This study aims to detect the temporal patterns in emotional fluctuation, significant events during the COVID-19 pandemic that affected emotional changes and variations, and hourly variations of emotions within a single day by analyzing data from the Chinese social media platform Weibo. Methods: Based on a longitudinal dataset of 816,556 posts published by 27,912 Weibo users in Wuhan, China, from December 31, 2019, to April 31, 2020, we processed general sentiment inclination rating and the type of sentiments of Weibo posts by using pandas and SnowNLP Python libraries. We also grouped the publication times into 5 time groups to measure changes in netizens’ sentiments during different periods in a single day. Results: Overall, negative emotions such as surprise, fear, and anger were the most salient emotions detected on Weibo. These emotions were triggered by certain milestone events such as the confirmation of human-to-human transmission of COVID-19. Emotions varied within a day. Although all emotions were more prevalent in the afternoon and night, fear and anger were more dominant in the morning and afternoon, whereas depression was more salient during the night. Conclusions: Various milestone events during the COVID-19 pandemic were the primary events that ignited netizens’ emotions. In addition, Weibo users’ emotions varied within a day. Our findings provide insights into providing better-tailored mental health services and interventions. %M 33661755 %R 10.2196/27078 %U https://www.jmir.org/2021/3/e27078 %U https://doi.org/10.2196/27078 %U http://www.ncbi.nlm.nih.gov/pubmed/33661755 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 2 %N 1 %P e22617 %T A Framework for a Statistical Characterization of Epidemic Cycles: COVID-19 Case Study %A De Carvalho,Eduardo Atem %A De Carvalho,Rogerio Atem %+ Innovation Hub, Instituto Federal Fluminense, R Cel Walter Kramer, 357, Campos, 28080-565, Brazil, 55 22 27375692, ratem@iff.edu.br %K COVID-19 %K SARS-CoV-2 %K pandemics %K infection control %K models %K experimental %K longitudinal studies %K statistical modeling %K epidemic cycles %D 2021 %7 18.3.2021 %9 Original Paper %J JMIRx Med %G English %X Background: Since the beginning of the COVID-19 pandemic, researchers and health authorities have sought to identify the different parameters that drive its local transmission cycles to make better decisions regarding prevention and control measures. Different modeling approaches have been proposed in an attempt to predict the behavior of these local cycles. Objective: This paper presents a framework to characterize the different variables that drive the local, or epidemic, cycles of the COVID-19 pandemic, in order to provide a set of relatively simple, yet efficient, statistical tools to be used by local health authorities to support decision making. Methods: Virtually closed cycles were compared to cycles in progress from different locations that present similar patterns in the figures that describe them. With the aim to compare populations of different sizes at different periods of time and locations, the cycles were normalized, allowing an analysis based on the core behavior of the numerical series. A model for the reproduction number was derived from the experimental data, and its performance was presented, including the effect of subnotification (ie, underreporting). A variation of the logistic model was used together with an innovative inventory model to calculate the actual number of infected persons, analyze the incubation period, and determine the actual onset of local epidemic cycles. Results: The similarities among cycles were demonstrated. A pattern between the cycles studied, which took on a triangular shape, was identified and used to make predictions about the duration of future cycles. Analyses on effective reproduction number (Rt) and subnotification effects for Germany, Italy, and Sweden were presented to show the performance of the framework introduced here. After comparing data from the three countries, it was possible to determine the probable dates of the actual onset of the epidemic cycles for each country, the typical duration of the incubation period for the disease, and the total number of infected persons during each cycle. In general terms, a probable average incubation time of 5 days was found, and the method used here was able to estimate the end of the cycles up to 34 days in advance, while demonstrating that the impact of the subnotification level (ie, error) on the effective reproduction number was <5%. Conclusions: It was demonstrated that, with relatively simple mathematical tools, it is possible to obtain a reliable understanding of the behavior of COVID-19 local epidemic cycles, by introducing an integrated framework for identifying cycle patterns and calculating the variables that drive it, namely: the Rt, the subnotification effects on estimations, the most probable actual cycles start dates, the total number of infected, and the most likely incubation period for SARS-CoV-2. %M 34077489 %R 10.2196/22617 %U https://xmed.jmir.org/2021/1/e22617 %U https://doi.org/10.2196/22617 %U http://www.ncbi.nlm.nih.gov/pubmed/34077489 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23218 %T Improving Predictions of COVID-19 Preventive Behavior: Development of a Sequential Mediation Model %A Roberts,James A %A David,Meredith E %+ Marketing Department, Hankamer School of Business, Baylor University, 1 Bear Pl Unit 98007, Waco, TX, 76798-8007, United States, 1 2547104952, jim_roberts@baylor.edu %K pandemic %K COVID-19 %K preventive behavior %K self-efficacy %K prevention %K behavior %K modeling %K student %K communication %D 2021 %7 17.3.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33651707 %R 10.2196/23218 %U https://www.jmir.org/2021/3/e23218 %U https://doi.org/10.2196/23218 %U http://www.ncbi.nlm.nih.gov/pubmed/33651707 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e27015 %T Social Media and Emotional Burnout Regulation During the COVID-19 Pandemic: Multilevel Approach %A Shao,Ruosi %A Shi,Zhen %A Zhang,Di %+ The Research Center for Journalism and Social Development, Renmin University of China, RM713 Mingde Journalism Building, 59 Zhongguancun Rd, Haidian Dist, Beijing, 100872, China, 86 13801247280, zhangdi204@gmail.com %K COVID-19 %K pandemic %K emotion regulation %K emotional exhaustion %K multilevel approach %K well-being %K emotion %K mental health %K social media %K perspective %K strategy %K effective %K modeling %K buffer %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In February 2020, the Chinese government imposed a complete lockdown of Wuhan and other cities in Hubei Province to contain a spike of COVID-19 cases. Although such measures are effective in preventing the spread of the virus, medical professionals strongly voiced a caveat concerning the pandemic emotional burnout at the individual level. Although the lockdown limited individuals’ interpersonal communication with people in their social networks, it is common that individuals turn to social media to seek and share health information, exchange social support, and express pandemic-generated feelings. Objective: Based on a holistic and multilevel perspective, this study examines how pandemic-related emotional exhaustion enacts intrapersonal, interpersonal, and hyperpersonal emotional regulation strategies, and then evaluates the effectiveness of these strategies, with a particular interest in understanding the role of hyperpersonal-level regulation or social media–based regulation. Methods: Using an online panel, this study sampled 538 Chinese internet users from Hubei Province, the epicenter of the COVID-19 outbreak in China. Survey data collection lasted for 12 days from February 7-18, 2020, two weeks after Hubei Province was placed under quarantine. The sample had an average age of 35 (SD 10.65, range 18-78) years, and a majority were married (n=369, 68.6%). Results: Using structural equation modeling, this study found that intrapersonal-level (B=0.22; β=.24; P<.001) and interpersonal-level (B=0.35; β=.49; P<.001) emotional regulation strategies were positively associated with individuals’ outcome reappraisal. In contrast with intrapersonal and interpersonal regulations, hyperpersonal (social media–based) regulation strategies, such as disclosing and retweeting negative emotions, were negatively related to the outcome reappraisal (B=–1.00; β=–.80; P<.001). Conclusions: Consistent with previous literature, intrapersonal-level regulation (eg, cognitive reappraisal, mindfulness, and self-kindness) and interpersonal-level supportive interaction may generate a buffering effect on emotional exhaustion and promote individuals’ reappraisal toward the stressful situation. However, hyperpersonal-level regulation may exacerbate the experienced negative emotions and impede reappraisal of the pandemic situation. It is speculated that retweeting content that contains pandemic-related stress and anxiety may cause a digital emotion contagion. Individuals who share other people’s negative emotional expressions on social media are likely to be affected by the negative affect contagion. More importantly, the possible benefits of intrapersonal and interpersonal emotion regulations may be counteracted by social media or hyperpersonal regulation. This suggests the necessity to conduct social media–based health communication interventions to mitigate the social media–wide negative affect contagion if lockdown policies related to highly infectious diseases are initiated. %M 33661753 %R 10.2196/27015 %U https://www.jmir.org/2021/3/e27015 %U https://doi.org/10.2196/27015 %U http://www.ncbi.nlm.nih.gov/pubmed/33661753 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25977 %T Social Media Engagement and Influenza Vaccination During the COVID-19 Pandemic: Cross-sectional Survey Study %A Benis,Arriel %A Khodos,Anna %A Ran,Sivan %A Levner,Eugene %A Ashkenazi,Shai %+ Faculty of Industrial Engineering and Technology Management, Holon Institute of Technology, Golomb St. 52, Holon, 5810201, Israel, 972 3 5026892, arrielb@hit.ac.il %K influenza %K vaccines %K vaccination %K social media %K online social networking %K health literacy %K eHealth %K information dissemination %K access to information %K COVID-19 %D 2021 %7 16.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Vaccines are one of the most important achievements of modern medicine. However, their acceptance is only partial, with vaccine hesitancy and refusal representing a major health threat. Influenza vaccines have low compliance since repeated, annual vaccination is required. Influenza vaccines stimulate discussions both in the real world and online. Social media is currently a significant source of health and medical information. Elucidating the association between social media engagement and influenza vaccination is important and may be applicable to other vaccines, including ones against COVID-19. Objective: The goal of this study is to characterize profiles of social media engagement regarding the influenza vaccine and their association with knowledge and compliance in order to support improvement of future web-associated vaccination campaigns. Methods: A weblink to an online survey in Hebrew was disseminated over social media and messaging platforms. The survey answers were collected during April 2020. Anonymous and volunteer participants aged 21 years and over answered 30 questions related to sociodemographics; social media usage; influenza- and vaccine-related knowledge and behavior; health-related information searching, its reliability, and its influence; and COVID-19-related information searching. A univariate descriptive data analysis was performed, followed by multivariate analysis via building a decision tree to define the most important attributes associated with vaccination compliance. Results: A total of 213 subjects responded to the survey, of whom 207 were included in the analysis; the majority of the respondents were female, were aged 21 to 40 years, had 1 to 2 children, lived in central Israel, were secular Israeli natives, had higher education, and had a salary close to the national average. Most respondents (128/207, 61.8%) were not vaccinated against influenza in 2019 and used social media. Participants that used social media were younger, secular, and living in high-density agglomerations and had lower influenza vaccination rates. The perceived influence and reliability of the information on social media about COVID-19 were generally similar to those perceptions about influenza. Conclusions: Using social media is negatively linked to compliance with seasonal influenza vaccination in this study. A high proportion of noncompliant individuals can lead to increased consumption of health care services and can, therefore, overload these health services. This is particularly crucial with a concomitant outbreak, such as COVID-19. Health care professionals should use improved and targeted health communication campaigns with the aid of experts in social media. Targeted communication, based on sociodemographic factors and personalized social media usage, might increase influenza vaccination rates and compliance with other vaccines as well. %M 33651709 %R 10.2196/25977 %U https://www.jmir.org/2021/3/e25977 %U https://doi.org/10.2196/25977 %U http://www.ncbi.nlm.nih.gov/pubmed/33651709 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e19633 %T Home-Based Intervention for the Prevention and Treatment of Malaria Among Children Younger Than 5 Years in the West Region of Cameroon: Protocol for a Randomized Controlled Trial %A Dongmo Kenfack,Esther %A Tendongfor,Nicholas %A Nsagha,Dickson Shey %+ Department of Public Health and Hygiene, Faculty of Health Sciences, University of Buea, P.O. Box 63, Molyko, Buea, Cameroon, 237 677499429 ext 699674201, nsaghads@hotmail.com %K home-based management %K malaria %K children younger than 5 years %K home caregivers %K West Region %K Cameroon %D 2021 %7 12.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although malaria is preventable and curable, 1 child dies of this disease every 2 minutes in Africa. Home-based management of malaria reduces the progression of severe malaria by more than 50%. Scalable, efficacious, and cost-effective strategies are needed to empower the capacities of home caregivers of children younger than 5 years of age in health education, diagnosis, and treatment of malaria at home. Objective: The main objective of this trial is to assess the impact of the management provided by home caregivers on the prevention, diagnosis, and treatment of malaria in children younger than 5 years as compared to the home-based malaria management component of the integrated community-directed intervention (CDI) strategy of community health workers (CHWs). Methods: A randomized controlled trial will be conducted. CHWs have conducted a census of all households where there is at least one child younger than 5 years with their home caregivers. These children and their home caregivers have been randomly placed into the intervention or control groups among the households identified. The trial will allow malaria home-based prevention, diagnosis, and treatment of 350 children younger than 5 years old by home caregivers in the Fombap area (intervention group) where the integrated CDI strategy will not implemented. This group will be compared to the home-based malaria management component of the integrated CDI strategy in which 350 children in the same age group will be followed up by CHWs in the Baneghang area (control group). The primary outcomes will be the prevention, diagnosis, and treatment of malaria in children younger than 5 years of age by home caregivers at home. The secondary outcomes comprise the malaria follow-up indicators produced by home caregivers in the intervention group and those produced by CHWs in the control group. Both descriptive and one-way analysis of variance estimation techniques will be used to compare the mean difference in the 2 strategies. Results: From September 2019 to October 2019, all home caregivers with children younger than 5 years of age were identified in the intervention and control group by CHWs. Following this, 203 home caregivers with their 350 children younger than 5 years were randomly selected and enrolled in the intervention group, while 225 home caregivers with their 350 children younger than 5 years were enrolled in the control group. In the intervention group, 203 home caregivers were trained in November 2019. This home treatment effectively started in December 2019 and will continue until May 2020. Conclusions: Findings from this randomized controlled trial will contribute to resolving the challenges of severe malaria and to limiting the death due to malaria of children younger than 5 years. This will bring benefits to home caregivers who will know how to promptly diagnose and properly treat malaria in their children at home. Trial Registration: Pan African Clinical Trial Registry (PACTR) 202003487018009; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=9788 International Registered Report Identifier (IRRID): DERR1-10.2196/19633 %M 33709938 %R 10.2196/19633 %U https://www.researchprotocols.org/2021/3/e19633 %U https://doi.org/10.2196/19633 %U http://www.ncbi.nlm.nih.gov/pubmed/33709938 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26182 %T A Self-Assessment Web-Based App to Assess Trends of the COVID-19 Pandemic in France: Observational Study %A Denis,Fabrice %A Fontanet,Arnaud %A Le Douarin,Yann-Mael %A Le Goff,Florian %A Jeanneau,Stephan %A Lescure,François-Xavier %+ Institut Inter-régional de Cancérologie Jean Bernard, 9 rue Beauverger, Le Mans, 72000, France, 33 684190480, f.denis@cjb72.org %K app %K big data %K COVID-19 %K diagnosis %K diagnostic test %K digital health %K France %K mobile phone %K observational %K participatory app %K self-assessment %K surveillance %K trend %K web-based app %D 2021 %7 12.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: We developed a self-assessment and participatory web-based triage app to assess the trends of the COVID-19 pandemic in France in March 2020. Objective: We compared daily large-scale RT–PCR test results to monitor recent reports of anosmia through a web-based app to assess the dynamics of emergency department visits, hospitalizations, and intensive care unit (ICU) admissions among individuals with COVID-19 in France. Methods: Between March 21 and November 18, 2020, users of the maladiecoronavirus.fr self-triage app were asked questions about COVID-19 symptoms. Data on daily hospitalizations, large-scale positive results on RT–PCR tests, emergency department visits, and ICU admission of individuals with COVID-19 were compared to data on daily reports of anosmia on the app. Results: As of November 18, 2020, recent anosmia was reported 575,214 times from among approximately 13,000,000 responses. Daily anosmia reports during peak engagement with the app on September 16, 2020, were spatially correlated with the peak in daily COVID-19–related hospitalizations in November 2020 (Spearman rank correlation coefficient [ρ]=0.77; P<.001). This peak in daily anosmia reports was observed primarily among young adults (age range 18-40 years), being observed 49 days before the peak of hospitalizations that corresponded to the first wave of infections among the young population, followed by a peak in hospitalizations among older individuals (aged ≥50 years) in November 2020. The reduction in the daily reports of anosmia associated with the peaks in the number of cases preceded the reduction in daily hospitalizations by 10 and 9 days during the first and the second waves of infection, respectively, although the reduction in the positivity rates on RT–PCR tests preceded the reduction in daily hospitalizations by only 2 days during the second wave of infections. Conclusions: Data on daily reports of anosmia collected through a nationwide, web-based self-assessment app can be a relevant tool to anticipate surges in outbreaks, hospitalizations, and ICU admission during the COVID-19 pandemic. Trial Registration: ClinicalTrials.gov NCT04331171; https://clinicaltrials.gov/ct2/show/NCT04331171 %M 33709945 %R 10.2196/26182 %U https://www.jmir.org/2021/3/e26182 %U https://doi.org/10.2196/26182 %U http://www.ncbi.nlm.nih.gov/pubmed/33709945 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24883 %T Examining Tweet Content and Engagement of Canadian Public Health Agencies and Decision Makers During COVID-19: Mixed Methods Analysis %A Slavik,Catherine E %A Buttle,Charlotte %A Sturrock,Shelby L %A Darlington,J Connor %A Yiannakoulias,Niko %+ School of Earth, Environment and Society, McMaster University, General Science Building, 1280 Main Street West, Room 204, Hamilton, ON, L8S 4K1, Canada, 1 905 525 9140 ext 20118, yiannan@mcmaster.ca %K COVID-19 %K coronavirus %K pandemic %K public health %K Twitter %K social media %K engagement %K risk communication %K infodemiology %K content analysis %D 2021 %7 11.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective communication during a health crisis can ease public concerns and promote the adoption of important risk-mitigating behaviors. Public health agencies and leaders have served as the primary communicators of information related to COVID-19, and a key part of their public outreach has taken place on social media platforms. Objective: This study examined the content and engagement of COVID-19 tweets authored by Canadian public health agencies and decision makers. We propose ways for public health accounts to adjust their tweeting practices during public health crises to improve risk communication and maximize engagement. Methods: We retrieved data from tweets by Canadian public health agencies and decision makers from January 1, 2020, to June 30, 2020. The Twitter accounts were categorized as belonging to either a public health agency, regional or local health department, provincial health authority, medical health officer, or minister of health. We analyzed trends in COVID-19 tweet engagement and conducted a content analysis on a stratified random sample of 485 tweets to examine the message functions and risk communication strategies used by each account type. Results: We analyzed 32,737 tweets authored by 118 Canadian public health Twitter accounts, of which 6982 tweets were related to COVID-19. Medical health officers authored the largest percentage of COVID-19–related tweets (n=1337, 35%) relative to their total number of tweets and averaged the highest number of retweets per COVID-19 tweet (112 retweets per tweet). Public health agencies had the highest frequency of daily tweets about COVID-19 throughout the study period. Compared to tweets containing media and user mentions, hashtags and URLs were used in tweets more frequently by all account types, appearing in 69% (n=4798 tweets) and 68% (n=4781 tweets) of COVID-19–related tweets, respectively. Tweets containing hashtags also received the highest average retweets (47 retweets per tweet). Our content analysis revealed that of the three tweet message functions analyzed (information, action, community), tweets providing information were the most commonly used across most account types, constituting 39% (n=181) of all tweets; however, tweets promoting actions from users received higher than average retweets (55 retweets per tweet). When examining tweets that received one or more retweet (n=359), the difference between mean retweets across the message functions was statistically significant (P<.001). The risk communication strategies that we examined were not widely used by any account type, appearing in only 262 out of 485 tweets. However, when these strategies were used, these tweets received more retweets compared to tweets that did not use any risk communication strategies (P<.001) (61 retweets versus 13 retweets on average). Conclusions: Public health agencies and decision makers should examine what messaging best meets the needs of their Twitter audiences to maximize sharing of their communications. Public health accounts that do not currently employ risk communication strategies in their tweets may be missing an important opportunity to engage with users about the mitigation of health risks related to COVID-19. %M 33651705 %R 10.2196/24883 %U https://www.jmir.org/2021/3/e24883 %U https://doi.org/10.2196/24883 %U http://www.ncbi.nlm.nih.gov/pubmed/33651705 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24804 %T Antecedents of Individuals’ Concerns Regarding Hospital Hygiene and Surgery Postponement During the COVID-19 Pandemic: Cross-sectional, Web-Based Survey Study %A Ostermann,Thomas %A Gampe,Julia %A Röer,Jan Philipp %A Radtke,Theda %+ Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Str 50, Witten, 58448, Germany, 49 2302926707, thomas.ostermann@uni-wh.de %K COVID-19 %K public health %K medical investigations %K surgery %K hospitalization, medical practices %D 2021 %7 11.3.2021 %9 Original Paper %J J Med Internet Res %G English %X 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 (β=−.12, 95% CI −.20 to −.05) and hygiene in hospitals (β=.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. %M 33617458 %R 10.2196/24804 %U https://www.jmir.org/2021/3/e24804 %U https://doi.org/10.2196/24804 %U http://www.ncbi.nlm.nih.gov/pubmed/33617458 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e23994 %T Bovine Lactoferrin to Prevent Neonatal Infections in Low-Birth-Weight Newborns in Pakistan: Protocol for a Three-Arm Double-Blind Randomized Controlled Trial %A Ariff,Shabina %A Soofi,Sajid %A Aamir,Almas %A D'Almeida,Michelle %A Aziz Ali,Arzina %A Alam,Ashraful %A Dibley,Michael %+ School of Public Health, Faculty of Medicine and Health, The University of Sydney, Rm 328, Edward Ford Building A27, New South Wales, Sydney, 2006, Australia, 61 407616500, michael.dibley@sydney.edu.au %K bovine lactoferrin %K low birth weight %K sepsis %K human milk %K premature %K mortality %D 2021 %7 11.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sepsis is a common and severe complication in premature neonates, particularly those born with low birth weights (<2500 g). Neonatal sepsis is steadily emerging as a leading cause of neonatal mortality in Pakistan. Lactoferrin is a natural product with broad-spectrum antimicrobial properties and glycoprotein that is actively involved in innate immune host responses. Clinical trials have revealed its protective effect on sepsis, but lactoferrin dosage, duration, and role in the prevention of sepsis are still uncertain. Objective: We aimed to establish the efficacy of bovine lactoferrin in the prevention of late-onset sepsis and to determine the optimal dose and method of administering bovine lactoferrin that may contribute to improvement in overall survival of low birth weight infants. Methods: We will implement the study in 2 phases at the Aga Khan University Hospital. The first phase, which we have completed, was formative research. This phase mainly focused on a qualitative exploration of perceptions about feeding and caring practices of low birth weight newborns and a trial of improved practices for the preparation and administration of bovine lactoferrin to newborns. The second phase is a 3-arm double-blind randomized controlled trial. In this phase, we randomly allocated 2 different daily oral prophylactic doses of bovine lactoferrin (150 mg or 300 mg) and placebo to 300 low–birth weight neonates starting within the first 72 hours of birth and continuing for the first 28 days of life. Results: The study protocol was approved by the Ethics Review Committee of Aga Khan University on August 16, 2017. Data collection began in April 2018 and was completed in September 2020. Data analyses are yet to be completed. We expect the results to be published in peer-reviewed journals by autumn of 2021. Conclusions: This intervention, if effective, has the potential to be translated into a safe, affordable, and widely utilized treatment to prevent sepsis and, subsequently, may improve the survival outcomes of low birth weight neonates in Pakistan and other low- and middle-income countries. Trial Registration: ClinicalTrials.gov NCT03431558; https://clinicaltrials.gov/ct2/show/NCT03431558 International Registered Report Identifier (IRRID): PRR1-10.2196/23994 %M 33704071 %R 10.2196/23994 %U https://www.researchprotocols.org/2021/3/e23994 %U https://doi.org/10.2196/23994 %U http://www.ncbi.nlm.nih.gov/pubmed/33704071 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23365 %T Evidence Synthesis of Digital Interventions to Mitigate the Negative Impact of the COVID-19 Pandemic on Public Mental Health: Rapid Meta-review %A Rauschenberg,Christian %A Schick,Anita %A Hirjak,Dusan %A Seidler,Andreas %A Paetzold,Isabell %A Apfelbacher,Christian %A Riedel-Heller,Steffi G %A Reininghaus,Ulrich %+ Department of Public Mental Health, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, J5, Mannheim, 68159, Germany, 49 62117031929, christian.rauschenberg@zi-mannheim.de %K COVID-19 %K mHealth %K eHealth %K telemedicine %K prevention %K mental health promotion %K intervention %K digital mental health %K digital intervention %K public mental health %D 2021 %7 10.3.2021 %9 Review %J J Med Internet Res %G English %X Background: Accumulating evidence suggests the COVID-19 pandemic has negative effects on public mental health. Digital interventions that have been developed and evaluated in recent years may be used to mitigate the negative consequences of the pandemic. However, evidence-based recommendations on the use of existing telemedicine and internet-based (eHealth) and app-based mobile health (mHealth) interventions are lacking. Objective: The aim of this study was to investigate the theoretical and empirical base, user perspective, safety, effectiveness, and cost-effectiveness of digital interventions related to public mental health provision (ie, mental health promotion, prevention, and treatment of mental disorders) that may help to reduce the consequences of the COVID-19 pandemic. Methods: A rapid meta-review was conducted. The MEDLINE, PsycINFO, and CENTRAL databases were searched on May 11, 2020. Study inclusion criteria were broad and considered systematic reviews and meta-analyses that investigated digital tools for health promotion, prevention, or treatment of mental health conditions and determinants likely affected by the COVID-19 pandemic. Results: Overall, 815 peer-reviewed systematic reviews and meta-analyses were identified, of which 83 met the inclusion criteria. Our findings suggest that there is good evidence on the usability, safety, acceptance/satisfaction, and effectiveness of eHealth interventions. Evidence on mHealth apps is promising, especially if social components (eg, blended care) and strategies to promote adherence are incorporated. Although most digital interventions focus on the prevention or treatment of mental disorders, there is some evidence on mental health promotion. However, evidence on process quality, cost-effectiveness, and long-term effects is very limited. Conclusions: There is evidence that digital interventions are particularly suited to mitigating psychosocial consequences at the population level. In times of physical distancing, quarantine, and restrictions on social contacts, decision makers should develop digital strategies for continued mental health care and invest time and efforts in the development and implementation of mental health promotion and prevention programs. %M 33606657 %R 10.2196/23365 %U https://www.jmir.org/2021/3/e23365 %U https://doi.org/10.2196/23365 %U http://www.ncbi.nlm.nih.gov/pubmed/33606657 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e19473 %T Digital Health Solutions to Control the COVID-19 Pandemic in Countries With High Disease Prevalence: Literature Review %A R Niakan Kalhori,Sharareh %A Bahaadinbeigy,Kambiz %A Deldar,Kolsoum %A Gholamzadeh,Marsa %A Hajesmaeel-Gohari,Sadrieh %A Ayyoubzadeh,Seyed Mohammad %+ Department of Health Information Management, Tehran University of Medical Sciences, 3rd Floor, School of Allied Medical Sciences, No #17, Farredanesh Alley, Ghods St, Enghelab Ave, Tehran, Iran, 98 2188983025, s.m.ayyoubzadeh@gmail.com %K COVID-19 %K digital health %K information technology %K telemedicine %K electronic health %D 2021 %7 10.3.2021 %9 Review %J J Med Internet Res %G English %X Background: COVID-19, the disease caused by the novel coronavirus SARS-CoV-2, has become a global pandemic, affecting most countries worldwide. Digital health information technologies can be applied in three aspects, namely digital patients, digital devices, and digital clinics, and could be useful in fighting the COVID-19 pandemic. Objective: Recent reviews have examined the role of digital health in controlling COVID-19 to identify the potential of digital health interventions to fight the disease. However, this study aims to review and analyze the digital technology that is being applied to control the COVID-19 pandemic in the 10 countries with the highest prevalence of the disease. Methods: For this review, the Google Scholar, PubMed, Web of Science, and Scopus databases were searched in August 2020 to retrieve publications from December 2019 to March 15, 2020. Furthermore, the Google search engine was used to identify additional applications of digital health for COVID-19 pandemic control. Results: We included 32 papers in this review that reported 37 digital health applications for COVID-19 control. The most common digital health projects to address COVID-19 were telemedicine visits (11/37, 30%). Digital learning packages for informing people about the disease, geographic information systems and quick response code applications for real-time case tracking, and cloud- or mobile-based systems for self-care and patient tracking were in the second rank of digital tool applications (all 7/37, 19%). The projects were deployed in various European countries and in the United States, Australia, and China. Conclusions: Considering the potential of available information technologies worldwide in the 21st century, particularly in developed countries, it appears that more digital health products with a higher level of intelligence capability remain to be applied for the management of pandemics and health-related crises. %M 33600344 %R 10.2196/19473 %U https://www.jmir.org/2021/3/e19473 %U https://doi.org/10.2196/19473 %U http://www.ncbi.nlm.nih.gov/pubmed/33600344 %0 Journal Article %@ 2561-7605 %I JMIR Publications %V 4 %N 1 %P e26340 %T A New Tool for Detecting COVID-19 Psychological Burden Among Postacute and Long-term Care Residents (Mood-5 Scale): Observational Study %A Mansbach,William E %A Mace,Ryan A %A Tanner,Melissa A %+ Mansbach Health Tools, LLC, PO Box 307, Simpsonville, MD, 21150, United States, 1 4438967409, wmansbach@thebcat.com %K nursing homes %K long-term care %K COVID-19 %K depression %K stress %K coping %K burden %K mental health %K elderly %K older adults %K risk %K telehealth %K self-assessment %K scale %K mood %D 2021 %7 10.3.2021 %9 Original Paper %J JMIR Aging %G English %X Background: Older adults are at high risk for developing serious somatic and psychological symptoms associated with COVID-19. Currently available instruments may not be sensitive to the concerns about COVID-19 in postacute and long-term care and their applications in telehealth remain to be clarified. Objective: We investigated the psychometric properties of the Mood-5 Scale (M5) as a rapid self-assessment of the COVID-19 psychological burden among postacute and long-term care residents. Methods: Residents (N=131), aged 50 years and above, from 20 postacute and long-term care facilities in Maryland, USA, were evaluated in-person or via telehealth (43/131, 32.8%) across a 4-week period (May 11 to June 5, 2020) during the COVID-19 pandemic. The COVID-19 psychological burden experienced by the residents was rated by geriatric psychologists who independently reviewed their clinical documentation. Psychometric analyses were performed on the M5 in relation to psychological tests, COVID-19 psychological burden, and diagnostic data collected during the evaluation. Results: The M5 demonstrated acceptable internal consistency (Cronbach α=.77). M5 scores were not confounded by demographic variables or telehealth administration (P>.08). Convergent validity for the M5 was established via positive associations with anxiety (r=0.56, P<.001) and depressive (r=0.49, P<.001) symptoms. An M5 cutoff score of 3 demonstrated strong sensitivity (0.92) and adequate specificity (0.75) for identifying COVID-19 psychological distress among postacute and long-term care residents (area under the curve of 0.89, positive predictive value=0.79, negative predictive value=0.91). Conclusions: The M5 is a reliable and valid tool for self-assessment of mood that can help identify postacute and long-term care residents with significant psychological burden associated with COVID-19. It can be completed in less than 1 minute and is appropriate for use in both in-person and virtual visits. %M 33640866 %R 10.2196/26340 %U https://aging.jmir.org/2021/1/e26340 %U https://doi.org/10.2196/26340 %U http://www.ncbi.nlm.nih.gov/pubmed/33640866 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e24673 %T Behavioral Intention to Receive a COVID-19 Vaccination Among Chinese Factory Workers: Cross-sectional Online Survey %A Zhang,Ke Chun %A Fang,Yuan %A Cao,He %A Chen,Hongbiao %A Hu,Tian %A Chen,Yaqi %A Zhou,Xiaofeng %A Wang,Zixin %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, N.T., Hong Kong, 666888, China, 852 22528740, wangzx@cuhk.edu.hk %K COVID-19 %K vaccination %K behavioral intention %K perception %K social media influence %K personal preventive behaviors %K factory workers %K China %K social media %K vaccine %K behavior %K intention %K risk %D 2021 %7 9.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 vaccines will become available in China soon. Understanding communities’ responses to the forthcoming COVID-19 vaccines is important. We applied the theory of planned behavior as the theoretical framework. Objective: This study investigates the prevalence of and factors associated with behavioral intention to receive self-financed or free COVID-19 vaccinations among Chinese factory workers who resumed work during the pandemic. We examined the effects of factors including sociodemographics, perceptions related to COVID-19 vaccination, exposure to information about COVID-19 vaccination through social media, and COVID-19 preventive measures implemented by individuals and factories. Methods: Participants were full-time employees 18 years or older who worked in factories in Shenzhen. Factory workers in Shenzhen are required to receive a physical examination annually. Eligible workers attending six physical examination sites were invited to complete a survey on September 1-7, 2020. Out of 2653 eligible factory workers, 2053 (77.4%) completed the online survey. Multivariate two-level logistic regression models and ordinal logistic regression models were fitted. Results: The prevalence of behavioral intention to receive a COVID-19 vaccination was 66.6% (n=1368, conditional on 80% vaccine efficacy and market rate) and 80.6% (n=1655, conditional on 80% vaccine efficacy and free vaccines). After adjusting for significant background characteristics, positive attitudes toward COVID-19 vaccination (adjusted odds ratio [AOR] 1.20, 95% CI 1.15-1.25 and AOR 1.24, 95% CI 1.19-1.30), perceived support from significant others for getting a COVID-19 vaccination (AOR 1.43, 95% CI 1.32-1.55 and AOR 1.37, 95% CI 1.25-1.50), and perceived behavioral control to get a COVID-19 vaccination (AOR 1.51, 95% CI 1.32-1.73 and AOR 1.28, 95% CI 1.09-1.51) were positively associated with both dependent variables (conditional on 80% vaccine efficacy and market rate or free vaccines, respectively). Regarding social media influence, higher frequency of exposure to positive information related to COVID-19 vaccination was associated with a higher intention to receive a COVID-19 vaccination at market rate (AOR 1.53, 95% CI 1.39-1.70) or a free vaccination (AOR 1.52, 95% CI 1.35-1.71). Higher self-reported compliance with wearing a face mask in the workplace (AOR 1.27, 95% CI 1.02-1.58 and AOR 1.67, 95% CI 1.24-2.27) and other public spaces (AOR 1.80, 95% CI 1.42-2.29 and AOR 1.34, 95% CI 1.01-1.77), hand hygiene (AOR 1.21, 95% CI 1.00-1.47 and AOR 1.52, 95% CI 1.19-1.93), and avoiding social gatherings (AOR 1.22, 95% CI 1.01-1.47 and AOR 1.55, 95% CI 1.23-1.95) and crowded places (AOR 1.24, 95% CI 1.02-1.51 and AOR 1.73, 95% CI 1.37-2.18) were also positively associated with both dependent variables. The number of COVID-19 preventive measures implemented by the factory was positively associated with the intention to receive a COVID-19 vaccination under both scenarios (AOR 1.08, 95% CI 1.04-1.12 and AOR 1.06, 95% CI 1.01-1.11). Conclusions: Factory workers in China reported a high behavioral intention to receive a COVID-19 vaccination. The theory of planned behavior is a useful framework to guide the development of future campaigns promoting COVID-19 vaccination. %M 33646966 %R 10.2196/24673 %U https://www.jmir.org/2021/3/e24673 %U https://doi.org/10.2196/24673 %U http://www.ncbi.nlm.nih.gov/pubmed/33646966 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e24843 %T Early Improvement of Acute Respiratory Distress Syndrome in Patients With COVID-19 in the Intensive Care Unit: Retrospective Analysis %A Zhan,Zhu %A Yang,Xin %A Du,Hu %A Zhang,Chuanlai %A Song,Yuyan %A Ran,Xiaoyun %A Zhang,An %A Yang,Mei %+ Department of Intensive Care Unit, The Second Affiliated Hospital of Chongqing Medical University, 76 Linjiang Rd, Yuzhong District, Chongqing, 600010, China, 86 63693449, zhangan@hospital.cqmu.edu.cn %K acute respiratory distress syndrome %K ARDS %K Chongqing %K COVID-19 %K critically ill %K intensive care unit %K outcome %K characteristic %K mortality %K epidemiology %K improvement %D 2021 %7 9.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the start of the COVID-19 pandemic, there have been over 2 million deaths globally. Acute respiratory distress syndrome (ARDS) may be the main cause of death. Objective: This study aimed to describe the clinical features, outcomes, and ARDS characteristics of patients with COVID-19 admitted to the intensive care unit (ICU) in Chongqing, China. Methods: The epidemiology of COVID-19 from January 21, 2020, to March 15, 2020, in Chongqing, China, was analyzed retrospectively, and 75 ICU patients from two hospitals were included in this study. On day 1, 56 patients with ARDS were selected for subgroup analysis, and a modified Poisson regression was performed to identify predictors for the early improvement of ARDS (eiARDS). Results: Chongqing reported a 5.3% case fatality rate for the 75 ICU patients. The median age of these patients was 57 (IQR 25-75) years, and no bias was present in the sex ratio. A total of 93% (n=70) of patients developed ARDS during ICU stay, and more than half had moderate ARDS. However, most patients (n=41, 55%) underwent high-flow nasal cannula oxygen therapy, but not mechanical ventilation. Nearly one-third of patients with ARDS improved (arterial blood oxygen partial pressure/oxygen concentration >300 mm Hg) in 1 week, which was defined as eiARDS. Patients with eiARDS had a higher survival rate and a shorter length of ICU stay than those without eiARDS. Age (<55 years) was the only variable independently associated with eiARDS, with a risk ratio of 2.67 (95% CI 1.17-6.08). Conclusions: A new subphenotype of ARDS—eiARDS—in patients with COVID-19 was identified. As clinical outcomes differ, the stratified management of patients based on eiARDS or age is highly recommended. %M 33630743 %R 10.2196/24843 %U https://publichealth.jmir.org/2021/3/e24843 %U https://doi.org/10.2196/24843 %U http://www.ncbi.nlm.nih.gov/pubmed/33630743 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 3 %P e18933 %T Regional Resource Assessment During the COVID-19 Pandemic in Italy: Modeling Study %A Guzzi,Pietro H %A Tradigo,Giuseppe %A Veltri,Pierangelo %+ Department of Surgical and Medical Sciences, University of Catanzaro, Catanzaro, CZ, , Italy, 39 09613694148, hguzzi@unicz.it %K COVID-19 %K data analysis %K ICU %K management %K intensive care unit %K pandemic %K outbreak %K infectious disease %K resource %K planning %D 2021 %7 9.3.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: COVID-19 has been declared a worldwide emergency and a pandemic by the World Health Organization. It started in China in December 2019, and it rapidly spread throughout Italy, which was the most affected country after China. The pandemic affected all countries with similarly negative effects on the population and health care structures. Objective: The evolution of the COVID-19 infections and the way such a phenomenon can be characterized in terms of resources and planning has to be considered. One of the most critical resources has been intensive care units (ICUs) with respect to the infection trend and critical hospitalization. Methods: We propose a model to estimate the needed number of places in ICUs during the most acute phase of the infection. We also define a scalable geographic model to plan emergency and future management of patients with COVID-19 by planning their reallocation in health structures of other regions. Results: We applied and assessed the prediction method both at the national and regional levels. ICU bed prediction was tested with respect to real data provided by the Italian government. We showed that our model is able to predict, with a reliable error in terms of resource complexity, estimation parameters used in health care structures. In addition, the proposed method is scalable at different geographic levels. This is relevant for pandemics such as COVID-19, which has shown different case incidences even among northern and southern Italian regions. Conclusions: Our contribution can be useful for decision makers to plan resources to guarantee patient management, but it can also be considered as a reference model for potential upcoming waves of COVID-19 and similar emergency situations. %M 33629957 %R 10.2196/18933 %U https://medinform.jmir.org/2021/3/e18933 %U https://doi.org/10.2196/18933 %U http://www.ncbi.nlm.nih.gov/pubmed/33629957 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e14837 %T A Mobile App and Dashboard for Early Detection of Infectious Disease Outbreaks: Development Study %A Ahn,Euijoon %A Liu,Na %A Parekh,Tej %A Patel,Ronak %A Baldacchino,Tanya %A Mullavey,Tracy %A Robinson,Amanda %A Kim,Jinman %+ School of Computer Science, The University of Sydney, Rm 340, Level 3, J12, 1 Cleveland St, Darlington, 2006, Australia, 61 290369804, jinman.kim@sydney.edu.au %K public health %K infectious disease reporting %K mobile app %K disease notification %K mobile phone %D 2021 %7 9.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Outbreaks of infectious diseases pose great risks, including hospitalization and death, to public health. Therefore, improving the management of outbreaks is important for preventing widespread infection and mitigating associated risks. Mobile health technology provides new capabilities that can help better capture, monitor, and manage infectious diseases, including the ability to quickly identify potential outbreaks. Objective: This study aims to develop a new infectious disease surveillance (IDS) system comprising a mobile app for accurate data capturing and dashboard for better health care planning and decision making. Methods: We developed the IDS system using a 2-pronged approach: a literature review on available and similar disease surveillance systems to understand the fundamental requirements and face-to-face interviews to collect specific user requirements from the local public health unit team at the Nepean Hospital, Nepean Blue Mountains Local Health District, New South Wales, Australia. Results: We identified 3 fundamental requirements when designing an electronic IDS system, which are the ability to capture and report outbreak data accurately, completely, and in a timely fashion. We then developed our IDS system based on the workflow, scope, and specific requirements of the public health unit team. We also produced detailed design and requirement guidelines. In our system, the outbreak data are captured and sent from anywhere using a mobile device or a desktop PC (web interface). The data are processed using a client-server architecture and, therefore, can be analyzed in real time. Our dashboard is designed to provide a daily, weekly, monthly, and historical summary of outbreak information, which can be potentially used to develop a future intervention plan. Specific information about certain outbreaks can also be visualized interactively to understand the unique characteristics of emerging infectious diseases. Conclusions: We demonstrated the design and development of our IDS system. We suggest that the use of a mobile app and dashboard will simplify the overall data collection, reporting, and analysis processes, thereby improving the public health responses and providing accurate registration of outbreak information. Accurate data reporting and collection are a major step forward in creating a better intervention plan for future outbreaks of infectious diseases. %M 33687334 %R 10.2196/14837 %U https://publichealth.jmir.org/2021/3/e14837 %U https://doi.org/10.2196/14837 %U http://www.ncbi.nlm.nih.gov/pubmed/33687334 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e27107 %T An Acute Stress Scale for Health Care Professionals Caring for Patients With COVID-19: Validation Study %A Mira,Jose Joaquin %A Cobos,Angel %A Martínez García,Olga %A Bueno Domínguez,María José %A Astier-Peña,María Pilar %A Pérez Pérez,Pastora %A Carrillo,Irene %A Guilabert,Mercedes %A Perez-Jover,Virtudes %A Fernandez,Cesar %A Vicente,María Asuncion %A Lahera-Martin,Matilde %A Silvestre Busto,Carmen %A Lorenzo Martínez,Susana %A Sanchez Martinez,Ascension %A Martin-Delgado,Jimmy %A Mula,Aurora %A Marco-Gomez,Barbara %A Abad Bouzan,Cristina %A Aibar-Remon,Carlos %A Aranaz-Andres,Jesus %A , %+ Atenea Research Group, Foundation for the Promotion of Health and Biomedical Research, Hermanos López de Osaba, Alicante, Spain, 34 606433599, jose.mira@umh.es %K SARS-CoV-2 virus %K COVID-19 outbreak %K medical staff %K acute stress %K moral injury %K posttraumatic stress %K COVID-19 %D 2021 %7 9.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has affected the response capacity of the health care workforce, and health care professionals have been experiencing acute stress reactions since the beginning of the pandemic. In Spain, the first wave was particularly severe among the population and health care professionals, many of whom were infected. These professionals required initial psychological supports that were gradual and in line with their conditions. Objective: In the early days of the pandemic in Spain (March 2020), this study aimed to design and validate a scale to measure acute stress experienced by the health care workforce during the care of patients with COVID-19: the Self-applied Acute Stress Scale (EASE). Methods: Item development, scale development, and scale evaluation were considered. Qualitative research was conducted to produce the initial pool of items, assure their legibility, and assess the validity of the content. Internal consistency was calculated using Cronbach α and McDonald ω. Confirmatory factor analysis and the Mann-Whitney-Wilcoxon test were used to assess construct validity. Linear regression was applied to assess criterion validity. Back-translation methodology was used to translate the scale into Portuguese and English. Results: A total of 228 health professionals from the Spanish public health system responded to the 10 items of the EASE scale. Internal consistency was .87 (McDonald ω). Goodness-of-fit indices confirmed a two-factor structure, explaining 55% of the variance. As expected, the highest level of stress was found among professionals working in health services where a higher number of deaths from COVID-19 occurred (P<.05). Conclusions: The EASE scale was shown to have adequate metric properties regarding consistency and construct validity. The EASE scale could be used to determine the levels of acute stress among the health care workforce in order to give them proportional support according to their needs during emergency conditions, such as the COVID-19 pandemic. %M 33687343 %R 10.2196/27107 %U https://formative.jmir.org/2021/3/e27107 %U https://doi.org/10.2196/27107 %U http://www.ncbi.nlm.nih.gov/pubmed/33687343 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e26168 %T Rapid Design and Delivery of an Experience-Based Co-designed Mobile App to Support the Mental Health Needs of Health Care Workers Affected by the COVID-19 Pandemic: Impact Evaluation Protocol %A Lewis,Matthew %A Palmer,Victoria J %A Kotevski,Aneta %A Densley,Konstancja %A O'Donnell,Meaghan L %A Johnson,Caroline %A Wohlgezogen,Franz %A Gray,Kathleen %A Robins-Browne,Kate %A Burchill,Luke %+ Department of Medicine, The University of Melbourne, Royal Melbourne Hospital, 4th Floor, Clinical Sciences Building, Parkville, 3050, Australia, 61 3 8344 7161, blj@unimelb.edu.au %K mental health %K mobile applications %K COVID-19 %K health personnel %K experience-based co-design %K impact %K evaluation %K digital interventions %K app %K intervention %K health care worker %K design %K delivery %K support %D 2021 %7 9.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has highlighted the importance of health care workers’ mental health and well-being for the successful function of the health care system. Few targeted digital tools exist to support the mental health of hospital-based health care workers, and none of them appear to have been led and co-designed by health care workers. Objective: RMHive is being led and developed by health care workers using experience-based co-design (EBCD) processes as a mobile app to support the mental health challenges posed by the COVID-19 pandemic to health care workers. We present a protocol for the impact evaluation for the rapid design and delivery of the RMHive mobile app. Methods: The impact evaluation will adopt a mixed methods design. Qualitative data from photo interviews undertaken with up to 30 health care workers and semistructured interviews conducted with up to 30 governance stakeholders will be integrated with qualitative and quantitative user analytics data and user-generated demographic and mental health data entered into the app. Analyses will address three evaluation questions related to engagement with the mobile app, implementation and integration of the app, and the impact of the app on individual mental health outcomes. The design and development will be described using the Mobile Health Evidence Reporting and Assessment guidelines. Implementation of the app will be evaluated using normalization process theory to analyze qualitative data from interviews combined with text and video analysis from the semistructured interviews. Mental health impacts will be assessed using the total score of the 4-item Patient Health Questionnaire (PHQ4) and subscale scores for the 2-item Patient Health Questionnaire for depression and the 2-item Generalized Anxiety Scale for anxiety. The PHQ4 will be completed at baseline and at 14 and 28 days. Results: The anticipated average use period of the app is 30 days. The rapid design will occur over four months using EBCD to collect qualitative data and develop app content. The impact evaluation will monitor outcome data for up to 12 weeks following hospital-wide release of the minimal viable product release. The study received funding and ethics approvals in June 2020. Outcome data is expected to be available in March 2021, and the impact evaluation is expected to be published mid-2021. Conclusions: The impact evaluation will examine the rapid design, development, and implementation of the RMHive app and its impact on mental health outcomes for health care workers. Findings from the impact evaluation will provide guidance for the integration of EBCD in rapid design and implementation processes. The evaluation will also inform future development and rollout of the app to support the mental health needs of hospital-based health care workers more widely. International Registered Report Identifier (IRRID): DERR1-10.2196/26168 %M 33635823 %R 10.2196/26168 %U https://www.researchprotocols.org/2021/3/e26168 %U https://doi.org/10.2196/26168 %U http://www.ncbi.nlm.nih.gov/pubmed/33635823 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23703 %T A Comprehensive Overview of the COVID-19 Literature: Machine Learning–Based Bibliometric Analysis %A Abd-Alrazaq,Alaa %A Schneider,Jens %A Mifsud,Borbala %A Alam,Tanvir %A Househ,Mowafa %A Hamdi,Mounir %A Shah,Zubair %+ Division of Information and Computing Technology, College of Science and Engineering, Hamad Bin Khalifa University, Qatar Foundation, P.O. Box 5825, Doha Al Luqta St, Ar-Rayyan, Doha, 00000, Qatar, 974 55708549, zshah@hbku.edu.qa %K novel coronavirus disease %K COVID-19 %K SARS-CoV-2 %K 2019-nCoV %K bibliometric analysis %K literature %K machine learning %K research %K review %D 2021 %7 8.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Shortly after the emergence of COVID-19, researchers rapidly mobilized to study numerous aspects of the disease such as its evolution, clinical manifestations, effects, treatments, and vaccinations. This led to a rapid increase in the number of COVID-19–related publications. Identifying trends and areas of interest using traditional review methods (eg, scoping and systematic reviews) for such a large domain area is challenging. Objective: We aimed to conduct an extensive bibliometric analysis to provide a comprehensive overview of the COVID-19 literature. Methods: We used the COVID-19 Open Research Dataset (CORD-19) that consists of a large number of research articles related to all coronaviruses. We used a machine learning–based method to analyze the most relevant COVID-19–related articles and extracted the most prominent topics. Specifically, we used a clustering algorithm to group published articles based on the similarity of their abstracts to identify research hotspots and current research directions. We have made our software accessible to the community via GitHub. Results: Of the 196,630 publications retrieved from the database, we included 28,904 in our analysis. The mean number of weekly publications was 990 (SD 789.3). The country that published the highest number of COVID-19–related articles was China (2950/17,270, 17.08%). The highest number of articles were published in bioRxiv. Lei Liu affiliated with the Southern University of Science and Technology in China published the highest number of articles (n=46). Based on titles and abstracts alone, we were able to identify 1515 surveys, 733 systematic reviews, 512 cohort studies, 480 meta-analyses, and 362 randomized control trials. We identified 19 different topics covered among the publications reviewed. The most dominant topic was public health response, followed by clinical care practices during the COVID-19 pandemic, clinical characteristics and risk factors, and epidemic models for its spread. Conclusions: We provide an overview of the COVID-19 literature and have identified current hotspots and research directions. Our findings can be useful for the research community to help prioritize research needs and recognize leading COVID-19 researchers, institutes, countries, and publishers. Our study shows that an AI-based bibliometric analysis has the potential to rapidly explore a large corpus of academic publications during a public health crisis. We believe that this work can be used to analyze other eHealth-related literature to help clinicians, administrators, and policy makers to obtain a holistic view of the literature and be able to categorize different topics of the existing research for further analyses. It can be further scaled (for instance, in time) to clinical summary documentation. Publishers should avoid noise in the data by developing a way to trace the evolution of individual publications and unique authors. %M 33600346 %R 10.2196/23703 %U https://www.jmir.org/2021/3/e23703 %U https://doi.org/10.2196/23703 %U http://www.ncbi.nlm.nih.gov/pubmed/33600346 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23231 %T 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 %A Bowman,Leigh %A Kwok,Kin On %A Redd,Rozlyn %A Yi,Yuanyuan %A Ward,Helen %A Wei,Wan In %A Atchison,Christina %A Wong,Samuel Yeung-Shan %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 419, 4/F, JC School of Public Health and Primary Care Building, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, Hong Kong, 852 22528405, kkokwok@cuhk.edu.hk %K COVID-19 %K novel coronavirus %K pandemic %K behavioural response %K risk perceptions %K anxiety %K comparative %K Hong Kong %K United Kingdom %D 2021 %7 8.3.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33539309 %R 10.2196/23231 %U https://www.jmir.org/2021/3/e23231 %U https://doi.org/10.2196/23231 %U http://www.ncbi.nlm.nih.gov/pubmed/33539309 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e25724 %T Collaboration Structures in COVID-19 Critical Care: Retrospective Network Analysis Study %A Yan,Chao %A Zhang,Xinmeng %A Gao,Cheng %A Wilfong,Erin %A Casey,Jonathan %A France,Daniel %A Gong,Yang %A Patel,Mayur %A Malin,Bradley %A Chen,You %+ Department of Biomedical Informatics, Vanderbilt University Medical Center, 2525 West End Ave, Nashville, TN, 37203, United States, 1 615 343 1939, you.chen@vanderbilt.edu %K COVID-19 %K intensive care unit %K collaboration structure %K critically ill patient %K health care worker %K network analysis %K electronic health record %K collaboration %K critical care %K relationship %K safety %K teamwork %D 2021 %7 8.3.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: Few intensive care unit (ICU) staffing studies have examined the collaboration structures of health care workers (HCWs). Knowledge about how HCWs are connected to the care of critically ill patients with COVID-19 is important for characterizing the relationships among team structures, care quality, and patient safety. Objective: We aimed to discover differences in the teamwork structures of COVID-19 critical care by comparing HCW collaborations in the management of critically ill patients with and without COVID-19. Methods: In this retrospective study, we used network analysis methods to analyze the electronic health records (EHRs) of 76 critically ill patients (with COVID-19: n=38; without COVID-19: n=38) who were admitted to a large academic medical center, and to learn about HCW collaboration. We used the EHRs of adult patients who were admitted to the COVID-19 ICU at the Vanderbilt University Medical Center (Nashville, Tennessee, United States) between March 17, 2020, and May 31, 2020. We matched each patient according to age, gender, and their length of stay. Patients without COVID-19 were admitted to the medical ICU between December 1, 2019, and February 29, 2020. We used two sociometrics—eigencentrality and betweenness—to quantify HCWs’ statuses in networks. Eigencentrality characterizes the degree to which an HCW is a core person in collaboration structures. Betweenness centrality refers to whether an HCW lies on the path of other HCWs who are not directly connected. This sociometric was used to characterize HCWs’ broad skill sets. We measured patient staffing intensity in terms of the number of HCWs who interacted with patients’ EHRs. We assessed the statistical differences in the core and betweenness statuses of HCWs and the patient staffing intensities of COVID-19 and non–COVID-19 critical care, by using Mann-Whitney U tests and reporting 95% CIs. Results: HCWs in COVID-19 critical care were more likely to frequently work with each other (eigencentrality: median 0.096) than those in non–COVID-19 critical care (eigencentrality: median 0.057; P<.001). Internal medicine physicians in COVID-19 critical care had higher core statuses than those in non–COVID-19 critical care (P=.001). Nurse practitioners in COVID-19 care had higher betweenness statuses than those in non–COVID-19 care (P<.001). Compared to HCWs in non–COVID-19 settings, the EHRs of critically ill patients with COVID-19 were used by a larger number of internal medicine nurse practitioners (P<.001), cardiovascular nurses (P<.001), and surgical ICU nurses (P=.002) and a smaller number of resident physicians (P<.001). Conclusions: Network analysis methodologies and data on EHR use provide a novel method for learning about differences in collaboration structures between COVID-19 and non–COVID-19 critical care. Health care organizations can use this information to learn about the novel changes that the COVID-19 pandemic has imposed on collaboration structures in urgent care. %M 33621187 %R 10.2196/25724 %U https://humanfactors.jmir.org/2021/1/e25724 %U https://doi.org/10.2196/25724 %U http://www.ncbi.nlm.nih.gov/pubmed/33621187 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26482 %T Understanding Concerns, Sentiments, and Disparities Among Population Groups During the COVID-19 Pandemic Via Twitter Data Mining: Large-scale Cross-sectional Study %A Zhang,Chunyan %A Xu,Songhua %A Li,Zongfang %A Hu,Shunxu %+ Institute of Medical Artificial Intelligence, The Second Affiliate Hospital of Xi’an Jiaotong University, No.157 Xiwu Road, Xi'an, China, 86 18710823698, songhua_xu1@163.com %K COVID-19 %K Twitter mining %K infodemiology %K infoveillance %K pandemic %K concerns %K sentiments %K population groups %K disparities %D 2021 %7 5.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the beginning of the COVID-19 pandemic in late 2019, its far-reaching impacts have been witnessed globally across all aspects of human life, such as health, economy, politics, and education. Such widely penetrating impacts cast significant and profound burdens on all population groups, incurring varied concerns and sentiments among them. Objective: This study aims to identify the concerns, sentiments, and disparities of various population groups during the COVID-19 pandemic through a cross-sectional study conducted via large-scale Twitter data mining infoveillance. Methods: This study consisted of three steps: first, tweets posted during the pandemic were collected and preprocessed on a large scale; second, the key population attributes, concerns, sentiments, and emotions were extracted via a collection of natural language processing procedures; third, multiple analyses were conducted to reveal concerns, sentiments, and disparities among population groups during the pandemic. Overall, this study implemented a quick, effective, and economical approach for analyzing population-level disparities during a public health event. The source code developed in this study was released for free public use at GitHub. Results: A total of 1,015,655 original English tweets posted from August 7 to 12, 2020, were acquired and analyzed to obtain the following results. Organizations were significantly more concerned about COVID-19 (odds ratio [OR] 3.48, 95% CI 3.39-3.58) and expressed more fear and depression emotions than individuals. Females were less concerned about COVID-19 (OR 0.73, 95% CI 0.71-0.75) and expressed less fear and depression emotions than males. Among all age groups (ie, ≤18, 19-29, 30-39, and ≥40 years of age), the attention ORs of COVID-19 fear and depression increased significantly with age. It is worth noting that not all females paid less attention to COVID-19 than males. In the age group of 40 years or older, females were more concerned than males, especially regarding the economic and education topics. In addition, males 40 years or older and 18 years or younger were the least positive. Lastly, in all sentiment analyses, the sentiment polarities regarding political topics were always the lowest among the five topics of concern across all population groups. Conclusions: Through large-scale Twitter data mining, this study revealed that meaningful differences regarding concerns and sentiments about COVID-19-related topics existed among population groups during the study period. Therefore, specialized and varied attention and support are needed for different population groups. In addition, the efficient analysis method implemented by our publicly released code can be utilized to dynamically track the evolution of each population group during the pandemic or any other major event for better informed public health research and interventions. %M 33617460 %R 10.2196/26482 %U https://www.jmir.org/2021/3/e26482 %U https://doi.org/10.2196/26482 %U http://www.ncbi.nlm.nih.gov/pubmed/33617460 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e23843 %T A Patient-Initiated Digital COVID-19 Contact Notification Tool (TellYourContacts): Evaluation Study %A Okpara,Kelechi S %A Hecht,Jennifer %A Wohlfeiler,Dan %A Prior,Matthew %A Klausner,Jeffrey D %+ David Geffen School of Medicine, University of California, Los Angeles, 10833 Le Conte Ave, Los Angeles, CA, United States, 1 (310) 825 6373, kokpara@mednet.ucla.edu %K patient-led digital contact notification %K COVID-19 %K digital contact tracing %K contact notification website %D 2021 %7 5.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Contact notification is a method used to control the spread of infectious disease. In this process, a patient who tests positive for an infectious disease and public health officials work to identify the patient’s close contacts, notify them of their risk of possible exposure to the disease, and provide resources to facilitate the decreased spreading of disease. Contact notification can be done physically in person, via phone call, or digitally through the use of media such as SMS text messages and email. When alerts are made through the latter, it is called digital contact notification. Objective: For this study, we aim to perform a preliminary evaluation of the use of the TellYourContacts website, a digital contact notification tool for COVID-19 that can be used confidentially and anonymously. We will gather information about the number of website users and message senders, the types of messages sent, and the geographic distribution of senders. Methods: Patients who chose to get tested for COVID-19 and subsequently tested positive for the disease were alerted of their positive results through Curative Inc (a COVID-19 testing laboratory) and Healthvana (a results disclosure app). Included in the notification was a link to the TellYourContacts website and a message encouraging the person who tested positive for COVID-19 to use the website to alert their close contacts of exposure risk. Over the course of three months, from May 18, 2020, to August 17, 2020, we used Google Analytics and Microsoft Excel to record data on the number of website users and message senders, types of messages sent, and geographic distribution of the senders. Results: Over the course of three months, 9130 users accessed the website and 1474 unique senders sent a total of 1957 messages, which included 1820 (93%) SMS text messages and 137 (7%) emails. Users sent messages from 40 US states, with the majority of US senders residing in California (49%). Conclusions: We set out to determine if individuals who test positive for COVID-19 will use the TellYourContacts website to notify their close contacts of COVID-19 exposure risk. Our findings reveal that, during the observation period, each unique sender sent an average of 1.33 messages. The TellYourContacts website offers an additional method that individuals can and will use to notify their close contacts about a recent COVID-19 diagnosis. %M 33621189 %R 10.2196/23843 %U https://formative.jmir.org/2021/3/e23843 %U https://doi.org/10.2196/23843 %U http://www.ncbi.nlm.nih.gov/pubmed/33621189 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 3 %P e25220 %T Preservation of Person-Centered Care Through Videoconferencing for Patient Follow-up During the COVID-19 Pandemic: Case Study of a Multidisciplinary Care Team %A Silsand,Line %A Severinsen,Gro-Hilde %A Berntsen,Gro %+ Norwegian Centre for E-health Research, Sykehusveien 23, Tromsø, 9019, Norway, 47 91335053, line.silsand@ehealthresearch.no %K person-centered care %K rapid digitalization %K health care %K videoconferencing %K persons with complex, long-term needs %K COVID-19 %D 2021 %7 5.3.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The Patient-Centered Team (PACT) focuses on the transitional phase between hospital and primary care for older patients in Northern Norway with complex and long-term needs. PACT emphasizes a person-centered care approach whereby the sharing of power and the patient’s response to “What matters to you?” drive care decisions. However, during the COVID-19 pandemic, videoconferencing was the only option for assessing, planning, coordinating, and performing treatment and care. Objective: The aim of this study is to report the experience of the PACT multidisciplinary health care team in shifting rapidly from face-to-face care to using videoconferencing for clinical and collaborative services during the initial phase of the COVID-19 pandemic. This study explores how PACT managed to maintain person-centered care under these conditions. Methods: This case study takes a qualitative approach based on four semistructured focus group interviews carried out in May and June 2020 with 19 PACT members and leaders. Results: The case study illustrates that videoconferencing is a good solution for many persons with complex and long-term needs and generates new opportunities for interaction between patients and health care personnel. Persons with complex and long-term needs are a heterogeneous group, and for many patients with reduced cognitive capacity or hearing and vision impairment, the use of videoconferencing was challenging and required support from relatives or health care personnel. The study shows that using videoconferencing offered an opportunity to use health care personnel more efficiently, reduce travelling time for patients, and improve the information exchange between health care levels. This suggests that the integration of videoconferencing contributed to the preservation of the person-centered focus on care during the COVID-19 pandemic. There was an overall agreement in PACT that face-to-face care needed to be at the core of the person-centered care approach; the main use of videoconferencing was to support follow-up and coordination. Conclusions: The COVID-19 pandemic and the rapid adoption of digital care have generated a unique opportunity to continue developing a health service to both preserve and improve the person-centered care approach for persons with complex and long-term needs. This creates demand for overall agreements, including guidelines and procedures for how and when to use videoconferencing to supplement face-to-face treatment and care. Implementing videoconferencing in clinical practice generates a need for systematic training and familiarization with the equipment and technology as well as for an extensive support organization. Videoconferencing can then contribute to better preparing health care services for future scenarios. %M 33646965 %R 10.2196/25220 %U https://formative.jmir.org/2021/3/e25220 %U https://doi.org/10.2196/25220 %U http://www.ncbi.nlm.nih.gov/pubmed/33646965 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e25726 %T Adoption of COVID-19 Contact Tracing Apps: A Balance Between Privacy and Effectiveness %A Seto,Emily %A Challa,Priyanka %A Ware,Patrick %+ Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, 155 College Street, Suite 425, Toronto, ON, M5T 3M6, Canada, 1 416 669 9295, emily.seto@utoronto.ca %K mobile apps %K COVID-19 %K contact tracing %K exposure notification %K privacy %K effectiveness %K app %K surveillance %K tracing %K transmission %K security %K digital health %D 2021 %7 4.3.2021 %9 Viewpoint %J J Med Internet Res %G English %X With the relative ubiquity of smartphones, contact tracing and exposure notification apps have been looked to as novel methods to help reduce the transmission of COVID-19. Many countries have created apps that lie across a spectrum from privacy-first approaches to those that have very few privacy measures. The level of privacy incorporated into an app is largely based on the societal norms and values of a particular country. Digital health technologies can be highly effective and preserve privacy at the same time, but in the case of contact tracing and exposure notification apps, there is a trade-off between increased privacy measures and the effectiveness of the app. In this article, examples from various countries are used to highlight how characteristics of contract tracing and exposure notification apps contribute to the perceived levels of privacy awarded to citizens and how this impacts an app’s effectiveness. We conclude that finding the right balance between privacy and effectiveness, while critical, is challenging because it is highly context-specific. %M 33617459 %R 10.2196/25726 %U https://www.jmir.org/2021/3/e25726 %U https://doi.org/10.2196/25726 %U http://www.ncbi.nlm.nih.gov/pubmed/33617459 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 3 %P e24795 %T Bridging Learning in Medicine and Citizenship During the COVID-19 Pandemic: A Telehealth-Based Case Study %A Cerqueira-Silva,Thiago %A Carreiro,Roberto %A Nunes,Victor %A Passos,Louran %A Canedo,Bernardo F %A Andrade,Sofia %A Ramos,Pablo Ivan P %A Khouri,Ricardo %A Santos,Carolina Barbosa Souza %A Nascimento,Jedson Dos Santos %A Paste,Aurea Angélica %A Paiva Filho,Ivan De Mattos %A Santini-Oliveira,Marília %A Cruz,Álvaro %A Barral-Netto,Manoel %A Boaventura,Viviane %+ Universidade Federal da Bahia, Av. Adhemar de Barros, s/nº - Ondina, Salvador, 40170-110, Brazil, 55 (71) 3283 6017, viviane.boaventura@fiocruz.br %K medical education %K surveillance %K COVID-19 %K education %K telehealth %K training %K impact %K medical student %K triage %K epidemiology %K monitoring %D 2021 %7 4.3.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 presented great challenges for not only those in the field of health care but also those undergoing medical training. The burden on health care services worldwide has limited the educational opportunities available for medical students due to social distancing requirements. Objective: In this paper, we describe a strategy that combines telehealth and medical training to mitigate the adverse effects of the COVID-19 pandemic. Methods: A toll-free telescreening service, Telecoronavirus, began operations in March 2020. This service was operated remotely by supervised medical students and was offered across all 417 municipalities (14.8 million inhabitants) in the Brazilian state of Bahia. Students recorded clinical and sociodemographic data by using a web-based application that was simultaneously accessed by medical volunteers for supervision purposes, as well as by state health authorities who conducted epidemiological surveillance and health management efforts. In parallel, students received up-to-date scientific information about COVID-19 via short educational videos prepared by professors. A continuously updated triage algorithm was conceived to provide consistent service. Results: The program operated for approximately 4 months, engaging 1396 medical students and 133 physicians. In total, 111,965 individuals residing in 343 municipalities used this service. Almost 70,000 individuals were advised to stay at home, and they received guidance to avoid disease transmission, potentially contributing to localized reductions in the spread of COVID-19. Additionally, the program promoted citizenship education for medical students, who were engaged in a real-life opportunity to fight the pandemic within their own communities. The objectives of the education, organization, and assistance domains of the Telecoronavirus program were successfully achieved according to the results of a web-based post-project survey that assessed physicians’ and students’ perceptions. Conclusions: In a prolonged pandemic scenario, a combination of remote tools and medical supervision via telehealth services may constitute a useful strategy for maintaining social distancing measures while preserving some practical aspects of medical education. A low-cost tool such as the Telecoronavirus program could be especially valuable in resource-limited health care scenarios, in addition to offering support for epidemiological surveillance actions. %M 33630746 %R 10.2196/24795 %U https://publichealth.jmir.org/2021/3/e24795 %U https://doi.org/10.2196/24795 %U http://www.ncbi.nlm.nih.gov/pubmed/33630746 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e24211 %T Molecular and Cellular Biomarkers of COVID-19 Prognosis: Protocol for the Prospective Cohort TARGET Study %A Kurizky,Patricia %A Nóbrega,Otávio T %A Soares,Alexandre Anderson De Sousa Munhoz %A Aires,Rodrigo Barbosa %A Albuquerque,Cleandro Pires De %A Nicola,André Moraes %A Albuquerque,Patrícia %A Teixeira-Carvalho,Andréa %A Naves,Luciana Ansaneli %A Fontes,Wagner %A Luz,Isabelle Souza %A Felicori,Liza %A Gomides,Ana Paulo Monteiro %A Mendonça-Silva,Dayde Lane %A Espindola,Laila Salmen %A Martins-Filho,Olindo Assis %A de Lima,Sheila Maria Barbosa %A Mota,Licia Maria Henrique %A Gomes,Ciro Martins %+ Programa de Pós-graduação em Ciências Médicas da Faculdade de Medicina, University of Brasília, Laboratório de Dermatomicologia - Faculdade de Medicina da UnB, Campus Universitário Darcy Ribeiro, Brasilia, 70910-900, Brazil, 55 61 98114 8432, patyshu79@gmail.com %K COVID-19 %K TARGET %K cytokine profile %K neutrophil function %K thromboelastometry %K neutralizing antibodies %K metabolomics %K proteomics %K biomarker %K prognosis %K design %K cohort %K virus %K immunology %K immune system %K genetics %D 2021 %7 4.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Since the beginning of the COVID-19 pandemic, the world’s attention has been focused on better understanding the relation between the human host and the SARS-CoV-2 virus, as its action has led to hundreds of thousands of deaths. Objective: In this context, we decided to study certain consequences of the abundant cytokine release over the innate and adaptive immune systems, inflammation, and hemostasis, comparing mild and severe forms of COVID-19. Methods: To accomplish these aims, we will analyze demographic characteristics, biochemical tests, immune biomarkers, leukocyte phenotyping, immunoglobulin profile, hormonal release (cortisol and prolactin), gene expression, thromboelastometry, neutralizing antibodies, metabolic profile, and neutrophil function (reactive oxygen species production, neutrophil extracellular trap production, phagocytosis, migration, gene expression, and proteomics). A total of 200 reverse transcription polymerase chain reaction–confirmed patients will be enrolled and divided into two groups: mild/moderate or severe/critical forms of COVID-19. Blood samples will be collected at different times: at inclusion and after 9 and 18 days, with an additional 3-day sample for severe patients. We believe that this information will provide more knowledge for future studies that will provide more robust and useful clinical information that may allow for better decisions at the front lines of health care. Results: The recruitment began in June 2020 and is still in progress. It is expected to continue until February 2021. Data analysis is scheduled to start after all data have been collected. The coagulation study branch is complete and is already in the analysis phase. Conclusions: This study is original in terms of the different parameters analyzed in the same sample of patients with COVID-19. The project, which is currently in the data collection phase, was approved by the Brazilian Committee of Ethics in Human Research (CAAE 30846920.7.0000.0008). Trial Registration: Brazilian Registry of Clinical Trials RBR-62zdkk; https://ensaiosclinicos.gov.br/rg/RBR-62zdkk International Registered Report Identifier (IRRID): DERR1-10.2196/24211 %M 33661132 %R 10.2196/24211 %U https://www.researchprotocols.org/2021/3/e24211 %U https://doi.org/10.2196/24211 %U http://www.ncbi.nlm.nih.gov/pubmed/33661132 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 3 %P e21242 %T Improving the Understanding of the Immunopathogenesis of Lymphopenia as a Correlate of SARS-CoV-2 Infection Risk and Disease Progression in African Patients: Protocol for a Cross-sectional Study %A Iwalokun,Bamidele Abiodun %A Olalekan,Adesola %A Adenipekun,Eyitayo %A Ojo,Olabisi %A Iwalokun,Senapon Olusola %A Mutiu,Bamidele %A Orija,Oluseyi %A Adegbola,Richard %A Salako,Babatunde %A Akinloye,Oluyemi %+ Nigerian Institute of Medical Research, 6 Edmund Crescent, Yaba-Lagos, PMB 2013, Lagos, 23401, Nigeria, 234 08023357646, ba.iwalokun@nimr.ov.ng %K SARS-COV-2 infection %K COVID-19 %K lymphopenia %K immunopathogenesis %K Nigeria %D 2021 %7 4.3.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic, caused by SARS-CoV-2, continues to impact health systems throughout the world with serious medical challenges being imposed on many African countries like Nigeria. Although emerging studies have identified lymphopenia as a driver of cytokine storm, disease progression, and poor outcomes in infected patients, its immunopathogenesis, as well as environmental and genetic determinants, remain unclear. Understanding the interplay of these determinants in the context of lymphopenia and COVID-19 complications in patients in Africa may help with risk stratification and appropriate deployment of targeted treatment regimens with repurposed drugs to improve prognosis. Objective: This study is designed to investigate the role of vitamin D status, vasculopathy, apoptotic pathways, and vitamin D receptor (VDR) gene polymorphisms in the immunopathogenesis of lymphopenia among African people infected with SARS-CoV-2. Methods: This cross-sectional study will enroll 230 participants, categorized as “SARS-CoV-2 negative” (n=69), “COVID-19 mild” (n=32), “hospitalized” (n=92), and “recovered” (n=37), from two health facilities in Lagos, Nigeria. Sociodemographic data, travel history, and information on comorbidities will be obtained from case files and through a pretested, interview-based structured questionnaire. Venous blood samples (5 mL) collected between 8 AM and 10 AM and aliquoted into EDTA (ethylenediaminetetraacetic acid) and plain tubes will be used for complete blood count and CD4 T cell assays to determine lymphopenia (lymphocyte count <1000 cells/µL) and CD4 T lymphocyte levels, as well as to measure the concentrations of vitamin D, caspase 3, soluble vascular cell adhesion molecule-1 (sVCAM-1), and soluble Fas ligand (sFasL) using an autoanalyzer, flow cytometry, and ELISA (enzyme-linked immunosorbent assay) techniques. Genomic DNA will be extracted from the buffy coat and used as a template for the amplification of apoptosis-related genes (Bax, Bcl-2, BCL2L12) by polymerase chain reaction (PCR) and genotyping of VDR (Apa1, Fok1, and Bsm1) gene polymorphisms by the PCR restriction fragment length polymorphism method and capillary sequencing. Total RNA will also be extracted, reverse transcribed, and subsequently quantitated by reverse transcription PCR (RT-PCR) to monitor the expression of apoptosis genes in the four participant categories. Data analyses, which include a test of association between VDR gene polymorphisms and study outcomes (lymphopenia and hypovitaminosis D prevalence, mild/moderate and severe infections) will be performed using the R statistical software. Hardy-Weinberg equilibrium and linkage disequilibrium analyses for the alleles, genotypes, and haplotypes of the genotyped VDR gene will also be carried out. Results: A total of 45 participants comprising 37 SARS-CoV-2–negative and 8 COVID-19–recovered individuals have been enrolled so far. Their complete blood counts and CD4 T lymphocyte counts have been determined, and their serum samples and genomic DNA and RNA samples have been extracted and stored at –20 °C until further analyses. Other expected outcomes include the prevalence and distribution of lymphopenia and hypovitaminosis D in the control (SARS-CoV-2 negative), confirmed, hospitalized, and recovered SARS-CoV-2–positive participants; association of lymphopenia with CD4 T lymphocyte level, serum vitamin D, sVCAM-1, sFasL, and caspase 3 levels in hospitalized patients with COVID-19; expression levels of apoptosis-related genes among hospitalized participants with COVID-19, and those with lymphopenia compared to those without lymphopenia; and frequency distribution of the alleles, genotypes, and haplotypes of VDR gene polymorphisms in COVID-19–infected participants. Conclusions: This study will aid in the genotypic and phenotypic stratification of COVID-19–infected patients in Nigeria with and without lymphopenia to enable biomarker discovery and pave the way for the appropriate and timely deployment of patient-centered treatments to improve prognosis. International Registered Report Identifier (IRRID): DERR1-10.2196/21242 %M 33621190 %R 10.2196/21242 %U https://www.researchprotocols.org/2021/3/e21242 %U https://doi.org/10.2196/21242 %U http://www.ncbi.nlm.nih.gov/pubmed/33621190 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26516 %T Cost-effectiveness of a Telemonitoring Program for Patients With Heart Failure During the COVID-19 Pandemic in Hong Kong: Model Development and Data Analysis %A Jiang,Xinchan %A Yao,Jiaqi %A You,Joyce Hoi-Sze %+ School of Pharmacy, Faculty of Medicine, The Chinese University of Hong Kong, 8th Floor, Lo Kwee-Seong Integrated Biomedical Sciences Building, Shatin, NT, Hong Kong, China (Hong Kong), 852 39436830, joyceyou@cuhk.edu.hk %K telemonitoring %K mobile health %K smartphone %K heart failure %K COVID-19 %K health care avoidance %K cost-effectiveness %D 2021 %7 3.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has caused patients to avoid seeking medical care. Provision of telemonitoring programs in addition to usual care has demonstrated improved effectiveness in managing patients with heart failure (HF). Objective: We aimed to examine the potential clinical and health economic outcomes of a telemonitoring program for management of patients with HF during the COVID-19 pandemic from the perspective of health care providers in Hong Kong. Methods: A Markov model was designed to compare the outcomes of a care under COVID-19 (CUC) group and a telemonitoring plus CUC group (telemonitoring group) in a hypothetical cohort of older patients with HF in Hong Kong. The model outcome measures were direct medical cost, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratio. Sensitivity analyses were performed to examine the model assumptions and the robustness of the base-case results. Results: In the base-case analysis, the telemonitoring group showed a higher QALY gain (1.9007) at a higher cost (US $15,888) compared to the CUC group (1.8345 QALYs at US $15,603). Adopting US $48,937/QALY (1 × the gross domestic product per capita of Hong Kong) as the willingness-to-pay threshold, telemonitoring was accepted as a highly cost-effective strategy, with an incremental cost-effective ratio of US $4292/QALY. No threshold value was identified in the deterministic sensitivity analysis. In the probabilistic sensitivity analysis, telemonitoring was accepted as cost-effective in 99.22% of 10,000 Monte Carlo simulations. Conclusions: Compared to the current outpatient care alone under the COVID-19 pandemic, the addition of telemonitoring-mediated management to the current care for patients with HF appears to be a highly cost-effective strategy from the perspective of health care providers in Hong Kong. %M 33656440 %R 10.2196/26516 %U https://www.jmir.org/2021/3/e26516 %U https://doi.org/10.2196/26516 %U http://www.ncbi.nlm.nih.gov/pubmed/33656440 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26399 %T Health Care Students’ Knowledge of and Attitudes, Beliefs, and Practices Toward the French COVID-19 App: Cross-sectional Questionnaire Study %A Montagni,Ilaria %A Roussel,Nicolas %A Thiébaut,Rodolphe %A Tzourio,Christophe %+ Bordeaux Population Health Research Center, U1219, Bordeaux University, INSERM, 146 rue Léo Saignat, Bordeaux, 33000, France, 33 05 57 57 16 5, ilaria.montagni@u-bordeaux.fr %K contact tracing %K COVID-19 %K mobile app %K students %K field survey %K app %K survey %K monitoring %K knowledge %K attitude %K belief %K practice %K communication %K use %D 2021 %7 3.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Many countries worldwide have developed mobile phone apps capable of supporting instantaneous contact tracing to control the COVID-19 pandemic. In France, a few people have downloaded and are using the StopCovid contact tracing app. Students in the health domain are of particular concern in terms of app uptake. Exploring their use and opinions about the app can inform improvements and diffusion of StopCovid among young people. Objective: The aim of this study is to investigate health care students’ knowledge of and attitudes, beliefs, and practices (KABP) toward the StopCovid app. Methods: A field survey was conducted among 318 students at the health sciences campus of the University of Bordeaux, France, between September 25 and October 16, 2020. A quota sampling method was used, and descriptive statistics and univariate analyses were performed. Results: Of the 318 respondents, 77.3% (n=246) had heard about the app, but only 11.3% (n=36) had downloaded it, and 4.7% (n=15) were still using it at the time of the survey. Among the 210 participants who had heard about the app but did not download it, the main reasons for not using the app were a belief that it was not effective given its limited diffusion (n=37, 17.6%), a lack of interest (n=37, 17.6%), and distrust in the data security and fear of being geolocated (n=33, 15.7%). Among the 72 students who had not heard of the app and were given a brief description of its functioning and confidentiality policy, 52.7% (n=38) said they would use it. Participants reported that the main solution for increasing the use of the app would be better communication about it (227/318, 71.4%). Conclusions: Even among health students, the contact tracing app was poorly used. The findings suggest that improved communication about its advantages and simplicity of use as well as clarifying false beliefs about it could help improve uptake. %M 33566793 %R 10.2196/26399 %U https://www.jmir.org/2021/3/e26399 %U https://doi.org/10.2196/26399 %U http://www.ncbi.nlm.nih.gov/pubmed/33566793 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e23362 %T Barriers to the Large-Scale Adoption of a COVID-19 Contact Tracing App in Germany: Survey Study %A Blom,Annelies G %A Wenz,Alexander %A Cornesse,Carina %A Rettig,Tobias %A Fikel,Marina %A Friedel,Sabine %A Möhring,Katja %A Naumann,Elias %A Reifenscheid,Maximiliane %A Krieger,Ulrich %+ School of Social Sciences, University of Mannheim, A5, 6, Mannheim, 68131, Germany, 49 621 181 2298, a.wenz@uni-mannheim.de %K digital health %K mobile health %K smartphone %K mobile phone %K app %K digital technology %K contact tracing %K coronavirus %K COVID-19 %K survey %D 2021 %7 2.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, one way to reduce further transmissions of SARS-CoV-2 is the widespread use of contact tracing apps. Such apps keep track of proximity contacts and warn contacts of persons who tested positive for an infection. Objective: In this study, we analyzed potential barriers to the large-scale adoption of the official contact tracing app that was introduced in Germany on June 16, 2020. Methods: Survey data were collected from 3276 adults during the week the app was introduced using an offline-recruited, probability-based online panel of the general adult population in Germany. Results: We estimate that 81% of the population aged 18 to 77 years possess the devices and ability to install the official app and that 35% are also willing to install and use it. Potential spreaders show high access to devices required to install the app (92%) and high ability to install the app (91%) but low willingness (31%) to correctly adopt the app, whereas for vulnerable groups, the main barrier is access (62%). Conclusions: The findings suggest a pessimistic view on the effectiveness of app-based contact tracing to contain the COVID-19 pandemic. We recommend targeting information campaigns at groups with a high potential to spread the virus but who are unwilling to install and correctly use the app, in particular men and those aged between 30 and 59 years. In addition, vulnerable groups, in particular older individuals and those in lower-income households, may be provided with equipment and support to overcome their barriers to app adoption. %M 33577466 %R 10.2196/23362 %U https://www.jmir.org/2021/3/e23362 %U https://doi.org/10.2196/23362 %U http://www.ncbi.nlm.nih.gov/pubmed/33577466 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 3 %P e24322 %T Health Apps for Combating COVID-19: Descriptive Review and Taxonomy %A Almalki,Manal %A Giannicchi,Anna %+ Department of Health Informatics, Faculty of Public Health and Tropical Medicine, Jazan University, Gizan, Jazan, 82726, Saudi Arabia, 966 597636563, manal_almalki@hotmail.com %K app %K COVID-19 %K corona %K self-care %K personal tracking %K review %K mHealth %K track %K surveillance %K awareness %K exposure %K consumer health informatics %D 2021 %7 2.3.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile phone apps have been leveraged to combat the spread of COVID-19. However, little is known about these technologies’ characteristics, technical features, and various applications in health care when responding to this public health crisis. The lack of understanding has led developers and governments to make poor choices about apps’ designs, which resulted in creating less useful apps that are overall less appealing to consumers due to their technical flaws. Objective: This review aims to identify, analyze, and categorize health apps related to COVID-19 that are currently available for consumers in app stores; in particular, it focuses on exploring their key technical features and classifying the purposes that these apps were designed to serve. Methods: A review of health apps was conducted using the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. The Apple Store and Google Play were searched between April 20 and September 11, 2020. An app was included if it was dedicated for this disease and was listed under the health and medical categories in these app stores. The descriptions of these apps were extracted from the apps’ web pages and thematically analyzed via open coding to identify both their key technical features and overall purpose. The characteristics of the included apps were summarized and presented with descriptive statistics. Results: Of the 298 health apps that were initially retrieved, 115 met the inclusion criteria. A total of 29 technical features were found in our sample of apps, which were then categorized into five key purposes of apps related to COVID-19. A total of 77 (67%) apps were developed by governments or national authorities and for the purpose of promoting users to track their personal health (9/29, 31%). Other purposes included raising awareness on how to combat COVID-19 (8/29, 27%), managing exposure to COVID-19 (6/29, 20%), monitoring health by health care professionals (5/29, 17%), and conducting research studies (1/29, 3.5%). Conclusions: This study provides an overview and taxonomy of the health apps currently available in the market to combat COVID-19 based on their differences in basic technical features and purpose. As most of the apps were provided by governments or national authorities, it indicates the essential role these apps have as tools in public health crisis management. By involving most of the population in self-tracking their personal health and providing them with the technology to self-assess, the role of these apps is deemed to be a key driver for a participatory approach to curtail the spread of COVID-19. Further effort is required from researchers to evaluate these apps’ effectiveness and from governmental organizations to increase public awareness of these digital solutions. %M 33626017 %R 10.2196/24322 %U https://mhealth.jmir.org/2021/3/e24322 %U https://doi.org/10.2196/24322 %U http://www.ncbi.nlm.nih.gov/pubmed/33626017 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 3 %P e26559 %T Exploring Usage of COVID Coach, a Public Mental Health App Designed for the COVID-19 Pandemic: Evaluation of Analytics Data %A Jaworski,Beth K %A Taylor,Katherine %A Ramsey,Kelly M %A Heinz,Adrienne %A Steinmetz,Sarah %A Pagano,Ian %A Moraja,Giovanni %A Owen,Jason E %+ National Center for PTSD, Dissemination & Training Division, US Department of Veterans Affairs, 795 Willow Road, Menlo Park, CA, 94025, United States, 1 650 308 9437, beth.jaworski@va.gov %K COVID-19 %K coronavirus %K mobile app %K mHealth %K digital health %K mental health %K public mental health %K stress %K coping %K public health %K app %D 2021 %7 1.3.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has significantly impacted mental health and well-being. Mobile mental health apps can be scalable and useful tools in large-scale disaster responses and are particularly promising for reaching vulnerable populations. COVID Coach is a free, evidence-informed mobile app designed specifically to provide tools and resources for addressing COVID-19–related stress. Objective: The purpose of this study was to characterize the overall usage of COVID Coach, explore retention and return usage, and assess whether the app was reaching individuals who may benefit from mental health resources. Methods: Anonymous usage data collected from COVID Coach between May 1, 2020, through October 31, 2020, were extracted and analyzed for this study. The sample included 49,287 unique user codes and 3,368,931 in-app events. Results: Usage of interactive tools for coping and stress management comprised the majority of key app events (n=325,691, 70.4%), and the majority of app users tried a tool for managing stress (n=28,009, 58.8%). COVID Coach was utilized for ≤3 days by 80.9% (n=34,611) of the sample whose first day of app use occurred within the 6-month observation window. Usage of the key content in COVID Coach predicted returning to the app for a second day. Among those who tried at least one coping tool on their first day of app use, 57.2% (n=11,444) returned for a second visit; whereas only 46.3% (n=10,546) of those who did not try a tool returned (P<.001). Symptoms of anxiety, depression, and posttraumatic stress disorder (PTSD) were prevalent among app users. For example, among app users who completed an anxiety assessment on their first day of app use (n=4870, 11.4% of users), 55.1% (n=2680) reported levels of anxiety that were moderate to severe, and 29.9% (n=1455) of scores fell into the severe symptom range. On average, those with moderate levels of depression on their first day of app use returned to the app for a greater number of days (mean 3.72 days) than those with minimal symptoms (mean 3.08 days; t1=3.01, P=.003). Individuals with significant PTSD symptoms on their first day of app use utilized the app for a significantly greater number of days (mean 3.79 days) than those with fewer symptoms (mean 3.13 days; t1=2.29, P=.02). Conclusions: As the mental health impacts of the pandemic continue to be widespread and increasing, digital health resources, such as apps like COVID Coach, are a scalable way to provide evidence-informed tools and resources. Future research is needed to better understand for whom and under what conditions the app is most helpful and how to increase and sustain engagement. %M 33606656 %R 10.2196/26559 %U https://www.jmir.org/2021/3/e26559 %U https://doi.org/10.2196/26559 %U http://www.ncbi.nlm.nih.gov/pubmed/33606656 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23720 %T Influence of Health Beliefs on Adherence to COVID-19 Preventative Practices: International, Social Media–Based Survey Study %A Hsing,Julianna C %A Ma,Jasmin %A Barrero-Castillero,Alejandra %A Jani,Shilpa G %A Pulendran,Uma Palam %A Lin,Bea-Jane %A Thomas-Uribe,Monika %A Wang,C Jason %+ Center for Policy, Outcomes, and Prevention, Department of Pediatrics, Stanford University School of Medicine, 117 Encina Commons, CHP/PCOR, Stanford, CA, 94305, United States, 1 (650) 736 0403, cjwang1@stanford.edu %K COVID-19 pandemic %K health belief model %K behavior change %K preventative health behaviors %K handwashing %K social distancing %K international %K online survey %K social media %K cross-sectional study %D 2021 %7 26.2.2021 %9 Original Paper %J J Med Internet Res %G English %X 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 (χ23=2169.7, P<.001), while respondents from Taiwan performed the most handwashing (χ23=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. %M 33571103 %R 10.2196/23720 %U https://www.jmir.org/2021/2/e23720 %U https://doi.org/10.2196/23720 %U http://www.ncbi.nlm.nih.gov/pubmed/33571103 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23458 %T Using Automated Machine Learning to Predict the Mortality of Patients With COVID-19: Prediction Model Development Study %A Ikemura,Kenji %A Bellin,Eran %A Yagi,Yukako %A Billett,Henny %A Saada,Mahmoud %A Simone,Katelyn %A Stahl,Lindsay %A Szymanski,James %A Goldstein,D Y %A Reyes Gil,Morayma %+ Department of Pathology, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E 210th St, The Bronx, NY, 10467, United States, 1 9493703777, kikemura@montefiore.org %K automated machine learning %K COVID-19 %K biomarker %K ranking %K decision support tool %K machine learning %K decision support %K Shapley additive explanation %K partial dependence plot %K dimensionality reduction %D 2021 %7 26.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During a pandemic, it is important for clinicians to stratify patients and decide who receives limited medical resources. Machine learning models have been proposed to accurately predict COVID-19 disease severity. Previous studies have typically tested only one machine learning algorithm and limited performance evaluation to area under the curve analysis. To obtain the best results possible, it may be important to test different machine learning algorithms to find the best prediction model. Objective: In this study, we aimed to use automated machine learning (autoML) to train various machine learning algorithms. We selected the model that best predicted patients’ chances of surviving a SARS-CoV-2 infection. In addition, we identified which variables (ie, vital signs, biomarkers, comorbidities, etc) were the most influential in generating an accurate model. Methods: Data were retrospectively collected from all patients who tested positive for COVID-19 at our institution between March 1 and July 3, 2020. We collected 48 variables from each patient within 36 hours before or after the index time (ie, real-time polymerase chain reaction positivity). Patients were followed for 30 days or until death. Patients’ data were used to build 20 machine learning models with various algorithms via autoML. The performance of machine learning models was measured by analyzing the area under the precision-recall curve (AUPCR). Subsequently, we established model interpretability via Shapley additive explanation and partial dependence plots to identify and rank variables that drove model predictions. Afterward, we conducted dimensionality reduction to extract the 10 most influential variables. AutoML models were retrained by only using these 10 variables, and the output models were evaluated against the model that used 48 variables. Results: Data from 4313 patients were used to develop the models. The best model that was generated by using autoML and 48 variables was the stacked ensemble model (AUPRC=0.807). The two best independent models were the gradient boost machine and extreme gradient boost models, which had an AUPRC of 0.803 and 0.793, respectively. The deep learning model (AUPRC=0.73) was substantially inferior to the other models. The 10 most influential variables for generating high-performing models were systolic and diastolic blood pressure, age, pulse oximetry level, blood urea nitrogen level, lactate dehydrogenase level, D-dimer level, troponin level, respiratory rate, and Charlson comorbidity score. After the autoML models were retrained with these 10 variables, the stacked ensemble model still had the best performance (AUPRC=0.791). Conclusions: We used autoML to develop high-performing models that predicted the survival of patients with COVID-19. In addition, we identified important variables that correlated with mortality. This is proof of concept that autoML is an efficient, effective, and informative method for generating machine learning–based clinical decision support tools. %M 33539308 %R 10.2196/23458 %U https://www.jmir.org/2021/2/e23458 %U https://doi.org/10.2196/23458 %U http://www.ncbi.nlm.nih.gov/pubmed/33539308 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 2 %P e23427 %T An Automated Patient Self-Monitoring System to Reduce Health Care System Burden During the COVID-19 Pandemic in Malaysia: Development and Implementation Study %A Lim,Hooi Min %A Teo,Chin Hai %A Ng,Chirk Jenn %A Chiew,Thiam Kian %A Ng,Wei Leik %A Abdullah,Adina %A Abdul Hadi,Haireen %A Liew,Chee Sun %A Chan,Chee Seng %+ eHealth Unit, Faculty of Medicine, University of Malaya, Kuala Lumpur, 50603, Malaysia, 60 142204126, ngcj@um.edu.my %K COVID-19 %K coronavirus disease %K home monitoring %K symptom monitoring %K system %K teleconsultation %K development %K eHealth %K digital health %K mHealth %K health services research %K telesurveillance %K infectious disease %K app %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: During the COVID-19 pandemic, there was an urgent need to develop an automated COVID-19 symptom monitoring system to reduce the burden on the health care system and to provide better self-monitoring at home. Objective: This paper aimed to describe the development process of the COVID-19 Symptom Monitoring System (CoSMoS), which consists of a self-monitoring, algorithm-based Telegram bot and a teleconsultation system. We describe all the essential steps from the clinical perspective and our technical approach in designing, developing, and integrating the system into clinical practice during the COVID-19 pandemic as well as lessons learned from this development process. Methods: CoSMoS was developed in three phases: (1) requirement formation to identify clinical problems and to draft the clinical algorithm, (2) development testing iteration using the agile software development method, and (3) integration into clinical practice to design an effective clinical workflow using repeated simulations and role-playing. Results: We completed the development of CoSMoS in 19 days. In Phase 1 (ie, requirement formation), we identified three main functions: a daily automated reminder system for patients to self-check their symptoms, a safe patient risk assessment to guide patients in clinical decision making, and an active telemonitoring system with real-time phone consultations. The system architecture of CoSMoS involved five components: Telegram instant messaging, a clinician dashboard, system administration (ie, back end), a database, and development and operations infrastructure. The integration of CoSMoS into clinical practice involved the consideration of COVID-19 infectivity and patient safety. Conclusions: This study demonstrated that developing a COVID-19 symptom monitoring system within a short time during a pandemic is feasible using the agile development method. Time factors and communication between the technical and clinical teams were the main challenges in the development process. The development process and lessons learned from this study can guide the future development of digital monitoring systems during the next pandemic, especially in developing countries. %M 33600345 %R 10.2196/23427 %U https://medinform.jmir.org/2021/2/e23427 %U https://doi.org/10.2196/23427 %U http://www.ncbi.nlm.nih.gov/pubmed/33600345 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 2 %P e23335 %T Utilization of Telehealth Services in Libya in Response to the COVID-19 Pandemic: Cross-sectional Analysis %A Elhadi,Muhammed %A Msherghi,Ahmed %A Elhadi,Ahmed %A Ashini,Aimen %A Alsoufi,Ahmed %A Bin Alshiteewi,Fatimah %A Elmabrouk,Amna %A Alsuyihili,Ali %A Elgherwi,Alsafa %A Elkhafeefi,Fatimah %A Abdulrazik,Sarah %A Tarek,Ahmed %+ Faculty of Medicine, University of Tripoli, Furnaj, University Road, Tripoli, 13275, Libyan Arab Jamahiriya, 218 945196407, muhammed.elhadi.uot@gmail.com %K COVID-19 %K cross-sectional study %K resource-limited countries %K SARS-CoV-2 %K telehealth %K telemedicine %K transitional countries %K usability %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Health care systems in transitional countries have witnessed unprecedented challenges related to adequate and continuous health care provision during the COVID-19 pandemic. In many countries, including Libya, institutions and organizations have begun to implement telehealth technology for the first time. This serves to establish an alternative modality for direct physician-patient interviews to reduce the risk of COVID-19 transmission. Objective: This study aimed to assess the usability of telehealth services in Libya and to provide an overview of the current COVID-19 scenario. Methods: In this cross-sectional study, an anonymous web-based survey was administered to Libyan residents between April and May 2020. Participants were contacted through text messaging, emails, and social media. The survey items yielded information on the sociodemographic characteristics, availability and accessibility of health care services, effects of the COVID-19 pandemic on health care services, mental health status, and the feasibility and application of the telehealth system. Results: We obtained 2512 valid responses, of which 1721 (68.5%) were from females. The participants were aged 28.2 (SD 7.6) years, of whom 2333 (92.9%) were aged <40 years, and 1463 (58.2%) were single. Regarding the health care services and their accessibility, 786 (31.1%) participants reported having a poor health status in general, and 492 (19.6%) reported having a confirmed diagnosis of at least one chronic disease. Furthermore, 498 (19.9%) participants reported varying degrees of difficulty in accessing health care centers, and 1558 (62.0%) could not access their medical records. Additionally, 1546 (61.6%) participants experienced problems in covering medical costs, and 1429 (56.9%) avoided seeking medical care owing to financial concerns. Regarding the feasibility of the telehealth system, approximately half of the participants reported that telehealth services were useful during the COVID-19 pandemic, and 1545 (61.5%) reported that the system was an effective means of communication and of obtaining health care services. Furthermore, 1435 (57.1%) participants felt comfortable using the telehealth system, and 1129 (44.9%) felt that they were able to express themselves effectively. Moreover, 1389 (55.3%) participants found the system easy to understand, and 1354 (53.9%) reported having excellent communication with physicians through the telehealth system. However, only 1018 (40.5%) participants reported that communication was better with the telehealth system than with traditional methods. Conclusions: Our study revealed high levels of usability and willingness to use the telemedicine system as an alternative modality to in-person consultations among the Libyan residents in this study. This system is advantageous because it helps overcome health care costs, increases access to prompt medical care and follow-up evaluation, and reduces the risk of COVID-19 transmission. However, internet connectivity and electricity issues could be a substantial barrier for many resource-limited communities, and further studies should address such obstacles. %M 33606654 %R 10.2196/23335 %U https://medinform.jmir.org/2021/2/e23335 %U https://doi.org/10.2196/23335 %U http://www.ncbi.nlm.nih.gov/pubmed/33606654 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 2 %P e25345 %T Challenges for Nontechnical Implementation of Digital Proximity Tracing During the COVID-19 Pandemic: Media Analysis of the SwissCovid App %A von Wyl,Viktor %+ Epidemiology, Biostatistics & Prevention Institute, University of Zurich, Hirschengraben 84, Zürich, 8001, Switzerland, 41 +41446346380, viktor.vonwyl@uzh.ch %K epidemiology %K normalization process theory %K implementation %K digital health %K digital proximity tracing %K digital contact tracing %K COVID-19 %K app %K surveillance %K implementation %K tracking %K tracing %K framework %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Several countries have released digital proximity tracing (DPT) apps to complement manual contact tracing for combatting the SARS-CoV-2 pandemic. DPT aims to notify app users about proximity exposures to persons infected with SARS-CoV-2 so that they can self-quarantine. The success of DPT apps depends on user acceptance and the embedding of DPT into the pandemic mitigation strategy. Objective: By searching for media articles published during the first 3 months after DPT launch, the implementation of DPT in Switzerland was evaluated to inform similar undertakings in other countries. The second aim of the study was to create a link between reported DPT implementation challenges and normalization process theory for planning and optimizing complex digital health interventions, which can provide useful guidance for decision-making in DPT design and implementation. Methods: A Swiss media database was searched for articles on the Swiss DPT app (SwissCovid) published in German or French between July 4 and October 3, 2020. In a structured process, topics were extracted and clustered manually from articles that were deemed pertinent. Extracted topics were mapped to four NPT constructs, which reflected the flow of intervention development from planning, stakeholder onboarding, and execution to critical appraisal. Coherence constructs describe sense-making by stakeholders, cognitive participation constructs reflect participants’ efforts to create engagement with the intervention, collective actions refer to intervention execution and joint stakeholder efforts to make the intervention work, and reflexive monitoring refers to collective risk-benefit appraisals to create improvements. Results: Out of 94 articles deemed pertinent and selected for closer inspection, 38 provided unique information on implementation challenges. Five challenge areas were identified: communication challenges, challenges for DPT to interface with other processes, fear of resource competition with established pandemic mitigation measures, unclear DPT effectiveness, and obstacles to greater user coverage and compliance. Specifically, several articles mentioned unclear DPT benefits to affect commitment and to raise fears among different health system actors regarding resource competition. Moreover, media reports indicated process interface challenges such as delays or unclear responsibilities in the notification cascade, as well as misunderstandings and unmet communication needs from health system actors. Finally, reports suggested misaligned incentives, not only for app usage by the public but also for process engagement by other actors in the app notification cascade. NPT provided a well-fitting framework to contextualize the different DPT implementation challenges and to highlight improvement strategies, namely a better alignment of stakeholder incentives, or stakeholder-specific communication to address their concerns about DPT. Conclusions: Early experiences from one of the first adopters of DPT indicate that nontechnical implementation challenges may affect the effectiveness of DPT. The NPT analysis provides a novel perspective on DPT implementation and stresses the need for stakeholder inclusion in development and operationalization. %M 33606658 %R 10.2196/25345 %U https://mhealth.jmir.org/2021/2/e25345 %U https://doi.org/10.2196/25345 %U http://www.ncbi.nlm.nih.gov/pubmed/33606658 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e22483 %T Expert Opinions on the Most Promising Treatments and Vaccine Candidates for COVID-19: Global Cross-sectional Survey of Virus Researchers in the Early Months of the Pandemic %A Cabral,Bernardo Pereira %A Braga,Luiza %A Mota,Fabio %+ Center for Strategic Studies, Oswaldo Cruz Foundation, Avenida Brasil, 4036, Manguinhos, Rio de Janeiro, 21040-361, Brazil, 55 2138829133, fabio.mota@fiocruz.br %K COVID-19 %K SARS-CoV-2 %K vaccine %K treatment %K survey %K public health %K drug %K clinical trial %D 2021 %7 26.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic presents a great public health challenge worldwide, especially given the urgent need to identify effective drugs and develop a vaccine in a short period of time. Globally, several drugs and vaccine candidates are in clinical trials. However, because these drugs and vaccines are still being tested, there is still no definition of which ones will succeed. Objective: This study aimed to assess the opinions of over 1000 virus researchers with knowledge on the prevention and treatment of coronavirus-related human diseases to determine the most promising drug and vaccine candidates to address COVID-19. Methods: We mapped the clinical trials related to COVID-19 registered at ClinicalTrials.gov. These data were used to prepare a survey questionnaire about treatments and vaccine candidates for COVID-19. In May 2020, a global survey was conducted with authors of recent scientific publications indexed in the Web of Science Core Collection related to viruses, severe acute respiratory syndrome coronavirus, coronaviruses, and COVID-19. Results: Remdesivir, immunoglobulin from cured patients, and plasma were considered to be the most promising treatments in May 2020, while ChAdOx1 and mRNA-1273 were considered to be the most promising vaccine candidates. Almost two-thirds of the respondents (766/1219, 62.8%) believed that vaccines for COVID-19 were likely to be available in the next 18 months. Slightly fewer than 25% (289/1219, 23.7%) believed that a vaccine was feasible, but probably not within 18 months. Conclusions: The issues addressed in this study are constantly evolving; therefore, the current state of knowledge has changed since the survey was conducted. However, for several months after the survey, the respondents’ expectations were in line with recent results related to treatments and vaccine candidates for COVID-19. %M 33635275 %R 10.2196/22483 %U https://publichealth.jmir.org/2021/2/e22483 %U https://doi.org/10.2196/22483 %U http://www.ncbi.nlm.nih.gov/pubmed/33635275 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e22197 %T Infection Control Behavior at Home During the COVID-19 Pandemic: Observational Study of a Web-Based Behavioral Intervention (Germ Defence) %A Ainsworth,Ben %A Miller,Sascha %A Denison-Day,James %A Stuart,Beth %A Groot,Julia %A Rice,Cathy %A Bostock,Jennifer %A Hu,Xiao-Yang %A Morton,Katherine %A Towler,Lauren %A Moore,Michael %A Willcox,Merlin %A Chadborn,Tim %A Gold,Natalie %A Amlôt,Richard %A Little,Paul %A Yardley,Lucy %+ Department of Psychology, University of Bath, Claverton Down, Bath, BA27AY, United Kingdom, 44 01225388388, ba548@bath.ac.uk %K COVID-19 %K novel coronavirus %K behavior change %K digital medicine %K infection control %K infectious disease %K protection %K digital health %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33566791 %R 10.2196/22197 %U https://www.jmir.org/2021/2/e22197 %U https://doi.org/10.2196/22197 %U http://www.ncbi.nlm.nih.gov/pubmed/33566791 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e24165 %T Effects of COVID-19 Emergency Alert Text Messages on Practicing Preventive Behaviors: Cross-sectional Web-Based Survey in South Korea %A Lee,Minjung %A You,Myoungsoon %+ Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, Gwanak-ro 1, Gwanak-gu, Seoul, 08826, Republic of Korea, 82 880 2773, msyou@snu.ac.kr %K COVID-19 %K coronavirus %K preventive behaviors %K text message %K mobile phone %K alert %K prevention %K behavior %K public health %K survey %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Sending emergency messages via mobile phone text messaging can be a promising communication tool to rapidly disseminate information and promote preventive behavior among the public during epidemic outbreaks. The battle to overcome COVID-19 is not yet over; thus, it is essential that the public practices preventive measures to prevent the spread of COVID-19. Objective: This study aimed to investigate the effectiveness of reading and obtaining information via emergency alert SMS text messages and their effects on the individual's practice of preventive behaviors during the early stages of the COVID-19 outbreak in South Korea. Methods: A cross-sectional web-based survey comprising 990 participants was conducted over 3 days (March 25-27, 2020). A multivariable logistic regression analysis revealed the sociodemographic factors that might influence the behavior of reading emergency alert text messages. A hierarchical linear regression model estimated the associations between reading emergency alert text messages for each precautionary behavior practiced against COVID-19. Additionally, the indirect effects of reading the text messages on each precautionary behavior via psychological factors (ie, perceived risk and response efficacy) were calculated. All data were weighted according to the 2019 Korea census data. Results: Overall, 49.2% (487/990) of the participants reported that they always read emergency alert text messages and visited the linked website to obtain more information. Factors such as female sex (odds ratio [OR] 1.68, 95% CI 1.28-2.21) and older age (30-39 years: OR 2.02, 95% CI 1.25-3.28; 40-49 years: OR 2.84, 95% CI 1.80-4.47; 50-59 years: OR 3.19, 95% CI 2.01-5.06; 60 years and above: OR 3.12, 95% CI 2.00-4.86 versus 18-29 years) were identified to be associated with a higher frequency of reading the text messages. Participants who always read the text messages practiced wearing facial masks (β=.074, P=.01) more frequently than those who did not. In terms of social distancing, participants who reported they always read the text messages avoided crowded places (β=.078, P=.01) and canceled or postponed social gatherings (β=.103, P<.001) more frequently than those who did not read the text messages. Furthermore, reading text messages directly and indirectly affected practicing precautionary behaviors, as the mediation effect of response efficacy between reading text messages and practicing preventive behaviors was significant. Conclusions: Our findings suggest that emergency alert text messages sent to individuals' mobile phones are timely and effective strategies for encouraging preventive behavior in public. Sending emergency alert text messages to provide the public with accurate and reliable information could be positively considered by the health authorities, which might reduce the negative impact of infodemics. %M 33544691 %R 10.2196/24165 %U https://www.jmir.org/2021/2/e24165 %U https://doi.org/10.2196/24165 %U http://www.ncbi.nlm.nih.gov/pubmed/33544691 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e25651 %T The Influence of Media Coverage and Governmental Policies on Google Queries Related to COVID-19 Cutaneous Symptoms: Infodemiology Study %A Huynh Dagher,Solene %A Lamé,Guillaume %A Hubiche,Thomas %A Ezzedine,Khaled %A Duong,Tu Anh %+ Assistance Publique des Hôpitaux de Paris (AP-HP), Département de dermatologie, Hôpital Henri Mondor, 51 avenue du Maréchal de Lattre de Tassigny, Créteil, 94000, France, 33 149812512, tu-anh.duong@aphp.fr %K chilblains %K COVID-19 %K dermatology %K Google Trends %K infodemiology %K lesion %K media %K media coverage %K online health information %K skin lesions %K trend %D 2021 %7 25.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During COVID-19, studies have reported the appearance of internet searches for disease symptoms before their validation by the World Health Organization. This suggested that monitoring of these searches with tools including Google Trends may help monitor the pandemic itself. In Europe and North America, dermatologists reported an unexpected outbreak of cutaneous acral lesions (eg, chilblain-like lesions) in April 2020. However, external factors such as public communications may also hinder the use of Google Trends as an infodemiology tool. Objective: The study aimed to assess the impact of media announcements and lockdown enforcement on internet searches related to cutaneous acral lesions during the COVID-19 outbreak in 2020. Methods: Two searches on Google Trends, including daily relative search volumes for (1) “toe” or “chilblains” and (2) “coronavirus,” were performed from January 1 to May 16, 2020, with the United States, the United Kingdom, France, Italy, Spain, and Germany as the countries of choice. The ratio of interest over time in “chilblains” and “coronavirus” was plotted. To assess the impact of lockdown enforcement and media coverage on these internet searches, we performed an interrupted time-series analysis for each country. Results: The ratio of interest over time in “chilblains” to “coronavirus” showed a constant upward trend. In France, Italy, and the United Kingdom, lockdown enforcement was associated with a significant slope change for “chilblain” searches with a variation coefficient of 1.06 (SE 0.42) (P=0.01), 1.04 (SE 0.28) (P<.01), and 1.21 (SE 0.44) (P=0.01), respectively. After media announcements, these ratios significantly increased in France, Spain, Italy, and the United States with variation coefficients of 18.95 (SE 5.77) (P=.001), 31.31 (SE 6.31) (P<.001), 14.57 (SE 6.33) (P=.02), and 11.24 (SE 4.93) (P=.02), respectively, followed by a significant downward trend in France (–1.82 [SE 0.45]), Spain (–1.10 [SE 0.38]), and Italy (–0.93 [SE 0.33]) (P<.001, P=0.004, and P<.001, respectively). The adjusted R2 values were 0.311, 0.351, 0.325, and 0.305 for France, Spain, Italy, and the United States, respectively, suggesting an average correlation between time and the search volume; however, this correlation was weak for Germany and the United Kingdom. Conclusions: To date, the association between chilblain-like lesions and COVID-19 remains controversial; however, our results indicate that Google queries of “chilblain” were highly influenced by media coverage and government policies, indicating that caution should be exercised when using Google Trends as a monitoring tool for emerging diseases. %M 33513563 %R 10.2196/25651 %U https://publichealth.jmir.org/2021/2/e25651 %U https://doi.org/10.2196/25651 %U http://www.ncbi.nlm.nih.gov/pubmed/33513563 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e21103 %T Perception of COVID-19 Physical Distancing Effectiveness and Contagiousness of Asymptomatic Individuals: Cross-sectional Survey of Deaf and Hard of Hearing Adults in the United States %A Paludneviciene,Raylene %A Knight,Tracy %A Firl,Gideon %A Luttrell,Kaela %A Takayama,Kota %A Kushalnagar,Poorna %+ Department of Psychology, Gallaudet University, 800 Florida Ave NE, Washington, DC, 20002, United States, 1 585 666 0818, poorna.kushalnagar@gallaudet.edu %K COVID-19 %K coronavirus %K physical distancing %K asymptomatic individual %K social media %K deaf %K hard of hearing %K sign language %K perception %K misinformation %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, there has been a rapid increase in the amount of information about the disease and SARS-CoV-2 on the internet. If the language used in video messages is not clear or understandable to deaf and hard of hearing (DHH) people with a high school degree or less, this can cause confusion and result in information gaps among DHH people during a health emergency. Objective: The aim of this study is to investigate the relationship between DHH people's perception of the effectiveness of physical distancing and contagiousness of an asymptomatic person. Methods: This is a cross-sectional survey study on DHH people's perceptions about COVID-19 (N=475). Items pertaining to COVID-19 knowledge were administered to US deaf adults from April 17, 2020, to May 1, 2020, via a bilingual American Sign Language/English online survey platform. Results: The sample consisted of 475 DHH adults aged 18-88 years old, with 74% (n=352) identifying as White and 54% (n=256) as female. About 88% (n=418) of the sample felt they knew most things or a lot about physical distancing. This figure dropped to 72% (n=342) for the question about the effectiveness of physical distancing in reducing the spread of COVID-19 and 70% (n=333) for the question about the contagiousness of an infected person without symptoms. Education and a knowledge of the effectiveness of physical distancing significantly predicted knowledge about the contagiousness of an asymptomatic individual. Race, gender, and age did not emerge as significant predictors. Conclusions: This results of this study point to the strong connection between education and coronavirus-related knowledge. Education-related disparities can be remedied by making information fully accessible and easily understood during emergencies and pandemics. %M 33560996 %R 10.2196/21103 %U https://www.jmir.org/2021/2/e21103 %U https://doi.org/10.2196/21103 %U http://www.ncbi.nlm.nih.gov/pubmed/33560996 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e23279 %T Prevalence of Misinformation and Factchecks on the COVID-19 Pandemic in 35 Countries: Observational Infodemiology Study %A Cha,Meeyoung %A Cha,Chiyoung %A Singh,Karandeep %A Lima,Gabriel %A Ahn,Yong-Yeol %A Kulshrestha,Juhi %A Varol,Onur %+ School of Computing, Korea Advanced Institute of Science and Technology, 291 Daehak-ro Yuseong-gu, Daejeon, Republic of Korea, 82 8789300, mcha@ibs.re.kr %K COVID-19 %K coronavirus %K infodemic %K infodemiology %K misinformation %K vulnerability %K LMIC countries %D 2021 %7 13.2.2021 %9 Original Paper %J JMIR Hum Factors %G English %X Background: The COVID-19 pandemic has been accompanied by an infodemic, in which a plethora of false information has been rapidly disseminated online, leading to serious harm worldwide. Objective: This study aims to analyze the prevalence of common misinformation related to the COVID-19 pandemic. Methods: We conducted an online survey via social media platforms and a survey company to determine whether respondents have been exposed to a broad set of false claims and fact-checked information on the disease. Results: We obtained more than 41,000 responses from 1257 participants in 85 countries, but for our analysis, we only included responses from 35 countries that had at least 15 respondents. We identified a strong negative correlation between a country’s Gross Domestic Product per-capita and the prevalence of misinformation, with poorer countries having a higher prevalence of misinformation (Spearman ρ=–0.72; P<.001). We also found that fact checks spread to a lesser degree than their respective false claims, following a sublinear trend (β=.64). Conclusions: Our results imply that the potential harm of misinformation could be more substantial for low-income countries than high-income countries. Countries with poor infrastructures might have to combat not only the spreading pandemic but also the COVID-19 infodemic, which can derail efforts in saving lives. %M 33395395 %R 10.2196/23279 %U https://humanfactors.jmir.org/2021/1/e23279 %U https://doi.org/10.2196/23279 %U http://www.ncbi.nlm.nih.gov/pubmed/33395395 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e20812 %T Telemedicine Awareness, Knowledge, Attitude, and Skills of Health Care Workers in a Low-Resource Country During the COVID-19 Pandemic: Cross-sectional Study %A Elhadi,Muhammed %A Elhadi,Ahmed %A Bouhuwaish,Ahmad %A Bin Alshiteewi,Fatimah %A Elmabrouk,Amna %A Alsuyihili,Ali %A Alhashimi,Ayiman %A Khel,Samer %A Elgherwi,Alsafa %A Alsoufi,Ahmed %A Albakoush,Ahmed %A Abdulmalik,Abdulmuez %+ Faculty of Medicine, University of Tripoli, University Road, Furnaj, Tripoli, 13275, Libyan Arab Jamahiriya, 218 945196407, muhammed.elhadi.uot@gmail.com %K attitude %K awareness %K coronavirus %K COVID-19 %K knowledge %K pandemic %K skills %K telemedicine %D 2021 %7 25.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the onset of the COVID-19 pandemic, several health care programs intended to provide telemedicine services have been introduced in Libya. Many physicians have used these services to provide care and advice to their patients remotely. Objective: This study aimed to provide an overview of physicians’ awareness, knowledge, attitude, and skill in using telehealth services in Libya. Methods: In this cross-sectional study, we administered a web-based survey to health care workers in Libya in May 2020. The questionnaire collected information on physicians’ general demographic characteristics, ability to use a computer, and telemedicine awareness, knowledge, attitude, and skills. Results: Among 673 health care workers who responded to the survey, 377 (56%) and 248 (36.8%) reported high awareness and high computer skill scores, respectively, for telemedicine. Furthermore, 582 (86.5%) and 566 (82.6%) health care workers reported high knowledge and high attitude scores, respectively. We observed no significant differences in awareness, knowledge, attitude, and skill scores among physicians employed at public, private, or both types of hospitals. We observed significant differences in the mean awareness (P<.001), attitude (P=.001), and computer skill scores (P<.001) , where the score distribution of the groups based on the ability to use computers was not similar. Knowledge scores did not significantly differ among the three groups (P=.37). Respondents with professional computer skills had significantly higher awareness (χ23=14.5; P<.001) and attitude (χ23=13.5; P=.001) scores than those without professional computer skills. We observed significant differences in the mean computer skill scores of the groups (χ23=199.6; P<.001). Conclusions: The consequences of the COVID-19 pandemic are expected to persist for a long time. Hence, policy programs such as telemedicine services, which aim to address the obstacles to medical treatment owing to physical distancing measures, will likely continue for a long time. Therefore, there is a need to train and support health care workers and initiate government programs that provide adequate and supportive health care services to patients in transitional countries. %M 33600350 %R 10.2196/20812 %U https://www.jmir.org/2021/2/e20812 %U https://doi.org/10.2196/20812 %U http://www.ncbi.nlm.nih.gov/pubmed/33600350 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25682 %T Features Constituting Actionable COVID-19 Dashboards: Descriptive Assessment and Expert Appraisal of 158 Public Web-Based COVID-19 Dashboards %A Ivanković,Damir %A Barbazza,Erica %A Bos,Véronique %A Brito Fernandes,Óscar %A Jamieson Gilmore,Kendall %A Jansen,Tessa %A Kara,Pinar %A Larrain,Nicolas %A Lu,Shan %A Meza-Torres,Bernardo %A Mulyanto,Joko %A Poldrugovac,Mircha %A Rotar,Alexandru %A Wang,Sophie %A Willmington,Claire %A Yang,Yuanhang %A Yelgezekova,Zhamin %A Allin,Sara %A Klazinga,Niek %A Kringos,Dionne %+ Department of Public and Occupational Health, Amsterdam UMC, Amsterdam Public Health Research Institute, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105AZ, Netherlands, 31 981801700, d.ivankovic@amsterdamumc.nl %K COVID-19 %K pandemic %K internet %K performance measures %K public reporting of health care data %K public health %K surveillance %K health information management %K dashboard %K accessibility %K online tool %K communication %K feature %K expert %D 2021 %7 24.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the outbreak of COVID-19, the development of dashboards as dynamic, visual tools for communicating COVID-19 data has surged worldwide. Dashboards can inform decision-making and support behavior change. To do so, they must be actionable. The features that constitute an actionable dashboard in the context of the COVID-19 pandemic have not been rigorously assessed. Objective: The aim of this study is to explore the characteristics of public web-based COVID-19 dashboards by assessing their purpose and users (“why”), content and data (“what”), and analyses and displays (“how” they communicate COVID-19 data), and ultimately to appraise the common features of highly actionable dashboards. Methods: We conducted a descriptive assessment and scoring using nominal group technique with an international panel of experts (n=17) on a global sample of COVID-19 dashboards in July 2020. The sequence of steps included multimethod sampling of dashboards; development and piloting of an assessment tool; data extraction and an initial round of actionability scoring; a workshop based on a preliminary analysis of the results; and reconsideration of actionability scores followed by joint determination of common features of highly actionable dashboards. We used descriptive statistics and thematic analysis to explore the findings by research question. Results: A total of 158 dashboards from 53 countries were assessed. Dashboards were predominately developed by government authorities (100/158, 63.0%) and were national (93/158, 58.9%) in scope. We found that only 20 of the 158 dashboards (12.7%) stated both their primary purpose and intended audience. Nearly all dashboards reported epidemiological indicators (155/158, 98.1%), followed by health system management indicators (85/158, 53.8%), whereas indicators on social and economic impact and behavioral insights were the least reported (7/158, 4.4% and 2/158, 1.3%, respectively). Approximately a quarter of the dashboards (39/158, 24.7%) did not report their data sources. The dashboards predominately reported time trends and disaggregated data by two geographic levels and by age and sex. The dashboards used an average of 2.2 types of displays (SD 0.86); these were mostly graphs and maps, followed by tables. To support data interpretation, color-coding was common (93/158, 89.4%), although only one-fifth of the dashboards (31/158, 19.6%) included text explaining the quality and meaning of the data. In total, 20/158 dashboards (12.7%) were appraised as highly actionable, and seven common features were identified between them. Actionable COVID-19 dashboards (1) know their audience and information needs; (2) manage the type, volume, and flow of displayed information; (3) report data sources and methods clearly; (4) link time trends to policy decisions; (5) provide data that are “close to home”; (6) break down the population into relevant subgroups; and (7) use storytelling and visual cues. Conclusions: COVID-19 dashboards are diverse in the why, what, and how by which they communicate insights on the pandemic and support data-driven decision-making. To leverage their full potential, dashboard developers should consider adopting the seven actionability features identified. %M 33577467 %R 10.2196/25682 %U https://www.jmir.org/2021/2/e25682 %U https://doi.org/10.2196/25682 %U http://www.ncbi.nlm.nih.gov/pubmed/33577467 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23957 %T Public Opinions and Concerns Regarding the Canadian Prime Minister’s Daily COVID-19 Briefing: Longitudinal Study of YouTube Comments Using Machine Learning Techniques %A Zheng,Chengda %A Xue,Jia %A Sun,Yumin %A Zhu,Tingshao %+ Key Laboratory of Behavioral Science, Institute of Psychology, Chinese Academy of Sciences, 16 Lincui Road, Chaoyang district, Beijing, 100101, China, 86 1064871661, tszhu@psych.ac.cn %K Canada %K PM Trudeau %K YouTube %K machine learning %K big data %K infodemiology %K infodemic %K public concerns %K communication %K concern %K social media %K video %D 2021 %7 23.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic in Canada, Prime Minister Justin Trudeau provided updates on the novel coronavirus and the government’s responses to the pandemic in his daily briefings from March 13 to May 22, 2020, delivered on the official Canadian Broadcasting Corporation (CBC) YouTube channel. Objective: The aim of this study was to examine comments on Canadian Prime Minister Trudeau’s COVID-19 daily briefings by YouTube users and track these comments to extract the changing dynamics of the opinions and concerns of the public over time. Methods: We used machine learning techniques to longitudinally analyze a total of 46,732 English YouTube comments that were retrieved from 57 videos of Prime Minister Trudeau’s COVID-19 daily briefings from March 13 to May 22, 2020. A natural language processing model, latent Dirichlet allocation, was used to choose salient topics among the sampled comments for each of the 57 videos. Thematic analysis was used to classify and summarize these salient topics into different prominent themes. Results: We found 11 prominent themes, including strict border measures, public responses to Prime Minister Trudeau’s policies, essential work and frontline workers, individuals’ financial challenges, rental and mortgage subsidies, quarantine, government financial aid for enterprises and individuals, personal protective equipment, Canada and China’s relationship, vaccines, and reopening. Conclusions: This study is the first to longitudinally investigate public discourse and concerns related to Prime Minister Trudeau’s daily COVID-19 briefings in Canada. This study contributes to establishing a real-time feedback loop between the public and public health officials on social media. Hearing and reacting to real concerns from the public can enhance trust between the government and the public to prepare for future health emergencies. %M 33544690 %R 10.2196/23957 %U https://www.jmir.org/2021/2/e23957 %U https://doi.org/10.2196/23957 %U http://www.ncbi.nlm.nih.gov/pubmed/33544690 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e21415 %T Public Knowledge, Attitudes, and Practices Related to COVID-19 in Iran: Questionnaire Study %A Abbasi-Kangevari,Mohsen %A Kolahi,Ali-Asghar %A Ghamari,Seyyed-Hadi %A Hassanian-Moghaddam,Hossein %+ Social Determinants of Health Research Center, Shahid Beheshti University of Medical Sciences, Koodakyar Ave and Daneshju Blvd, Tehran, Iran, 98 2122220980, a.kolahi@sbmu.ac.ir %K COVID-19 %K SARS-CoV-2 %K attitudes %K coronavirus %K knowledge %K perceptions %K practices %K Iran %D 2021 %7 23.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic is a rapidly growing outbreak, the future course of which is strongly determined by people’s adherence to social distancing measures. Objective: The objective of this study was to determine the knowledge level, attitudes, and practices of the Iranian population in the context of COVID-19. Methods: A nationwide study was conducted from March 24 to April 3, 2020, whereby data were collected via an online self-administered questionnaire. Results: Responses from 12,332 participants were analyzed. Participants’ mean knowledge score was 23.2 (SD 4.3) out of 30. Most participants recognized the cause of COVID-19, its routes of transmission, its symptoms and signs, predisposing factors, and prevention measures. Social media was the leading source of information. Participants recognized the dangers of the situation and felt responsible for following social distancing protocols, as well as isolating themselves upon symptom presentation. Participants’ mean practice score was 20.7 (SD 2.2) out of 24. Nearly none of the respondents went on a trip, and 92% (n=11,342) washed their hands before touching their faces. Conclusions: Knowledge of COVID-19 among people in Iran was nearly sufficient, their attitudes were mainly positive, and their practices were satisfactory. There is still room for improvement in correcting misinformation and protecting people from deception. Iranians appear to support government actions like social distancing and care for their and others’ safety. %M 33620326 %R 10.2196/21415 %U https://publichealth.jmir.org/2021/2/e21415 %U https://doi.org/10.2196/21415 %U http://www.ncbi.nlm.nih.gov/pubmed/33620326 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 2 %P e26773 %T Rapid Response to Drive COVID-19 Research in a Learning Health Care System: Rationale and Design of the Houston Methodist COVID-19 Surveillance and Outcomes Registry (CURATOR) %A Vahidy,Farhaan %A Jones,Stephen L %A Tano,Mauricio E %A Nicolas,Juan Carlos %A Khan,Osman A %A Meeks,Jennifer R %A Pan,Alan P %A Menser,Terri %A Sasangohar,Farzan %A Naufal,George %A Sostman,Dirk %A Nasir,Khurram %A Kash,Bita A %+ Houston Methodist, 7550 Greenbriar Drive, Houston, TX, 77030, United States, 1 3463561479, fvahidy@houstonmethodist.org %K COVID-19 %K SARS-CoV-2 %K data science %K data curation %K electronic health records %K learning health system %K databases, factual %D 2021 %7 23.2.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: The COVID-19 pandemic has exacerbated the challenges of meaningful health care digitization. The need for rapid yet validated decision-making requires robust data infrastructure. Organizations with a focus on learning health care (LHC) systems tend to adapt better to rapidly evolving data needs. Few studies have demonstrated a successful implementation of data digitization principles in an LHC context across health care systems during the COVID-19 pandemic. Objective: We share our experience and provide a framework for assembling and organizing multidisciplinary resources, structuring and regulating research needs, and developing a single source of truth (SSoT) for COVID-19 research by applying fundamental principles of health care digitization, in the context of LHC systems across a complex health care organization. Methods: Houston Methodist (HM) comprises eight tertiary care hospitals and an expansive primary care network across Greater Houston, Texas. During the early phase of the pandemic, institutional leadership envisioned the need to streamline COVID-19 research and established the retrospective research task force (RRTF). We describe an account of the structure, functioning, and productivity of the RRTF. We further elucidate the technical and structural details of a comprehensive data repository—the HM COVID-19 Surveillance and Outcomes Registry (CURATOR). We particularly highlight how CURATOR conforms to standard health care digitization principles in the LHC context. Results: The HM COVID-19 RRTF comprises expertise in epidemiology, health systems, clinical domains, data sciences, information technology, and research regulation. The RRTF initially convened in March 2020 to prioritize and streamline COVID-19 observational research; to date, it has reviewed over 60 protocols and made recommendations to the institutional review board (IRB). The RRTF also established the charter for CURATOR, which in itself was IRB-approved in April 2020. CURATOR is a relational structured query language database that is directly populated with data from electronic health records, via largely automated extract, transform, and load procedures. The CURATOR design enables longitudinal tracking of COVID-19 cases and controls before and after COVID-19 testing. CURATOR has been set up following the SSoT principle and is harmonized across other COVID-19 data sources. CURATOR eliminates data silos by leveraging unique and disparate big data sources for COVID-19 research and provides a platform to capitalize on institutional investment in cloud computing. It currently hosts deeply phenotyped sociodemographic, clinical, and outcomes data of approximately 200,000 individuals tested for COVID-19. It supports more than 30 IRB-approved protocols across several clinical domains and has generated numerous publications from its core and associated data sources. Conclusions: A data-driven decision-making strategy is paramount to the success of health care organizations. Investment in cross-disciplinary expertise, health care technology, and leadership commitment are key ingredients to foster an LHC system. Such systems can mitigate the effects of ongoing and future health care catastrophes by providing timely and validated decision support. %M 33544692 %R 10.2196/26773 %U https://medinform.jmir.org/2021/2/e26773 %U https://doi.org/10.2196/26773 %U http://www.ncbi.nlm.nih.gov/pubmed/33544692 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23026 %T Learning From Past Respiratory Infections to Predict COVID-19 Outcomes: Retrospective Study %A Sang,Shengtian %A Sun,Ran %A Coquet,Jean %A Carmichael,Harris %A Seto,Tina %A Hernandez-Boussard,Tina %+ Department of Medicine, Biomedical Informatics, Stanford University, 1265 Welch Rd, 245, Stanford, CA, 94305-5479, United States, 1 650 725 5507, boussard@stanford.edu %K COVID-19 %K invasive mechanical ventilation %K all-cause mortality %K machine learning %K artificial intelligence %K respiratory %K infection %K outcome %K data %K feasibility %K framework %D 2021 %7 22.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: For the clinical care of patients with well-established diseases, randomized trials, literature, and research are supplemented with clinical judgment to understand disease prognosis and inform treatment choices. In the void created by a lack of clinical experience with COVID-19, artificial intelligence (AI) may be an important tool to bolster clinical judgment and decision making. However, a lack of clinical data restricts the design and development of such AI tools, particularly in preparation for an impending crisis or pandemic. Objective: This study aimed to develop and test the feasibility of a “patients-like-me” framework to predict the deterioration of patients with COVID-19 using a retrospective cohort of patients with similar respiratory diseases. Methods: Our framework used COVID-19–like cohorts to design and train AI models that were then validated on the COVID-19 population. The COVID-19–like cohorts included patients diagnosed with bacterial pneumonia, viral pneumonia, unspecified pneumonia, influenza, and acute respiratory distress syndrome (ARDS) at an academic medical center from 2008 to 2019. In total, 15 training cohorts were created using different combinations of the COVID-19–like cohorts with the ARDS cohort for exploratory purposes. In this study, two machine learning models were developed: one to predict invasive mechanical ventilation (IMV) within 48 hours for each hospitalized day, and one to predict all-cause mortality at the time of admission. Model performance was assessed using the area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, positive predictive value, and negative predictive value. We established model interpretability by calculating SHapley Additive exPlanations (SHAP) scores to identify important features. Results: Compared to the COVID-19–like cohorts (n=16,509), the patients hospitalized with COVID-19 (n=159) were significantly younger, with a higher proportion of patients of Hispanic ethnicity, a lower proportion of patients with smoking history, and fewer patients with comorbidities (P<.001). Patients with COVID-19 had a lower IMV rate (15.1 versus 23.2, P=.02) and shorter time to IMV (2.9 versus 4.1 days, P<.001) compared to the COVID-19–like patients. In the COVID-19–like training data, the top models achieved excellent performance (AUROC>0.90). Validating in the COVID-19 cohort, the top-performing model for predicting IMV was the XGBoost model (AUROC=0.826) trained on the viral pneumonia cohort. Similarly, the XGBoost model trained on all 4 COVID-19–like cohorts without ARDS achieved the best performance (AUROC=0.928) in predicting mortality. Important predictors included demographic information (age), vital signs (oxygen saturation), and laboratory values (white blood cell count, cardiac troponin, albumin, etc). Our models had class imbalance, which resulted in high negative predictive values and low positive predictive values. Conclusions: We provided a feasible framework for modeling patient deterioration using existing data and AI technology to address data limitations during the onset of a novel, rapidly changing pandemic. %M 33534724 %R 10.2196/23026 %U https://www.jmir.org/2021/2/e23026 %U https://doi.org/10.2196/23026 %U http://www.ncbi.nlm.nih.gov/pubmed/33534724 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e24266 %T Digital Pathology During the COVID-19 Outbreak in Italy: Survey Study %A Giaretto,Simone %A Renne,Salvatore Lorenzo %A Rahal,Daoud %A Bossi,Paola %A Colombo,Piergiuseppe %A Spaggiari,Paola %A Manara,Sofia %A Sollai,Mauro %A Fiamengo,Barbara %A Brambilla,Tatiana %A Fernandes,Bethania %A Rao,Stefania %A Elamin,Abubaker %A Valeri,Marina %A De Carlo,Camilla %A Belsito,Vincenzo %A Lancellotti,Cesare %A Cieri,Miriam %A Cagini,Angelo %A Terracciano,Luigi %A Roncalli,Massimo %A Di Tommaso,Luca %+ Department of Pathology, Humanitas Clinical and Research Center – IRCCS, via Manzoni 56, Rozzano (MI), 20089, Italy, 39 0282244787, salvatore.renne@hunimed.eu %K COVID19 %K digital pathology %K Bayesian data analysis %K probabilistic modeling %D 2021 %7 22.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Transition to digital pathology usually takes months or years to be completed. We were familiarizing ourselves with digital pathology solutions at the time when the COVID-19 outbreak forced us to embark on an abrupt transition to digital pathology. Objective: The aim of this study was to quantitatively describe how the abrupt transition to digital pathology might affect the quality of diagnoses, model possible causes by probabilistic modeling, and qualitatively gauge the perception of this abrupt transition. Methods: A total of 17 pathologists and residents participated in this study; these participants reviewed 25 additional test cases from the archives and completed a final psychologic survey. For each case, participants performed several different diagnostic tasks, and their results were recorded and compared with the original diagnoses performed using the gold standard method (ie, conventional microscopy). We performed Bayesian data analysis with probabilistic modeling. Results: The overall analysis, comprising 1345 different items, resulted in a 9% (117/1345) error rate in using digital slides. The task of differentiating a neoplastic process from a nonneoplastic one accounted for an error rate of 10.7% (42/392), whereas the distinction of a malignant process from a benign one accounted for an error rate of 4.2% (11/258). Apart from residents, senior pathologists generated most discrepancies (7.9%, 13/164). Our model showed that these differences among career levels persisted even after adjusting for other factors. Conclusions: Our findings are in line with previous findings, emphasizing that the duration of transition (ie, lengthy or abrupt) might not influence the diagnostic performance. Moreover, our findings highlight that senior pathologists may be limited by a digital gap, which may negatively affect their performance with digital pathology. These results can guide the process of digital transition in the field of pathology. %M 33503002 %R 10.2196/24266 %U https://www.jmir.org/2021/2/e24266 %U https://doi.org/10.2196/24266 %U http://www.ncbi.nlm.nih.gov/pubmed/33503002 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23390 %T Establishing Classifiers With Clinical Laboratory Indicators to Distinguish COVID-19 From Community-Acquired Pneumonia: Retrospective Cohort Study %A Dai,Wanfa %A Ke,Pei-Feng %A Li,Zhen-Zhen %A Zhuang,Qi-Zhen %A Huang,Wei %A Wang,Yi %A Xiong,Yujuan %A Huang,Xian-Zhang %+ Department of Laboratory Medicine, The Second Affiliated Hospital, Guangzhou University of Chinese Medicine, 111 Dade Rd, Guangzhou, 510210, China, 86 020 81887233 ext 35362, huangxz020@gzucm.edu.cn %K COVID-19 %K clinical laboratory indicators %K community-acquired pneumonia %K classifier %K classification algorithm %D 2021 %7 22.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The initial symptoms of patients with COVID-19 are very much like those of patients with community-acquired pneumonia (CAP); it is difficult to distinguish COVID-19 from CAP with clinical symptoms and imaging examination. Objective: The objective of our study was to construct an effective model for the early identification of COVID-19 that would also distinguish it from CAP. Methods: The clinical laboratory indicators (CLIs) of 61 COVID-19 patients and 60 CAP patients were analyzed retrospectively. Random combinations of various CLIs (ie, CLI combinations) were utilized to establish COVID-19 versus CAP classifiers with machine learning algorithms, including random forest classifier (RFC), logistic regression classifier, and gradient boosting classifier (GBC). The performance of the classifiers was assessed by calculating the area under the receiver operating characteristic curve (AUROC) and recall rate in COVID-19 prediction using the test data set. Results: The classifiers that were constructed with three algorithms from 43 CLI combinations showed high performance (recall rate >0.9 and AUROC >0.85) in COVID-19 prediction for the test data set. Among the high-performance classifiers, several CLIs showed a high usage rate; these included procalcitonin (PCT), mean corpuscular hemoglobin concentration (MCHC), uric acid, albumin, albumin to globulin ratio (AGR), neutrophil count, red blood cell (RBC) count, monocyte count, basophil count, and white blood cell (WBC) count. They also had high feature importance except for basophil count. The feature combination (FC) of PCT, AGR, uric acid, WBC count, neutrophil count, basophil count, RBC count, and MCHC was the representative one among the nine FCs used to construct the classifiers with an AUROC equal to 1.0 when using the RFC or GBC algorithms. Replacing any CLI in these FCs would lead to a significant reduction in the performance of the classifiers that were built with them. Conclusions: The classifiers constructed with only a few specific CLIs could efficiently distinguish COVID-19 from CAP, which could help clinicians perform early isolation and centralized management of COVID-19 patients. %M 33534722 %R 10.2196/23390 %U https://www.jmir.org/2021/2/e23390 %U https://doi.org/10.2196/23390 %U http://www.ncbi.nlm.nih.gov/pubmed/33534722 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e26302 %T Using Tweets to Understand How COVID-19–Related Health Beliefs Are Affected in the Age of Social Media: Twitter Data Analysis Study %A Wang,Hanyin %A Li,Yikuan %A Hutch,Meghan %A Naidech,Andrew %A Luo,Yuan %+ Department of Preventive Medicine, Northwestern University, 750 N Lakeshore Dr, Chicago, IL, 60611, United States, 1 312 503 5742, yuan.luo@northwestern.edu %K COVID-19 %K social media %K health belief %K Twitter %K infodemic %K infodemiology %K machine learning %K natural language processing %D 2021 %7 22.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of SARS-CoV-2 (ie, COVID-19) has given rise to a global pandemic affecting 215 countries and over 40 million people as of October 2020. Meanwhile, we are also experiencing an infodemic induced by the overabundance of information, some accurate and some inaccurate, spreading rapidly across social media platforms. Social media has arguably shifted the information acquisition and dissemination of a considerably large population of internet users toward higher interactivities. Objective: This study aimed to investigate COVID-19-related health beliefs on one of the mainstream social media platforms, Twitter, as well as potential impacting factors associated with fluctuations in health beliefs on social media. Methods: We used COVID-19-related posts from the mainstream social media platform Twitter to monitor health beliefs. A total of 92,687,660 tweets corresponding to 8,967,986 unique users from January 6 to June 21, 2020, were retrieved. To quantify health beliefs, we employed the health belief model (HBM) with four core constructs: perceived susceptibility, perceived severity, perceived benefits, and perceived barriers. We utilized natural language processing and machine learning techniques to automate the process of judging the conformity of each tweet with each of the four HBM constructs. A total of 5000 tweets were manually annotated for training the machine learning architectures. Results: The machine learning classifiers yielded areas under the receiver operating characteristic curves over 0.86 for the classification of all four HBM constructs. Our analyses revealed a basic reproduction number R0 of 7.62 for trends in the number of Twitter users posting health belief–related content over the study period. The fluctuations in the number of health belief–related tweets could reflect dynamics in case and death statistics, systematic interventions, and public events. Specifically, we observed that scientific events, such as scientific publications, and nonscientific events, such as politicians’ speeches, were comparable in their ability to influence health belief trends on social media through a Kruskal-Wallis test (P=.78 and P=.92 for perceived benefits and perceived barriers, respectively). Conclusions: As an analogy of the classic epidemiology model where an infection is considered to be spreading in a population with an R0 greater than 1, we found that the number of users tweeting about COVID-19 health beliefs was amplifying in an epidemic manner and could partially intensify the infodemic. It is “unhealthy” that both scientific and nonscientific events constitute no disparity in impacting the health belief trends on Twitter, since nonscientific events, such as politicians’ speeches, might not be endorsed by substantial evidence and could sometimes be misleading. %M 33529155 %R 10.2196/26302 %U https://www.jmir.org/2021/2/e26302 %U https://doi.org/10.2196/26302 %U http://www.ncbi.nlm.nih.gov/pubmed/33529155 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e26257 %T Prognosis Score System to Predict Survival for COVID-19 Cases: a Korean Nationwide Cohort Study %A Cho,Sung-Yeon %A Park,Sung-Soo %A Song,Min-Kyu %A Bae,Young Yi %A Lee,Dong-Gun %A Kim,Dong-Wook %+ Catholic Hematology Hospital, College of Medicine, The Catholic University of Korea, Seoul St. Mary's Hospital, 222 Banpo-daero, Seocho-Gu, Seoul, 06591, Republic of Korea, 82 222586003, symonlee@catholic.ac.kr %K COVID-19 %K length of stay %K mortality %K prognosis %K triage %K digital health %K prediction %K cohort %K risk %K allocation %K disease management %K intensive care %K decision making %D 2021 %7 22.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: As the COVID-19 pandemic continues, an initial risk-adapted allocation is crucial for managing medical resources and providing intensive care. Objective: In this study, we aimed to identify factors that predict the overall survival rate for COVID-19 cases and develop a COVID-19 prognosis score (COPS) system based on these factors. In addition, disease severity and the length of hospital stay for patients with COVID-19 were analyzed. Methods: We retrospectively analyzed a nationwide cohort of laboratory-confirmed COVID-19 cases between January and April 2020 in Korea. The cohort was split randomly into a development cohort and a validation cohort with a 2:1 ratio. In the development cohort (n=3729), we tried to identify factors associated with overall survival and develop a scoring system to predict the overall survival rate by using parameters identified by the Cox proportional hazard regression model with bootstrapping methods. In the validation cohort (n=1865), we evaluated the prediction accuracy using the area under the receiver operating characteristic curve. The score of each variable in the COPS system was rounded off following the log-scaled conversion of the adjusted hazard ratio. Results: Among the 5594 patients included in this analysis, 234 (4.2%) died after receiving a COVID-19 diagnosis. In the development cohort, six parameters were significantly related to poor overall survival: older age, dementia, chronic renal failure, dyspnea, mental disturbance, and absolute lymphocyte count <1000/mm3. The following risk groups were formed: low-risk (score 0-2), intermediate-risk (score 3), high-risk (score 4), and very high-risk (score 5-7) groups. The COPS system yielded an area under the curve value of 0.918 for predicting the 14-day survival rate and 0.896 for predicting the 28-day survival rate in the validation cohort. Using the COPS system, 28-day survival rates were discriminatively estimated at 99.8%, 95.4%, 82.3%, and 55.1% in the low-risk, intermediate-risk, high-risk, and very high-risk groups, respectively, of the total cohort (P<.001). The length of hospital stay and disease severity were directly associated with overall survival (P<.001), and the hospital stay duration was significantly longer among survivors (mean 26.1, SD 10.7 days) than among nonsurvivors (mean 15.6, SD 13.3 days). Conclusions: The newly developed predictive COPS system may assist in making risk-adapted decisions for the allocation of medical resources, including intensive care, during the COVID-19 pandemic. %M 33539312 %R 10.2196/26257 %U https://www.jmir.org/2021/2/e26257 %U https://doi.org/10.2196/26257 %U http://www.ncbi.nlm.nih.gov/pubmed/33539312 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e26107 %T Use of Physiological Data From a Wearable Device to Identify SARS-CoV-2 Infection and Symptoms and Predict COVID-19 Diagnosis: Observational Study %A Hirten,Robert P %A Danieletto,Matteo %A Tomalin,Lewis %A Choi,Katie Hyewon %A Zweig,Micol %A Golden,Eddye %A Kaur,Sparshdeep %A Helmus,Drew %A Biello,Anthony %A Pyzik,Renata %A Charney,Alexander %A Miotto,Riccardo %A Glicksberg,Benjamin S %A Levin,Matthew %A Nabeel,Ismail %A Aberg,Judith %A Reich,David %A Charney,Dennis %A Bottinger,Erwin P %A Keefer,Laurie %A Suarez-Farinas,Mayte %A Nadkarni,Girish N %A Fayad,Zahi A %+ The Dr Henry D Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, 1468 Madison Avenue, Annenberg Building RM 5-12, New York, NY, 10029, United States, 1 212 241 0150, robert.hirten@mountsinai.org %K wearable device %K COVID-19 %K identification %K prediction %K heart rate variability %K physiological %K wearable %K app %K data %K infectious disease %K symptom %K prediction %K diagnosis %K observational %D 2021 %7 22.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Changes in autonomic nervous system function, characterized by heart rate variability (HRV), have been associated with infection and observed prior to its clinical identification. Objective: We performed an evaluation of HRV collected by a wearable device to identify and predict COVID-19 and its related symptoms. Methods: Health care workers in the Mount Sinai Health System were prospectively followed in an ongoing observational study using the custom Warrior Watch Study app, which was downloaded to their smartphones. Participants wore an Apple Watch for the duration of the study, measuring HRV throughout the follow-up period. Surveys assessing infection and symptom-related questions were obtained daily. Results: Using a mixed-effect cosinor model, the mean amplitude of the circadian pattern of the standard deviation of the interbeat interval of normal sinus beats (SDNN), an HRV metric, differed between subjects with and without COVID-19 (P=.006). The mean amplitude of this circadian pattern differed between individuals during the 7 days before and the 7 days after a COVID-19 diagnosis compared to this metric during uninfected time periods (P=.01). Significant changes in the mean and amplitude of the circadian pattern of the SDNN was observed between the first day of reporting a COVID-19–related symptom compared to all other symptom-free days (P=.01). Conclusions: Longitudinally collected HRV metrics from a commonly worn commercial wearable device (Apple Watch) can predict the diagnosis of COVID-19 and identify COVID-19–related symptoms. Prior to the diagnosis of COVID-19 by nasal swab polymerase chain reaction testing, significant changes in HRV were observed, demonstrating the predictive ability of this metric to identify COVID-19 infection. %M 33529156 %R 10.2196/26107 %U https://www.jmir.org/2021/2/e26107 %U https://doi.org/10.2196/26107 %U http://www.ncbi.nlm.nih.gov/pubmed/33529156 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e24445 %T Telehealth Demand Trends During the COVID-19 Pandemic in the Top 50 Most Affected Countries: Infodemiological Evaluation %A Wong,Mark Yu Zheng %A Gunasekeran,Dinesh Visva %A Nusinovici,Simon %A Sabanayagam,Charumathi %A Yeo,Khung Keong %A Cheng,Ching-Yu %A Tham,Yih-Chung %+ Singapore Eye Research Institute, Singapore National Eye Centre, 20 College Road Discovery Tower, Level 6, The Academia, Singapore, 169856, Singapore, 65 6576 7200, tham.yih.chung@seri.com.sg %K COVID-19 %K infodemiology %K telehealth %K telemedicine %K internet %D 2021 %7 19.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has led to urgent calls for the adoption of telehealth solutions. However, public interest and demand for telehealth during the pandemic remain unknown. Objective: We used an infodemiological approach to estimate the worldwide demand for telehealth services during COVID-19, focusing on the 50 most affected countries and comparing the demand for such services with the level of information and communications technology (ICT) infrastructure available. Methods: We used Google Trends, the Baidu Index (China), and Yandex Keyword Statistics (Russia) to extract data on worldwide and individual countries’ telehealth-related internet searches from January 1 to July 7, 2020, presented as relative search volumes (RSV; range 0-100). Daily COVID-19 cases and deaths were retrieved from the World Health Organization. Individual countries’ ICT infrastructure profiles were retrieved from the World Economic Forum Report. Results: Across the 50 countries, the mean RSV was 18.5 (SD 23.2), and the mean ICT index was 62.1 (SD 15.0). An overall spike in worldwide telehealth-related RSVs was observed from March 11, 2020 (RSV peaked to 76.0), which then tailed off in June-July 2020 (mean RSV for the period was 25.8), but remained higher than pre-March RSVs (mean 7.29). By country, 42 (84%) manifested increased RSVs over the evaluation period, with the highest observed in Canada (RSV=100) and the United States (RSV=96). When evaluating associations between RSV and the ICT index, both the United States and Canada demonstrated high RSVs and ICT scores (≥70.3). In contrast, European countries had relatively lower RSVs (range 3.4-19.5) despite high ICT index scores (mean 70.3). Several Latin American (Brazil, Chile, Colombia) and South Asian (India, Bangladesh, Pakistan) countries demonstrated relatively higher RSVs (range 13.8-73.3) but low ICT index scores (mean 44.6), indicating that the telehealth demand outstrips the current ICT infrastructure. Conclusions: There is generally increased interest and demand for telehealth services across the 50 countries most affected by COVID-19, highlighting the need to scale up telehealth capabilities, during and beyond the pandemic. %M 33605883 %R 10.2196/24445 %U http://publichealth.jmir.org/2021/2/e24445/ %U https://doi.org/10.2196/24445 %U http://www.ncbi.nlm.nih.gov/pubmed/33605883 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e24341 %T Influenza and Respiratory Virus Surveillance, Vaccine Uptake, and Effectiveness at a Time of Cocirculating COVID-19: Protocol for the English Primary Care Sentinel System for 2020-2021 %A de Lusignan,Simon %A Lopez Bernal,Jamie %A Byford,Rachel %A Amirthalingam,Gayatri %A Ferreira,Filipa %A Akinyemi,Oluwafunmi %A Andrews,Nick %A Campbell,Helen %A Dabrera,Gavin %A Deeks,Alexandra %A Elliot,Alex J %A Krajenbrink,Else %A Liyanage,Harshana %A McGagh,Dylan %A Okusi,Cecilia %A Parimalanathan,Vaishnavi %A Ramsay,Mary %A Smith,Gillian %A Tripathy,Manasa %A Williams,John %A Victor,William %A Zambon,Maria %A Howsam,Gary %A Nicholson,Brian David %A Tzortziou Brown,Victoria %A Butler,Christopher C %A Joy,Mark %A Hobbs,FD Richard %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House, 7 Walton Well Road, Oxford, OX2 6ED, United Kingdom, 44 1865617975, simon.delusignan@phc.ox.ac.uk %K COVID-19 %K general practice %K influenza %K computerized medical record systems %K sentinel surveillance %K coronavirus infections %K records as topic %K serology %K virology %D 2021 %7 19.2.2021 %9 Protocol %J JMIR Public Health Surveill %G English %X Background: The Oxford–Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) are commencing their 54th season of collaboration at a time when SARS-CoV-2 infections are likely to be cocirculating with the usual winter infections. Objective: The aim of this study is to conduct surveillance of influenza and other monitored respiratory conditions and to report on vaccine uptake and effectiveness using nationally representative surveillance data extracted from primary care computerized medical records systems. We also aim to have general practices collect virology and serology specimens and to participate in trials and other interventional research. Methods: The RCGP RSC network comprises over 1700 general practices in England and Wales. We will extract pseudonymized data twice weekly and are migrating to a system of daily extracts. First, we will collect pseudonymized, routine, coded clinical data for the surveillance of monitored and unexpected conditions; data on vaccine exposure and adverse events of interest; and data on approved research study outcomes. Second, we will provide dashboards to give general practices feedback about levels of care and data quality, as compared to other network practices. We will focus on collecting data on influenza-like illness, upper and lower respiratory tract infections, and suspected COVID-19. Third, approximately 300 practices will participate in the 2020-2021 virology and serology surveillance; this will include responsive surveillance and long-term follow-up of previous SARS-CoV-2 infections. Fourth, member practices will be able to recruit volunteer patients to trials, including early interventions to improve COVID-19 outcomes and point-of-care testing. Lastly, the legal basis for our surveillance with PHE is Regulation 3 of the Health Service (Control of Patient Information) Regulations 2002; other studies require appropriate ethical approval. Results: The RCGP RSC network has tripled in size; there were previously 100 virology practices and 500 practices overall in the network and we now have 322 and 1724, respectively. The Oxford–RCGP Clinical Informatics Digital Hub (ORCHID) secure networks enable the daily analysis of the extended network; currently, 1076 practices are uploaded. We are implementing a central swab distribution system for patients self-swabbing at home in addition to in-practice sampling. We have converted all our primary care coding to Systematized Nomenclature of Medicine Clinical Terms (SNOMED CT) coding. Throughout spring and summer 2020, the network has continued to collect specimens in preparation for the winter or for any second wave of COVID-19 cases. We have collected 5404 swabs and detected 623 cases of COVID-19 through extended virological sampling, and 19,341 samples have been collected for serology. This shows our preparedness for the winter season. Conclusions: The COVID-19 pandemic has been associated with a groundswell of general practices joining our network. It has also created a permissive environment in which we have developed the capacity and capability of the national primary care surveillance systems and our unique public health institute, the RCGP and University of Oxford collaboration. %M 33605892 %R 10.2196/24341 %U http://publichealth.jmir.org/2021/2/e24341/ %U https://doi.org/10.2196/24341 %U http://www.ncbi.nlm.nih.gov/pubmed/33605892 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25232 %T Impact of the COVID-19 Pandemic on the Psychological Distress of Medical Students in Japan: Cross-sectional Survey Study %A Nishimura,Yoshito %A Ochi,Kanako %A Tokumasu,Kazuki %A Obika,Mikako %A Hagiya,Hideharu %A Kataoka,Hitomi %A Otsuka,Fumio %+ Department of General Medicine, Okayama University Hospital, 2-5-1 Shikata-Cho, Kita-Ku, Okayama, Japan, 81 86 235 7342, nishimura-yoshito@okayama-u.ac.jp %K COVID-19 %K online education %K depression %K pandemic %K anxiety %K medical student %D 2021 %7 18.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has negatively affected medical education. However, little data are available about medical students’ distress during the pandemic. Objective: This study aimed to provide details on how medical students have been affected by the pandemic. Methods: A cross-sectional study was conducted. A total of 717 medical students participated in the web-based survey. The survey included questions about how the participants’ mental status had changed from before to after the Japanese nationwide state of emergency (SOE). Results: Out of 717 medical students, 473 (66.0%) participated in the study. In total, 29.8% (141/473) of the students reported concerns about the shift toward online education, mostly because they thought online education would be ineffective compared with in-person learning. The participants’ subjective mental health status significantly worsened after the SOE was lifted (P<.001). Those who had concerns about a shift toward online education had higher odds of having generalized anxiety and being depressed (odds ratio [OR] 1.97, 95% CI 1.19-3.28) as did those who said they would request food aid (OR 1.99, 95% CI 1.16-3.44) and mental health care resources (OR 3.56, 95% CI 2.07-6.15). Conclusions: Given our findings, the sudden shift to online education might have overwhelmed medical students. Thus, we recommend that educators inform learners that online learning is not inferior to in-person learning, which could attenuate potential depression and anxiety. %M 33556033 %R 10.2196/25232 %U http://www.jmir.org/2021/2/e25232/ %U https://doi.org/10.2196/25232 %U http://www.ncbi.nlm.nih.gov/pubmed/33556033 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e23870 %T Evaluating Closures of Fresh Fruit and Vegetable Vendors During the COVID-19 Pandemic: Methodology and Preliminary Results Using Omnidirectional Street View Imagery %A Ali,Shahmir H %A Imbruce,Valerie M %A Russo,Rienna G %A Kaplan,Samuel %A Stevenson,Kaye %A Mezzacca,Tamar Adjoian %A Foster,Victoria %A Radee,Ashley %A Chong,Stella %A Tsui,Felice %A Kranick,Julie %A Yi,Stella S %+ Department of Population Health, NYU Grossman School of Medicine, 8th Floor, Room 8-13, 180 Madison Avenue, New York, NY, United States, 1 646 501 3477, Stella.Yi@nyulangone.org %K built environment %K Google Street View %K food retail environment %K COVID-19 %K geographic surveillance %K food %K longitudinal %K supply chain %K economy %K demand %K service %K vendor %K surveillance %D 2021 %7 18.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic has significantly disrupted the food retail environment. However, its impact on fresh fruit and vegetable vendors remains unclear; these are often smaller, more community centered, and may lack the financial infrastructure to withstand supply and demand changes induced by such crises. Objective: This study documents the methodology used to assess fresh fruit and vegetable vendor closures in New York City (NYC) following the start of the COVID-19 pandemic by using Google Street View, the new Apple Look Around database, and in-person checks. Methods: In total, 6 NYC neighborhoods (in Manhattan and Brooklyn) were selected for analysis; these included two socioeconomically advantaged neighborhoods (Upper East Side, Park Slope), two socioeconomically disadvantaged neighborhoods (East Harlem, Brownsville), and two Chinese ethnic neighborhoods (Chinatown, Sunset Park). For each neighborhood, Google Street View was used to virtually walk down each street and identify vendors (stores, storefronts, street vendors, or wholesalers) that were open and active in 2019 (ie, both produce and vendor personnel were present at a location). Past vendor surveillance (when available) was used to guide these virtual walks. Each identified vendor was geotagged as a Google Maps pinpoint that research assistants then physically visited. Using the “notes” feature of Google Maps as a data collection tool, notes were made on which of three categories best described each vendor: (1) open, (2) open with a more limited setup (eg, certain sections of the vendor unit that were open and active in 2019 were missing or closed during in-person checks), or (3) closed/absent. Results: Of the 135 open vendors identified in 2019 imagery data, 35% (n=47) were absent/closed and 10% (n=13) were open with more limited setups following the beginning of the COVID-19 pandemic. When comparing boroughs, 35% (28/80) of vendors in Manhattan were absent/closed, as were 35% (19/55) of vendors in Brooklyn. Although Google Street View was able to provide 2019 street view imagery data for most neighborhoods, Apple Look Around was required for 2019 imagery data for some areas of Park Slope. Past surveillance data helped to identify 3 additional established vendors in Chinatown that had been missed in street view imagery. The Google Maps “notes” feature was used by multiple research assistants simultaneously to rapidly collect observational data on mobile devices. Conclusions: The methodology employed enabled the identification of closures in the fresh fruit and vegetable retail environment and can be used to assess closures in other contexts. The use of past baseline surveillance data to aid vendor identification was valuable for identifying vendors that may have been absent or visually obstructed in the street view imagery data. Data collection using Google Maps likewise has the potential to enhance the efficiency of fieldwork in future studies. %M 33539310 %R 10.2196/23870 %U http://formative.jmir.org/2021/2/e23870/ %U https://doi.org/10.2196/23870 %U http://www.ncbi.nlm.nih.gov/pubmed/33539310 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23795 %T Telemedicine Use and Health-Related Concerns of Patients With Chronic Conditions During COVID-19: Survey of Members of Online Health Communities %A Horrell,Lindsey Nicole %A Hayes,Sara %A Herbert,Leslie Beth %A MacTurk,Katie %A Lawhon,Lauren %A Valle,Carmina G %A Bhowmick,Amrita %+ William F Connell School of Nursing, Boston College, Maloney Hall 378B, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, United States, 1 617 552 4886, lindsey.horrell@bc.edu %K telehealth %K telemedicine %K coronavirus %K COVID-19 %K chronic disease %D 2021 %7 18.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: It has been widely communicated that individuals with underlying health conditions are at higher risk of severe disease due to COVID-19 than healthy peers. As social distancing measures continue during the COVID-19 pandemic, experts encourage individuals with underlying conditions to engage in telehealth appointments to maintain continuity of care while minimizing risk exposure. To date, however, little information has been provided regarding telehealth uptake among this high-risk population. Objective: The aim of this study is to describe the telehealth use, resource needs, and information sources of individuals with chronic conditions during the COVID-19 pandemic. Secondary objectives include exploring differences in telehealth use by sociodemographic characteristics. Methods: Data for this study were collected through an electronic survey distributed between May 12-14, 2020, to members of 26 online health communities for individuals with chronic disease. Descriptive statistics were run to explore telehealth use, support needs, and information sources, and z tests were run to assess differences in sociodemographic factors and information and support needs among those who did and did not use telehealth services. Results: Among the 2210 respondents, 1073 (49%) reported engaging in telehealth in the past 4 months. Higher proportions of women engaged in telehealth than men (890/1781, 50% vs 181/424, 43%; P=.007), and a higher proportion of those earning household incomes of more than US $100,000 engaged in telehealth than those earning less than US $30,000 (195/370, 53% vs 241/530 45%; P=.003). Although 59% (133/244) of those younger than 40 years and 54% (263/486) of those aged 40-55 years used telehealth, aging populations were less likely to do so, with only 45% (677/1500) of individuals 56 years or older reporting telehealth use (P<.001 and P=.001, respectively). Patients with cystic fibrosis, lupus, and ankylosing spondylitis recorded the highest proportions of individuals using telehealth when compared to those with other diagnoses. Of the 2210 participants, 1333 (60%) participants either looked up information about the virus online or planned to in the future, and when asked what information or support would be most helpful right now, over half (1151/2210, 52%) responded “understanding how COVID-19 affects people with my health condition.” Conclusions: Nearly half of the study sample reported participating in telehealth in the past 4 months. Future efforts to engage individuals with underlying medical conditions in telehealth should focus on outreach to men, members of lower-income households, and aging populations. These results may help inform and refine future health communications to further engage this at-risk population in telehealth as the pandemic continues. %M 33539307 %R 10.2196/23795 %U http://www.jmir.org/2021/2/e23795/ %U https://doi.org/10.2196/23795 %U http://www.ncbi.nlm.nih.gov/pubmed/33539307 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23168 %T Quality of Information and Future Directions. Comment on “Influence of Mass and Social Media on Psychobehavioral Responses Among Medical Students During the Downward Trend of COVID-19 in Fujian, China: Cross-Sectional Study” %A Sasikumar,Smriti %A Sulaiman,Hafsa Omer %A Bedi,Simran %A Nozdrin,Mikhail %A Rundell,Caroline %A Zaman,Sadia %+ St George’s University of London, Cranmer Terrace, London, United Kingdom, 44 2086729944, Sasikumar.s@live.sgul.ac.cy %K COVID-19 %K social media %K mass media %K information quality %D 2021 %7 18.2.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33599623 %R 10.2196/23168 %U https://www.jmir.org/2021/2/e23168 %U https://doi.org/10.2196/23168 %U http://www.ncbi.nlm.nih.gov/pubmed/33599623 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23363 %T Defining Telemedicine and Engaging Future Medical Practitioners. Comment on “Telemedicine in Germany During the COVID-19 Pandemic: Multi-Professional National Survey” %A Sadik,Neha %A Salman,Reem %+ Barts and the London School of Medicine and Dentistry, Queen Mary University of London, Garrod Building, Turner St, Whitechapel, London, E1 2AD, United Kingdom, 44 7444321677, ha17302@qmul.ac.uk %K telemedicine %K coronavirus %K COVID-19 %K medical education %D 2021 %7 17.2.2021 %9 Letter to the Editor %J J Med Internet Res %G English %X %M 33595454 %R 10.2196/23363 %U https://www.jmir.org/2021/2/e23363 %U https://doi.org/10.2196/23363 %U http://www.ncbi.nlm.nih.gov/pubmed/33595454 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e24204 %T The Global Infectious Diseases Epidemic Information Monitoring System: Development and Usability Study of an Effective Tool for Travel Health Management in China %A Gu,Dayong %A He,Jianan %A Sun,Jie %A Shi,Xin %A Ye,Ying %A Zhang,Zishuai %A Wang,Xiangjun %A Su,Qun %A Yu,Wenjin %A Yuan,Xiaopeng %A Dong,Ruiling %+ Shenzhen International Travel Health Care Center (Shenzhen Customs District Port Outpatient Clinics), Shenzhen Customs District, Room 406, Shenzhen Kouan Hospital, Huanggang Kouan Shenghuo Qu, Futian District, Shenzhen, China, 86 15019457579, 1047194259@qq.com %K infectious disease %K epidemic information %K travel health %K global %K surveillance %D 2021 %7 16.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 33591286 %R 10.2196/24204 %U http://publichealth.jmir.org/2021/2/e24204/ %U https://doi.org/10.2196/24204 %U http://www.ncbi.nlm.nih.gov/pubmed/33591286 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e20335 %T Evaluating Apple Inc Mobility Trend Data Related to the COVID-19 Outbreak in Japan: Statistical Analysis %A Kurita,Junko %A Sugishita,Yoshiyuki %A Sugawara,Tamie %A Ohkusa,Yasushi %+ Department of Nursing, Tokiwa University, 1-430-1 Miwa, Mito, Ibraki, 3108585, Japan, 81 29 232 2511, kuritaj@tokiwa.ac.jp %K peak %K COVID-19 %K effective reproduction number %K mobility trend data %K Apple %K countermeasure %D 2021 %7 15.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In Japan, as a countermeasure against the COVID-19 outbreak, both the national and local governments issued voluntary restrictions against going out from residences at the end of March 2020 in preference to the lockdowns instituted in European and North American countries. The effect of such measures can be studied with mobility data, such as data which is generated by counting the number of requests made to Apple Maps for directions in select countries/regions, sub-regions, and cities. Objective: We investigate the associations of mobility data provided by Apple Inc and an estimate an an effective reproduction number R(t). Methods: We regressed R(t) on a polynomial function of daily Apple data, estimated using the whole period, and analyzed subperiods delimited by March 10, 2020. Results: In the estimation results, R(t) was 1.72 when voluntary restrictions against going out ceased and mobility reverted to a normal level. However, the critical level of reducing R(t) to <1 was obtained at 89.3% of normal mobility. Conclusions: We demonstrated that Apple mobility data are useful for short-term prediction of R(t). The results indicate that the number of trips should decrease by 10% until herd immunity is achieved and that higher voluntary restrictions against going out might not be necessary for avoiding a re-emergence of the outbreak. %M 33481755 %R 10.2196/20335 %U http://publichealth.jmir.org/2021/2/e20335/ %U https://doi.org/10.2196/20335 %U http://www.ncbi.nlm.nih.gov/pubmed/33481755 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e26392 %T Promoting Mask Use on TikTok: Descriptive, Cross-sectional Study %A Basch,Corey H %A Fera,Joseph %A Pierce,Isabela %A Basch,Charles E %+ Department of Public Health, William Paterson University, 300 Pompton Rd, University Hall, Wayne, NJ, 07470, United States, 1 9737202603, baschc@wpunj.edu %K TikTok %K COVID-19 %K social media %K infodemiology %K infoveillance %K mask use %K prevention %K promotion %K communication %K public health %K cross-sectional %K content analysis %K transmission %D 2021 %7 12.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 33523823 %R 10.2196/26392 %U http://publichealth.jmir.org/2021/2/e26392/ %U https://doi.org/10.2196/26392 %U http://www.ncbi.nlm.nih.gov/pubmed/33523823 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25734 %T Quantifying the Influence of Delay in Opinion Transmission of COVID-19 Information Propagation: Modeling Study %A Yin,Fulian %A Shao,Xueying %A Ji,Meiqi %A Wu,Jianhong %+ Fields-CQAM Laboratory of Mathematics for Public Health, Laboratory for Industrial and Applied Mathematics, York University, 4700 Keele St, Toronto, ON, M3J1P3, Canada, 1 416 736 5243, wujhhida@hotmail.com %K COVID-19 %K delay transmission %K dynamic model %K Sina Microblog %K social media %K communication %K online health information %K health information %K public health %K opinion %K strategy %K model %K information transmission %K delay %K infodemiology %K infoveillance %D 2021 %7 12.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: In a fast-evolving public health crisis such as the COVID-19 pandemic, multiple pieces of relevant information can be posted sequentially on a social media platform. The interval between subsequent posting times may have a different impact on the transmission and cross-propagation of the old and new information that results in a different peak value and a final size of forwarding users of the new information, depending on the content correlation and whether the new information is posted during the outbreak or quasi–steady-state phase of the old information. Objective: This study aims to help in designing effective communication strategies to ensure information is delivered to the maximal number of users. Methods: We developed and analyzed two classes of susceptible-forwarding-immune information propagation models with delay in transmission to describe the cross-propagation process of relevant information. A total of 28,661 retweets of typical information were posted frequently by each opinion leader related to COVID-19 with high influence (data acquisition up to February 19, 2020). The information was processed into discrete points with a frequency of 10 minutes, and the real data were fitted by the model numerical simulation. Furthermore, the influence of parameters on information dissemination and the design of a publishing strategy were analyzed. Results: The current epidemic outbreak situation, epidemic prevention, and other related authoritative information cannot be timely and effectively browsed by the public. The ingenious use of information release intervals can effectively enhance the interaction between information and realize the effective diffusion of information. We parameterized our models using real data from Sina Microblog and used the parameterized models to define and evaluate mutual attractiveness indexes, and we used these indexes and parameter sensitivity analyses to inform optimal strategies for new information to be effectively propagated in the microblog. The results of the parameter analysis showed that using different attractiveness indexes as the key parameters can control the information transmission with different release intervals, so it is considered as a key link in the design of an information communication strategy. At the same time, the dynamic process of information was analyzed through index evaluation. Conclusions: Our model can carry out an accurate numerical simulation of information at different release intervals and achieve a dynamic evaluation of information transmission by constructing an indicator system so as to provide theoretical support and strategic suggestions for government decision making. This study optimizes information posting strategies to maximize communication efforts for delivering key public health messages to the public for better outcomes of public health emergency management. %M 33529153 %R 10.2196/25734 %U http://www.jmir.org/2021/2/e25734/ %U https://doi.org/10.2196/25734 %U http://www.ncbi.nlm.nih.gov/pubmed/33529153 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25363 %T Exposure to COVID-19-Related Information and its Association With Mental Health Problems in Thailand: Nationwide, Cross-sectional Survey Study %A Mongkhon,Pajaree %A Ruengorn,Chidchanok %A Awiphan,Ratanaporn %A Thavorn,Kednapa %A Hutton,Brian %A Wongpakaran,Nahathai %A Wongpakaran,Tinakon %A Nochaiwong,Surapon %+ Department of Pharmaceutical Care, Faculty of Pharmacy, Chiang Mai University, 239, Suthep Road, Chiang Mai, 50200, Thailand, 66 899973365, surapon.nochaiwong@gmail.com %K coronavirus %K COVID-19 %K insomnia %K mental health %K social media %K depression %K anxiety %K stress %K psychosocial problem %D 2021 %7 12.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had a negative impact on both the physical and mental health of individuals worldwide. Evidence regarding the association between mental health problems and information exposure among Thai citizens during the COVID-19 outbreak is limited. Objective: This study aimed to explore the relationship between information exposure and mental health problems during the COVID-19 pandemic in Thailand. Methods: Between April 21 and May 4, 2020, we conducted a cross-sectional, nationwide online survey of the general population in Thailand. We categorized the duration of exposure to COVID-19-related information as follows: <1 h/day (reference group), 1-2 h/day, and ≥3 h/day. Mental health outcomes were assessed using the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7 scale, the Perceived Stress Scale-10, and the Insomnia Severity Index for symptoms of depression, anxiety, perceived stress, and insomnia, respectively. Multivariable logistic regression models were used to evaluate the relationship between information exposure and the risk of developing the aforementioned symptoms. An ancillary analysis using multivariable multinomial logistic regression models was also conducted to assess the possible dose-response relationship across the severity strata of mental health problems. Results: Of the 4322 eligible participants, 4004 (92.6%) completed the online survey. Of them, 1481 (37.0%), 1644 (41.1%), and 879 (22.0%) participants were exposed to COVID-19-related information for less than 1 hour per day, 1 to 2 hours per day, or 3 or more hours per day, respectively. The major source of information related to the COVID-19 pandemic was social media (95.3%), followed by traditional media (68.7%) and family members (34.9%). Those exposed to information for 3 or more hours per day had a higher risk of developing symptoms of depression (adjusted odds ratio [OR] 1.35, 95% CI 1.03-1.76; P=.03), anxiety (adjusted OR 1.88, 95% CI 1.43-2.46; P<.001), and insomnia (adjusted OR 1.52, 95% CI 1.17-1.97; P=.001) than people exposed to information for less than 1 hour per day. Meanwhile, people exposed to information for 1 to 2 hours per day were only at risk of developing symptoms of anxiety (adjusted OR 1.35, 95% CI 1.08-1.69; P=.008). However, no association was found between information exposure and the risk of perceived stress. In the ancillary analysis, a dose-response relationship was observed between information exposure of 3 or more hours per day and the severity of mental health problems. Conclusions: These findings suggest that social media is the main source of COVID-19-related information. Moreover, people who are exposed to information for 3 or more hours per day are more likely to develop psychological problems, including depression, anxiety, and insomnia. Longitudinal studies investigating the long-term effects of COVID-19-related information exposure on mental health are warranted. %M 33523828 %R 10.2196/25363 %U http://www.jmir.org/2021/2/e25363/ %U https://doi.org/10.2196/25363 %U http://www.ncbi.nlm.nih.gov/pubmed/33523828 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e22222 %T Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis in US Mothers and Children Aged 0-2: PREVAIL Cohort Study %A Morrow,Ardythe L %A Staat,Mary A %A DeFranco,Emily A %A McNeal,Monica M %A Cline,Allison R %A Conrey,Shannon C %A Schlaudecker,Elizabeth P %A Piasecki,Alexandra M %A Burke,Rachel M %A Niu,Liang %A Hall,Aron J %A Bowen,Michael D %A Gerber,Susan I %A Langley,Gayle E %A Thornburg,Natalie J %A Campbell,Angela P %A Vinjé,Jan %A Parashar,Umesh D %A Payne,Daniel C %+ Department of Environmental and Public Health Sciences, Division of Epidemiology, University of Cincinnati College of Medicine, 160 Panzeca Way, Cincinnati, OH, 45220, United States, 1 513 505 1994, morrowa@ucmail.uc.edu %K birth cohort %K RSV %K influenza %K rotavirus %K norovirus %K vaccines %K vaccine effectiveness %K immunology %K pediatrics %D 2021 %7 12.2.2021 %9 Original Paper %J JMIR Res Protoc %G English %X Background: Acute gastroenteritis (AGE) and acute respiratory infections (ARIs) cause significant pediatric morbidity and mortality. Developing childhood vaccines against major enteric and respiratory pathogens should be guided by the natural history of infection and acquired immunity. The United States currently lacks contemporary birth cohort data to guide vaccine development. Objective: The PREVAIL (Pediatric Respiratory and Enteric Virus Acquisition and Immunogenesis Longitudinal) Cohort study was undertaken to define the natural history of infection and immune response to major pathogens causing AGE and ARI in US children. Methods: Mothers in Cincinnati, Ohio, were enrolled in their third trimester of pregnancy, with intensive child follow-up to 2 years. Blood samples were obtained from children at birth (cord), 6 weeks, and 6, 12, 18, and 24 months. Whole stool specimens and midturbinate nasal swabs were collected weekly and tested by multipathogen molecular assays. Saliva, meconium, maternal blood, and milk samples were also collected. AGE (≥3 loose or watery stools or ≥1 vomiting episode within 24 hours) and ARI (cough or fever) cases were documented by weekly cell phone surveys to mothers via automated SMS text messaging and review of medical records. Immunization records were obtained from registries and providers. follow-up ended in October 2020. Pathogen-specific infections are defined by a PCR-positive sample or rise in serum antibody. Results: Of the 245 enrolled mother–child pairs, 51.8% (n=127) were White, 43.3% (n=106) Black, 55.9% (n=137) publicly insured, and 86.5% (n=212) initiated breastfeeding. Blood collection was 100.0% for mothers (n=245) and 85.7% for umbilical cord (n=210). A total of 194/245 (79.2%) mother–child pairs were compliant based on participation in at least 70% (≥71/102 study weeks) of child-weeks and providing 70% or more of weekly samples during that time, or blood samples at 18 or 24 months. Compliant participants (n=194) had 71.0% median nasal swab collection (IQR 30.0%-90.5%), with 98.5% (191/194) providing either an 18- or 24-month blood sample; median response to weekly SMS text message surveys was 95.1% (IQR 76.5%-100%). Compliant mothers reported 2.0 AGE and 4.5 ARI cases per child-year, of which 25.5% (160/627) and 38.06% (486/1277) of cases, respectively, were medically attended; 0.5% of AGE (3/627) and 0.55% of ARI (7/1277) cases were hospitalized. Conclusions: The PREVAIL Cohort demonstrates intensive follow-up to document the natural history of enteric and respiratory infections and immunity in children 0-2 years of age in the United States and will contribute unique data to guide vaccine recommendations. Testing for pathogens and antibodies is ongoing. International Registered Report Identifier (IRRID): RR1-10.2196/22222 %M 33576746 %R 10.2196/22222 %U http://www.researchprotocols.org/2021/2/e22222/ %U https://doi.org/10.2196/22222 %U http://www.ncbi.nlm.nih.gov/pubmed/33576746 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e26570 %T Consuming Information Related to COVID-19 on Social Media Among Older Adults and Its Association With Anxiety, Social Trust in Information, and COVID-Safe Behaviors: Cross-sectional Telephone Survey %A Wong,Frankie Ho Chun %A Liu,Tianyin %A Leung,Dara Kiu Yi %A Zhang,Anna Y %A Au,Walker Siu Hong %A Kwok,Wai Wai %A Shum,Angie K Y %A Wong,Gloria Hoi Yan %A Lum,Terry Yat-Sang %+ Department of Social Work and Social Administration, The University of Hong Kong, CJT-514, The University of Hong Kong, Pokfulam, Hong Kong, 852 39178569, tlum@hku.hk %K COVID-19 %K anxiety %K social media %K infodemic %K Hong Kong %D 2021 %7 11.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19-related information on social media is overabundant and sometimes questionable, resulting in an “infodemic” during the pandemic. While previous studies suggest social media usage increases the risk of developing anxiety symptoms, how induced anxiety affects attitudes and behaviors is less discussed, let alone during a global pandemic. Little is known about the relationship between older adults using social media during a pandemic and their anxiety, their attitudes toward social trust in information, and behaviors to avoid contracting COVID-19. Objective: The goal of this study was to investigate the associations between using social media for COVID-19-related information and anxiety symptoms as well as the mediation effect of anxiety symptoms on social trust in information and COVID-safe behaviors among older adults. Methods: A cross-sectional telephone survey was conducted in Hong Kong between May and August 2020. A rapid warm-call protocol was developed to train social workers and volunteers from participant nongovernmental organizations to conduct the telephone surveys. Questions related to COVID-safe behaviors, social trust in information, social media use, anxiety and depressive symptoms, and sociodemographic information were asked. The number of confirmed COVID-19 cases at the community level was used to account for the risk of contracting COVID-19. Ordinary least squares regressions examined the associations between social media use and anxiety symptoms, and how they were associated with social trust in information and COVID-safe behaviors. Structural equation modeling further mapped out these relationships to identify the mediation effects of anxiety symptoms. Results: This study collected information regarding 3421 adults aged 60 years and older. Use of social media for COVID-19-related information was associated with more anxiety symptoms and lower social trust in information but had no significant relationship with COVID-safe behaviors. Anxiety symptoms predicted lower social trust in information and higher COVID-safe behaviors. Lower social trust in information was predicted by using social media for COVID-19 information, mediated by anxiety symptoms, while no mediation effect was found for COVID-safe behaviors. Conclusions: Older adults who rely on social media for COVID-19-related information exhibited more anxiety symptoms, while showing mixed effects on attitudes and behaviors. Social trust in information may be challenged by unverified and contradictory information online. The negligible impact on COVID-safe behaviors suggested that social media may have caused more confusion than consolidating a consistent effort against the pandemic. Media literacy education is recommended to promote critical evaluation of COVID-19-related information and responsible sharing among older adults. %M 33523825 %R 10.2196/26570 %U http://www.jmir.org/2021/2/e26570/ %U https://doi.org/10.2196/26570 %U http://www.ncbi.nlm.nih.gov/pubmed/33523825 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e24246 %T A Machine Learning Prediction Model of Respiratory Failure Within 48 Hours of Patient Admission for COVID-19: Model Development and Validation %A Bolourani,Siavash %A Brenner,Max %A Wang,Ping %A McGinn,Thomas %A Hirsch,Jamie S %A Barnaby,Douglas %A Zanos,Theodoros P %A , %+ Feinstein Institutes for Medical Research, Northwell Health, 350 Community Dr, Room 1257, Manhasset, NY, 11030, United States, 1 5165620484, tzanos@northwell.edu %K artificial intelligence %K prognostic %K model %K pandemic %K severe acute respiratory syndrome coronavirus 2 %K modeling %K development %K validation %K COVID-19 %K machine learning %D 2021 %7 10.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Predicting early respiratory failure due to COVID-19 can help triage patients to higher levels of care, allocate scarce resources, and reduce morbidity and mortality by appropriately monitoring and treating the patients at greatest risk for deterioration. Given the complexity of COVID-19, machine learning approaches may support clinical decision making for patients with this disease. Objective: Our objective is to derive a machine learning model that predicts respiratory failure within 48 hours of admission based on data from the emergency department. Methods: Data were collected from patients with COVID-19 who were admitted to Northwell Health acute care hospitals and were discharged, died, or spent a minimum of 48 hours in the hospital between March 1 and May 11, 2020. Of 11,525 patients, 933 (8.1%) were placed on invasive mechanical ventilation within 48 hours of admission. Variables used by the models included clinical and laboratory data commonly collected in the emergency department. We trained and validated three predictive models (two based on XGBoost and one that used logistic regression) using cross-hospital validation. We compared model performance among all three models as well as an established early warning score (Modified Early Warning Score) using receiver operating characteristic curves, precision-recall curves, and other metrics. Results: The XGBoost model had the highest mean accuracy (0.919; area under the curve=0.77), outperforming the other two models as well as the Modified Early Warning Score. Important predictor variables included the type of oxygen delivery used in the emergency department, patient age, Emergency Severity Index level, respiratory rate, serum lactate, and demographic characteristics. Conclusions: The XGBoost model had high predictive accuracy, outperforming other early warning scores. The clinical plausibility and predictive ability of XGBoost suggest that the model could be used to predict 48-hour respiratory failure in admitted patients with COVID-19. %M 33476281 %R 10.2196/24246 %U http://www.jmir.org/2021/2/e24246/ %U https://doi.org/10.2196/24246 %U http://www.ncbi.nlm.nih.gov/pubmed/33476281 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e23693 %T Fast and Accurate Detection of COVID-19 Along With 14 Other Chest Pathologies Using a Multi-Level Classification: Algorithm Development and Validation Study %A Albahli,Saleh %A Yar,Ghulam Nabi Ahmad Hassan %+ Department of Information Technology, College of Computer, Qassim University, Buraydah, 51452, Saudi Arabia, 966 163012604, salbahli@qu.edu.sa %K COVID-19 %K chest x-ray %K convolutional neural network %K data augmentation %K biomedical imaging %K automatic detection %D 2021 %7 10.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has spread very rapidly, and it is important to build a system that can detect it in order to help an overwhelmed health care system. Many research studies on chest diseases rely on the strengths of deep learning techniques. Although some of these studies used state-of-the-art techniques and were able to deliver promising results, these techniques are not very useful if they can detect only one type of disease without detecting the others. Objective: The main objective of this study was to achieve a fast and more accurate diagnosis of COVID-19. This study proposes a diagnostic technique that classifies COVID-19 x-ray images from normal x-ray images and those specific to 14 other chest diseases. Methods: In this paper, we propose a novel, multilevel pipeline, based on deep learning models, to detect COVID-19 along with other chest diseases based on x-ray images. This pipeline reduces the burden of a single network to classify a large number of classes. The deep learning models used in this study were pretrained on the ImageNet dataset, and transfer learning was used for fast training. The lungs and heart were segmented from the whole x-ray images and passed onto the first classifier that checks whether the x-ray is normal, COVID-19 affected, or characteristic of another chest disease. If it is neither a COVID-19 x-ray image nor a normal one, then the second classifier comes into action and classifies the image as one of the other 14 diseases. Results: We show how our model uses state-of-the-art deep neural networks to achieve classification accuracy for COVID-19 along with 14 other chest diseases and normal cases based on x-ray images, which is competitive with currently used state-of-the-art models. Due to the lack of data in some classes such as COVID-19, we applied 10-fold cross-validation through the ResNet50 model. Our classification technique thus achieved an average training accuracy of 96.04% and test accuracy of 92.52% for the first level of classification (ie, 3 classes). For the second level of classification (ie, 14 classes), our technique achieved a maximum training accuracy of 88.52% and test accuracy of 66.634% by using ResNet50. We also found that when all the 16 classes were classified at once, the overall accuracy for COVID-19 detection decreased, which in the case of ResNet50 was 88.92% for training data and 71.905% for test data. Conclusions: Our proposed pipeline can detect COVID-19 with a higher accuracy along with detecting 14 other chest diseases based on x-ray images. This is achieved by dividing the classification task into multiple steps rather than classifying them collectively. %M 33529154 %R 10.2196/23693 %U http://www.jmir.org/2021/2/e23693/ %U https://doi.org/10.2196/23693 %U http://www.ncbi.nlm.nih.gov/pubmed/33529154 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25518 %T A Virtual Ward Model of Care for Patients With COVID-19: Retrospective Single-Center Clinical Study %A Ferry,Olivia R %A Moloney,Emma C %A Spratt,Owen T %A Whiting,Gerald F M %A Bennett,Cameron J %+ Metro North Hospital and Health Service, Royal Brisbane and Women's Hospital, Butterfield Street, Herston, Brisbane, 4006, Australia, 61 36468111, cameron.bennett@health.qld.gov.au %K COVID-19 %K efficacy %K hospital %K innovation %K model %K remote care %K safety %K telemedicine %K virtual health care %K virtual ward %D 2021 %7 10.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has necessitated the implementation of innovative health care models in preparation for an influx of patients. A virtual ward model delivers clinical care remotely to patients in isolation. We report on an Australian cohort of patients with COVID-19 treated in a virtual ward. Objective: The aim of this study was to describe and evaluate the safety and efficacy of a virtual ward model of care for an Australian cohort of patients with COVID-19. Methods: Retrospective clinical assessment was performed for 223 patients with confirmed COVID-19 treated in a virtual ward in Brisbane, Australia, from March 25 to May 15, 2020. Statistical analysis was performed for variables associated with the length of stay and hospitalization. Results: Of 223 patients, 205 (92%) recovered without the need for escalation to hospital care. The median length of stay in the virtual ward was 8 days (range 1-44 days). In total, 18 (8%) patients were referred to hospital, of which 6 (33.3%) were discharged after assessment at the emergency department. Furthermore, 12 (5.4%) patients were admitted to hospital, of which 4 (33.3%) required supplemental oxygen and 2 (16.7%) required mechanical ventilation. No deaths were recorded. Factors associated with escalation to hospital care were the following: hypertension (odds ratio [OR] 3.6, 95% CI 1.28-9.87; P=.01), sputum production (OR 5.2, 95% CI 1.74-15.49; P=.001), and arthralgia (OR 3.8, 95% CI 1.21-11.71; P=.02) at illness onset and a polymerase chain reaction cycle threshold of ≤20 on a diagnostic nasopharyngeal swab (OR 5.0, 95% CI 1.25-19.63; P=.02). Conclusions: Our results suggest that a virtual ward model of care to treat patients with COVID-19 is safe and efficacious, and only a small number of patients would potentially require escalation to hospital care. Further studies are required to validate this model of care. %M 33529157 %R 10.2196/25518 %U http://www.jmir.org/2021/2/e25518/ %U https://doi.org/10.2196/25518 %U http://www.ncbi.nlm.nih.gov/pubmed/33529157 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25431 %T Tracking COVID-19 Discourse on Twitter in North America: Infodemiology Study Using Topic Modeling and Aspect-Based Sentiment Analysis %A Jang,Hyeju %A Rempel,Emily %A Roth,David %A Carenini,Giuseppe %A Janjua,Naveed Zafar %+ British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z 4R4, Canada, 1 604 707 2514, naveed.janjua@bccdc.ca %K COVID-19 %K Twitter %K topic modeling %K aspect-based sentiment analysis %K racism %K anti-Asians %K Canada %K North America %K sentiment analysis %K social media %K discourse %K reaction %K public health %D 2021 %7 10.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media is a rich source where we can learn about people’s reactions to social issues. As COVID-19 has impacted people’s lives, it is essential to capture how people react to public health interventions and understand their concerns. Objective: We aim to investigate people’s reactions and concerns about COVID-19 in North America, especially in Canada. Methods: We analyzed COVID-19–related tweets using topic modeling and aspect-based sentiment analysis (ABSA), and interpreted the results with public health experts. To generate insights on the effectiveness of specific public health interventions for COVID-19, we compared timelines of topics discussed with the timing of implementation of interventions, synergistically including information on people’s sentiment about COVID-19–related aspects in our analysis. In addition, to further investigate anti-Asian racism, we compared timelines of sentiments for Asians and Canadians. Results: Topic modeling identified 20 topics, and public health experts provided interpretations of the topics based on top-ranked words and representative tweets for each topic. The interpretation and timeline analysis showed that the discovered topics and their trend are highly related to public health promotions and interventions such as physical distancing, border restrictions, handwashing, staying home, and face coverings. After training the data using ABSA with human-in-the-loop, we obtained 545 aspect terms (eg, “vaccines,” “economy,” and “masks”) and 60 opinion terms such as “infectious” (negative) and “professional” (positive), which were used for inference of sentiments of 20 key aspects selected by public health experts. The results showed negative sentiments related to the overall outbreak, misinformation and Asians, and positive sentiments related to physical distancing. Conclusions: Analyses using natural language processing techniques with domain expert involvement can produce useful information for public health. This study is the first to analyze COVID-19–related tweets in Canada in comparison with tweets in the United States by using topic modeling and human-in-the-loop domain-specific ABSA. This kind of information could help public health agencies to understand public concerns as well as what public health messages are resonating in our populations who use Twitter, which can be helpful for public health agencies when designing a policy for new interventions. %M 33497352 %R 10.2196/25431 %U http://www.jmir.org/2021/2/e25431/ %U https://doi.org/10.2196/25431 %U http://www.ncbi.nlm.nih.gov/pubmed/33497352 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e24585 %T Comparing News Articles and Tweets About COVID-19 in Brazil: Sentiment Analysis and Topic Modeling Approach %A de Melo,Tiago %A Figueiredo,Carlos M S %+ Intelligent Systems Laboratory, Superior School of Technology, Amazonas State University, Av Darcy Vargas, 1200, Manaus, Brazil, 55 9233487601, tmelo@uea.edu.br %K COVID-19 %K Twitter %K infodemiology %K news %K sentiment analysis %K social media %K Brazil %K monitoring %K topic modeling %K entity recognition %K text analysis %D 2021 %7 10.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic is severely affecting people worldwide. Currently, an important approach to understand this phenomenon and its impact on the lives of people consists of monitoring social networks and news on the internet. Objective: The purpose of this study is to present a methodology to capture the main subjects and themes under discussion in news media and social media and to apply this methodology to analyze the impact of the COVID-19 pandemic in Brazil. Methods: This work proposes a methodology based on topic modeling, namely entity recognition, and sentiment analysis of texts to compare Twitter posts and news, followed by visualization of the evolution and impact of the COVID-19 pandemic. We focused our analysis on Brazil, an important epicenter of the pandemic; therefore, we faced the challenge of addressing Brazilian Portuguese texts. Results: In this work, we collected and analyzed 18,413 articles from news media and 1,597,934 tweets posted by 1,299,084 users in Brazil. The results show that the proposed methodology improved the topic sentiment analysis over time, enabling better monitoring of internet media. Additionally, with this tool, we extracted some interesting insights about the evolution of the COVID-19 pandemic in Brazil. For instance, we found that Twitter presented similar topic coverage to news media; the main entities were similar, but they differed in theme distribution and entity diversity. Moreover, some aspects represented negative sentiment toward political themes in both media, and a high incidence of mentions of a specific drug denoted high political polarization during the pandemic. Conclusions: This study identified the main themes under discussion in both news and social media and how their sentiments evolved over time. It is possible to understand the major concerns of the public during the pandemic, and all the obtained information is thus useful for decision-making by authorities. %M 33480853 %R 10.2196/24585 %U http://publichealth.jmir.org/2021/2/e24585/ %U https://doi.org/10.2196/24585 %U http://www.ncbi.nlm.nih.gov/pubmed/33480853 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e26081 %T Dynamic Panel Data Modeling and Surveillance of COVID-19 in Metropolitan Areas in the United States: Longitudinal Trend Analysis %A Oehmke,Theresa B %A Post,Lori A %A Moss,Charles B %A Issa,Tariq Z %A Boctor,Michael J %A Welch,Sarah B %A Oehmke,James F %+ Department of Civil and Environmental Engineering, University of California, Berkeley, 202 O'Brien Hall, Berkeley, CA, 94720, United States, 1 5108986406, toehmke@berkeley.edu %K COVID-19 %K SARS-CoV-2 %K SARS-CoV-2 surveillance %K second wave %K wave two %K wave 2 %K global COVID-19 surveillance %K COVID-19 metropolitan areas %K COVID-19 cities %K US public health surveillance %K US COVID-19 %K US surveillance metrics %K dynamic panel data %K generalized method of the moments %K US econometrics %K US SARS-CoV-2 %K US COVID-19 surveillance system %K US COVID-19 transmission speed %K US COVID-19 transmission acceleration %K COVID-19 transmission deceleration %K COVID-19 transmission jerk %K COVID-19 7-day lag %K Arellano-Bond estimator %K generalized method of moments %K GMM %K New York City %K Los Angeles %K Chicago %K Dallas %K Houston %K Washington, DC %K Miami %K Philadelphia %K Atlanta %K Phoenix %K Boston %K San Francisco %K Riverside %K Detroit %K Seattle %K Minneapolis %K San Diego %K Tampa %K Denver %K St Louis %K Baltimore %K Charlotte %K Orlando %K San Antonio %K Portland %D 2021 %7 9.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had profound and differential impacts on metropolitan areas across the United States and around the world. Within the United States, metropolitan areas that were hit earliest with the pandemic and reacted with scientifically based health policy were able to contain the virus by late spring. For other areas that kept businesses open, the first wave in the United States hit in mid-summer. As the weather turns colder, universities resume classes, and people tire of lockdowns, a second wave is ascending in both metropolitan and rural areas. It becomes more obvious that additional SARS-CoV-2 surveillance is needed at the local level to track recent shifts in the pandemic, rates of increase, and persistence. Objective: The goal of this study is to provide advanced surveillance metrics for COVID-19 transmission that account for speed, acceleration, jerk and persistence, and weekly shifts, to better understand and manage risk in metropolitan areas. Existing surveillance measures coupled with our dynamic metrics of transmission will inform health policy to control the COVID-19 pandemic until, and after, an effective vaccine is developed. Here, we provide values for novel indicators to measure COVID-19 transmission at the metropolitan area level. Methods: Using a longitudinal trend analysis study design, we extracted 260 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in the 25 largest US metropolitan areas as a function of the prior number of cases and weekly shift variables based on a dynamic panel data model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: Minneapolis and Chicago have the greatest average number of daily new positive results per standardized 100,000 population (which we refer to as speed). Extreme behavior in Minneapolis showed an increase in speed from 17 to 30 (67%) in 1 week. The jerk and acceleration calculated for these areas also showed extreme behavior. The dynamic panel data model shows that Minneapolis, Chicago, and Detroit have the largest persistence effects, meaning that new cases pertaining to a specific week are statistically attributable to new cases from the prior week. Conclusions: Three of the metropolitan areas with historically early and harsh winters have the highest persistence effects out of the top 25 most populous metropolitan areas in the United States at the beginning of their cold weather season. With these persistence effects, and with indoor activities becoming more popular as the weather gets colder, stringent COVID-19 regulations will be more important than ever to flatten the second wave of the pandemic. As colder weather grips more of the nation, southern metropolitan areas may also see large spikes in the number of cases. %M 33481757 %R 10.2196/26081 %U https://www.jmir.org/2021/2/e26081 %U https://doi.org/10.2196/26081 %U http://www.ncbi.nlm.nih.gov/pubmed/33481757 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e25935 %T Collaborating in the Time of COVID-19: The Scope and Scale of Innovative Responses to a Global Pandemic %A Bernardo,Theresa %A Sobkowich,Kurtis Edward %A Forrest,Russell Othmer %A Stewart,Luke Silva %A D'Agostino,Marcelo %A Perez Gutierrez,Enrique %A Gillis,Daniel %+ Department of Population Medicine, University of Guelph, 50 Stone Rd E, Guelph, ON, N1G 2W1, Canada, 1 519 824 4120 ext 54184, theresabernardo@gmail.com %K crowdsourcing %K artificial intelligence %K collaboration %K personal protective equipment %K big data %K AI %K COVID-19 %K innovation %K information sharing %K communication %K teamwork %K knowledge %K dissemination %D 2021 %7 9.2.2021 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The emergence of COVID-19 spurred the formation of myriad teams to tackle every conceivable aspect of the virus and thwart its spread. Enabled by global digital connectedness, collaboration has become a constant theme throughout the pandemic, resulting in the expedition of the scientific process (including vaccine development), rapid consolidation of global outbreak data and statistics, and experimentation with novel partnerships. To document the evolution of these collaborative efforts, the authors collected illustrative examples as the pandemic unfolded, supplemented with publications from the JMIR COVID-19 Special Issue. Over 60 projects rooted in collaboration are categorized into five main themes: knowledge dissemination, data propagation, crowdsourcing, artificial intelligence, and hardware design and development. They highlight the numerous ways that citizens, industry professionals, researchers, and academics have come together worldwide to consolidate information and produce products to combat the COVID-19 pandemic. Initially, researchers and citizen scientists scrambled to access quality data within an overwhelming quantity of information. As global curated data sets emerged, derivative works such as visualizations or models were developed that depended on consistent data and would fail when there were unanticipated changes. Crowdsourcing was used to collect and analyze data, aid in contact tracing, and produce personal protective equipment by sharing open designs for 3D printing. An international consortium of entrepreneurs and researchers created a ventilator based on an open-source design. A coalition of nongovernmental organizations and governmental organizations, led by the White House Office of Science and Technology Policy, created a shared open resource of over 200,000 research publications about COVID-19 and subsequently offered cash prizes for the best solutions to 17 key questions involving artificial intelligence. A thread of collaboration weaved throughout the pandemic response, which will shape future efforts. Novel partnerships will cross boundaries to create better processes, products, and solutions to consequential societal challenges. %M 33503001 %R 10.2196/25935 %U http://publichealth.jmir.org/2021/2/e25935/ %U https://doi.org/10.2196/25935 %U http://www.ncbi.nlm.nih.gov/pubmed/33503001 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e26190 %T Analyzing Digital Evidence From a Telemental Health Platform to Assess Complex Psychological Responses to the COVID-19 Pandemic: Content Analysis of Text Messages %A Hull,Thomas D %A Levine,Jacob %A Bantilan,Niels %A Desai,Angel N %A Majumder,Maimuna S %+ Talkspace, 2578 Broadway #607, New York, NY, 10025, United States, 1 4802548815, tdh732@mail.harvard.edu %K digital phenotyping %K COVID-19 %K telehealth %K digital mental health %K natural language processing %K machine learning %K mental health %K phenotyping %K burden %K treatment %K symptom %D 2021 %7 9.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The novel COVID-19 disease has negatively impacted mortality, economic conditions, and mental health. These impacts are likely to continue after the COVID-19 pandemic ends. There are no methods for characterizing the mental health burden of the COVID-19 pandemic, and differentiating this burden from that of the prepandemic era. Accurate illness detection methods are critical for facilitating pandemic-related treatment and preventing the worsening of symptoms. Objective: We aimed to identify major themes and symptom clusters in the SMS text messages that patients send to therapists. We assessed patients who were seeking treatment for pandemic-related distress on Talkspace, which is a popular telemental health platform. Methods: We used a machine learning algorithm to identify patients’ pandemic-related concerns, based on their SMS text messages in a large, digital mental health service platform (ie, Talkspace). This platform uses natural language processing methods to analyze unstructured therapy transcript data, in parallel with brief clinical assessment methods for analyzing depression and anxiety symptoms. Results: Our results show a significant increase in the incidence of COVID-19–related intake anxiety symptoms (P<.001), but no significant differences in the incidence of intake depression symptoms (P=.79). During our transcript analyses, we identified terms that were related to 24 symptoms outside of those included in the diagnostic criteria for anxiety and depression. Conclusions: Our findings for Talkspace suggest that people who seek treatment during the pandemic experience more severe intake anxiety than they did before the COVID-19 outbreak. It is important to monitor the symptoms that we identified in this study and the symptoms of anxiety and depression, to fully understand the effects of the COVID-19 pandemic on mental health. %M 33502999 %R 10.2196/26190 %U http://formative.jmir.org/2021/2/e26190/ %U https://doi.org/10.2196/26190 %U http://www.ncbi.nlm.nih.gov/pubmed/33502999 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e21734 %T Tracking Demographic Movements and Immunization Status to Improve Children's Access to Immunization (TDM-IAI): Protocol for a Field-Based Randomized Controlled Trial %A Ateudjieu,Jérôme %A Yakum,Ndinakie Martin %A Goura,André Pascal %A Guenou,Etienne %A Beyala,Landry Bita’a %A Amada,Lapia %A Ngoche,Isabelle %A Kiadjieu,Frank Forex %A Nangue,Charlette %A Djosseu,Elvis Briand Soukep %A Kenfack,Bruno %+ Meilleur Accès aux soins de Santé (MA SANTE), Mvolye Street, Yaoundé, 33490, Cameroon, 237 679336464, pgoura@masante-cam.org %K immunization status %K coverage: completeness %K timeliness %K EPI vaccines %K children under five %K Foumban %K Cameroon %K vaccines %K infectious %K immunization %D 2021 %7 8.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33555269 %R 10.2196/21734 %U https://www.researchprotocols.org/2021/2/e21734 %U https://doi.org/10.2196/21734 %U http://www.ncbi.nlm.nih.gov/pubmed/33555269 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 2 %P e25452 %T Clinical Characterization of Patients With COVID-19 in Primary Care in Catalonia: Retrospective Observational Study %A Mayer,Miguel Angel %A Vidal-Alaball,Josep %A Puigdellívol-Sánchez,Anna %A Marín Gomez,Francesc X %A Leis,Angela %A Mendioroz Peña,Jacobo %+ Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Carrer Pica d'Estats, 13-15, Sant Fruitós de Bages, 08272, Spain, 34 936930040, jvidal.cc.ics@gencat.cat %K COVID-19 %K risk factors %K primary health care %K angiotensin-converting enzyme inhibitors %K angiotensin II type 2 receptor blockers %K risk %K characteristic %K retrospective %K observational %K Spain %K mortality %D 2021 %7 8.2.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The country of Spain has one of the highest incidences of COVID-19, with more than 1,000,000 cases as of the end of October 2020. Patients with a history of chronic conditions, obesity, and cancer are at greater risk from COVID-19; moreover, concerns surrounding the use of angiotensin-converting enzyme inhibitors (ACEIs) and angiotensin type II receptor blockers (ARBs) and its relationship to COVID-19 susceptibility have increased since the beginning of the pandemic. Objective: The objectives of this study were to compare the characteristics of patients diagnosed with COVID-19 to those of patients without COVID-19 in primary care; to determine the risk factors associated with the outcome of mortality; and to determine the potential influence of certain medications, such as ACEIs and ARBs, on the mortality of patients with COVID-19. Methods: An observational retrospective study of patients diagnosed with COVID-19 in the Catalan Central Region of Spain between March 1 and August 17, 2020, was conducted. The data were obtained from the Primary Care Services Information Technologies System of the Catalan Institute of Health in Barcelona, Spain. Results: The study population included 348,596 patients (aged >15 years) registered in the Primary Care Services Information Technologies System of the Catalan Central Region. The mean age of the patients was 49.53 years (SD 19.42), and 31.17% of the patients were aged ≥60 years. 175,484/348,596 patients (50.34%) were women. A total of 23,844/348,596 patients (6.84%) in the population studied were diagnosed with COVID-19 during the study period, and the most common clinical conditions of these patients were hypertension (5267 patients, 22.1%) and obesity (5181 patients, 21.7%). Overall, 2680/348,596 patients in the study population (0.77%) died during the study period. The number of deaths among patients without COVID-19 was 1825/324,752 (0.56%; mean age 80.6 years, SD 13.3), while among patients diagnosed with COVID-19, the number of deaths was 855/23,844 (3.58%; mean age 83.0 years, SD 10.80) with an OR of 6.58 (95% CI 6.06-7.15). Conclusions: We observed that women were more likely to contract COVID-19 than men. In addition, our study did not show that hypertension, obesity, or being treated with ACEIs or ARBs was linked to an increase in mortality in patients with COVID-19. Age is the main factor associated with mortality in patients infected with SARS-CoV-2. %M 33496668 %R 10.2196/25452 %U http://publichealth.jmir.org/2021/2/e25452/ %U https://doi.org/10.2196/25452 %U http://www.ncbi.nlm.nih.gov/pubmed/33496668 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25799 %T Surveillance Metrics of SARS-CoV-2 Transmission in Central Asia: Longitudinal Trend Analysis %A Post,Lori Ann %A Benishay,Elana T %A Moss,Charles B %A Murphy,Robert Leo %A Achenbach,Chad J %A Ison,Michael G %A Resnick,Danielle %A Singh,Lauren Nadya %A White,Janine %A Chaudhury,Azraa S %A Boctor,Michael J %A Welch,Sarah B %A Oehmke,James Francis %+ Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K SARS-CoV-2 surveillance %K second wave %K wave two %K global COVID-19 surveillance %K Central Asia public health surveillance %K Central Asia COVID-19 %K Central Asia surveillance metrics %K dynamic panel data %K generalized method of moments %K Central Asia econometrics %K Central Asia SARS-CoV-2 %K Central Asia COVID-19 surveillance system %K Central Asia COVID-19 transmission speed %K Central Asia COVID transmission acceleration %K COVID-19 transmission deceleration %K COVID-19 transmission jerk %K COVID-19 7-day lag %K SARS-CoV-2 %K Arellano-Bond estimator, generalized method of moments %K GMM %K Armenia %K Azerbaijan %K Cyprus %K Faeroe Islands %K Georgia %K Gibraltar %K Kazakhstan %K Kosovo %K Kyrgyzstan %K Macedonia %K Russia %K Tajikistan Turkey %K Turkmenistan %K Uzbekistan %K COVID-19 %K surveillance %K longitudinal %K trend %K trend analysis %K monitoring %K public health %K infectious disease %K transmission %K risk %K management %K policy %K prevention %D 2021 %7 3.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: SARS-CoV-2, the virus that caused the global COVID-19 pandemic, has severely impacted Central Asia; in spring 2020, high numbers of cases and deaths were reported in this region. The second wave of the COVID-19 pandemic is currently breaching the borders of Central Asia. Public health surveillance is necessary to inform policy and guide leaders; however, existing surveillance explains past transmissions while obscuring shifts in the pandemic, increases in infection rates, and the persistence of the transmission of COVID-19. Objective: The goal of this study is to provide enhanced surveillance metrics for SARS-CoV-2 transmission that account for weekly shifts in the pandemic, including speed, acceleration, jerk, and persistence, to better understand the risk of explosive growth in each country and which countries are managing the pandemic successfully. Methods: Using a longitudinal trend analysis study design, we extracted 60 days of COVID-19–related data from public health registries. We used an empirical difference equation to measure the daily number of cases in the Central Asia region as a function of the prior number of cases, level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: COVID-19 transmission rates were tracked for the weeks of September 30 to October 6 and October 7-13, 2020, in Central Asia. The region averaged 11,730 new cases per day for the first week and 14,514 for the second week. Infection rates increased across the region from 4.74 per 100,000 persons to 5.66. Russia and Turkey had the highest 7-day moving averages in the region, with 9836 and 1469, respectively, for the week of October 6 and 12,501 and 1603, respectively, for the week of October 13. Russia has the fourth highest speed in the region and continues to have positive acceleration, driving the negative trend for the entire region as the largest country by population. Armenia is experiencing explosive growth of COVID-19; its infection rate of 13.73 for the week of October 6 quickly jumped to 25.19, the highest in the region, the following week. The region overall is experiencing increases in its 7-day moving average of new cases, infection, rate, and speed, with continued positive acceleration and no sign of a reversal in sight. Conclusions: The rapidly evolving COVID-19 pandemic requires novel dynamic surveillance metrics in addition to static metrics to effectively analyze the pandemic trajectory and control spread. Policy makers need to know the magnitude of transmission rates, how quickly they are accelerating, and how previous cases are impacting current caseload due to a lag effect. These metrics applied to Central Asia suggest that the region is trending negatively, primarily due to minimal restrictions in Russia. %M 33475513 %R 10.2196/25799 %U https://www.jmir.org/2021/2/e25799 %U https://doi.org/10.2196/25799 %U http://www.ncbi.nlm.nih.gov/pubmed/33475513 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e24730 %T Predicting Public Uptake of Digital Contact Tracing During the COVID-19 Pandemic: Results From a Nationwide Survey in Singapore %A Saw,Young Ern %A Tan,Edina Yi-Qin %A Liu,Jessica Shijia %A Liu,Jean CJ %+ Division of Social Sciences, Yale-NUS College, 28 College Avenue West #01-501, Singapore, 138533, Singapore, 65 6601 3694, jeanliu@yale-nus.edu.sg %K contact tracing %K COVID-19 %K mobile app %K digital health %K epidemiology %D 2021 %7 3.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: During the COVID-19 pandemic, new digital solutions have been developed for infection control. In particular, contact tracing mobile apps provide a means for governments to manage both health and economic concerns. However, public reception of these apps is paramount to their success, and global uptake rates have been low. Objective: In this study, we sought to identify the characteristics of individuals or factors potentially associated with voluntary downloads of a contact tracing mobile app in Singapore. Methods: A cohort of 505 adults from the general community completed an online survey. As the primary outcome measure, participants were asked to indicate whether they had downloaded the contact tracing app TraceTogether introduced at the national level. The following were assessed as predictor variables: (1) participant demographics, (2) behavioral modifications on account of the pandemic, and (3) pandemic severity (the number of cases and lockdown status). Results: Within our data set, the strongest predictor of the uptake of TraceTogether was the extent to which individuals had already adjusted their lifestyles because of the pandemic (z=13.56; P<.001). Network analyses revealed that uptake was most related to the following: using hand sanitizers, avoiding public transport, and preferring outdoor over indoor venues during the pandemic. However, demographic and situational characteristics were not significantly associated with app downloads. Conclusions: Efforts to introduce contact tracing apps could capitalize on pandemic-related behavioral adjustments among individuals. Given that a large number of individuals is required to download contact tracing apps for contact tracing to be effective, further studies are required to understand how citizens respond to contact tracing apps. Trial Registration: ClinicalTrials.gov NCT04468581, https://clinicaltrials.gov/ct2/show/NCT04468581 %M 33465034 %R 10.2196/24730 %U https://www.jmir.org/2021/2/e24730 %U https://doi.org/10.2196/24730 %U http://www.ncbi.nlm.nih.gov/pubmed/33465034 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 2 %P e21156 %T COVID-19–Induced Fear in Infoveillance Studies: Pilot Meta-analysis Study of Preliminary Results %A Geronikolou,Styliani %A Chrousos,George %+ University Research Institute of Maternal and Child Health and Precision Medicine, National and Kapodistrian University of Athens, Levadias 1, Athens, Greece, 30 2132013362, sgeronik@gmail.com %K COVID-19 %K social media %K misinformation %K infodemics %K infodemiology %K infoveillance %K fear %K meta-analysis %D 2021 %7 3.2.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The World Health Organization named the phenomenon of misinformation spread through social media as an “infodemic” and recognized the need to curb it. Misinformation infodemics undermine not only population safety but also compliance to the suggestions and prophylactic measures recommended during pandemics. Objective: The aim of this pilot study is to review the impact of social media on general population fear in “infoveillance” studies during the COVID-19 pandemic. Methods: The PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) protocol was followed, and 6 out of 20 studies were retrieved, meta-analyzed, and had their findings presented in the form of a forest plot. Results: The summary random and significant event rate was 0.298 (95% CI 0.213-0.400), suggesting that social media–circulated misinformation related to COVID-19 triggered public fear and other psychological manifestations. These findings merit special attention by public health authorities. Conclusions: Infodemiology and infoveillance are valid tools in the hands of epidemiologists to help prevent dissemination of false information, which has potentially damaging effects. %M 33400681 %R 10.2196/21156 %U https://formative.jmir.org/2021/2/e21156 %U https://doi.org/10.2196/21156 %U http://www.ncbi.nlm.nih.gov/pubmed/33400681 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 2 %P e23316 %T Clinical and Epidemiological Characteristics of Postdischarge Patients With COVID-19 in Tehran, Iran: Protocol for a Prospective Cohort Study (Tele-COVID-19 Study) %A Jalilian Khave,Laya %A Vahidi,Mohammad %A Shirini,Dorsa %A Sanadgol,Ghazal %A Ashrafi,Farzad %A Arab-Ahmadi,Mehran %A Fatemi,Alireza %A Shabani Barzegar,Minoosh %A Hassanzadeh,Taha %A Rezaei,Behandokht %A Zali,Alireza %A Ommi,Davood %A Nohesara,Shabnam %A Jalili Khoshnood,Reza %A Abdi,Saeed %A Pirsalehi,Ali %A Masarat,Ehsan %A Shokoohi,Mostafa %A Karamouzian,Mohammad %+ Faculty of Medicine, School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, Canada, 1 6048222772, karamouzian.m@alumni.ubc.ca %K cohort studies %K COVID-19 %K health care delivery %K Iran %K medical education %K telemedicine %D 2021 %7 2.2.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19 was declared a pandemic on March 11, 2020. Given that the severe shortage of hospital beds has led to early discharge and insufficient patient education on home care routines and isolation protocols, the close follow-up of patients and their immediate relatives is an integral part of transitioning from hospital care to home care for patients with COVID-19. Objective: We designed the Tele-COVID-19 prospective cohort to follow-up with COVID-19 patients in Tehran, Iran, and improve health care delivery and the recording of postdischarge patients’ clinical profiles. Methods: All adult patients who were admitted to the COVID-19 wards of teaching hospitals in Tehran, Iran were eligible to participate in this cohort study. At baseline, patients were recruited from 4 major hospitals from March 9, 2020 to May 20, 2020. Telephone follow-ups, which were led by volunteer medical students, were conducted on postdischarge days 1-3, 5, 7, 10, and 14. We collected data on a range of sociodemographic, epidemiological, and clinical characteristics by using a standard questionnaire. Results: Of the 950 patients with confirmed COVID-19 who were approached, 823 (response rate: 86.6%) consented and were enrolled into the cohort. Of the 823 participants, 449 (54.5%) were male. The mean age of participants was 50.1 years (SD 12.6 years). During the initial data collection phase, more than 5000 phone calls were made and over 577 reports of critical patients who were in need of urgent medical attention were recorded. Conclusions: The Tele-COVID-19 cohort will provide patients with sufficient education on home care and isolation, and medical advice on care and the proper use of drugs. In addition, by preventing unnecessary hospital returns and providing information on household SARS-CoV-2 transmission as early as possible, this cohort will help with effective disease management in resource-limited settings. International Registered Report Identifier (IRRID): DERR1-10.2196/23316 %M 33471777 %R 10.2196/23316 %U https://www.researchprotocols.org/2021/2/e23316 %U https://doi.org/10.2196/23316 %U http://www.ncbi.nlm.nih.gov/pubmed/33471777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 2 %P e25454 %T SARS-CoV-2 Wave Two Surveillance in East Asia and the Pacific: Longitudinal Trend Analysis %A Post,Lori Ann %A Lin,Jasmine S %A Moss,Charles B %A Murphy,Robert Leo %A Ison,Michael G %A Achenbach,Chad J %A Resnick,Danielle %A Singh,Lauren Nadya %A White,Janine %A Boctor,Michael J %A Welch,Sarah B %A Oehmke,James Francis %+ Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL, 60611, United States, 1 2039807108, lori.post@northwestern.edu %K COVID-19 %K SARS-CoV-2 %K SARS-CoV-2 surveillance %K second wave %K wave two %K wave 2 %K global COVID-19 surveillance %K Asia Pacific public health surveillance %K Asia Pacific COVID-19 %K Asian Pacific SARS-CoV-2 %K Asia Pacific surveillance metrics %K dynamic panel data %K generalized method of the moments %K Asian Pacific econometrics %K East Asian Pacific COVID-19 surveillance system %K Pacific Asian COVID-19 transmission speed %K Asian Pacific COVID-19 transmission acceleration %K COVID-19 transmission deceleration %K COVID-19 transmission jerk %K COVID-19 7-day lag %K Arellano-Bond estimator %K generalized method of moments %K GMM %K Australia %K Brunei %K Cambodia %K China %K Fiji %K French Polynesia %K Guam %K Indonesia %K Japan %K Kiribati %K Laos %K Malaysia %K Mongolia %K Myanmar %K New Caledonia %K Philippines %D 2021 %7 1.2.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has had a profound global impact on governments, health care systems, economies, and populations around the world. Within the East Asia and Pacific region, some countries have mitigated the spread of the novel coronavirus effectively and largely avoided severe negative consequences, while others still struggle with containment. As the second wave reaches East Asia and the Pacific, it becomes more evident that additional SARS-CoV-2 surveillance is needed to track recent shifts, rates of increase, and persistence associated with the pandemic. Objective: The goal of this study is to provide advanced surveillance metrics for COVID-19 transmission that account for speed, acceleration, jerk, persistence, and weekly shifts, to better understand country risk for explosive growth and those countries who are managing the pandemic successfully. Existing surveillance coupled with our dynamic metrics of transmission will inform health policy to control the COVID-19 pandemic until an effective vaccine is developed. We provide novel indicators to measure disease transmission. Methods: Using a longitudinal trend analysis study design, we extracted 330 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in East Asia and the Pacific as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: The standard surveillance metrics for Indonesia, the Philippines, and Myanmar were concerning as they had the largest new caseloads at 4301, 2588, and 1387, respectively. When looking at the acceleration of new COVID-19 infections, we found that French Polynesia, Malaysia, and the Philippines had rates at 3.17, 0.22, and 0.06 per 100,000. These three countries also ranked highest in terms of jerk at 15.45, 0.10, and 0.04, respectively. Conclusions: Two of the most populous countries in East Asia and the Pacific, Indonesia and the Philippines, have alarming surveillance metrics. These two countries rank highest in new infections in the region. The highest rates of speed, acceleration, and positive upwards jerk belong to French Polynesia, Malaysia, and the Philippines, and may result in explosive growth. While all countries in East Asia and the Pacific need to be cautious about reopening their countries since outbreaks are likely to occur in the second wave of COVID-19, the country of greatest concern is the Philippines. Based on standard and enhanced surveillance, the Philippines has not gained control of the COVID-19 epidemic, which is particularly troubling because the country ranks 4th in population in the region. Without extreme and rigid social distancing, quarantines, hygiene, and masking to reverse trends, the Philippines will remain on the global top 5 list of worst COVID-19 outbreaks resulting in high morbidity and mortality. The second wave will only exacerbate existing conditions and increase COVID-19 transmissions. %M 33464207 %R 10.2196/25454 %U https://www.jmir.org/2021/2/e25454 %U https://doi.org/10.2196/25454 %U http://www.ncbi.nlm.nih.gov/pubmed/33464207 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e23126 %T Geographic Distribution of Mental Health Problems Among Chinese College Students During the COVID-19 Pandemic: Nationwide, Web-Based Survey Study %A Wu,Xiaoyan %A Tao,Shuman %A Zhang,Yi %A Li,Shiyue %A Ma,Le %A Yu,Yizhen %A Sun,Guilong %A Li,Tingting %A Tao,Fangbiao %+ Department of Maternal, Child and Adolescent Health, School of Public Health, Anhui Medical University, No. 81 Meishan Road, Anhui, China, 86 055165161169, fbtao@ahmu.edu.cn %K COVID-19 pandemic %K college students %K mental health problems %K geographic location %D 2021 %7 29.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the COVID-19 outbreak was first reported, considerable attention has been drawn to mental health problems among college students. Objective: We aimed to estimate the prevalence of anxiety and depressive symptoms among college students in different geographical areas of China during the early stage of the COVID-19 outbreak. Methods: A nationwide cross-sectional survey was conducted among Chinese college students of 16 provinces or municipalities from February 4 to 12, 2020. A web-based survey was adopted to collect information from these college students, including demographics, perceived risk of infection, attitudes toward the epidemic and its control, and mental health status. Anxiety symptoms were assessed using the Generalized Anxiety Disorder scale, and depressive symptoms were assessed using the Patient Health Questionnaire. Chi-square test was used to compare the percentage of perceived risk of infection and attitude toward COVID-19 among college students in different geographic locations. Binary logistic models were used to identify associations between geographic locations and mental health problems after controlling for covariates. Results: A total of 11,787 participants were analyzed in this study (response rate: 79.7%). The prevalence of anxiety and depressive symptoms among college students was 17.8% (95% CI 17.1%-18.5%) and 25.9% (95% CI 25.1%-26.7%), respectively. After controlling for covariates, current residence area in Wuhan city was found to have a positive association with anxiety symptoms (odds ratio [OR] 1.37, 95% CI 1.11-1.68) and depressive symptoms (OR 1.32, 95% CI 1.09-1.59). Similarly, college location in Wuhan city was found to have a positive association with anxiety symptoms (OR 1.20, 95% CI 1.07-1.35) and depressive symptoms (OR 1.22, 95% CI 1.10-1.36). History of residence in or travel to Wuhan city in the past month was also positively associated with anxiety symptoms (OR 1.62, 95% CI 1.46-1.80) and depressive symptoms (OR 1.48, 95% CI 1.35-1.63). Furthermore, the perceived risk of COVID-19 was higher among students whose college location and current residence area were in Wuhan city, and it was positively associated with anxiety and depressive symptoms. Conclusions: During the COVID-19 pandemic, mental health problems among Chinese college students were widespread and geographically diverse. Our study results provide further insight for policymakers to develop targeted intervention strategies. %M 33439853 %R 10.2196/23126 %U http://www.jmir.org/2021/1/e23126/ %U https://doi.org/10.2196/23126 %U http://www.ncbi.nlm.nih.gov/pubmed/33439853 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 1 %P e24973 %T Deep Learning Models for Predicting Severe Progression in COVID-19-Infected Patients: Retrospective Study %A Ho,Thao Thi %A Park,Jongmin %A Kim,Taewoo %A Park,Byunggeon %A Lee,Jaehee %A Kim,Jin Young %A Kim,Ki Beom %A Choi,Sooyoung %A Kim,Young Hwan %A Lim,Jae-Kwang %A Choi,Sanghun %+ School of Mechanical Engineering, Kyungpook National University, 80 Daehak-ro, Buk-gu, Daegu, 41566, Republic of Korea, 82 53 950 5578, s-choi@knu.ac.kr %K COVID-19 %K deep learning %K artificial neural network %K convolutional neural network %K lung CT %D 2021 %7 28.1.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Many COVID-19 patients rapidly progress to respiratory failure with a broad range of severities. Identification of high-risk cases is critical for early intervention. Objective: The aim of this study is to develop deep learning models that can rapidly identify high-risk COVID-19 patients based on computed tomography (CT) images and clinical data. Methods: We analyzed 297 COVID-19 patients from five hospitals in Daegu, South Korea. A mixed artificial convolutional neural network (ACNN) model, combining an artificial neural network for clinical data and a convolutional neural network for 3D CT imaging data, was developed to classify these cases as either high risk of severe progression (ie, event) or low risk (ie, event-free). Results: Using the mixed ACNN model, we were able to obtain high classification performance using novel coronavirus pneumonia lesion images (ie, 93.9% accuracy, 80.8% sensitivity, 96.9% specificity, and 0.916 area under the curve [AUC] score) and lung segmentation images (ie, 94.3% accuracy, 74.7% sensitivity, 95.9% specificity, and 0.928 AUC score) for event versus event-free groups. Conclusions: Our study successfully differentiated high-risk cases among COVID-19 patients using imaging and clinical features. The developed model can be used as a predictive tool for interventions in aggressive therapies. %M 33455900 %R 10.2196/24973 %U http://medinform.jmir.org/2021/1/e24973/ %U https://doi.org/10.2196/24973 %U http://www.ncbi.nlm.nih.gov/pubmed/33455900 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 1 %P e24207 %T Federated Learning of Electronic Health Records to Improve Mortality Prediction in Hospitalized Patients With COVID-19: Machine Learning Approach %A Vaid,Akhil %A Jaladanki,Suraj K %A Xu,Jie %A Teng,Shelly %A Kumar,Arvind %A Lee,Samuel %A Somani,Sulaiman %A Paranjpe,Ishan %A De Freitas,Jessica K %A Wanyan,Tingyi %A Johnson,Kipp W %A Bicak,Mesude %A Klang,Eyal %A Kwon,Young Joon %A Costa,Anthony %A Zhao,Shan %A Miotto,Riccardo %A Charney,Alexander W %A Böttinger,Erwin %A Fayad,Zahi A %A Nadkarni,Girish N %A Wang,Fei %A Glicksberg,Benjamin S %+ The Hasso Plattner Institute for Digital Health at Mount Sinai, Icahn School of Medicine at Mount Sinai, 770 Lexington Avenue, 14th Floor, New York, NY, 10065, United States, 1 (212) 731 7078, benjamin.glicksberg@mssm.edu %K federated learning %K COVID-19 %K machine learning %K electronic health records %D 2021 %7 27.1.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Machine learning models require large datasets that may be siloed across different health care institutions. Machine learning studies that focus on COVID-19 have been limited to single-hospital data, which limits model generalizability. Objective: We aimed to use federated learning, a machine learning technique that avoids locally aggregating raw clinical data across multiple institutions, to predict mortality in hospitalized patients with COVID-19 within 7 days. Methods: Patient data were collected from the electronic health records of 5 hospitals within the Mount Sinai Health System. Logistic regression with L1 regularization/least absolute shrinkage and selection operator (LASSO) and multilayer perceptron (MLP) models were trained by using local data at each site. We developed a pooled model with combined data from all 5 sites, and a federated model that only shared parameters with a central aggregator. Results: The LASSOfederated model outperformed the LASSOlocal model at 3 hospitals, and the MLPfederated model performed better than the MLPlocal model at all 5 hospitals, as determined by the area under the receiver operating characteristic curve. The LASSOpooled model outperformed the LASSOfederated model at all hospitals, and the MLPfederated model outperformed the MLPpooled model at 2 hospitals. Conclusions: The federated learning of COVID-19 electronic health record data shows promise in developing robust predictive models without compromising patient privacy. %M 33400679 %R 10.2196/24207 %U http://medinform.jmir.org/2021/1/e24207/ %U https://doi.org/10.2196/24207 %U http://www.ncbi.nlm.nih.gov/pubmed/33400679 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e23034 %T Using the Novel Mortality-Prevalence Ratio to Evaluate Potentially Undocumented SARS-CoV-2 Infection: Correlational Study %A Lin,Sheng-Hsuan %A Fu,Shih-Chen %A Kao,Chu-Lan Michael %+ Institute of Statistics, National Chiao Tung University, Assembly Building I, 4th Floor, 1001 University Road, Hsinchu, 30010, Taiwan, 886 35712121 ext 56822, chulankao@gmail.com %K COVID-19 %K prevalence %K mortality %K undocumented infection %K mortality-prevalence ratio %K China %D 2021 %7 27.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The high prevalence of COVID-19 has resulted in 200,000 deaths as of early 2020. The corresponding mortality rate among different countries and times varies. Objective: This study aims to investigate the relationship between the mortality rate and prevalence of COVID-19 within a country. Methods: We collected data from the Johns Hopkins Coronavirus Resource Center. These data included the daily cumulative death count, recovered count, and confirmed count for each country. This study focused on a total of 36 countries with over 10,000 confirmed COVID-19 cases. Mortality was the main outcome and dependent variable, and it was computed by dividing the number of COVID-19 deaths by the number of confirmed cases. Results: The results of our global panel regression analysis showed that there was a highly significant correlation between prevalence and mortality (ρ=0.8304; P<.001). We found that every increment of 1 confirmed COVID-19 case per 1000 individuals led to a 1.29268% increase in mortality, after controlling for country-specific baseline mortality and time-fixed effects. Over 70% of excess mortality could be attributed to prevalence, and the heterogeneity among countries’ mortality-prevalence ratio was significant (P<.001). Further, our results showed that China had an abnormally high and significant mortality-prevalence ratio compared to other countries (P<.001). This unusual deviation in the mortality-prevalence ratio disappeared with the removal of the data that was collected from China after February 17, 2020. It is worth noting that the prevalence of a disease relies on accurate diagnoses and comprehensive surveillance, which can be difficult to achieve due to practical or political concerns. Conclusions: The association between COVID-19 mortality and prevalence was observed and quantified as the mortality-prevalence ratio. Our results highlight the importance of constraining disease transmission to decrease mortality rates. The comparison of mortality-prevalence ratios between countries can be a powerful method for detecting, or even quantifying, the proportion of individuals with undocumented SARS-CoV-2 infection. %M 33332282 %R 10.2196/23034 %U http://publichealth.jmir.org/2021/1/e23034/ %U https://doi.org/10.2196/23034 %U http://www.ncbi.nlm.nih.gov/pubmed/33332282 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e25265 %T Assessing COVID-19–Related Knowledge, Attitudes, and Practices Among Hispanic Primary Care Patients: Protocol for a Cross-sectional Survey Study %A Burger,Zoe C %A Mehta,Shivani N %A Ortiz,Dayanna %A Sor,Sekboppa %A Kothari,Jigna %A Lam,Yvonne %A Meka,Meena %A Meka,Ajay %A Rodwell,Timothy %+ School of Medicine, University of California San Diego, 9500 Gilman Dr #0039, La Jolla, CA, 92093, United States, 1 7146790080, s1mehta@ucsd.edu %K COVID-19 %K knowledge %K attitude %K practices %K Hispanic %K California %K protocol %K cross-sectional %K survey %D 2021 %7 27.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Recent epidemiological data indicate that minority groups, especially Hispanic communities, experience higher rates of infection, hospitalization, and death due to COVID-19. It is important to understand the nature of this health disparity and the socioeconomic or behavioral factors that are placing Hispanic communities and other minority populations at higher risk for morbidity and mortality. Objective: The purpose of this project is to assess current COVID-19–related knowledge, attitudes, and practices (KAP) among a predominantly Hispanic population from Orange County, California, and identify risk factors that may contribute to increased susceptibility and vulnerability to contracting SARS-CoV-2. Methods: Our Orange County–wide community survey consists of quantitative survey questions in four domains: demographic information, COVID-19 knowledge questions, COVID-19 attitude questions, and COVID-19 practices questions. The survey questions are adapted from recent global KAP studies. Participants are being recruited from Amistad Medical Clinic, a private primary health clinic group in Orange County that treats a predominantly Hispanic population. Patients recruited during telehealth visits are surveyed remotely by telephone, and those recruited during in-person clinic visits are surveyed in person. Surveys are conducted by trained members of the study team who are native to the community setting. Results: As of October 12, 2020, we had recruited and enrolled 327 participants. Data collection occurred June 26th to October 30th. Data analysis is ongoing. Conclusions: Very few current COVID-19 studies focus on the perspective and experience of minority populations. Because Hispanic communities are disproportionately affected by COVID-19, it is important to understand the factors the contribute to this disparity and the next steps that should be taken to reduce the COVID-19 burden in this population. We believe that our study model of partnering with a local clinic system that serves our study population can be expanded to other settings to compare COVID-19 KAP and associated factors within different minority communities. International Registered Report Identifier (IRRID): DERR1-10.2196/25265 %M 33406051 %R 10.2196/25265 %U http://www.researchprotocols.org/2021/1/e25265/ %U https://doi.org/10.2196/25265 %U http://www.ncbi.nlm.nih.gov/pubmed/33406051 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e22717 %T Diet, Nutrition, Obesity, and Their Implications for COVID-19 Mortality: Development of a Marginalized Two-Part Model for Semicontinuous Data %A Kamyari,Naser %A Soltanian,Ali Reza %A Mahjub,Hossein %A Moghimbeigi,Abbas %+ Modeling of Noncommunicable Diseases Research Center, Hamadan University of Medical Sciences, Daneshgah-e-Bu Ali Sina, Hamadan, Iran, 98 81 38380025, soltanian@umsha.ac.ir %K COVID-19 %K diet %K nutrition %K obesity %K marginalized two-part model %K semicontinuous data %D 2021 %7 26.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Nutrition is not a treatment for COVID-19, but it is a modifiable contributor to the development of chronic disease, which is highly associated with COVID-19 severe illness and deaths. A well-balanced diet and healthy patterns of eating strengthen the immune system, improve immunometabolism, and reduce the risk of chronic disease and infectious diseases. Objective: This study aims to assess the effect of diet, nutrition, obesity, and their implications for COVID-19 mortality among 188 countries by using new statistical marginalized two-part models. Methods: We globally evaluated the distribution of diet and nutrition at the national level while considering the variations between different World Health Organization regions. The effects of food supply categories and obesity on (as well as associations with) the number of deaths and the number of recoveries were reported globally by estimating coefficients and conducting color maps. Results: The findings show that a 1% increase in supplementation of pulses reduced the odds of having a zero death by 4-fold (OR 4.12, 95% CI 11.97-1.42). In addition, a 1% increase in supplementation of animal products and meat increased the odds of having a zero death by 1.076-fold (OR 1.076, 95% CI 1.01-1.15) and 1.13-fold (OR 1.13, 95% CI 1.0-1.28), respectively. Tree nuts reduced the odds of having a zero death, and vegetables increased the number of deaths. Globally, the results also showed that populations (countries) who consume more eggs, cereals excluding beer, spices, and stimulants had the greatest impact on the recovery of patients with COVID-19. In addition, populations that consume more meat, vegetal products, sugar and sweeteners, sugar crops, animal fats, and animal products were associated with more death and less recoveries in patients. The effect of consuming sugar products on mortality was considerable, and obesity has affected increased death rates and reduced recovery rates. Conclusions: Although there are differences in dietary patterns, overall, unbalanced diets are a health threat across the world and not only affect death rates but also the quality of life. To achieve the best results in preventing nutrition-related pandemic diseases, strategies and policies should fully recognize the essential role of both diet and obesity in determining good nutrition and optimal health. Policies and programs must address the need for change at the individual level and make modifications in society and the environment to make healthier choices accessible and preferable. %M 33439850 %R 10.2196/22717 %U http://publichealth.jmir.org/2021/1/e22717/ %U https://doi.org/10.2196/22717 %U http://www.ncbi.nlm.nih.gov/pubmed/33439850 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 9 %N 1 %P e24924 %T Machine Learning Prediction of Foodborne Disease Pathogens: Algorithm Development and Validation Study %A Wang,Hanxue %A Cui,Wenjuan %A Guo,Yunchang %A Du,Yi %A Zhou,Yuanchun %+ Computer Network Information Center, Chinese Academy of Sciences, No 4, South Fourth Street, Zhongguancun, Haidian District, Beijing, 100190, China, 86 15810134970, duyi@cnic.cn %K foodborne disease %K pathogens prediction %K machine learning %D 2021 %7 26.1.2021 %9 Original Paper %J JMIR Med Inform %G English %X Background: Foodborne diseases have a high global incidence; thus, they place a heavy burden on public health and the social economy. Foodborne pathogens, as the main factor of foodborne diseases, play an important role in the treatment and prevention of foodborne diseases; however, foodborne diseases caused by different pathogens lack specificity in their clinical features, and there is a low proportion of actual clinical pathogen detection in real life. Objective: We aimed to analyze foodborne disease case data, select appropriate features based on analysis results, and use machine learning methods to classify foodborne disease pathogens to predict foodborne disease pathogens for cases where the pathogen is not known or tested. Methods: We extracted features such as space, time, and exposed food from foodborne disease case data and analyzed the relationships between these features and the foodborne disease pathogens using a variety of machine learning methods to classify foodborne disease pathogens. We compared the results of four models to obtain the pathogen prediction model with the highest accuracy. Results: The gradient boost decision tree model obtained the highest accuracy, with accuracy approaching 69% in identifying 4 pathogens: Salmonella, Norovirus, Escherichia coli, and Vibrio parahaemolyticus. By evaluating the importance of features such as time of illness, geographical longitude and latitude, and diarrhea frequency, we found that these features play important roles in classifying foodborne disease pathogens. Conclusions: Data analysis can reflect the distribution of some features of foodborne diseases and the relationships among the features. The classification of pathogens based on the analysis results and machine learning methods can provide beneficial support for clinical auxiliary diagnosis and treatment of foodborne diseases. %M 33496675 %R 10.2196/24924 %U http://medinform.jmir.org/2021/1/e24924/ %U https://doi.org/10.2196/24924 %U http://www.ncbi.nlm.nih.gov/pubmed/33496675 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e20495 %T The Influence of Average Temperature and Relative Humidity on New Cases of COVID-19: Time-Series Analysis %A He,Zonglin %A Chin,Yiqiao %A Yu,Shinning %A Huang,Jian %A Zhang,Casper J P %A Zhu,Ke %A Azarakhsh,Nima %A Sheng,Jie %A He,Yi %A Jayavanth,Pallavi %A Liu,Qian %A Akinwunmi,Babatunde O %A Ming,Wai-Kit %+ School of Medicine, Jinan University, 601 West Huangpu Avenue, Guangzhou, China, 86 14715485116, wkming@connect.hku.hk %K COVID-19 %K coronavirus %K meteorological factors %K temperature %K humidity %K weather %K transmission %K virus %K Asia %K time-series %K analysis %K public health %D 2021 %7 25.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The influence of meteorological factors on the transmission and spread of COVID-19 is of interest and has not been investigated. Objective: This study aimed to investigate the associations between meteorological factors and the daily number of new cases of COVID-19 in 9 Asian cities. Methods: Pearson correlation and generalized additive modeling (GAM) were performed to assess the relationships between daily new COVID-19 cases and meteorological factors (daily average temperature and relative humidity) with the most updated data currently available. Results: The Pearson correlation showed that daily new confirmed cases of COVID-19 were more correlated with the average temperature than with relative humidity. Daily new confirmed cases were negatively correlated with the average temperature in Beijing (r=–0.565, P<.001), Shanghai (r=–0.47, P<.001), and Guangzhou (r=–0.53, P<.001). In Japan, however, a positive correlation was observed (r=0.416, P<.001). In most of the cities (Shanghai, Guangzhou, Hong Kong, Seoul, Tokyo, and Kuala Lumpur), GAM analysis showed the number of daily new confirmed cases to be positively associated with both average temperature and relative humidity, especially using lagged 3D modeling where the positive influence of temperature on daily new confirmed cases was discerned in 5 cities (exceptions: Beijing, Wuhan, Korea, and Malaysia). Moreover, the sensitivity analysis showed, by incorporating the city grade and public health measures into the model, that higher temperatures can increase daily new case numbers (beta=0.073, Z=11.594, P<.001) in the lagged 3-day model. Conclusions: The findings suggest that increased temperature yield increases in daily new cases of COVID-19. Hence, large-scale public health measures and expanded regional research are still required until a vaccine becomes widely available and herd immunity is established. %M 33232262 %R 10.2196/20495 %U https://publichealth.jmir.org/2021/1/e20495 %U https://doi.org/10.2196/20495 %U http://www.ncbi.nlm.nih.gov/pubmed/33232262 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e21220 %T COVID-19–Related Knowledge and Practices Among Health Care Workers in Saudi Arabia: Cross-sectional Questionnaire Study %A Shaikhain,Talal Ahmad %A Al-Husayni,Faisal Abdulmohsen %A Alhejaili,Essam Awadh %A Al-Harbi,Maha Nawaf %A Bogari,Anas Abdullah %A Baghlaf,Bayan Abdulaziz %A Alzahrani,Mohammed Saeed %+ Department of Infectious Disease, National Guard Hospital, Old Makkah Road, Jeddah, 22384, Saudi Arabia, 966 556655712, mzahrani@gmail.com %K COVID-19 %K health care workers %K infection control %K attitude %K knowledge %K Saudi Arabia %D 2021 %7 25.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Health care workers are at the front line against COVID-19. The risk of transmission decreases with adequate knowledge of infection prevention methods. However, health care workers reportedly lack a proper attitude and knowledge of different viral outbreaks. Objective: This study aimed to assess the knowledge and attitude of health care workers in Saudi Arabia toward COVID-19. Assessment of these parameters may help researchers focus on areas that require improvement. Methods: A cross-sectional questionnaire study was conducted among 563 participants recruited from multiple cities in Saudi Arabia. An online questionnaire was shared via social media applications, which contained questions to health care workers about general information regarding COVID-19 and standard practices. Results: The mean age of the study population was 30.7 (SD 8) years. Approximately 8.3% (47/563) of the health care workers were isolated as suspected cases of COVID-19, and 0.9% (n=5) were found positive. The majority agreed that social distancing, face masks, and hand washing are effective methods for preventing disease transmission. However, only 63.7% (n=359) knew the correct duration of hand washing. Almost 70% (n=394) strictly adhered to hand hygiene practices, but less than half complied with the practice of wearing a face mask. Significant differences in health care workers' attitudes were observed on the basis of their city of residence, their adherence to COVID-19 practices, and their compliance with the use of a face mask. Among the health care workers, 27.2% (n=153) declared that they will isolate themselves at home and take influenza medication if they experience COVID-19 symptoms. Conclusions: The majority of health care workers in Saudi Arabia presented acceptable levels of general knowledge on COVID-19, but they lack awareness in some crucial details that may prevent disease spread. Intense courses and competency assessments are highly recommended. Prevention of disease progression is the only option for the time being. %M 33460390 %R 10.2196/21220 %U http://formative.jmir.org/2021/1/e21220/ %U https://doi.org/10.2196/21220 %U http://www.ncbi.nlm.nih.gov/pubmed/33460390 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e26165 %T Expanding Telemonitoring in a Virtual World: A Case Study of the Expansion of a Heart Failure Telemonitoring Program During the COVID-19 Pandemic %A Wali,Sahr %A Guessi Margarido,Milena %A Shah,Amika %A Ware,Patrick %A McDonald,Michael %A O'Sullivan,Mary %A Duero Posada,Juan %A Ross,Heather %A Seto,Emily %+ Centre for Global eHealth Innovation, Techna Institute, University Health Network, TGH/RFE Building, 4th Floor, 190 Elizabeth Street, Toronto, ON, M5G 2C4, Canada, 1 416 340 4800 ext 4765, sahr.wali@mail.utoronto.ca %K telemedicine %K telehealth %K digital health %K digital medicine %K virtual care %K COVID-19 %K coronavirus %K SARS-CoV-2 %K public health %K surveillance %K outbreak %K pandemic %K infectious disease %K cardiology %K patient %D 2021 %7 22.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: To minimize the spread and risk of a COVID-19 outbreak, societal norms have been challenged with respect to how essential services are delivered. With pressures to reduce the number of in-person ambulatory visits, innovative models of telemonitoring have been used during the pandemic as a necessary alternative to support access to care for patients with chronic conditions. The pandemic has led health care organizations to consider the adoption of telemonitoring interventions for the first time, while others have seen existing programs rapidly expand. Objective: At the Toronto General Hospital in Ontario, Canada, the rapid expansion of a telemonitoring program began on March 9, 2020, in response to COVID-19. The objective of this study was to understand the experiences related to the expanded role of a telemonitoring program under the changing conditions of the pandemic. Methods: A single-case qualitative study was conducted with 3 embedded units of analysis. Semistructured interviews probed the experiences of patients, clinicians, and program staff from the Medly telemonitoring program at a heart function clinic in Toronto, Canada. Data were analyzed using inductive thematic analysis as well as Eakin and Gladstone’s value-adding approach to enhance the analytic interpretation of the study findings. Results: A total of 29 participants were interviewed, including patients (n=16), clinicians (n=9), and operational staff (n=4). Four themes were identified: (1) providing care continuity through telemonitoring; (2) adapting telemonitoring operations for a more virtual health care system; (3) confronting virtual workflow challenges; and (4) fostering a meaningful patient-provider relationship. Beyond supporting virtual visits, the program’s ability to provide a more comprehensive picture of the patient’s health was valued. However, issues relating to the lack of system integration and alert-driven interactions jeopardized the perceived sustainability of the program. Conclusions: With the reduction of in-person visits during the pandemic, virtual services such as telemonitoring have demonstrated significant value. Based on our study findings, we offer recommendations to proactively adapt and scale telemonitoring programs under the changing conditions of an increasingly virtual health care system. These include revisiting the scope and expectations of telemedicine interventions, streamlining virtual patient onboarding processes, and personalizing the collection of patient information to build a stronger virtual relationship and a more holistic assessment of patient well-being. %M 33444153 %R 10.2196/26165 %U http://www.jmir.org/2021/1/e26165/ %U https://doi.org/10.2196/26165 %U http://www.ncbi.nlm.nih.gov/pubmed/33444153 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24591 %T Socioeconomic Disparities in Social Distancing During the COVID-19 Pandemic in the United States: Observational Study %A Garnier,Romain %A Benetka,Jan R %A Kraemer,John %A Bansal,Shweta %+ Department of Biology, Georgetown University, Reiss Science Building, 37th and O Streets, Washington, DC, 20057, United States, 1 2026879256, sb753@georgetown.edu %K COVID-19 %K SARS-CoV-2 %K disease ecology %K nonpharmaceutical interventions %K mobility data %K economic %K disparity %K social distancing %K equity %K access %K socioeconomic %K infectious disease %K mobility %D 2021 %7 22.1.2021 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33351774 %R 10.2196/24591 %U http://www.jmir.org/2021/1/e24591/ %U https://doi.org/10.2196/24591 %U http://www.ncbi.nlm.nih.gov/pubmed/33351774 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 9 %N 1 %P e26836 %T Digital Contact Tracing Based on a Graph Database Algorithm for Emergency Management During the COVID-19 Epidemic: Case Study %A Mao,Zijun %A Yao,Hong %A Zou,Qi %A Zhang,Weiting %A Dong,Ying %+ College of Public Administration, Huazhong University of Science and Technology, 1037 Luoyu Road, Wuhan, 430074, China, 86 15871410683, maozijun@hust.edu.cn %K COVID-19 %K digital contact tracing %K emergency management %K graph database %K big data %K visualization %K China %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The COVID-19 epidemic is still spreading globally. Contact tracing is a vital strategy in epidemic emergency management; however, traditional contact tracing faces many limitations in practice. The application of digital technology provides an opportunity for local governments to trace the contacts of individuals with COVID-19 more comprehensively, efficiently, and precisely. Objective: Our research aimed to provide new solutions to overcome the limitations of traditional contact tracing by introducing the organizational process, technical process, and main achievements of digital contact tracing in Hainan Province. Methods: A graph database algorithm, which can efficiently process complex relational networks, was applied in Hainan Province; this algorithm relies on a governmental big data platform to analyze multisource COVID-19 epidemic data and build networks of relationships among high-risk infected individuals, the general population, vehicles, and public places to identify and trace contacts. We summarized the organizational and technical process of digital contact tracing in Hainan Province based on interviews and data analyses. Results: An integrated emergency management command system and a multi-agency coordination mechanism were formed during the emergency management of the COVID-19 epidemic in Hainan Province. The collection, storage, analysis, and application of multisource epidemic data were realized based on the government’s big data platform using a centralized model. The graph database algorithm is compatible with this platform and can analyze multisource and heterogeneous big data related to the epidemic. These practices were used to quickly and accurately identify and trace 10,871 contacts among hundreds of thousands of epidemic data records; 378 closest contacts and a number of public places with high risk of infection were identified. A confirmed patient was found after quarantine measures were implemented by all contacts. Conclusions: During the emergency management of the COVID-19 epidemic, Hainan Province used a graph database algorithm to trace contacts in a centralized model, which can identify infected individuals and high-risk public places more quickly and accurately. This practice can provide support to government agencies to implement precise, agile, and evidence-based emergency management measures and improve the responsiveness of the public health emergency response system. Strengthening data security, improving tracing accuracy, enabling intelligent data collection, and improving data-sharing mechanisms and technologies are directions for optimizing digital contact tracing. %M 33460389 %R 10.2196/26836 %U http://mhealth.jmir.org/2021/1/e26836/ %U https://doi.org/10.2196/26836 %U http://www.ncbi.nlm.nih.gov/pubmed/33460389 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e24830 %T Assessment of Strategies and Epidemiological Characteristics of Tuberculosis in Henan Province, China: Observational Study %A Jiang,Hui %A Zhang,Guolong %A Yin,Jinfeng %A Zhao,Dongyang %A Liu,Fangchao %A Yao,Yuxia %A Cai,Chao %A Xu,Jiying %A Li,Xinwei %A Xu,Wangli %A Li,Weimin %+ Beijing Chest Hospital, Capital Medical University, District 1, No. 9 Beiguan Street, Tongzhou District, Beijing, 101149, China, 86 1089509359, lwm_18@aliyun.com %K notified pulmonary tuberculosis %K Tuberculosis Information Management System %K epidemiological characteristics %K dynamic compartmental model %K policy evaluation %K %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In 2005, China established an internet-based Tuberculosis Information Management System (TBIMS) to monitor changes in tuberculosis (TB). Many scholars have conducted epidemiological research using TBIMS; however, few studies assessing control strategies have been performed based on this platform data. Henan province is a high TB incidence area in China where, in addition to following the nationwide TB strategies, a series of local intervention combinations have been implemented. Objective: Our study aims to evaluate the impact of nationwide TB intervention combinations on epidemiological changes and determine whether Henan province can achieve the World Health Organization’s (WHO) goal of reducing TB incidence by 50% and TB mortality by 75% by the year 2025. Methods: We used descriptive statistical methods to show the spatial and temporal distribution of pulmonary tuberculosis (PTB) reported to the TBIMS database from 2005 to 2018, and logistic regression analysis was performed to identify the risk factors of bacteriological-positive TB. The dynamic compartmental model and Bayesian melding approach was adopted to estimate the burden of TB under the impact of different TB control policies. Results: In total, 976,526 PTB cases were notified to the TBIMS in Henan in a period of 14 years. Although the overall incidence of PTB declined from 91.4/105 to 58.5/105, and the overall incidence of bacteriological-positive PTB declined from 44.5/105 to 14.7/105, the WHO’s 2025 goal could not be met. The distribution of high incidence and poverty-stricken counties were basically overlapped. Men, farmers and herdsmen (in rural areas), and subjects aged ≥60 years were more likely to develop bacteriological-positive PTB. The increasing treatment success for drug-susceptible tuberculosis and multidrug-resistant tuberculosis has not provided the desired reduction in incidence and mortality. Conclusions: To achieve the targeted goal, while improving the cure rate of TB, new active (rather than passive) detection and intervention strategies should be formulated based on epidemiological characteristics in Henan province. %M 33480857 %R 10.2196/24830 %U http://publichealth.jmir.org/2021/1/e24830/ %U https://doi.org/10.2196/24830 %U http://www.ncbi.nlm.nih.gov/pubmed/33480857 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e21409 %T The Effect of a Name-Based Mask Rationing Plan in Taiwan on Public Anxiety Regarding a Mask Shortage During the COVID-19 Pandemic: Observational Study %A Tai,Yu-Lin %A Chi,Hsin %A Chiu,Nan-Chang %A Tseng,Cheng-Yin %A Huang,Ya-Ning %A Lin,Chien-Yu %+ Hsinchu MacKay Memorial Hospital, Department of Pediatrics and Infectious Disease, 690 Guanfu Rd, East District, Hsinchu, 300, Taiwan, 886 6119595 ext 2582, mmhped.lin@gmail.com %K coronavirus %K COVID-19 %K novel coronavirus %K SARS-CoV-2 %K mask %K rationing %K Taiwan %K anxiety %K mental health %K observational %K crisis %K plan %D 2021 %7 22.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: The COVID-19 pandemic is a severe global health crisis. Wearing a mask is a straightforward action that can be taken, but shortage of stock and equity of allocation were important issues in Taiwan. Furthermore, increased anxiety leading to the stockpiling of masks has been common during the pandemic. Objective: We aim to summarize the name-based mask rationing plan implemented in Taiwan and explore the public’s perceived anxiety about mask shortages. Methods: The government of Taiwan took action to control the supply and allocation of face masks. We summarize the timeline and important components of the mask rationing plan. A survey that aimed to investigate the overall response to the mask rationing plan was answered by 44 participants. Results: The mask rationing plan was implemented in late January 2020. Daily production capacity was increased from 2 million masks to 16 million masks in April 2020. People could buy 9 masks in 14 days by verification via their National Health Insurance card. Digital face mask availability maps were created. Moreover, the mask plan safeguarded the purchase of masks and resulted in decreased anxiety about a mask shortage (4.05 [SD 1.15] points; 72.7% [n=32] of participants answered “agree” or “strongly agree”). The majority of people felt that the mask plan was satisfactory (4.2 [SD 0.92] points; 79.5% [n=35] of participants answered “agree” or “strongly agree”). Conclusions: We found that the unique name-based mask rationing plan allowed for control of the production and supply of masks, and contributed to the appropriate allocation of masks. The mask rationing plan not only provided the public with physical protection, but also resulted in reduced anxiety about mask shortages during the pandemic. %M 33400678 %R 10.2196/21409 %U http://formative.jmir.org/2021/1/e21409/ %U https://doi.org/10.2196/21409 %U http://www.ncbi.nlm.nih.gov/pubmed/33400678 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e24756 %T Knowledge About COVID-19 in Brazil: Cross-Sectional Web-Based Study %A Guimarães,Vinícius Henrique Almeida %A de Oliveira-Leandro,Maísa %A Cassiano,Carolina %A Marques,Anna Laura Piantino %A Motta,Clara %A Freitas-Silva,Ana Letícia %A de Sousa,Marlos Aureliano Dias %A Silveira,Luciano Alves Matias %A Pardi,Thiago César %A Gazotto,Fernanda Castro %A Silva,Marcos Vinícius %A Rodrigues Jr,Virmondes %A Rodrigues,Wellington Francisco %A Oliveira,Carlo Jose Freire %+ Laboratory of Immunology and Bioinformatics, Institute of Biological and Natural Sciences, Federal University of Triangulo Mineiro, Uberaba, Brazil, 55 34988567251, carlo.oliveira@uftm.edu.br %K COVID-19 %K coronavirus %K perception %K knowledge %K Brazil %K cross-sectional %K online survey %K health information %D 2021 %7 21.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 is a highly transmissible illness caused by SARS-CoV-2. The disease has affected more than 200 countries, and the measures that have been implemented to combat its spread, as there is still no vaccine or definitive medication, have been based on supportive interventions and drug repositioning. Brazil, the largest country in South America, has had more than 140,000 recorded deaths and is one of the most affected countries. Despite the extensive quantity of scientifically recognized information, there are still conflicting discussions on how best to face the disease and the virus, especially with regard to social distancing, preventive methods, and the use of medications. Objective: The main purpose of this study is to evaluate the Brazilian population’s basic knowledge about COVID-19 to demonstrate how Brazilians are managing to identify scientifically proven information. Methods: A cross-sectional study design was used. An original online questionnaire survey was administered from June 16 to August 21, 2020, across all five different geopolitical regions of the country (ie, the North, Northeast, Center-West, Southeast, and South). The questionnaire was comprised of questions about basic aspects of COVID-19, such as the related symptoms, conduct that should be followed when suspected of infection, risk groups, prevention, transmission, and social distancing. The wrong questionnaire response alternatives were taken from the fake news combat website of the Brazilian Ministry of Health. Participants (aged ≥18 years) were recruited through social networking platforms, including Facebook, WhatsApp, and Twitter. The mean distributions, frequencies, and similarities or dissimilarities between the responses for the different variables of the study were evaluated. The significance level for all statistical tests was less than .05. Results: A total of 4180 valid responses representative of all the states and regions of Brazil were recorded. Most respondents had good knowledge about COVID-19, getting an average of 86.59% of the total score with regard to the basic aspects of the disease. The region, education level, age, sex, and social condition had a significant association (P<.001) with knowledge about the disease, which meant that women, the young, those with higher education levels, nonrecipients of social assistance, and more economically and socially developed regions had more correct answers. Conclusions: Overall, Brazilians with social media access have a good level of basic knowledge about COVID-19 but with differences depending on the analyzed subgroup. Due to the limitation of the platform used in carrying out the study, care should be taken when generalizing the study findings to populations with less education or who are not used to accessing social networking platforms. %M 33400684 %R 10.2196/24756 %U http://publichealth.jmir.org/2021/1/e24756/ %U https://doi.org/10.2196/24756 %U http://www.ncbi.nlm.nih.gov/pubmed/33400684 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e24298 %T Mental Health and Burnout Syndrome Among Postgraduate Students in Medical and Multidisciplinary Residencies During the COVID-19 Pandemic in Brazil: Protocol for a Prospective Cohort Study %A Pinho,Rebeca Da Nóbrega Lucena %A Costa,Thais Ferreira %A Silva,Nayane Miranda %A Barros-Areal,Adriana F %A Salles,André De Mattos %A Oliveira,Andrea Pedrosa %A Rassi,Carlos %A Valero,Caroline Elizabeth Brero %A Gomes,Ciro Martins %A Mendonça-Silva,Dayde %A Oliveira,Fernando %A Jochims,Isadora %A Ranulfo,Ivan %A Neves,Juliana De Brito Seixas %A Oliveira,Lucas %A Dantas,Maria Nogueira %A Rosal,Marta %A Soares,Mayra %A Kurizky,Patrícia %A Peterle,Viviane Uliana %A Faro,Yasmin Furtado %A Gomides,Ana Paula %A da Mota,Licia %A Albuquerque,Cleandro %A Simaan,Cezar Kozak %A Amado,Veronica M %+ Programa de Pós-Graduação em Ciências Médicas FM-UnB, SGAN 605, Av. L2 Norte, Brasília, Brazil, 55 61 98343 6834, nlp.rebeca@gmail.com %K burnout syndrome %K medical residency %K multidisciplinary residency %K COVID-19 %K mental health %K burnout %K stress %K anxiety %K prospective %K cohort %K health care professional %K medical student %D 2021 %7 19.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic has led to high levels of physical, psychological, and social stress among health care professionals, including postgraduate students in medical and multidisciplinary residencies. This stress is associated with the intense fear of occupational exposure to SARS-CoV-2, the virus known to cause COVID-19. These professionals are at risk of developing physical and mental illnesses not only due to the infection but also due to prolonged exposure to multidimensional stress and continued work overload. Objective: This study aims to evaluate the prevalence of symptoms suggestive of mental disorders and burnout syndrome and determine the risk factors for burnout among postgraduate students in medical and multidisciplinary residencies in Brazil during the COVID-19 pandemic. Methods: For this prospective cohort study with parallel groups, participants were recruited between July and September 2020 to achieve a sample size of at least 1144 participants. Research instruments such as Depression, Anxiety, and Stress Scale; Patient Health Questionnaire; Brief Resilient Coping Scale; and Oldenburg Burnout Inventory will be used to collect data. Data will be collected in 2 waves: the first wave will include data related to sample characterization and psychosocial evaluation, and the second wave will be launched 12 weeks later and will include an evaluation of the incidence of burnout as well as correlations with the potential predictive factors collected in the first wave. Additionally, we will collect data regarding participants’ withdrawal from work. Results: The recruitment took place from July 29 to September 5, 2020. Data analyses for this phase is already in progress. The second phase of the study is also in progress. The final data collection began on December 1, 2020, and it will be completed by December 31, 2020. Conclusions: We believe the findings of this study will help evaluate the impact of the COVID-19 pandemic on the mental health conditions of health professionals in Brazil as well as contribute to the planning and implementation of appropriate measures that can alleviate these mental health challenges. International Registered Report Identifier (IRRID): DERR1-10.2196/24298 %M 33290246 %R 10.2196/24298 %U https://www.researchprotocols.org/2021/1/e24298 %U https://doi.org/10.2196/24298 %U http://www.ncbi.nlm.nih.gov/pubmed/33290246 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e25538 %T Nowcasting for Real-Time COVID-19 Tracking in New York City: An Evaluation Using Reportable Disease Data From Early in the Pandemic %A Greene,Sharon K %A McGough,Sarah F %A Culp,Gretchen M %A Graf,Laura E %A Lipsitch,Marc %A Menzies,Nicolas A %A Kahn,Rebecca %+ Bureau of Communicable Disease, New York City Department of Health and Mental Hygiene, 42-09 28th Street, CN 22A, WS 06-154, Long Island City, NY, 11101, United States, 1 347 396 2679, sgreene4@health.nyc.gov %K COVID-19 %K data quality %K epidemiology %K forecasting %K infectious disease %K morbidity and mortality trends %K public health practice %K surveillance %D 2021 %7 15.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Nowcasting approaches enhance the utility of reportable disease data for trend monitoring by correcting for delays, but implementation details affect accuracy. Objective: To support real-time COVID-19 situational awareness, the New York City Department of Health and Mental Hygiene used nowcasting to account for testing and reporting delays. We conducted an evaluation to determine which implementation details would yield the most accurate estimated case counts. Methods: A time-correlated Bayesian approach called Nowcasting by Bayesian Smoothing (NobBS) was applied in real time to line lists of reportable disease surveillance data, accounting for the delay from diagnosis to reporting and the shape of the epidemic curve. We retrospectively evaluated nowcasting performance for confirmed case counts among residents diagnosed during the period from March to May 2020, a period when the median reporting delay was 2 days. Results: Nowcasts with a 2-week moving window and a negative binomial distribution had lower mean absolute error, lower relative root mean square error, and higher 95% prediction interval coverage than nowcasts conducted with a 3-week moving window or with a Poisson distribution. Nowcasts conducted toward the end of the week outperformed nowcasts performed earlier in the week, given fewer patients diagnosed on weekends and lack of day-of-week adjustments. When estimating case counts for weekdays only, metrics were similar across days when the nowcasts were conducted, with Mondays having the lowest mean absolute error of 183 cases in the context of an average daily weekday case count of 2914. Conclusions: Nowcasting using NobBS can effectively support COVID-19 trend monitoring. Accounting for overdispersion, shortening the moving window, and suppressing diagnoses on weekends—when fewer patients submitted specimens for testing—improved the accuracy of estimated case counts. Nowcasting ensured that recent decreases in observed case counts were not overinterpreted as true declines and supported officials in anticipating the magnitude and timing of hospitalizations and deaths and allocating resources geographically. %M 33406053 %R 10.2196/25538 %U http://publichealth.jmir.org/2021/1/e25538/ %U https://doi.org/10.2196/25538 %U http://www.ncbi.nlm.nih.gov/pubmed/33406053 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e25830 %T SARS-CoV-2 Surveillance in the Middle East and North Africa: Longitudinal Trend Analysis %A Post,Lori %A Marogi,Emily %A Moss,Charles B %A Murphy,Robert Leo %A Ison,Michael G %A Achenbach,Chad J %A Resnick,Danielle %A Singh,Lauren %A White,Janine %A Boctor,Michael J %A Welch,Sarah B %A Oehmke,James Francis %+ Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K COVID-19 %K SARS-CoV-2 surveillance %K wave two %K second wave %K global COVID-19 surveillance %K MENA public health surveillance %K MENA COVID-19 %K Middle East and North Africa surveillance metrics %K dynamic panel data %K MENA econometrics %K MENA SARS-CoV-2 %K Middle East and North Africa COVID-19 surveillance system %K MENA COVID-19 transmission speed %K MENA COVID-19 transmission acceleration %K COVID-19 transmission deceleration %K COVID-19 transmission jerk %K COVID-19 7-day lag %K SARS-CoV-2 %K Arellano-Bond estimator %K generalized method of moments %K GMM %K Bahrain %K Iran %K Iraq %K Israel %K Jordan %K Kuwait %K Lebanon %K Oman %K Qatar %K Saudi Arabia %K Syria %K United Arab Emirates %K Yemen %K Algeria %K Djibouti %K Egypt %K Libya %K Morocco %K Tunisia %D 2021 %7 15.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has disrupted the lives of millions and forced countries to devise public health policies to reduce the pace of transmission. In the Middle East and North Africa (MENA), falling oil prices, disparities in wealth and public health infrastructure, and large refugee populations have significantly increased the disease burden of COVID-19. In light of these exacerbating factors, public health surveillance is particularly necessary to help leaders understand and implement effective disease control policies to reduce SARS-CoV-2 persistence and transmission. Objective: The goal of this study is to provide advanced surveillance metrics, in combination with traditional surveillance, for COVID-19 transmission that account for weekly shifts in the pandemic speed, acceleration, jerk, and persistence to better understand a country’s risk for explosive growth and to better inform those who are managing the pandemic. Existing surveillance coupled with our dynamic metrics of transmission will inform health policy to control the COVID-19 pandemic until an effective vaccine is developed. Methods: Using a longitudinal trend analysis study design, we extracted 30 days of COVID-19 data from public health registries. We used an empirical difference equation to measure the daily number of cases in MENA as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel data model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: The regression Wald statistic was significant (χ25=859.5, P<.001). The Sargan test was not significant, failing to reject the validity of overidentifying restrictions (χ2294=16, P=.99). Countries with the highest cumulative caseload of the novel coronavirus include Iran, Iraq, Saudi Arabia, and Israel with 530,380, 426,634, 342,202, and 303,109 cases, respectively. Many of the smaller countries in MENA have higher infection rates than those countries with the highest caseloads. Oman has 33.3 new infections per 100,000 population while Bahrain has 12.1, Libya has 14, and Lebanon has 14.6 per 100,000 people. In order of largest to smallest number of cumulative deaths since January 2020, Iran, Iraq, Egypt, and Saudi Arabia have 30,375, 10,254, 6120, and 5185, respectively. Israel, Bahrain, Lebanon, and Oman had the highest rates of COVID-19 persistence, which is the number of new infections statistically related to new infections in the prior week. Bahrain had positive speed, acceleration, and jerk, signaling the potential for explosive growth. Conclusions: Static and dynamic public health surveillance metrics provide a more complete picture of pandemic progression across countries in MENA. Static measures capture data at a given point in time such as infection rates and death rates. By including speed, acceleration, jerk, and 7-day persistence, public health officials may design policies with an eye to the future. Iran, Iraq, Saudi Arabia, and Israel all demonstrated the highest rate of infections, acceleration, jerk, and 7-day persistence, prompting public health leaders to increase prevention efforts. %M 33302252 %R 10.2196/25830 %U http://www.jmir.org/2021/1/e25830/ %U https://doi.org/10.2196/25830 %U http://www.ncbi.nlm.nih.gov/pubmed/33302252 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e23190 %T Mobile App–Based Remote Patient Monitoring in Acute Medical Conditions: Prospective Feasibility Study Exploring Digital Health Solutions on Clinical Workload During the COVID Crisis %A Shah,Sachin Shailendra %A Gvozdanovic,Andrew %A Knight,Matthew %A Gagnon,Julien %+ Huma Therapeutics, 13th Floor Millbank Tower, 21-24 Millbank, London, SW1P 4QP, United Kingdom, 44 7875210783, sachsshah@gmail.com %K mHealth %K remote patient monitoring %K digital health %K COVID-19 %K service improvement %K cost-effectiveness %K monitoring %D 2021 %7 15.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital remote patient monitoring can add value to virtual wards; this has become more apparent in the context of the COVID-19 pandemic. Health care providers are overwhelmed, resulting in clinical teams spread more thinly. We aimed to assess the impact of introducing an app-based remote patient monitoring system (Huma Therapeutics) on a clinician’s workload in the context of a COVID-19–specific virtual ward. Objective: This prospective feasibility study aimed to evaluate the health economic effects (in terms of clinical workload) of a mobile app on a telephone-based virtual ward used in the monitoring of patients with COVID-19 who are clinically ready for discharge from the hospital. Methods: A prospective feasibility study was carried out over 1 month where clinician workload was monitored, and full-time equivalents savings were determined. An NHS hospital repurposed a telephone-based respiratory virtual ward for COVID-19. Patients with COVID-19 in the amber zone (according to the National Health Service definition) were monitored for 14 days postdischarge to help identify deteriorating patients earlier. A smartphone-based app was introduced to monitor data points submitted by the patients via communication over telephone calls. We then comparatively evaluated the clinical workload between patients monitored by telephone only (cohort 1) with those monitored via mobile app and telephone (cohort 2). Results: In all, 56 patients were enrolled in the app-based virtual ward (cohort 2). Digital remote patient monitoring resulted in a reduction in the number of phone calls from a mean total of 9 calls to 4 calls over the monitoring period. There was no change in the mean duration of phone calls (8.5 minutes) and no reports of readmission or mortality. These results equate to a mean saving of 47.60 working hours. Moreover, it translates to 3.30 fewer full-time equivalents (raw phone call data), resulting in 1.1 fewer full-time equivalents required to monitor 100 patients when adjusted for time spent reviewing app data. Individual clinicians spent an average of 10.9 minutes per day reviewing data. Conclusions: Smartphone-based remote patient monitoring technologies may offer tangible reductions in clinician workload at a time when service is severely strained. In this small-scale pilot study, we demonstrated the economic and operational impact that digital remote patient monitoring technology can have in improving working efficiency and reducing operational costs. Although this particular RPM solution was deployed for the COVID-19 pandemic, it may set a precedent for wider utilization of digital, remote patient monitoring solutions in other clinical scenarios where increased care delivery efficiency is sought. %M 33400675 %R 10.2196/23190 %U http://formative.jmir.org/2021/1/e23190/ %U https://doi.org/10.2196/23190 %U http://www.ncbi.nlm.nih.gov/pubmed/33400675 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e23592 %T A Text Messaging Intervention for Coping With Social Distancing During COVID-19 (StayWell at Home): Protocol for a Randomized Controlled Trial %A Figueroa,Caroline Astrid %A Hernandez-Ramos,Rosa %A Boone,Claire Elizabeth %A Gómez-Pathak,Laura %A Yip,Vivian %A Luo,Tiffany %A Sierra,Valentín %A Xu,Jing %A Chakraborty,Bibhas %A Darrow,Sabrina %A Aguilera,Adrian %+ School of Social Welfare, University of California Berkeley, 105 Havilland Hall, Berkeley, CA, 94709, United States, 1 5106436669, c.a.figueroa@berkeley.edu %K COVID-19 %K mental health %K depression %K reinforcement learning %K microrandomized trial %D 2021 %7 14.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: Social distancing is a crucial intervention to slow down person-to-person transmission of COVID-19. However, social distancing has negative consequences, including increases in depression and anxiety. Digital interventions, such as text messaging, can provide accessible support on a population-wide scale. We developed text messages in English and Spanish to help individuals manage their depressive mood and anxiety during the COVID-19 pandemic. Objective: In a two-arm randomized controlled trial, we aim to examine the effect of our 60-day text messaging intervention. Additionally, we aim to assess whether the use of machine learning to adapt the messaging frequency and content improves the effectiveness of the intervention. Finally, we will examine the differences in daily mood ratings between the message categories and time windows. Methods: The messages were designed within two different categories: behavioral activation and coping skills. Participants will be randomized into (1) a random messaging arm, where message category and timing will be chosen with equal probabilities, and (2) a reinforcement learning arm, with a learned decision mechanism for choosing the messages. Participants in both arms will receive one message per day within three different time windows and will be asked to provide their mood rating 3 hours later. We will compare self-reported daily mood ratings; self-reported depression, using the 8-item Patient Health Questionnaire; and self-reported anxiety, using the 7-item Generalized Anxiety Disorder scale at baseline and at intervention completion. Results: The Committee for the Protection of Human Subjects at the University of California Berkeley approved this study in April 2020 (No. 2020-04-13162). Data collection began in April 2020 and will run to April 2021. As of August 24, 2020, we have enrolled 229 participants. We plan to submit manuscripts describing the main results of the trial and results from the microrandomized trial for publication in peer-reviewed journals and for presentations at national and international scientific meetings. Conclusions: Results will contribute to our knowledge of effective psychological tools to alleviate the negative effects of social distancing and the benefit of using machine learning to personalize digital mental health interventions. Trial Registration: ClinicalTrials.gov NCT04473599; https://clinicaltrials.gov/ct2/show/NCT04473599 International Registered Report Identifier (IRRID): DERR1-10.2196/23592 %M 33370721 %R 10.2196/23592 %U http://www.researchprotocols.org/2021/1/e23592/ %U https://doi.org/10.2196/23592 %U http://www.ncbi.nlm.nih.gov/pubmed/33370721 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e22794 %T The Association Between Chronic Disease and Serious COVID-19 Outcomes and Its Influence on Risk Perception: Survey Study and Database Analysis %A Laires,Pedro Almeida %A Dias,Sónia %A Gama,Ana %A Moniz,Marta %A Pedro,Ana R %A Soares,Patricia %A Aguiar,Pedro %A Nunes,Carla %+ Public Health Research Centre, NOVA National School of Public Health, Universidade NOVA de Lisboa, Av Padre Cruz, Lisbon, Portugal, 351 919783234, pedro.laires@ensp.unl.pt %K COVID-19 %K risk factors %K morbidity %K chronic disease %K risk %K perception %K outcome %K association %D 2021 %7 12.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19, a viral respiratory disease first reported in December 2019, quickly became a threat to global public health. Further understanding of the epidemiology of the SARS-CoV-2 virus and the risk perception of the community may better inform targeted interventions to reduce the impact and spread of COVID-19. Objective: In this study, we aimed to examine the association between chronic diseases and serious outcomes following COVID-19 infection, and to explore its influence on people’s self-perception of risk for worse COVID-19 outcomes. Methods: This study draws data from two databases: (1) the nationwide database of all confirmed COVID-19 cases in Portugal, extracted on April 28, 2020 (n=20,293); and (2) the community-based COVID-19 Barometer survey, which contains data on health status, perceptions, and behaviors during the first wave of COVID-19 (n=171,087). We assessed the association between relevant chronic diseases (ie, respiratory, cardiovascular, and renal diseases; diabetes; and cancer) and death and intensive care unit (ICU) admission following COVID-19 infection. We identified determinants of self-perception of risk for severe COVID-19 outcomes using logistic regression models. Results: Respiratory, cardiovascular, and renal diseases were associated with mortality and ICU admission among patients hospitalized due to COVID-19 infection (odds ratio [OR] 1.48, 95% CI 1.11-1.98; OR 3.39, 95% CI 1.80-6.40; and OR 2.25, 95% CI 1.66-3.06, respectively). Diabetes and cancer were associated with serious outcomes only when considering the full sample of COVID-19–infected cases in the country (OR 1.30, 95% CI 1.03-1.64; and OR 1.40, 95% CI 1.03-1.89, respectively). Older age and male sex were both associated with mortality and ICU admission. The perception of risk for severe COVID-19 disease in the study population was 23.9% (n=40,890). This was markedly higher for older adults (n=5235, 46.4%), those with at least one chronic disease (n=17,647, 51.6%), or those in both of these categories (n=3212, 67.7%). All included diseases were associated with self-perceptions of high risk in this population. Conclusions: Our results demonstrate the association between some prevalent chronic diseases and increased risk of worse COVID-19 outcomes. It also brings forth a greater understanding of the community’s risk perceptions of serious COVID-19 disease. Hence, this study may aid health authorities to better adapt measures to the real needs of the population and to identify vulnerable individuals requiring further education and awareness of preventive measures. %M 33433397 %R 10.2196/22794 %U http://publichealth.jmir.org/2021/1/e22794/ %U https://doi.org/10.2196/22794 %U http://www.ncbi.nlm.nih.gov/pubmed/33433397 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 23 %N 1 %P e24069 %T Investigating and Improving the Accuracy of US Citizens’ Beliefs About the COVID-19 Pandemic: Longitudinal Survey Study %A van Stekelenburg,Aart %A Schaap,Gabi %A Veling,Harm %A Buijzen,Moniek %+ Behavioural Science Institute, Radboud University, Montessorilaan 3, Nijmegen, 6525 HR, Netherlands, 31 024 3615723, a.vanstekelenburg@bsi.ru.nl %K infodemic %K infodemiology %K misinformation %K COVID-19 pandemic %K belief accuracy %K boosting %K trust in scientists %K political orientation %K media use %D 2021 %7 12.1.2021 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 infodemic, a surge of information and misinformation, has sparked worry about the public’s perception of the coronavirus pandemic. Excessive information and misinformation can lead to belief in false information as well as reduce the accurate interpretation of true information. Such incorrect beliefs about the COVID-19 pandemic might lead to behavior that puts people at risk of both contracting and spreading the virus. Objective: The objective of this study was two-fold. First, we attempted to gain insight into public beliefs about the novel coronavirus and COVID-19 in one of the worst hit countries: the United States. Second, we aimed to test whether a short intervention could improve people’s belief accuracy by empowering them to consider scientific consensus when evaluating claims related to the pandemic. Methods: We conducted a 4-week longitudinal study among US citizens, starting on April 27, 2020, just after daily COVID-19 deaths in the United States had peaked. Each week, we measured participants’ belief accuracy related to the coronavirus and COVID-19 by asking them to indicate to what extent they believed a number of true and false statements (split 50/50). Furthermore, each new survey wave included both the original statements and four new statements: two false and two true statements. Half of the participants were exposed to an intervention aimed at increasing belief accuracy. The intervention consisted of a short infographic that set out three steps to verify information by searching for and verifying a scientific consensus. Results: A total of 1202 US citizens, balanced regarding age, gender, and ethnicity to approximate the US general public, completed the baseline (T0) wave survey. Retention rate for the follow-up waves— first follow-up wave (T1), second follow-up wave (T2), and final wave (T3)—was high (≥85%). Mean scores of belief accuracy were high for all waves, with scores reflecting low belief in false statements and high belief in true statements; the belief accuracy scale ranged from –1, indicating completely inaccurate beliefs, to 1, indicating completely accurate beliefs (T0 mean 0.75, T1 mean 0.78, T2 mean 0.77, and T3 mean 0.75). Accurate beliefs were correlated with self-reported behavior aimed at preventing the coronavirus from spreading (eg, social distancing) (r at all waves was between 0.26 and 0.29 and all P values were less than .001) and were associated with trust in scientists (ie, higher trust was associated with more accurate beliefs), political orientation (ie, liberal, Democratic participants held more accurate beliefs than conservative, Republican participants), and the primary news source (ie, participants reporting CNN or Fox News as the main news source held less accurate beliefs than others). The intervention did not significantly improve belief accuracy. Conclusions: The supposed infodemic was not reflected in US citizens’ beliefs about the COVID-19 pandemic. Most people were quite able to figure out the facts in these relatively early days of the crisis, calling into question the prevalence of misinformation and the public’s susceptibility to misinformation. %M 33351776 %R 10.2196/24069 %U http://www.jmir.org/2021/1/e24069/ %U https://doi.org/10.2196/24069 %U http://www.ncbi.nlm.nih.gov/pubmed/33351776 %0 Journal Article %@ 2292-9495 %I JMIR Publications %V 8 %N 1 %P e23232 %T Information Sources, Risk Perception, and Efficacy Appraisal’s Prediction of Engagement in Protective Behaviors Against COVID-19 in China: Repeated Cross-sectional Survey %A Rui,Jian Raymond %A Yang,Keqing %A Chen,Juan %+ College of Journalism and Communication, South China University of Technology, 382 Waihuan East Rd, Guangzhou, 510006, China, 86 17819720631, jckqyang@scut.edu.cn %K information source %K perceived severity %K perceived susceptibility %K response efficacy %K self-efficacy %K health information %K protective behavior %K COVID-19 %K protection %K behavior %K risk %K perception %K prediction %D 2021 %7 12.1.2021 %9 Original Paper %J JMIR Hum Factors %G English %X 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. %M 33338027 %R 10.2196/23232 %U http://humanfactors.jmir.org/2021/1/e23232/ %U https://doi.org/10.2196/23232 %U http://www.ncbi.nlm.nih.gov/pubmed/33338027 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e24320 %T Jobs, Housing, and Mask Wearing: Cross-Sectional Study of Risk Factors for COVID-19 %A van den Broek-Altenburg,Eline M %A Atherly,Adam J %A Diehl,Sean A %A Gleason,Kelsey M %A Hart,Victoria C %A MacLean,Charles D %A Barkhuff,Daniel A %A Levine,Mark A %A Carney,Jan K %+ Department of Radiology, Larner College of Medicine, University of Vermont, 89 Beaumont Avenue, Burlington, VT, 05405, United States, 1 8024613951, eline.altenburg@med.uvm.edu %K COVID-19 %K risk of infection %K community exposure %K self-protecting behavior %K mask wearing %K infection fatality rate %K infection %K self-protecting %K mask %K fatality rate %K exposure %K virus %K SARS-CoV-2 %D 2021 %7 11.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 33315576 %R 10.2196/24320 %U http://publichealth.jmir.org/2021/1/e24320/ %U https://doi.org/10.2196/24320 %U http://www.ncbi.nlm.nih.gov/pubmed/33315576 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 5 %N 1 %P e23000 %T Attitudes and Perceptions Toward COVID-19 Digital Surveillance: Survey of Young Adults in the United States %A Maytin,Lauren %A Maytin,Jason %A Agarwal,Priya %A Krenitsky,Anna %A Krenitsky,JoAnn %A Epstein,Robert S %+ Epstein Health LLC, 50 Tice Blvd, Suite 340, Woodcliff Lake, NJ, 07677, United States, 1 201 285 5800, repstein@epsteinhealth.com %K attitude %K perception %K young adult %K COVID-19 %K digital surveillance %K population health technologies %K surveillance %K population %K survey %K adolescent %D 2021 %7 8.1.2021 %9 Original Paper %J JMIR Form Res %G English %X Background: COVID-19 is an international health crisis of particular concern in the United States, which saw surges of infections with the lifting of lockdowns and relaxed social distancing. Young adults have proven to be a critical factor for COVID-19 transmission and are an important target of the efforts to contain the pandemic. Scalable digital public health technologies could be deployed to reduce COVID-19 transmission, but their use depends on the willingness of young adults to participate in surveillance. Objective: The aim of this study is to determine the attitudes of young adults regarding COVID-19 digital surveillance, including which aspects they would accept and which they would not, as well as to determine factors that may be associated with their willingness to participate in digital surveillance. Methods: We conducted an anonymous online survey of young adults aged 18-24 years throughout the United States in June 2020. The questionnaire contained predominantly closed-ended response options with one open-ended question. Descriptive statistics were applied to the data. Results: Of 513 young adult respondents, 383 (74.7%) agreed that COVID-19 represents a public health crisis. However, only 231 (45.1%) agreed to actively share their COVID-19 status or symptoms for monitoring and only 171 (33.4%) reported a willingness to allow access to their cell phone for passive location tracking or contact tracing. Conclusions: Despite largely agreeing that COVID-19 represents a serious public health risk, the majority of young adults sampled were reluctant to participate in digital monitoring to manage the pandemic. This was true for both commonly used methods of public health surveillance (such as contact tracing) and novel methods designed to facilitate a return to normal (such as frequent symptom checking through digital apps). This is a potential obstacle to ongoing containment measures (many of which rely on widespread surveillance) and may reflect a need for greater education on the benefits of public health digital surveillance for young adults. %M 33347420 %R 10.2196/23000 %U http://formative.jmir.org/2021/1/e23000/ %U https://doi.org/10.2196/23000 %U http://www.ncbi.nlm.nih.gov/pubmed/33347420 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 7 %N 1 %P e24132 %T Improving Detection of Disease Re-emergence Using a Web-Based Tool (RED Alert): Design and Case Analysis Study %A Parikh,Nidhi %A Daughton,Ashlynn R %A Rosenberger,William Earl %A Aberle,Derek Jacob %A Chitanvis,Maneesha Elizabeth %A Altherr,Forest Michael %A Velappan,Nileena %A Fairchild,Geoffrey %A Deshpande,Alina %+ Biosecurity and Public Health Group, Los Alamos National Laboratory, TA-43, Building 1, MS - M888, Los Alamos, NM, 87545, United States, 1 505 667 9938, deshpande_a@lanl.gov %K disease re-emergence %K infectious disease %K supervised learning %K random forest %K visual analytics %K surveillance %D 2021 %7 7.1.2021 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Currently, the identification of infectious disease re-emergence is performed without describing specific quantitative criteria that can be used to identify re-emergence events consistently. This practice may lead to ineffective mitigation. In addition, identification of factors contributing to local disease re-emergence and assessment of global disease re-emergence require access to data about disease incidence and a large number of factors at the local level for the entire world. This paper presents Re-emerging Disease Alert (RED Alert), a web-based tool designed to help public health officials detect and understand infectious disease re-emergence. Objective: Our objective is to bring together a variety of disease-related data and analytics needed to help public health analysts answer the following 3 primary questions for detecting and understanding disease re-emergence: Is there a potential disease re-emergence at the local (country) level? What are the potential contributing factors for this re-emergence? Is there a potential for global re-emergence? Methods: We collected and cleaned disease-related data (eg, case counts, vaccination rates, and indicators related to disease transmission) from several data sources including the World Health Organization (WHO), Pan American Health Organization (PAHO), World Bank, and Gideon. We combined these data with machine learning and visual analytics into a tool called RED Alert to detect re-emergence for the following 4 diseases: measles, cholera, dengue, and yellow fever. We evaluated the performance of the machine learning models for re-emergence detection and reviewed the output of the tool through a number of case studies. Results: Our supervised learning models were able to identify 82%-90% of the local re-emergence events, although with 18%-31% (except 46% for dengue) false positives. This is consistent with our goal of identifying all possible re-emergences while allowing some false positives. The review of the web-based tool through case studies showed that local re-emergence detection was possible and that the tool provided actionable information about potential factors contributing to the local disease re-emergence and trends in global disease re-emergence. Conclusions: To the best of our knowledge, this is the first tool that focuses specifically on disease re-emergence and addresses the important challenges mentioned above. %M 33316766 %R 10.2196/24132 %U http://publichealth.jmir.org/2021/1/e24132/ %U https://doi.org/10.2196/24132 %U http://www.ncbi.nlm.nih.gov/pubmed/33316766 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 10 %N 1 %P e18029 %T Using a Mobile Health Intervention (DOT Selfie) With Transfer of Social Bundle Incentives to Increase Treatment Adherence in Tuberculosis Patients in Uganda: Protocol for a Randomized Controlled Trial %A Sekandi,Juliet Nabbuye %A Onuoha,Nicole Amara %A Buregyeya,Esther %A Zalwango,Sarah %A Kaggwa,Patrick Evans %A Nakkonde,Damalie %A Kakaire,Robert %A Atuyambe,Lynn %A Whalen,Christopher C %A Dobbin,Kevin K %+ Global Health Institute, College of Public Health, University of Georgia, 100 Foster Road, Athens, GA, 30606, United States, 1 706 542 5257, jsekandi@uga.edu %K tuberculosis %K mHealth %K digital health %K eHealth %K directly observed therapy %K video observed therapy %K DOT Selfie %K treatment adherence %K Africa %D 2021 %7 5.1.2021 %9 Protocol %J JMIR Res Protoc %G English %X Background: The World Health Organization’s End TB Strategy envisions a world free of tuberculosis (TB)—free of deaths, disease, and suffering due to TB—by 2035. Nonadherence reduces cure rates, prolongs infectiousness, and contributes to the emergence of multidrug-resistant TB (MDR-TB). Moreover, MDR-TB is a growing, complex, and costly problem that presents a major obstacle to TB control. Directly observed therapy (DOT) for treatment adherence monitoring is the recommended standard; however, it is challenging to implement at scale because it is labor-intensive. Mobile health interventions can facilitate remote adherence monitoring and minimize the costs and inconveniences associated with standard DOT. Objective: The study aims to evaluate the effectiveness of using video directly observed therapy (VDOT) plus incentives to improve medication adherence in TB treatment versus usual-care DOT in an African context. Methods: The DOT Selfie study is an open-label, randomized controlled trial (RCT) with 2 parallel groups, in which 144 adult patients with TB aged 18-65 years will be randomly assigned to receive the usual-care DOT monitoring or VDOT as the intervention. The intervention will consist of a smartphone app, a weekly internet subscription, translated text message reminders, and incentives for those who adhere. The participant will use a smartphone to record and send time-stamped encrypted videos showing their daily medication ingestion. This video component will directly substitute the need for daily face-to-face meetings between the health provider and patients. We hypothesize that the VDOT intervention will be more effective because it allows patients to swallow their pills anywhere, anytime. Moreover, patients will receive mobile-phone–based “social bundle” incentives to motivate adherence to continued daily submission of videos to the health system. The health providers will log into a secured computer system to verify treatment adherence, document missed doses, investigate the reasons for missed doses, and follow prespecified protocol measures to re-establish medication adherence. The primary endpoint is the adherence level as measured by the fraction of expected doses observed over the treatment period. The main secondary outcome will be time-to-treatment completion in both groups. Results: This study was funded in 2019. Enrollment began in July and is expected to be completed by November 2020. Data collection and follow-up are expected to be completed by June 2021. Results from the analyses based on the primary endpoint are expected to be submitted for publication by December 2021. Conclusions: This random control trial will be among the first to evaluate the effectiveness of VDOT within an African setting. The results will provide robust scientific evidence on the implementation and adoption of mobile health (mHealth) tools, coupled with incentives to motivate TB medication adherence. If successful, VDOT will apply to other low-income settings and a range of chronic diseases with lifelong treatment, such as HIV/AIDs. Trial Registration: ClinicalTrials.gov NCT04134689; http://clinicaltrials.gov/ct2/show/NCT04134689 International Registered Report Identifier (IRRID): DERR1-10.2196/18029 %M 32990629 %R 10.2196/18029 %U https://www.researchprotocols.org/2021/1/e18029 %U https://doi.org/10.2196/18029 %U http://www.ncbi.nlm.nih.gov/pubmed/32990629 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23729 %T Knowledge, Perceived Beliefs, and Preventive Behaviors Related to COVID-19 Among Chinese Older Adults: Cross-Sectional Web-Based Survey %A Chen,Ying %A Zhou,Rui %A Chen,Boyan %A Chen,Hao %A Li,Ying %A Chen,Zhi %A Zhu,Haihong %A Wang,Hongmei %+ Department of Social Medicine of School of Public Health, and Department of Pharmacy of the First Affiliated Hospital, Zhejiang University School of Medicine, 866 Yuhangtang Road, Xihu District, Hangzhou, Zhejiang Province, 310058, China, 86 571 88208222, rosa@zju.edu.cn %K COVID-19 %K knowledge %K perceived beliefs %K behaviors %K elderly %K China %D 2020 %7 31.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic continues to pose an international public health threat. Prevention is of paramount importance to protect the high-risk group of older adults until specific treatments for COVID-19 become available; however, little work has been done to explore factors that promote preventive behaviors among this population. Objective: This study aims to investigate the knowledge, perceived beliefs, and preventive behaviors towards COVID-19 of older adults in China and determine the factors that influence their practice of preventive behaviors. Methods: From February 19 to March 19, 2020, a cross-sectional, web-based survey was administered to Chinese older adults in all 31 provinces of mainland China using a convenience sampling method to assess the respondents’ knowledge, perceived beliefs, and preventive behaviors towards COVID-19. Standard descriptive statistics and hierarchical linear regression analyses were conducted to analyze the data. Results: A total of 1501 participants responded to the survey, and 1263 valid responses (84.1%) were obtained for further analysis. The overall correct rate on the knowledge questionnaire was 87%, overall positive beliefs regarding COVID-19 were found, and the mean behavior score was 13.73/15 (SD 1.62, range 5-15). The hierarchical linear regression showed that respondents who were married or cohabitating and who lived in areas with community-level control measures were more likely to practice preventive behaviors (P<.01). Knowledge (β=0.198, P<.001), perceived susceptibility (β=0.263, P=.03), perceived benefits (β=0.643, P<.001), and self-efficacy in preventing COVID-19 (β=0.468, P<.001) were also found to be significantly associated with preventive behaviors. Conclusions: Most older residents had adequate knowledge and positive beliefs regarding COVID-19 and engaged in proactive behaviors to prevent the disease. Knowledge and beliefs were confirmed to be significantly associated with behavior responses. Our findings have significant implications in enhancing the effectiveness of COVID-19 prevention programs targeting the older population; these programs must be continued and strengthened as the epidemic continues. %M 33293262 %R 10.2196/23729 %U https://www.jmir.org/2020/12/e23729 %U https://doi.org/10.2196/23729 %U http://www.ncbi.nlm.nih.gov/pubmed/33293262 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e25546 %T SARS-CoV-2 Testing Service Preferences of Adults in the United States: Discrete Choice Experiment %A Zimba,Rebecca %A Kulkarni,Sarah %A Berry,Amanda %A You,William %A Mirzayi,Chloe %A Westmoreland,Drew %A Parcesepe,Angela %A Waldron,Levi %A Rane,Madhura %A Kochhar,Shivani %A Robertson,McKaylee %A Maroko,Andrew %A Grov,Christian %A Nash,Denis %+ Institute for Implementation Science in Population Health, City University of New York, 55 W 125th St, 6th Floor, New York, NY, 10027, United States, 1 646 364 9618, rebecca.zimba@sph.cuny.edu %K COVID-19 %K SARS-CoV-2 %K discrete choice experiment %K implementation science %K engagement %K testing %K cohort study %K stated preference study %K pandemic %D 2020 %7 31.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Ascertaining preferences for SARS-CoV-2 testing and incorporating findings into the design and implementation of strategies for delivering testing services may enhance testing uptake and engagement, a prerequisite to reducing onward transmission. Objective: This study aims to determine important drivers of decisions to obtain a SARS-CoV-2 test in the context of increasing community transmission. Methods: We used a discrete choice experiment to assess preferences for SARS-CoV-2 test type, specimen type, testing venue, and results turnaround time. Participants (n=4793) from the US national longitudinal Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study completed our online survey from July 30 to September 8, 2020. We estimated the relative importance of testing method attributes and part-worth utilities of attribute levels, and simulated the uptake of an optimized testing scenario relative to the current typical testing scenario of polymerase chain reaction (PCR) via nasopharyngeal swab in a provider’s office or urgent care clinic with results in >5 days. Results: Test result turnaround time had the highest relative importance (30.4%), followed by test type (28.3%), specimen type (26.2%), and venue (15.0%). In simulations, immediate or same-day test results, both PCR and serology, or oral specimens substantially increased testing uptake over the current typical testing option. Simulated uptake of a hypothetical testing scenario of PCR and serology via a saliva sample at a pharmacy with same-day results was 97.7%, compared to 0.6% for the current typical testing scenario, with 1.8% opting for no test. Conclusions: Testing strategies that offer both PCR and serology with noninvasive methods and rapid turnaround time would likely have the most uptake and engagement among residents in communities with increasing community transmission of SARS-CoV-2. %M 33315584 %R 10.2196/25546 %U http://publichealth.jmir.org/2020/4/e25546/ %U https://doi.org/10.2196/25546 %U http://www.ncbi.nlm.nih.gov/pubmed/33315584 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e22478 %T Mobile Health Strategies to Tackle Skin Neglected Tropical Diseases With Recommendations From Innovative Experiences: Systematic Review %A Carrion,Carme %A Robles,Noemí %A Sola-Morales,Oriol %A Aymerich,Marta %A Ruiz Postigo,Jose Antonio %+ eHealth Lab Research Group, School of Health Sciences, Universitat Oberta de Catalunya, Rambla Poble Nou 156, Barcelona, 08035, Spain, 34 1 416 340 3200, mcarrionr@uoc.edu %K mHealth %K mobile health %K neglected tropical diseases %K skin neglected tropical diseases %K apps %K SMS text messaging %K low- and middle-income countries %D 2020 %7 31.12.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: Neglected tropical diseases (NTDs) represent a diverse group of 20 communicable diseases that occur in tropical and subtropical areas in 149 countries, affecting over 1 billion people and costing developing economies billions of dollars every year. Within these diseases, those that present lesions on the skin surface are classified as skin NTDs (sNTDs). Mobile health interventions are currently being used worldwide to manage skin diseases and can be a good strategy in the epidemiological and clinical management of sNTDs. Objective: We aimed to analyze existing evidence about mobile health interventions to control and manage sNTDs in low- and middle-income countries (LMICs) and make recommendations for what should be considered in future interventions. Methods: A systematic review was conducted of the MEDLINE, Embase, and Scopus databases over 10 years up to April 30, 2020. All types of clinical studies were considered. Data were synthesized into evidence tables. Apps were selected through a comprehensive systematic search in the Google Play Store and Apple App Store conducted between March 20 and April 15, 2020. Results: From 133 potentially relevant publications, 13 studies met our criteria (9.8%). These analyzed eight different interventions (three SMS text messaging interventions and five app interventions). Six of the 13 (46%) studies were community-based cross-sectional studies intended to epidemiologically map a specific disease, mainly lymphatic filariasis, but also cutaneous leishmaniasis, leprosy, and NTDs, as well as sNTDs in general. Most of the studies were considered to have a high (5/13, 39%) or moderate (4/13, 31%) risk of bias. Fifteen apps were identified in the Google Play Store, of which three were also in the Apple App Store. Most of the apps (11/15, 73%) were targeted at health care professionals, with only four targeted at patients. The apps focused on scabies (3/15, 20%), lymphatic filariasis (3/15, 20%), cutaneous leishmaniasis (1/15, 7%), leprosy (1/15, 7%), yaws and Buruli ulcer (1/15, 7%), tropical diseases including more than one sNTDs (3/15, 20%), and NTDs including sNTDs (2/15, 13%). Only 1 (7%) app focused on the clinical management of sNTDs. Conclusions: All mobile health interventions that were identified face technological, legal, final user, and organizational issues. There was a remarkable heterogeneity among studies, and the majority had methodological limitations that leave considerable room for improvement. Based on existing evidence, eight recommendations have been made for future interventions. %M 33382382 %R 10.2196/22478 %U http://mhealth.jmir.org/2020/12/e22478/ %U https://doi.org/10.2196/22478 %U http://www.ncbi.nlm.nih.gov/pubmed/33382382 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e24797 %T Evaluating the Onset, Severity, and Recovery of Changes to Smell and Taste Associated With COVID-19 Infection in a Singaporean Population (the COVOSMIA-19 Trial): Protocol for a Prospective Case-Control Study %A Sheen,Florence %A Tan,Vicki %A Haldar,Sumanto %A Sengupta,Sharmila %A Allen,David %A Somani,Jyoti %A Chen,Hui Yee %A Tambyah,Paul %A Forde,Ciaran G %+ Singapore Institute of Food and Biotechnology Innovation, Agency of Science and Research, 14 Medical Drive #07-02, MD 6 Building, Yong Loo Lin School of Medicine, Singapore, 117599, Singapore, 65 6407 0104, Ciaran_Forde@sifbi.a-star.edu.sg %K SARS-CoV-2 %K COVID-19 %K olfactory dysfunction %K gustatory dysfunction %K anosmia %K ageusia %K onset %K severity %K symptom %K infectious disease %K dysfunction %K protocol %K marker %K recovery %K monitoring %K taste %K smell %D 2020 %7 31.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Sudden loss of smell and/or taste has been suggested to be an early marker of COVID-19 infection, with most findings based on self-reporting of sensory changes at a single time point. Objective: To understand the onset, severity, and recovery of sensory changes associated with COVID-19 infection, this study will longitudinally track changes in chemosensory acuity among people with suspected COVID-19 infection using standardized test stimuli that are self-administered over 28 days. Methods: In a prospective, case-controlled observational study, volunteers will be recruited when they present for COVID-19 screening by respiratory tract polymerase chain reaction test (“swab test”). The volunteers will initially complete a series of questionnaires to record their recent changes in smell and taste ability, followed by a brief standardized smell and taste test. Participants will receive a home-use smell and taste test kit to prospectively complete daily self-assessments of their smell and taste acuity at their place of residence for up to 4 weeks, with all data submitted for collection through web-based software. Results: This study has been approved by the Domain Specific Review Board of the National Healthcare Group, Singapore, and is funded by the Biomedical Research Council Singapore COVID-19 Research Fund. Recruitment began on July 23, 2020, and will continue through to March 31, 2021. As of October 2, 2020, 69 participants had been recruited. Conclusions: To our knowledge, this study will be the first to collect longitudinal data on changes to smell and taste sensitivity related to clinically diagnosed COVID-19 infection, confirmed by PCR swab test, in a population-based cohort. The findings will provide temporal insights on the onset, severity, and recovery of sensory changes with COVID-19 infection, the consistency of symptoms, and the frequency of full smell recovery among patients with COVID-19. This self-administered and cost-effective approach has many advantages over self-report questionnaire–based methods and provides a more objective measure of smell and taste changes associated with COVID-19 infection; this will encourage otherwise asymptomatic individuals who are potential spreaders of the virus to self-isolate and seek formal medical diagnosis if they experience a sudden change in sensory acuity. This broadened case finding can potentially help control the COVID-19 pandemic and reduce the emergence of clusters of infections. Trial Registration: ClinicalTrials.gov NCT04492904; https://clinicaltrials.gov/ct2/show/NCT04492904. International Registered Report Identifier (IRRID): DERR1-10.2196/24797 %M 33351775 %R 10.2196/24797 %U http://www.researchprotocols.org/2020/12/e24797/ %U https://doi.org/10.2196/24797 %U http://www.ncbi.nlm.nih.gov/pubmed/33351775 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21815 %T Harnessing Digital Health Technologies During and After the COVID-19 Pandemic: Context Matters %A Petracca,Francesco %A Ciani,Oriana %A Cucciniello,Maria %A Tarricone,Rosanna %+ Centre for Research in Health and Social Care Management (CERGAS), Government, Health and Non Profit Division, SDA Bocconi, Via Roentgen 1, 20136, Milan, Italy, 39 02 58365257, francesco.petracca@unibocconi.it %K mobile apps %K coronavirus %K COVID-19 %K digital health %K mHealth %K organizational context %K public health %K telemedicine %D 2020 %7 30.12.2020 %9 Viewpoint %J J Med Internet Res %G English %X A common development observed during the COVID-19 pandemic is the renewed reliance on digital health technologies. Prior to the pandemic, the uptake of digital health technologies to directly strengthen public health systems had been unsatisfactory; however, a relentless acceleration took place within health care systems during the COVID-19 pandemic. Therefore, digital health technologies could not be prescinded from the organizational and institutional merits of the systems in which they were introduced. The Italian National Health Service is strongly decentralized, with the national government exercising general stewardship and regions responsible for the delivery of health care services. Together with the substantial lack of digital efforts previously, these institutional characteristics resulted in delays in the uptake of appropriate solutions, territorial differences, and issues in engaging the appropriate health care professionals during the pandemic. An in-depth analysis of the organizational context is instrumental in fully interpreting the contribution of digital health during the pandemic and providing the foundation for the digital reconstruction of what is to come after. %M 33351777 %R 10.2196/21815 %U http://www.jmir.org/2020/12/e21815/ %U https://doi.org/10.2196/21815 %U http://www.ncbi.nlm.nih.gov/pubmed/33351777 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e25174 %T Public Health Interventions’ Effect on Hospital Use in Patients With COVID-19: Comparative Study %A Wang,Xiaofeng %A Ren,Rui %A Kattan,Michael W %A Jehi,Lara %A Cheng,Zhenshun %A Fang,Kuangnan %+ Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH, 44195, United States, 1 216 445 7737, wangx6@ccf.org %K COVID-19 %K public health %K intervention %K hospital %K use %K prediction %K comparative %K United States %K China %K implementation %K observational %D 2020 %7 23.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 33315585 %R 10.2196/25174 %U http://publichealth.jmir.org/2020/4/e25174/ %U https://doi.org/10.2196/25174 %U http://www.ncbi.nlm.nih.gov/pubmed/33315585 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e24598 %T The Use of Digital Tools to Mitigate the COVID-19 Pandemic: Comparative Retrospective Study of Six Countries %A Zeng,Kylie %A Bernardo,Stephanie N %A Havins,Weldon E %+ College of Osteopathic Medicine, Touro University Nevada, 874 American Pacific Dr #8801, Henderson, NV, 89014, United States, 1 702 777 8687, kzeng2@student.touro.edu %K COVID-19 %K digital tool %K policy %K proposal %K digital health %K precaution %K spread %K contact tracing %K public health %D 2020 %7 23.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the COVID-19 outbreak began in Wuhan, China, countries worldwide have been forced to take unprecedented measures to combat it. While some countries are still grappling with the COVID-19 pandemic, others have fared better and have re-established relative normalcy quickly. The rapid transmission rate of the virus has shown a greater need for efficient and technologically modern containment measures. The use of digital tools to facilitate strict containment measures in countries that have fared well against the COVID-19 pandemic has sparked both interest and controversy. Objective: In this study, we compare the precautions taken against the spread of COVID-19 in the United States, Spain, and Italy, with Taiwan, South Korea, and Singapore, particularly related to the use of digital tools for contact tracing, and propose policies that could be used in the United States for future COVID-19 waves or pandemics. Methods: COVID-19 death rate data were obtained from the European Center for Disease Prevention and Control (ECDC), accessed through the Our World in Data database, and were evaluated based on population size per 100,000 people from December 31, 2019, to September 6, 2020. All policies and measures enacted were obtained from their respective governmental websites. Results: We found a strong association between lower death rates per capita and countries that implemented early mask use and strict border control measures that included mandatory quarantine using digital tools. There is a significant difference in the number of deaths per 100,000 when comparing Taiwan, South Korea, and Singapore with the United States, Spain, and Italy. Conclusions: Based on our research, it is evident that early intervention with the use of digital tools had a strong correlation with the successful containment of COVID-19. Infection rates and subsequent deaths in Italy, Spain, and the United States could have been much lower with early mask use and, more importantly, timely border control measures using modern digital tools. Thus, we propose that the United States execute the following national policies should a public health emergency be declared: (1) immediately establish a National Command responsible for enacting strict mandatory guidelines enforced by federal and state governments, including national mask use; (2) mandate civilian cooperation with health officials in contact tracing and quarantine orders; and (3) require incoming travelers to the United States and those quarantined to download a contact tracing app. We acknowledge the countries we studied differ in their cultures, political systems, and reporting criteria for COVID-19 deaths. Further research may need to be conducted to address these limitations; however, we believe that the proposed policies could protect the American public. %M 33302255 %R 10.2196/24598 %U http://publichealth.jmir.org/2020/4/e24598/ %U https://doi.org/10.2196/24598 %U http://www.ncbi.nlm.nih.gov/pubmed/33302255 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e23902 %T County-Level Social Distancing and Policy Impact in the United States: A Dynamical Systems Model %A McKee,Kevin L %A Crandell,Ian C %A Hanlon,Alexandra L %+ Center for Biostatistics and Health Data Science, Virginia Tech, One Riverside Circle, Suite 104, Roanoke, VA, 24016, United States, 1 703 593 1690, klmckee@vt.edu %K pandemic %K SARS-CoV-2 %K infection control %K COVID-19 %K social distancing %K lockdown %K nonpharmaceutical interventions %K public health %K intervention %K model %K infectious disease %K policy %D 2020 %7 23.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social distancing and public policy have been crucial for minimizing the spread of SARS-CoV-2 in the United States. Publicly available, county-level time series data on mobility are derived from individual devices with global positioning systems, providing a variety of indices of social distancing behavior per day. Such indices allow a fine-grained approach to modeling public behavior during the pandemic. Previous studies of social distancing and policy have not accounted for the occurrence of pre-policy social distancing and other dynamics reflected in the long-term trajectories of public mobility data. Objective: We propose a differential equation state-space model of county-level social distancing that accounts for distancing behavior leading up to the first official policies, equilibrium dynamics reflected in the long-term trajectories of mobility, and the specific impacts of four kinds of policy. The model is fit to each US county individually, producing a nationwide data set of novel estimated mobility indices. Methods: A differential equation model was fit to three indicators of mobility for each of 3054 counties, with T=100 occasions per county of the following: distance traveled, visitations to key sites, and the log number of interpersonal encounters. The indicators were highly correlated and assumed to share common underlying latent trajectory, dynamics, and responses to policy. Maximum likelihood estimation with the Kalman-Bucy filter was used to estimate the model parameters. Bivariate distributional plots and descriptive statistics were used to examine the resulting county-level parameter estimates. The association of chronology with policy impact was also considered. Results: Mobility dynamics show moderate correlations with two census covariates: population density (Spearman r ranging from 0.11 to 0.31) and median household income (Spearman r ranging from –0.03 to 0.39). Stay-at-home order effects were negatively correlated with both (r=–0.37 and r=–0.38, respectively), while the effects of the ban on all gatherings were positively correlated with both (r=0.51, r=0.39). Chronological ordering of policies was a moderate to strong determinant of their effect per county (Spearman r ranging from –0.12 to –0.56), with earlier policies accounting for most of the change in mobility, and later policies having little or no additional effect. Conclusions: Chronological ordering, population density, and median household income were all associated with policy impact. The stay-at-home order and the ban on gatherings had the largest impacts on mobility on average. The model is implemented in a graphical online app for exploring county-level statistics and running counterfactual simulations. Future studies can incorporate the model-derived indices of social distancing and policy impacts as important social determinants of COVID-19 health outcomes. %M 33296866 %R 10.2196/23902 %U http://publichealth.jmir.org/2020/4/e23902/ %U https://doi.org/10.2196/23902 %U http://www.ncbi.nlm.nih.gov/pubmed/33296866 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e25442 %T An Artificial Intelligence Model to Predict the Mortality of COVID-19 Patients at Hospital Admission Time Using Routine Blood Samples: Development and Validation of an Ensemble Model %A Ko,Hoon %A Chung,Heewon %A Kang,Wu Seong %A Park,Chul %A Kim,Do Wan %A Kim,Seong Eun %A Chung,Chi Ryang %A Ko,Ryoung Eun %A Lee,Hooseok %A Seo,Jae Ho %A Choi,Tae-Young %A Jaimes,Rafael %A Kim,Kyung Won %A Lee,Jinseok %+ Biomedical Engineering, Wonkwang University, Iksan Daero, Iksan, 54538, Republic of Korea, 82 1638506970, gonasago@gmail.com %K COVID-19 %K artificial intelligence %K blood samples %K mortality prediction %D 2020 %7 23.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19, which is accompanied by acute respiratory distress, multiple organ failure, and death, has spread worldwide much faster than previously thought. However, at present, it has limited treatments. Objective: To overcome this issue, we developed an artificial intelligence (AI) model of COVID-19, named EDRnet (ensemble learning model based on deep neural network and random forest models), to predict in-hospital mortality using a routine blood sample at the time of hospital admission. Methods: We selected 28 blood biomarkers and used the age and gender information of patients as model inputs. To improve the mortality prediction, we adopted an ensemble approach combining deep neural network and random forest models. We trained our model with a database of blood samples from 361 COVID-19 patients in Wuhan, China, and applied it to 106 COVID-19 patients in three Korean medical institutions. Results: In the testing data sets, EDRnet provided high sensitivity (100%), specificity (91%), and accuracy (92%). To extend the number of patient data points, we developed a web application (BeatCOVID19) where anyone can access the model to predict mortality and can register his or her own blood laboratory results. Conclusions: Our new AI model, EDRnet, accurately predicts the mortality rate for COVID-19. It is publicly available and aims to help health care providers fight COVID-19 and improve patients’ outcomes. %M 33301414 %R 10.2196/25442 %U http://www.jmir.org/2020/12/e25442/ %U https://doi.org/10.2196/25442 %U http://www.ncbi.nlm.nih.gov/pubmed/33301414 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e20343 %T Canada’s Decentralized “Human-Driven” Approach During the Early COVID-19 Pandemic %A Hansen,Gregory %A Cyr,Amelie %+ Jim Pattison Children's Hospital, 103 Hospital Drive, Pediatric Intensive Care Unit, Saskatoon, SK, S7N 0W8, Canada, 1 306 655 1000, gregory.hansen@usask.ca %K COVID-19 %K coronavirus infection %K public health %D 2020 %7 23.12.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X A country’s early response to a pandemic is critical for controlling the disease outbreak. During the COVID-19 pandemic, a number of southeast Asian countries adopted centralized, coordinated, rapid, and comprehensive approaches that involved smart technology (the “techno-driven” approach). In comparison, Canada’s approach appeared to be decentralized, uncoordinated, and slow, and it focused on educating citizens and enhancing social and human capital (the “human-driven” approach). We propose that in future pandemics, early and coordinated “techno-driven” approaches should receive more careful consideration to curtail outbreaks; however, these approaches must be balanced with protecting individuals’ freedoms. %M 33315582 %R 10.2196/20343 %U http://publichealth.jmir.org/2020/4/e20343/ %U https://doi.org/10.2196/20343 %U http://www.ncbi.nlm.nih.gov/pubmed/33315582 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24614 %T Reduction of COVID-19 Incidence and Nonpharmacologic Interventions: Analysis Using a US County–Level Policy Data Set %A Ebrahim,Senan %A Ashworth,Henry %A Noah,Cray %A Kadambi,Adesh %A Toumi,Asmae %A Chhatwal,Jagpreet %+ Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, United States, 1 617 432 1000, senan@hikmahealth.org %K communicable diseases %K COVID-19 %K data set %K pandemic %K policy %K public health %K data %K intervention %K effectiveness %K incidence %K time series %D 2020 %7 21.12.2020 %9 Original Paper %J J Med Internet Res %G English %X 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 contact tracing (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. %M 33302253 %R 10.2196/24614 %U http://www.jmir.org/2020/12/e24614/ %U https://doi.org/10.2196/24614 %U http://www.ncbi.nlm.nih.gov/pubmed/33302253 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23518 %T COVID-19 Symptom-Related Google Searches and Local COVID-19 Incidence in Spain: Correlational Study %A Jimenez,Alberto Jimenez %A Estevez-Reboredo,Rosa M %A Santed,Miguel A %A Ramos,Victoria %+ Faculty of Psychology, Universidad Nacional de Educación a Distancia, Calle de Juan del Rosal 10, Madrid, 28040, Spain, 34 646517577, msanted@psi.uned.es %K behavioral epidemiology %K big data %K smart data %K tracking %K nowcasting %K forecast %K predict %K infosurveillance %K infodemiology %K COVID-19 %D 2020 %7 18.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is one of the biggest pandemics in human history, along with other disease pandemics, such as the H1N1 influenza A, bubonic plague, and smallpox pandemics. This study is a small contribution that tries to find contrasted formulas to alleviate global suffering and guarantee a more manageable future. Objective: In this study, a statistical approach was proposed to study the correlation between the incidence of COVID-19 in Spain and search data provided by Google Trends. Methods: We assessed the linear correlation between Google Trends search data and the data provided by the National Center of Epidemiology in Spain—which is dependent on the Instituto de Salud Carlos III—regarding the number of COVID-19 cases reported with a certain time lag. These data enabled the identification of anticipatory patterns. Results: In response to the ongoing outbreak, our results demonstrate that by using our correlation test, the evolution of the COVID-19 pandemic can be predicted in Spain up to 11 days in advance. Conclusions: During the epidemic, Google Trends offers the possibility to preempt health care decisions in real time by tracking people's concerns through their search patterns. This can be of great help given the critical, if not dramatic need for complementary monitoring approaches that work on a population level and inform public health decisions in real time. This study of Google search patterns, which was motivated by the fears of individuals in the face of a pandemic, can be useful in anticipating the development of the pandemic. %M 33156803 %R 10.2196/23518 %U http://www.jmir.org/2020/12/e23518/ %U https://doi.org/10.2196/23518 %U http://www.ncbi.nlm.nih.gov/pubmed/33156803 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24478 %T Computing SARS-CoV-2 Infection Risk From Symptoms, Imaging, and Test Data: Diagnostic Model Development %A D'Ambrosia,Christopher %A Christensen,Henrik %A Aronoff-Spencer,Eliah %+ Division of Infectious Diseases and Global Public Health, School of Medicine, University of California San Diego, 9500 Gilman Drive 0711, San Diego, CA, 92101, United States, 1 6462348153, earonoffspencer@health.ucsd.edu %K health %K informatics %K computation %K COVID-19 %K infection %K risk %K symptom %K imaging %K diagnostic %K probability %K machine learning %K Bayesian %K model %D 2020 %7 16.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Assigning meaningful probabilities of SARS-CoV-2 infection risk presents a diagnostic challenge across the continuum of care. Objective: The aim of this study was to develop and clinically validate an adaptable, personalized diagnostic model to assist clinicians in ruling in and ruling out COVID-19 in potential patients. We compared the diagnostic performance of probabilistic, graphical, and machine learning models against a previously published benchmark model. Methods: We integrated patient symptoms and test data using machine learning and Bayesian inference to quantify individual patient risk of SARS-CoV-2 infection. We trained models with 100,000 simulated patient profiles based on 13 symptoms and estimated local prevalence, imaging, and molecular diagnostic performance from published reports. We tested these models with consecutive patients who presented with a COVID-19–compatible illness at the University of California San Diego Medical Center over the course of 14 days starting in March 2020. Results: We included 55 consecutive patients with fever (n=43, 78%) or cough (n=42, 77%) presenting for ambulatory (n=11, 20%) or hospital care (n=44, 80%). In total, 51% (n=28) were female and 49% (n=27) were aged <60 years. Common comorbidities included diabetes (n=12, 22%), hypertension (n=15, 27%), cancer (n=9, 16%), and cardiovascular disease (n=7, 13%). Of these, 69% (n=38) were confirmed via reverse transcription-polymerase chain reaction (RT-PCR) to be positive for SARS-CoV-2 infection, and 20% (n=11) had repeated negative nucleic acid testing and an alternate diagnosis. Bayesian inference network, distance metric learning, and ensemble models discriminated between patients with SARS-CoV-2 infection and alternate diagnoses with sensitivities of 81.6%-84.2%, specificities of 58.8%-70.6%, and accuracies of 61.4%-71.8%. After integrating imaging and laboratory test statistics with the predictions of the Bayesian inference network, changes in diagnostic uncertainty at each step in the simulated clinical evaluation process were highly sensitive to location, symptom, and diagnostic test choices. Conclusions: Decision support models that incorporate symptoms and available test results can help providers diagnose SARS-CoV-2 infection in real-world settings. %M 33301417 %R 10.2196/24478 %U http://www.jmir.org/2020/12/e24478/ %U https://doi.org/10.2196/24478 %U http://www.ncbi.nlm.nih.gov/pubmed/33301417 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e23624 %T An Epidemiological Model Considering Isolation to Predict COVID-19 Trends in Tokyo, Japan: Numerical Analysis %A Utamura,Motoaki %A Koizumi,Makoto %A Kirikami,Seiichi %+ Research Laboratory for Nuclear Reactors, Tokyo Institute of Technology, Ookayama 2-12-1, Meguro-ku, Tokyo, 1528550, Japan, 81 3 5477 3464, titech02715@gmail.com %K coronavirus %K COVID-19 %K epidemiological model %K prediction %K Tokyo %K delay differential equation %K SIR model %K model %K epidemiology %K isolation %K trend %D 2020 %7 16.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: COVID-19 currently poses a global public health threat. Although Tokyo, Japan, is no exception to this, it was initially affected by only a small-level epidemic. Nevertheless, medical collapse nearly happened since no predictive methods were available to assess infection counts. A standard susceptible-infectious-removed (SIR) epidemiological model has been widely used, but its applicability is limited often to the early phase of an epidemic in the case of a large collective population. A full numerical simulation of the entire period from beginning until end would be helpful for understanding COVID-19 trends in (separate) counts of inpatient and infectious cases and can also aid the preparation of hospital beds and development of quarantine strategies. Objective: This study aimed to develop an epidemiological model that considers the isolation period to simulate a comprehensive trend of the initial epidemic in Tokyo that yields separate counts of inpatient and infectious cases. It was also intended to induce important corollaries of governing equations (ie, effective reproductive number) and equations for the final count. Methods: Time-series data related to SARS-CoV-2 from February 28 to May 23, 2020, from Tokyo and antibody testing conducted by the Japanese government were adopted for this study. A novel epidemiological model based on a discrete delay differential equation (apparent time-lag model [ATLM]) was introduced. The model can predict trends in inpatient and infectious cases in the field. Various data such as daily new confirmed cases, cumulative infections, inpatients, and PCR (polymerase chain reaction) test positivity ratios were used to verify the model. This approach also derived an alternative formulation equivalent to the standard SIR model. Results: In a typical parameter setting, the present ATLM provided 20% less infectious cases in the field compared to the standard SIR model prediction owing to isolation. The basic reproductive number was inferred as 2.30 under the condition that the time lag T from infection to detection and isolation is 14 days. Based on this, an adequate vaccine ratio to avoid an outbreak was evaluated for 57% of the population. We assessed the date (May 23) that the government declared a rescission of the state of emergency. Taking into consideration the number of infectious cases in the field, a date of 1 week later (May 30) would have been most effective. Furthermore, simulation results with a shorter time lag of T=7 and a larger transmission rate of α=1.43α0 suggest that infections at large should reduce by half and inpatient numbers should be similar to those of the first wave of COVID-19. Conclusions: A novel mathematical model was proposed and examined using SARS-CoV-2 data for Tokyo. The simulation agreed with data from the beginning of the pandemic. Shortening the period from infection to hospitalization is effective against outbreaks without rigorous public health interventions and control. %M 33259325 %R 10.2196/23624 %U http://publichealth.jmir.org/2020/4/e23624/ %U https://doi.org/10.2196/23624 %U http://www.ncbi.nlm.nih.gov/pubmed/33259325 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e25595 %T 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 %A Suppan,Laurent %A Abbas,Mohamed %A Catho,Gaud %A Stuby,Loric %A Regard,Simon %A Harbarth,Stephan %A Achab,Sophia %A Suppan,Mélanie %+ Division of Emergency Medicine, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 223723311, laurent.suppan@hcuge.ch %K COVID-19 %K transmission %K serious game %K infection prevention %K health care worker %K SARS-COV-2 %K nursing home %K randomized controlled trial %K elderly %K older adult %K infection control %K infectious disease %D 2020 %7 15.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X 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 %M 33296329 %R 10.2196/25595 %U http://www.researchprotocols.org/2020/12/e25595/ %U https://doi.org/10.2196/25595 %U http://www.ncbi.nlm.nih.gov/pubmed/33296329 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 12 %P e24357 %T A Brazilian Cohort of Patients With Immuno-Mediated Chronic Inflammatory Diseases Infected by SARS-CoV-2 (ReumaCoV-Brasil Registry): Protocol for a Prospective, Observational Study %A Marques,Claudia %A Kakehasi,Adriana Maria %A Gomides,Ana Paula Monteiro %A Paiva,Eduardo Dos Santos %A dos Reis Neto,Edgard Torres %A Pileggi,Gecilmara Cristina Salviato %A Provenza,José Roberto %A Mota,Licia %A Xavier,Ricardo Machado %A Ferreira,Gilda Aparecida %A Pinheiro,Marcelo Medeiros %+ Hospital das Clínicas, Universidade Federal de Minas Gerais, Av Prof Alfredo Balena, 110 - Santa Efigênia, Belo Horizonte, 30130-100, Brazil, 55 31 996174211, gildaferreira9@gmail.com %K COVID-19 %K SARS-CoV-2 %K prospective study %K immune-mediated rheumatic diseases %K registry %K Brazil %K inflammatory %K chronic disease %K cohort %K immunology %K infection rate %K mortality %K morbidity %D 2020 %7 15.12.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Patients with immune-mediated rheumatic diseases (IMRD) are at increased risk of infections, including significant morbidity and high mortality. Considering the potential for unfavorable outcomes of SARS-CoV-2 infection in patients with IMRD, several questions were raised regarding the impact of COVID-19 at the start of the pandemic. Objective: This paper presents the protocol of a study that aims to prospectively evaluate patients with IMRD and a confirmed COVID-19 diagnosis (using criteria provided by the Brazilian Ministry of Health). Methods: The study comprised a prospective, observational cohort (patients with IMRD and COVID-19) and a comparison group (patients with only IMRD), with a follow-up time of 6 months to evaluate differences in health outcomes. The primary outcomes will be changes in IMRD disease activity after SARS-CoV-2 infection at 4 time points: (1) at baseline, (2) within 4-6 weeks after infection, (3) at 3 months after the second assessment (±15 days), and (4) at 6 months (±15 days). The secondary outcomes will be the progression rate to moderate or severe forms of COVID-19, need for intensive care unit admission and mechanical ventilation, death, and therapeutic changes related to IMRD. Two outcomes—pulmonary and thromboembolic events in patients with both IMRD and SARS-CoV-2 infection—are of particular interest and will be monitored with close attention (clinical, laboratory, and function tests as well as imaging). Results: Recruitment opened in May 2020, with 1300 participants recruited from 43 sites as of November 2020. Patient recruitment will conclude by the end of December 2020, with follow-up occurring until April 2021. Data analysis is scheduled to start after all inclusion data have been collected, with an aim to publish a peer-reviewed paper in December 2020. Conclusions: We believe this study will provide clinically relevant data on the general impact of COVID-19 on patients with IMRD. Trial Registration: Brazilian Registry of Clinical Trials RBR-33YTQC; http://www.ensaiosclinicos.gov.br/rg/RBR-33ytqc/ International Registered Report Identifier (IRRID): DERR1-10.2196/24357 %M 33156812 %R 10.2196/24357 %U https://www.researchprotocols.org/2020/12/e24357 %U https://doi.org/10.2196/24357 %U http://www.ncbi.nlm.nih.gov/pubmed/33156812 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24531 %T People’s Experiences and Satisfaction With Telehealth During the COVID-19 Pandemic in Australia: Cross-Sectional Survey Study %A Isautier,Jennifer MJ %A Copp,Tessa %A Ayre,Julie %A Cvejic,Erin %A Meyerowitz-Katz,Gideon %A Batcup,Carys %A Bonner,Carissa %A Dodd,Rachael %A Nickel,Brooke %A Pickles,Kristen %A Cornell,Samuel %A Dakin,Thomas %A McCaffery,Kirsten J %+ Faculty of Medicine and Health, Sydney Health Literacy Lab, School of Public Health, The University of Sydney, Edward Ford Building, A27 Fisher Rd, Sydney, 2006, Australia, 61 02 9114 2199, jennifer.isautier@sydney.edu.au %K COVID-19 %K patient experience %K telehealth %K experience %K satisfaction %K telemedicine %K Australia %K usability %K cross-sectional %K survey %D 2020 %7 10.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In response to the COVID-19 pandemic, telehealth has rapidly been adopted to deliver health care services around the world. To date, studies have not compared people’s experiences with telehealth services during the pandemic in Australia to their experiences with traditional in-person visits. Objective: This study aimed to compare participants’ perceptions of telehealth consults to their perceptions of traditional in-person visits and investigate whether people believe that telehealth services would be useful after the pandemic. Methods: A national, cross-sectional, community survey was conducted between June 5 and June 12, 2020 in Australia. In total, 1369 participants who were aged ≥18 years and lived in Australia were recruited via targeted advertisements on social media (ie, Facebook and Instagram). Participants responded to survey questions about their telehealth experience, which included a free-text response option. A generalized linear model was used to estimate the adjusted relative risks of having a poorer telehealth experience than a traditional in-person visit experience. Content analysis was performed to determine the reasons why telehealth experiences were worse than traditional in-person visit experiences. Results: Of the 596 telehealth users, the majority of respondents (n=369, 61.9%) stated that their telehealth experience was “just as good as” or “better than” their traditional in-person medical appointment experience. On average, respondents perceived that telehealth would be moderately useful to very useful for medical appointments after the COVID-19 pandemic ends (mean 3.67, SD 1.1). Being male (P=.007), having a history of both depression and anxiety (P=.016), and lower patient activation scores (ie, individuals’ willingness to take on the role of managing their health/health care) (P=.036) were significantly associated with a poor telehealth experience. In total, 6 overarching themes were identified from free-text responses for why participants’ telehealth experiences were poorer than their traditional in-person medical appointment experiences, as follows: communication is not as effective, limitations with technology, issues with obtaining prescriptions and pathology results, reduced confidence in their doctor, additional burden for complex care, and inability to be physically examined. Conclusions: Based on our sample’s responses, telehealth appointment experiences were comparable to traditional in-person medical appointment experiences. Telehealth may be worthwhile as a mode of health care delivery while the pandemic continues, and it may continue to be worthwhile after the pandemic. %M 33156806 %R 10.2196/24531 %U http://www.jmir.org/2020/12/e24531/ %U https://doi.org/10.2196/24531 %U http://www.ncbi.nlm.nih.gov/pubmed/33156806 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e22103 %T Effective Control of COVID-19 in South Korea: Cross-Sectional Study of Epidemiological Data %A Jeong,Gwang Hun %A Lee,Hyo Jeong %A Lee,Jinhee %A Lee,Jun Young %A Lee,Keum Hwa %A Han,Young Joo %A Yoon,Sojung %A Ryu,Seohyun %A Kim,Da Kyung %A Park,Myung Bae %A Yang,Jae Won %A Effenberger,Maria %A Eisenhut,Michael %A Hong,Sung Hwi %A Kronbichler,Andreas %A Ghayda,Ramy Abou %A Shin,Jae Il %+ Department of Pediatrics, Yonsei University College of Medicine, Yonsei-ro 50, Seodaemun-gu, CPO Box 8044, Seoul, 03722, Republic of Korea, 82 222282050, shinji@yuhs.ac %K COVID-19 %K Korea %K strategies %K epidemiological characteristics %D 2020 %7 10.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: South Korea is one of the few countries that has succeeded in flattening the curve of new COVID-19 cases and avoiding a second outbreak by implementing multiple strategies, ranging from an individual level to the population level. Objective: We aim to discuss the unique strategies and epidemiological characteristics of COVID-19 in South Korea and present a summary of policies implemented by the Korean government during the COVID-19 pandemic. Methods: We designed a cross-sectional study of epidemiological data published by the Korea Centers for Disease Control and Prevention on October 1, 2020. We analyzed detailed epidemiological information of COVID-19 cases, including the number of confirmed cases and resulting deaths. Results: As of October 1, 2020, a total of 23,889 confirmed COVID-19 cases and 415 deaths were reported in South Korea. In this paper, we present data on the epidemiological characteristics and transmission of the disease and discuss how the South Korean government, health care providers, and society responded to the COVID-19 outbreak. Conclusions: Understanding the epidemiological characteristics of COVID-19 in South Korea and the government’s successful efforts in managing the spread of the disease can provide important insights to other countries dealing with the ongoing pandemic. %M 33151893 %R 10.2196/22103 %U http://www.jmir.org/2020/12/e22103/ %U https://doi.org/10.2196/22103 %U http://www.ncbi.nlm.nih.gov/pubmed/33151893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e23170 %T COVID-19 Mobile Apps: A Systematic Review of the Literature %A Kondylakis,Haridimos %A Katehakis,Dimitrios G %A Kouroubali,Angelina %A Logothetidis,Fokion %A Triantafyllidis,Andreas %A Kalamaras,Ilias %A Votis,Konstantinos %A Tzovaras,Dimitrios %+ Computational Biomedicine Laboratory, Foundation for Research and Technology - Hellas–Institute of Computer Science, N. Plastira 100, Heraklion, 70013, Greece, 30 2810391449, kondylak@ics.forth.gr %K mobile apps %K systematic survey %K COVID-19 %K mobile health %K eHealth %D 2020 %7 9.12.2020 %9 Review %J J Med Internet Res %G English %X Background: A vast amount of mobile apps have been developed during the past few months in an attempt to “flatten the curve” of the increasing number of COVID-19 cases. Objective: This systematic review aims to shed light into studies found in the scientific literature that have used and evaluated mobile apps for the prevention, management, treatment, or follow-up of COVID-19. Methods: We searched the bibliographic databases Global Literature on Coronavirus Disease, PubMed, and Scopus to identify papers focusing on mobile apps for COVID-19 that show evidence of their real-life use and have been developed involving clinical professionals in their design or validation. Results: Mobile apps have been implemented for training, information sharing, risk assessment, self-management of symptoms, contact tracing, home monitoring, and decision making, rapidly offering effective and usable tools for managing the COVID-19 pandemic. Conclusions: Mobile apps are considered to be a valuable tool for citizens, health professionals, and decision makers in facing critical challenges imposed by the pandemic, such as reducing the burden on hospitals, providing access to credible information, tracking the symptoms and mental health of individuals, and discovering new predictors. %M 33197234 %R 10.2196/23170 %U http://www.jmir.org/2020/12/e23170/ %U https://doi.org/10.2196/23170 %U http://www.ncbi.nlm.nih.gov/pubmed/33197234 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e22609 %T Detection of Hate Speech in COVID-19–Related Tweets in the Arab Region: Deep Learning and Topic Modeling Approach %A Alshalan,Raghad %A Al-Khalifa,Hend %A Alsaeed,Duaa %A Al-Baity,Heyam %A Alshalan,Shahad %+ King Saud University, Riyadh 11451, Riyadh, , Saudi Arabia, 966 504426816, hend.alkhalifa@gmail.com %K COVID-19 %K coronavirus %K Twitter %K hate speech %K social network analysis %K social media %K public health %K pandemic %K deep learning %K non-negative matrix factorization %K NMF %K convolutional neural network %K CNN %D 2020 %7 8.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The massive scale of social media platforms requires an automatic solution for detecting hate speech. These automatic solutions will help reduce the need for manual analysis of content. Most previous literature has cast the hate speech detection problem as a supervised text classification task using classical machine learning methods or, more recently, deep learning methods. However, work investigating this problem in Arabic cyberspace is still limited compared to the published work on English text. Objective: This study aims to identify hate speech related to the COVID-19 pandemic posted by Twitter users in the Arab region and to discover the main issues discussed in tweets containing hate speech. Methods: We used the ArCOV-19 dataset, an ongoing collection of Arabic tweets related to COVID-19, starting from January 27, 2020. Tweets were analyzed for hate speech using a pretrained convolutional neural network (CNN) model; each tweet was given a score between 0 and 1, with 1 being the most hateful text. We also used nonnegative matrix factorization to discover the main issues and topics discussed in hate tweets. Results: The analysis of hate speech in Twitter data in the Arab region identified that the number of non–hate tweets greatly exceeded the number of hate tweets, where the percentage of hate tweets among COVID-19 related tweets was 3.2% (11,743/547,554). The analysis also revealed that the majority of hate tweets (8385/11,743, 71.4%) contained a low level of hate based on the score provided by the CNN. This study identified Saudi Arabia as the Arab country from which the most COVID-19 hate tweets originated during the pandemic. Furthermore, we showed that the largest number of hate tweets appeared during the time period of March 1-30, 2020, representing 51.9% of all hate tweets (6095/11,743). Contrary to what was anticipated, in the Arab region, it was found that the spread of COVID-19–related hate speech on Twitter was weakly related with the dissemination of the pandemic based on the Pearson correlation coefficient (r=0.1982, P=.50). The study also identified the commonly discussed topics in hate tweets during the pandemic. Analysis of the 7 extracted topics showed that 6 of the 7 identified topics were related to hate speech against China and Iran. Arab users also discussed topics related to political conflicts in the Arab region during the COVID-19 pandemic. Conclusions: The COVID-19 pandemic poses serious public health challenges to nations worldwide. During the COVID-19 pandemic, frequent use of social media can contribute to the spread of hate speech. Hate speech on the web can have a negative impact on society, and hate speech may have a direct correlation with real hate crimes, which increases the threat associated with being targeted by hate speech and abusive language. This study is the first to analyze hate speech in the context of Arabic COVID-19–related tweets in the Arab region. %M 33207310 %R 10.2196/22609 %U http://www.jmir.org/2020/12/e22609/ %U https://doi.org/10.2196/22609 %U http://www.ncbi.nlm.nih.gov/pubmed/33207310 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 12 %P e19270 %T Iterative Adaptation of a Tuberculosis Digital Medication Adherence Technology to Meet User Needs: Qualitative Study of Patients and Health Care Providers Using Human-Centered Design Methods %A Patel,Devika %A Berger,Christopher Allen %A Kityamuwesi,Alex %A Ggita,Joseph %A Kunihira Tinka,Lynn %A Turimumahoro,Patricia %A Feler,Joshua %A Chehab,Lara %A Chen,Amy Z %A Gupta,Nakull %A Turyahabwe,Stavia %A Katamba,Achilles %A Cattamanchi,Adithya %A Sammann,Amanda %+ Division of Pulmonary and Critical Care Medicine and Center for Tuberculosis, University of California, San Francisco, 1001 Potrero Avenue, San Francisco, CA, 94110, United States, 1 4152064679, Christopher.berger@ucsf.edu %K human-centered design %K tuberculosis %K digital adherence technology %K digital health %K adherence %K medication %K treatment %K outcome %K lung %K respiratory %K infectious disease %D 2020 %7 8.12.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Digital adherence technologies have been widely promoted as a means to improve tuberculosis medication adherence. However, uptake of these technologies has been suboptimal by both patients and health workers. Not surprisingly, studies have not demonstrated significant improvement in treatment outcomes. Objective: This study aimed to optimize a well-known digital adherence technology, 99DOTS, for end user needs in Uganda. We describe the findings of the ideation phase of the human-centered design methodology to adapt 99DOTS according to a set of design principles identified in the previous inspiration phase. Methods: 99DOTS is a low-cost digital adherence technology wherein tuberculosis medication blister packs are encased within an envelope that reveals toll-free numbers that patients can call to report dosing. We identified 2 key areas for design and testing: (1) the envelope, including the form factor, content, and depiction of the order of pill taking; and (2) the patient call-in experience. We conducted 5 brainstorming sessions with all relevant stakeholders to generate a suite of potential prototype concepts. Senior investigators identified concepts to further develop based on feasibility and consistency with the predetermined design principles. Prototypes were revised with feedback from the entire team. The envelope and call-in experience prototypes were tested and iteratively revised through focus groups with health workers (n=52) and interviews with patients (n=7). We collected and analyzed qualitative feedback to inform each subsequent iteration. Results: The 5 brainstorming sessions produced 127 unique ideas that we clustered into 6 themes: rewards, customization, education, logistics, wording and imagery, and treatment countdown. We developed 16 envelope prototypes, 12 icons, and 28 audio messages for prototype testing. In the final design, we altered the pill packaging envelope by adding a front flap to conceal the pills and reduce potential stigma associated with tuberculosis. The flap was adorned with either a blank calendar or map of Uganda. The inside cover contained a personalized message from a local health worker including contact information, pictorial pill-taking instructions, and a choice of stickers to tailor education to the patient and phase of treatment. Pill-taking order was indicated with colors, chevron arrows, and small mobile phone icons. Last, the call-in experience when patients report dosing was changed to a rotating series of audio messages centered on the themes of prevention, encouragement, and reassurance that tuberculosis is curable. Conclusions: We demonstrated the use of human-centered design as a promising tool to drive the adaptation of digital adherence technologies to better address the needs and motivations of end users. The next phase of research, known as the implementation phase in the human-centered design methodology, will investigate whether the adapted 99DOTS platform results in higher levels of engagement from patients and health workers, and ultimately improves tuberculosis treatment outcomes. %M 33289494 %R 10.2196/19270 %U https://formative.jmir.org/2020/12/e19270 %U https://doi.org/10.2196/19270 %U http://www.ncbi.nlm.nih.gov/pubmed/33289494 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e24125 %T Characterizing Weibo Social Media Posts From Wuhan, China During the Early Stages of the COVID-19 Pandemic: Qualitative Content Analysis %A Xu,Qing %A Shen,Ziyi %A Shah,Neal %A Cuomo,Raphael %A Cai,Mingxiang %A Brown,Matthew %A Li,Jiawei %A Mackey,Tim %+ Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 8950 Villa La Jolla Drive, A124, La Jolla, CA, 92037, United States, 1 951 491 4161, tmackey@ucsd.edu %K COVID-19 %K infodemiology %K infoveillance %K infodemic %K Weibo %K social media %K content analysis %K China %K data mining %K knowledge %K attitude %K behavior %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The COVID-19 pandemic has reached 40 million confirmed cases worldwide. Given its rapid progression, it is important to examine its origins to better understand how people’s knowledge, attitudes, and reactions have evolved over time. One method is to use data mining of social media conversations related to information exposure and self-reported user experiences. Objective: This study aims to characterize the knowledge, attitudes, and behaviors of social media users located at the initial epicenter of the outbreak by analyzing data from the Sina Weibo platform in Chinese. Methods: We used web scraping to collect public Weibo posts from December 31, 2019, to January 20, 2020, from users located in Wuhan City that contained COVID-19–related keywords. We then manually annotated all posts using an inductive content coding approach to identify specific information sources and key themes including news and knowledge about the outbreak, public sentiment, and public reaction to control and response measures. Results: We identified 10,159 COVID-19 posts from 8703 unique Weibo users. Among our three parent classification areas, 67.22% (n=6829) included news and knowledge posts, 69.72% (n=7083) included public sentiment, and 47.87% (n=4863) included public reaction and self-reported behavior. Many of these themes were expressed concurrently in the same Weibo post. Subtopics for news and knowledge posts followed four distinct timelines and evidenced an escalation of the outbreak’s seriousness as more information became available. Public sentiment primarily focused on expressions of anxiety, though some expressions of anger and even positive sentiment were also detected. Public reaction included both protective and elevated health risk behavior. Conclusions: Between the announcement of pneumonia and respiratory illness of unknown origin in late December 2019 and the discovery of human-to-human transmission on January 20, 2020, we observed a high volume of public anxiety and confusion about COVID-19, including different reactions to the news by users, negative sentiment after being exposed to information, and public reaction that translated to self-reported behavior. These findings provide early insight into changing knowledge, attitudes, and behaviors about COVID-19, and have the potential to inform future outbreak communication, response, and policy making in China and beyond. %M 33175693 %R 10.2196/24125 %U http://publichealth.jmir.org/2020/4/e24125/ %U https://doi.org/10.2196/24125 %U http://www.ncbi.nlm.nih.gov/pubmed/33175693 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e22471 %T Clinical Characteristics and Outcomes of Patients With Diabetes Admitted for COVID-19 Treatment in Dubai: Single-Centre Cross-Sectional Study %A Bhatti,Rahila %A Khamis,Amar Hassan %A Khatib,Samara %A Shiraz,Seemin %A Matfin,Glenn %+ Department of Endocrinology, Mediclinic Parkview Hospital, 3 Umm Suqeim, Al Barsha South 1, Dubai, United Arab Emirates, 971 505290575, rsbhatti91@hotmail.com %K Diabetes %K COVID-19 %K characteristic %K outcome %K chronic condition %K cross-sectional %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Recent studies have shown that diabetes is a major risk factor that contributes to the severity of COVID-19 and resulting mortality. Poor glycemic control is also associated with poor patient outcomes (eg, hospitalization and death). Objective: This study aimed to describe the clinical characteristics and outcomes of patients with diabetes who were admitted to our hospital for COVID-19 treatment. Methods: This cross-sectional, observational study comprised patients with diabetes admitted with COVID-19 to Mediclinic Parkview Hospital in Dubai, United Arab Emirates, from March 30 to June 7, 2020. We studied the differences among characteristics, length of hospital stay, diabetes status, comorbidities, treatments, and outcomes among these patients. Results: Of the cohort patients, 25.1% (103/410) had coexistent diabetes or prediabetes. These patients represented 17 different ethnicities, with 59.2% (61/103) from Asian countries and 35% (36/103) from Arab countries. Mean patient age was 54 (SD 12.5) years, and 66.9% (69/103) of patients were male. Moreover, 85.4% (88/103) of patients were known to have diabetes prior to admission, and 14.6% (15/103) were newly diagnosed with either diabetes or prediabetes at admission. Most cohort patients had type 2 diabetes or prediabetes, and only 2.9% (3/103) of all patients had type 1 diabetes. Furthermore, 44.6% (46/103) of patients demonstrated evidence suggesting good glycemic control during the 4-12 weeks prior to admission, as defined arbitrarily by admission hemoglobin A1c level <7.5%, and 73.8% (76/103) of patients had other comorbidities, including hypertension, ischemic heart disease, and dyslipidemia. Laboratory data (mean and SD values) at admission for patients who needed ward-based care versus those who needed intensive care were as follows: fibrinogen, 462.8 (SD 125.1) mg/dL vs 660.0 (SD 187.6) mg/dL; D-dimer, 0.7 (SD 0.5) µg/mL vs 2.3 (SD 3.5) µg/mL; ferritin, 358.0 (SD 442.0) mg/dL vs 1762.4 (SD 2586.4) mg/dL; and C-reactive protein, 33.9 (SD 38.6) mg/L vs 137.0 (SD 111.7) mg/L. Laboratory data were all significantly higher for patients in the intensive care unit subcohort (P<.05). The average length of hospital stay was 14.55 days for all patients, with 28.2% (29/103) of patients requiring intensive care. In all, 4.9% (5/103) died during hospitalization—all of whom were in the intensive care unit. Conclusions: Majority of patients with diabetes or prediabetes and COVID-19 had other notable comorbidities. Only 4 patients tested negative for COVID-19 RT-PCR but showed pathognomonic changes of COVID-19 radiologically. Laboratory analyses revealed distinct abnormal patterns of biomarkers that were associated with a poor prognosis: fibrinogen, D-dimer, ferritin, and C-reactive protein levels were all significantly higher at admission in patients who subsequently needed intensive care than in those who needed ward-based care. More studies with larger sample sizes are needed to compare data of COVID-19 patients admitted with and without diabetes within the UAE region. %M 33284130 %R 10.2196/22471 %U http://publichealth.jmir.org/2020/4/e22471/ %U https://doi.org/10.2196/22471 %U http://www.ncbi.nlm.nih.gov/pubmed/33284130 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 12 %P e21790 %T Comprehensive Computer-Aided Decision Support Framework to Diagnose Tuberculosis From Chest X-Ray Images: Data Mining Study %A Owais,Muhammad %A Arsalan,Muhammad %A Mahmood,Tahir %A Kim,Yu Hwan %A Park,Kang Ryoung %+ Division of Electronics and Electrical Engineering, Dongguk University, 30 Pildong-ro 1-gil, Jung-gu, Seoul, 04620, Republic of Korea, 82 10 3111 7022, parkgr@dgu.edu %K tuberculosis %K computer-aided diagnosis %K chest radiograph %K lung disease %K neural network %K classification-based retrieval %D 2020 %7 7.12.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Tuberculosis (TB) is one of the most infectious diseases that can be fatal. Its early diagnosis and treatment can significantly reduce the mortality rate. In the literature, several computer-aided diagnosis (CAD) tools have been proposed for the efficient diagnosis of TB from chest radiograph (CXR) images. However, the majority of previous studies adopted conventional handcrafted feature-based algorithms. In addition, some recent CAD tools utilized the strength of deep learning methods to further enhance diagnostic performance. Nevertheless, all these existing methods can only classify a given CXR image into binary class (either TB positive or TB negative) without providing further descriptive information. Objective: The main objective of this study is to propose a comprehensive CAD framework for the effective diagnosis of TB by providing visual as well as descriptive information from the previous patients’ database. Methods: To accomplish our objective, first we propose a fusion-based deep classification network for the CAD decision that exhibits promising performance over the various state-of-the-art methods. Furthermore, a multilevel similarity measure algorithm is devised based on multiscale information fusion to retrieve the best-matched cases from the previous database. Results: The performance of the framework was evaluated based on 2 well-known CXR data sets made available by the US National Library of Medicine and the National Institutes of Health. Our classification model exhibited the best diagnostic performance (0.929, 0.937, 0.921, 0.928, and 0.965 for F1 score, average precision, average recall, accuracy, and area under the curve, respectively) and outperforms the performance of various state-of-the-art methods. Conclusions: This paper presents a comprehensive CAD framework to diagnose TB from CXR images by retrieving the relevant cases and their clinical observations from the previous patients’ database. These retrieval results assist the radiologist in making an effective diagnostic decision related to the current medical condition of a patient. Moreover, the retrieval results can facilitate the radiologists in subjectively validating the CAD decision. %M 33284119 %R 10.2196/21790 %U http://medinform.jmir.org/2020/12/e21790/ %U https://doi.org/10.2196/21790 %U http://www.ncbi.nlm.nih.gov/pubmed/33284119 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24286 %T Dynamic Public Health Surveillance to Track and Mitigate the US COVID-19 Epidemic: Longitudinal Trend Analysis Study %A Post,Lori Ann %A Issa,Tariq Ziad %A Boctor,Michael J %A Moss,Charles B %A Murphy,Robert L %A Ison,Michael G %A Achenbach,Chad J %A Resnick,Danielle %A Singh,Lauren Nadya %A White,Janine %A Faber,Joshua Marco Mitchell %A Culler,Kasen %A Brandt,Cynthia A %A Oehmke,James Francis %+ Buehler Center for Health Policy & Economics and Departments of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr, 9th Floor, Suite 9-9035 Rubloff Building, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K global COVID-19 surveillance %K United States public health surveillance %K US COVID-19 %K surveillance metrics %K dynamic panel data %K generalized method of the moments %K United States econometrics %K US SARS-CoV-2 %K US COVID-19 surveillance system %K US COVID-19 transmission speed %K COVID-19 transmission acceleration %K COVID-19 speed %K COVID-19 acceleration %K COVID-19 jerk %K COVID-19 persistence %K Arellano-Bond estimator %K COVID-19 %D 2020 %7 3.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of SARS-CoV-2, the virus that causes COVID-19, has led to a global pandemic. The United States has been severely affected, accounting for the most COVID-19 cases and deaths worldwide. Without a coordinated national public health plan informed by surveillance with actionable metrics, the United States has been ineffective at preventing and mitigating the escalating COVID-19 pandemic. Existing surveillance has incomplete ascertainment and is limited by the use of standard surveillance metrics. Although many COVID-19 data sources track infection rates, informing prevention requires capturing the relevant dynamics of the pandemic. Objective: The aim of this study is to develop dynamic metrics for public health surveillance that can inform worldwide COVID-19 prevention efforts. Advanced surveillance techniques are essential to inform public health decision making and to identify where and when corrective action is required to prevent outbreaks. Methods: Using a longitudinal trend analysis study design, we extracted COVID-19 data from global public health registries. We used an empirical difference equation to measure daily case numbers for our use case in 50 US states and the District of Colombia as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: Examination of the United States and state data demonstrated that most US states are experiencing outbreaks as measured by these new metrics of speed, acceleration, jerk, and persistence. Larger US states have high COVID-19 caseloads as a function of population size, density, and deficits in adherence to public health guidelines early in the epidemic, and other states have alarming rates of speed, acceleration, jerk, and 7-day persistence in novel infections. North and South Dakota have had the highest rates of COVID-19 transmission combined with positive acceleration, jerk, and 7-day persistence. Wisconsin and Illinois also have alarming indicators and already lead the nation in daily new COVID-19 infections. As the United States enters its third wave of COVID-19, all 50 states and the District of Colombia have positive rates of speed between 7.58 (Hawaii) and 175.01 (North Dakota), and persistence, ranging from 4.44 (Vermont) to 195.35 (North Dakota) new infections per 100,000 people. Conclusions: Standard surveillance techniques such as daily and cumulative infections and deaths are helpful but only provide a static view of what has already occurred in the pandemic and are less helpful in prevention. Public health policy that is informed by dynamic surveillance can shift the country from reacting to COVID-19 transmissions to being proactive and taking corrective action when indicators of speed, acceleration, jerk, and persistence remain positive week over week. Implicit within our dynamic surveillance is an early warning system that indicates when there is problematic growth in COVID-19 transmissions as well as signals when growth will become explosive without action. A public health approach that focuses on prevention can prevent major outbreaks in addition to endorsing effective public health policies. Moreover, subnational analyses on the dynamics of the pandemic allow us to zero in on where transmissions are increasing, meaning corrective action can be applied with precision in problematic areas. Dynamic public health surveillance can inform specific geographies where quarantines are necessary while preserving the economy in other US areas. %M 33216726 %R 10.2196/24286 %U https://www.jmir.org/2020/12/e24286 %U https://doi.org/10.2196/24286 %U http://www.ncbi.nlm.nih.gov/pubmed/33216726 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24550 %T Tweets by People With Arthritis During the COVID-19 Pandemic: Content and Sentiment Analysis %A Berkovic,Danielle %A Ackerman,Ilana N %A Briggs,Andrew M %A Ayton,Darshini %+ School of Public Health and Preventive Medicine, Monash University, , Melbourne, , Australia, 61 425 705 130, darshini.ayton@monash.edu %K COVID-19 %K SARS-CoV-2 %K novel coronavirus %K social media %K Twitter %K content analysis %K sentiment analysis %K microblogging %K arthritis %D 2020 %7 3.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Emerging evidence suggests that people with arthritis are reporting increased physical pain and psychological distress during the COVID-19 pandemic. At the same time, Twitter’s daily usage has surged by 23% throughout the pandemic period, presenting a unique opportunity to assess the content and sentiment of tweets. Individuals with arthritis use Twitter to communicate with peers, and to receive up-to-date information from health professionals and services about novel therapies and management techniques. Objective: The aim of this research was to identify proxy topics of importance for individuals with arthritis during the COVID-19 pandemic, and to explore the emotional context of tweets by people with arthritis during the early phase of the pandemic. Methods: From March 20 to April 20, 2020, publicly available tweets posted in English and with hashtag combinations related to arthritis and COVID-19 were extracted retrospectively from Twitter. Content analysis was used to identify common themes within tweets, and sentiment analysis was used to examine positive and negative emotions in themes to understand the COVID-19 experiences of people with arthritis. Results: In total, 149 tweets were analyzed. The majority of tweeters were female and were from the United States. Tweeters reported a range of arthritis conditions, including rheumatoid arthritis, systemic lupus erythematosus, and psoriatic arthritis. Seven themes were identified: health care experiences, personal stories, links to relevant blogs, discussion of arthritis-related symptoms, advice sharing, messages of positivity, and stay-at-home messaging. Sentiment analysis demonstrated marked anxiety around medication shortages, increased physical symptom burden, and strong desire for trustworthy information and emotional connection. Conclusions: Tweets by people with arthritis highlight the multitude of concurrent concerns during the COVID-19 pandemic. Understanding these concerns, which include heightened physical and psychological symptoms in the context of treatment misinformation, may assist clinicians to provide person-centered care during this time of great health uncertainty. %M 33170802 %R 10.2196/24550 %U https://www.jmir.org/2020/12/e24550 %U https://doi.org/10.2196/24550 %U http://www.ncbi.nlm.nih.gov/pubmed/33170802 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21572 %T COVID-19 Contact-Tracing Apps: Analysis of the Readability of Privacy Policies %A Zhang,Melvyn %A Chow,Aloysius %A Smith,Helen %+ Family Medicine and Primary Care, Lee Kong Chian School of Medicine, Nanyang Technological University Singapore, 11 Mandalay Road Level 18, Clinical Sciences Building, Singapore, 308322, Singapore, 65 63892504, melvynzhangweibin@gmail.com %K COVID-19 %K smartphone apps %K contact tracing %K privacy policy %K readability %K app %K privacy %K surveillance %D 2020 %7 3.12.2020 %9 Viewpoint %J J Med Internet Res %G English %X Apps that enable contact-tracing are instrumental in mitigating the transmission of COVID-19, but there have been concerns among users about the data collected by these apps and their management. Contact tracing is of paramount importance when dealing with a pandemic, as it allows for rapid identification of cases based on the information collected from infected individuals about other individuals they may have had recent contact with. Advances in digital technology have enabled devices such as mobile phones to be used in the contract-tracing process. However, there is a potential risk of users’ personal information and sensitive data being stolen should hackers be in the near vicinity of these devices. Thus, there is a need to develop privacy-preserving apps. Meanwhile, privacy policies that outline the risk associated with the use of contact-tracing apps are needed, in formats that are easily readable and comprehensible by the public. To our knowledge, no previous study has examined the readability of privacy policies of contact-tracings apps. Therefore, we performed a readability analysis to evaluate the comprehensibility of privacy policies of 7 contact-tracing apps currently in use. The contents of the privacy policies of these apps were assessed for readability using Readability Test Tool, a free web-based reliability calculator, which computes scores based on a number of statistics (ie, word count and the number of complex words) and indices (ie, Flesch Reading Ease, Flesch-Kincaid Reading Grade Level, Gunning Fog Index, and Simplified Measure of Gobbledygook index). Our analysis revealed that explanations used in the privacy policies of these apps require a reading grade between 7 and 14, which is considerably higher than the reading ability of the average individual. We believe that improving the readability of privacy policies of apps could be potentially reassuring for users and may help facilitate the increased use of such apps. %M 33170798 %R 10.2196/21572 %U https://www.jmir.org/2020/12/e21572 %U https://doi.org/10.2196/21572 %U http://www.ncbi.nlm.nih.gov/pubmed/33170798 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e21499 %T The Twitter Social Mobility Index: Measuring Social Distancing Practices With Geolocated Tweets %A Xu,Paiheng %A Dredze,Mark %A Broniatowski,David A %+ Malone Center for Engineering in Healthcare, Center for Language and Speech Processing, Department of Computer Science, Johns Hopkins University, Malone 339, 3400 N Charles St, Baltimore, MD, 21218, United States, 1 4105166786, mdredze@cs.jhu.edu %K COVID-19 %K social distancing %K mobility %K Twitter %K social media %K surveillance %K tracking %K travel %K index %D 2020 %7 3.12.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33048823 %R 10.2196/21499 %U https://www.jmir.org/2020/12/e21499 %U https://doi.org/10.2196/21499 %U http://www.ncbi.nlm.nih.gov/pubmed/33048823 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 1 %N 1 %P e22470 %T Predicting Health Disparities in Regions at Risk of Severe Illness to Inform Health Care Resource Allocation During Pandemics: Observational Study %A Fusillo,Tara %+ John F Kennedy High School, 3000 Bellmore Ave, Bellmore, NY, 11710, United States, 1 516 992 1400, ifusil@optonline.net %K coronavirus %K SARS-CoV-2 %K COVID-19 %K pandemic %K socioeconomic status %K predictive model %K health care resource allocation %D 2020 %7 2.12.2020 %9 Original Paper %J JMIRx Med %G English %X Background: Pandemics including COVID-19 have disproportionately affected socioeconomically vulnerable populations. Objective: Our objective was to create a repeatable modeling process to identify regional population centers with pandemic vulnerability. Methods: Using readily available COVID-19 and socioeconomic variable data sets, we used stepwise linear regression techniques to build predictive models during the early days of the COVID-19 pandemic. The models were validated later in the pandemic timeline using actual COVID-19 mortality rates in high population density states. The mean sample size was 43 and ranged from 8 (Connecticut) to 82 (Michigan). Results: The New York, New Jersey, Connecticut, Massachusetts, Louisiana, Michigan, and Pennsylvania models provided the strongest predictions of top counties in densely populated states with a high likelihood of disproportionate COVID-19 mortality rates. For all of these models, P values were less than .05. Conclusions: The models have been shared with the Department of Health Commissioners of each of these states with strong model predictions as input into a much needed “pandemic playbook” for local health care agencies in allocating medical testing and treatment resources. We have also confirmed the utility of our models with pharmaceutical companies for use in decisions pertaining to vaccine trial and distribution locations. %M 33711085 %R 10.2196/22470 %U https://med.jmirx.org/2020/1/e22470/ %U https://doi.org/10.2196/22470 %U http://www.ncbi.nlm.nih.gov/pubmed/33711085 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24240 %T Mental Health Burden in Different Professions During the Final Stage of the COVID-19 Lockdown in China: Cross-sectional Survey Study %A Du,Junfeng %A Mayer,Gwendolyn %A Hummel,Svenja %A Oetjen,Neele %A Gronewold,Nadine %A Zafar,Ali %A Schultz,Jobst-Hendrik %+ Department of General Internal Medicine and Psychosomatics, Heidelberg University Hospital, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 62215635685, gwendolyn.mayer@med.uni-heidelberg.de %K mental health %K COVID-19 %K China %K depression %K anxiety %K lockdown %K coping strategies %K stressors %K stress %K doctors %K nurses %K students %K media consumption %K WeChat %D 2020 %7 2.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 resulted in considerable mental health burden in the Chinese general population and among health care workers at the beginning and peak of the pandemic. However, little is known about potentially vulnerable groups during the final stage of the lockdown. Objective: The aim of this survey study was to assess the mental health burden of different professions in China in order to find vulnerable groups, possible influencing factors, and successful ways of coping during the last 4 weeks of the lockdown in Hubei Province. Methods: A cross-sectional online survey asked participants about current residence, daily working hours, exposure to COVID-19 at work, and media preferences. We used a shortened version of the Depression, Anxiety and Stress Scale (DASS-21) to assess mental health. Further assessments included perceived stress (Simplified Chinese version of the 14-item Perceived Stress Scale), coping strategies for all participants, and specific stressors for health care workers. We followed the reporting guidelines of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement for observational studies. Results: The sample (N=687) consisted of 158 doctors, 221 nurses, 24 other medical staff, 43 students, 60 teachers/government staff, 135 economy staff, 26 workers/farmers, and 20 professions designated under the “other” category. We found increased depression (n=123, 17.9%), anxiety (n=208, 30.3%), and stress (n=94, 13.7%) in our sample. Professions that were vulnerable to depression were other medical staff and students. Doctors, nurses, and students were vulnerable to anxiety; and other medical staff, students, and economy staff were vulnerable to stress. Coping strategies were reduced to three factors: active, mental, and emotional. Being female and emotional coping were independently associated with depression, anxiety, or stress. Applying active coping strategies showed lower odds for anxiety while mental coping strategies showed lower odds for depression, anxiety, and stress. Age, being inside a lockdown area, exposure to COVID-19 at work, and having a high workload (8-12 hours per day) were not associated with depression, anxiety, or stress. WeChat was the preferred way of staying informed across all groups. Conclusions: By the end of the lockdown, a considerable part of the Chinese population showed increased levels of depression and anxiety. Students and other medical staff were the most affected, while economy staff were highly stressed. Doctors and nurses need support regarding potential anxiety disorders. Future work should focus on longitudinal results of the pandemic and develop targeted preventive measures. %M 33197231 %R 10.2196/24240 %U https://www.jmir.org/2020/12/e24240 %U https://doi.org/10.2196/24240 %U http://www.ncbi.nlm.nih.gov/pubmed/33197231 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24048 %T Development and External Validation of a Machine Learning Tool to Rule Out COVID-19 Among Adults in the Emergency Department Using Routine Blood Tests: A Large, Multicenter, Real-World Study %A Plante,Timothy B %A Blau,Aaron M %A Berg,Adrian N %A Weinberg,Aaron S %A Jun,Ik C %A Tapson,Victor F %A Kanigan,Tanya S %A Adib,Artur B %+ Larner College of Medicine at the University of Vermont, 360 S Park Drive, Suite 206B, Colchester, VT, 05446, United States, 1 802 656 3688, timothy.plante@uvm.edu %K COVID-19 %K SARS-CoV-2 %K machine learning %K artificial intelligence %K electronic medical records %K laboratory results %K development %K validation %K testing %K model %K emergency department %D 2020 %7 2.12.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Conventional diagnosis of COVID-19 with reverse transcription polymerase chain reaction (RT-PCR) testing (hereafter, PCR) is associated with prolonged time to diagnosis and significant costs to run the test. The SARS-CoV-2 virus might lead to characteristic patterns in the results of widely available, routine blood tests that could be identified with machine learning methodologies. Machine learning modalities integrating findings from these common laboratory test results might accelerate ruling out COVID-19 in emergency department patients. Objective: We sought to develop (ie, train and internally validate with cross-validation techniques) and externally validate a machine learning model to rule out COVID 19 using only routine blood tests among adults in emergency departments. Methods: Using clinical data from emergency departments (EDs) from 66 US hospitals before the pandemic (before the end of December 2019) or during the pandemic (March-July 2020), we included patients aged ≥20 years in the study time frame. We excluded those with missing laboratory results. Model training used 2183 PCR-confirmed cases from 43 hospitals during the pandemic; negative controls were 10,000 prepandemic patients from the same hospitals. External validation used 23 hospitals with 1020 PCR-confirmed cases and 171,734 prepandemic negative controls. The main outcome was COVID 19 status predicted using same-day routine laboratory results. Model performance was assessed with area under the receiver operating characteristic (AUROC) curve as well as sensitivity, specificity, and negative predictive value (NPV). Results: Of 192,779 patients included in the training, external validation, and sensitivity data sets (median age decile 50 [IQR 30-60] years, 40.5% male [78,249/192,779]), AUROC for training and external validation was 0.91 (95% CI 0.90-0.92). Using a risk score cutoff of 1.0 (out of 100) in the external validation data set, the model achieved sensitivity of 95.9% and specificity of 41.7%; with a cutoff of 2.0, sensitivity was 92.6% and specificity was 59.9%. At the cutoff of 2.0, the NPVs at a prevalence of 1%, 10%, and 20% were 99.9%, 98.6%, and 97%, respectively. Conclusions: A machine learning model developed with multicenter clinical data integrating commonly collected ED laboratory data demonstrated high rule-out accuracy for COVID-19 status, and might inform selective use of PCR-based testing. %M 33226957 %R 10.2196/24048 %U https://www.jmir.org/2020/12/e24048 %U https://doi.org/10.2196/24048 %U http://www.ncbi.nlm.nih.gov/pubmed/33226957 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e24521 %T Academic Nurse-Managed Community Clinics Transitioning to Telehealth: Case Report on the Rapid Response to COVID-19 %A Sutter,Rebecca %A Cuellar,Alison E %A Harvey,Megan %A Hong,Y Alicia %+ Department of Health Administration and Policy, College of Health and Human Services, George Mason University, 4400 University Dr, MS 1J3, Fairfax, VA, 22030, United States, 1 7039931929, yhong22@gmu.edu %K telehealth %K telemedicine %K COVID-19, nurse practitioners %K safety net clinics %K community clinics %K nurse %K clinic %K transition %D 2020 %7 1.12.2020 %9 Original Paper %J JMIR Nursing %G English %X Background: In response to the COVID-19 pandemic, many health care organizations have adopted telehealth. The current literature on transitioning to telehealth has mostly been from large health care or specialty care organizations, with limited data from safety net or community clinics. Objective: This is a case report on the rapid implementation of a telehealth hub at an academic nurse-managed community clinic in response to the national COVID-19 emergency. We also identify factors of success and challenges associated with the transition to telehealth. Methods: This study was conducted at the George Mason University Mason and Partners clinic, which serves the dual mission of caring for community clinic patients and providing health professional education. We interviewed the leadership team of Mason and Partners clinics and summarized our findings. Results: Mason and Partners clinics reacted quickly to the COVID-19 crisis and transitioned to telehealth within 2 weeks of the statewide lockdown. Protocols were developed for a coordination hub, a main patient triage and appointment telephone line, a step-by-step flowchart of clinical procedure, and a team structure with clearly defined work roles and backups. The clinics were able to maintain most of its clinical service and health education functions while adapting to new clinic duties that arose during the pandemic. Conclusions: The experiences learned from the Mason and Partners clinics are transferable to other safety net clinics and academic nurse-led community clinics. The changes arising from the pandemic have resulted in sustainable procedures, and these changes will have a long-term impact on health care delivery and training. %M 33496682 %R 10.2196/24521 %U https://nursing.jmir.org/2020/1/e24521/ %U https://doi.org/10.2196/24521 %U http://www.ncbi.nlm.nih.gov/pubmed/33496682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 12 %P e24087 %T Use of Telehealth During the COVID-19 Pandemic: Scoping Review %A Doraiswamy,Sathyanarayanan %A Abraham,Amit %A Mamtani,Ravinder %A Cheema,Sohaila %+ Institute for Population Health, Weill Cornell Medicine, Education City, Al Luqta St, Ar-Rayyan, Doha, PO 24144, Qatar, 974 50422860, sdo4003@qatar-med.cornell.edu %K COVID-19 %K telehealth %K telemedicine %K scoping review %D 2020 %7 1.12.2020 %9 Review %J J Med Internet Res %G English %X Background: With over 37.8 million cases and over 1 million deaths worldwide, the COVID-19 pandemic has created a societal and economic upheaval of unparalleled magnitude. A positive transformation has been brought about by innovative solutions in the health care sector that aim to mitigate the impact of COVID-19 on human health. For instance, the use of telehealth has been on the rise amidst this public health emergency. Objective: Given the unprecedented scale of the pandemic with no definitive endpoint, we aimed to scope the existing telehealth-related literature during a defined period of the ongoing pandemic (ie, January to June 2020). Methods: Our scoping review was guided by the Joanna Briggs Institute Reviewer Manual. We systematically searched PubMed and Embase databases with specific eligibility criteria. Data extracted from the shortlisted articles included first author and affiliation, journal title, publication type, terminologies used to describe telehealth and their accompanying definitions, health discipline or medical specialties and subspecialties wherein telehealth had been applied, the purpose of telehealth use, and the authors’ overall sentiment on telehealth use. We collated the available information and used descriptive statistics to analyze the synthesized data. Results: In all, 543 articles published across 331 different journals were included in this scoping review. The Journal of Medical Internet Research and its sister journals featured the highest number of articles (25/543, 4.6%). Nearly all (533/543, 98.2%) articles were in English. The majority of the articles were opinions, commentaries, and perspectives (333/543, 61.3%). Most authors of the articles reviewed were from high-income countries (470/543, 86.6%), especially from the United States of America (237/543, 43.6%). In all, 39 different definitions were used to describe terms equivalent to telehealth. A small percentage (42/543, 7.7%) of the articles focused on the provision of COVID-19–related care. Moreover, 49.7% (270/543) of the articles primarily focused on the provision of multiple components of clinical care, and 23% (125/543) of the articles focused on various specialties and subspecialties of internal medicine. For a vast majority (461/543, 84.9%) of the articles, the authors expressed a celebratory sentiment about the use of telehealth. Conclusions: This review identified considerable emerging literature on telehealth during the first six months of the COVID-19 pandemic, albeit mostly from high-income countries. There is compelling evidence to suggest that telehealth may have a significant effect on advancing health care in the future. However, the feasibility and application of telehealth in resource-limited settings and low- and middle-income countries must be established to avail its potential and transform health care for the world’s population. Given the rapidity with which telehealth is advancing, a global consensus on definitions, boundaries, protocols, monitoring, evaluation, and data privacy is urgently needed. %M 33147166 %R 10.2196/24087 %U https://www.jmir.org/2020/12/e24087 %U https://doi.org/10.2196/24087 %U http://www.ncbi.nlm.nih.gov/pubmed/33147166 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 12 %P e22098 %T Evaluation of the Design and Implementation of a Peer-To-Peer COVID-19 Contact Tracing Mobile App (COCOA) in Japan %A Nakamoto,Ichiro %A Jiang,Ming %A Zhang,Jilin %A Zhuang,Weiqing %A Guo,Yan %A Jin,Ming-Hui %A Huang,Yi %A Tang,Kuotai %+ School of Internet Economics and Business, Fujian University of Technology, 999 Dongsanhuang Road, JinAn District, Fuzhou, China, 86 059183503931, ichiro2019@163.com %K COVID-19 %K contact tracing %K mobile app %K peer-to-peer %K Bluetooth-based %K telehealth %K privacy protection %K load balancing %K close contact %K decentralized %D 2020 %7 1.12.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X We evaluate a Bluetooth-based mobile contact-confirming app, COVID-19 Contact-Confirming Application (COCOA), which is being used in Japan to contain the spread of COVID-19, the disease caused by the novel virus termed SARS-COV-2. The app prioritizes the protection of users’ privacy from a variety of parties (eg, other users, potential attackers, and public authorities), enhances the capacity to balance the current load of excessive pressure on health care systems (eg, local triage of exposure risk and reduction of in-person hospital visits), increases the speed of responses to the pandemic (eg, automated recording of close contact based on proximity), and reduces operation errors and population mobility. The peer-to-peer framework of COCOA is intended to provide the public with dynamic and credible updates on the COVID-19 pandemic without sacrificing the privacy of their information. However, cautions must be exercised to address critical concerns, such as the rate of participation and delays in data sharing. The results of a simulation imply that the participation rate in Japan needs to be close 90% to effectively control the spread of COVID-19. %M 33170801 %R 10.2196/22098 %U https://mhealth.jmir.org/2020/12/e22098 %U https://doi.org/10.2196/22098 %U http://www.ncbi.nlm.nih.gov/pubmed/33170801 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20144 %T Novel Indicator to Ascertain the Status and Trend of COVID-19 Spread: Modeling Study %A Nakano,Takashi %A Ikeda,Yoichi %+ Research Center for Nuclear Physics, Osaka University, 10-1 Mihogaoka, Ibaraki, Osaka, 567-0047, Japan, 81 6 6879 8900, nakano@rcnp.osaka-u.ac.jp %K communicable diseases %K COVID-19 %K SARS-CoV-2 %K model %K modeling %K virus %K infectious disease %K spread %D 2020 %7 30.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In the fight against the pandemic of COVID-19, it is important to ascertain the status and trend of the infection spread quickly and accurately. Objective: The purpose of our study is to formulate a new and simple indicator that represents the COVID-19 spread rate by using publicly available data. Methods: The new indicator K is a backward difference approximation of the logarithmic derivative of the cumulative number of cases with a time interval of 7 days. It is calculated as a ratio of the number of newly confirmed cases in a week to the total number of cases. Results: The analysis of the current status of COVID-19 spreading over countries showed an approximate linear decrease in the time evolution of the K value. The slope of the linear decrease differed from country to country. In addition, it was steeper for East and Southeast Asian countries than for European countries. The regional difference in the slope seems to reflect both social and immunological circumstances for each country. Conclusions: The approximate linear decrease of the K value indicates that the COVID-19 spread does not grow exponentially but starts to attenuate from the early stage. The K trajectory in a wide range was successfully reproduced by a phenomenological model with the constant attenuation assumption, indicating that the total number of the infected people follows the Gompertz curve. Focusing on the change in the value of K will help to improve and refine epidemiological models of COVID-19. %M 33180742 %R 10.2196/20144 %U http://www.jmir.org/2020/11/e20144/ %U https://doi.org/10.2196/20144 %U http://www.ncbi.nlm.nih.gov/pubmed/33180742 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e23194 %T COVID-19 Contact Tracing Apps: A Technologic Tower of Babel and the Gap for International Pandemic Control %A Du,Li %A Raposo,Vera Lúcia %A Wang,Meng %+ Faculty of Law, University of Macau, Avenida da Universidade, Taipa, Macau, SAR, 999078, China, 853 88224733, stephendu@um.edu.mo %K COVID-19 %K contact tracing apps %K privacy %K public health %K global health %D 2020 %7 27.11.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X As the world struggles with the new COVID-19 pandemic, contact tracing apps of various types have been adopted in many jurisdictions for combating the spread of the SARS-CoV-2 virus. However, even if they are successful in containing the virus within national borders, these apps are becoming ineffective as international travel is gradually resumed. The problem rests in the plurality of apps and their inability to operate in a synchronized manner, as well as the absence of an international entity with the power to coordinate and analyze the information collected by the disparate apps. The risk of creating a useless Tower of Babel of COVID-19 contact tracing apps is very real, endangering global health. This paper analyzes legal barriers for realizing the interoperability of contact tracing apps and emphasizes the need for developing coordinated solutions to promote safe international travel and global pandemic control. %M 33156804 %R 10.2196/23194 %U http://mhealth.jmir.org/2020/11/e23194/ %U https://doi.org/10.2196/23194 %U http://www.ncbi.nlm.nih.gov/pubmed/33156804 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e23083 %T The Relationship Between Demographic, Socioeconomic, and Health-Related Parameters and the Impact of COVID-19 on 24 Regions in India: Exploratory Cross-Sectional Study %A Rajkumar,Ravi Philip %+ Jawaharlal Institute of Postgraduate Medical Education and Research, Dhanvantari Nagar Post, Pondicherry, 605006, India, 91 4132296280, ravi.psych@gmail.com %K burden of disease %K COVID-19 %K diarrheal disease %K ischemic heart disease %K population size %K sex ratio %D 2020 %7 27.11.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The impact of the COVID-19 pandemic has varied widely across nations and even in different regions of the same nation. Some of this variability may be due to the interplay of pre-existing demographic, socioeconomic, and health-related factors in a given population. Objective: The aim of this study was to examine the statistical associations between the statewise prevalence, mortality rate, and case fatality rate of COVID-19 in 24 regions in India (23 states and Delhi), as well as key demographic, socioeconomic, and health-related indices. Methods: Data on disease prevalence, crude mortality, and case fatality were obtained from statistics provided by the Government of India for 24 regions, as of June 30, 2020. The relationship between these parameters and the demographic, socioeconomic, and health-related indices of the regions under study was examined using both bivariate and multivariate analyses. Results: COVID-19 prevalence was negatively associated with male-to-female sex ratio (defined as the number of females per 1000 male population) and positively associated with the presence of an international airport in a particular state. The crude mortality rate for COVID-19 was negatively associated with sex ratio and the statewise burden of diarrheal disease, and positively associated with the statewise burden of ischemic heart disease. Multivariate analyses demonstrated that the COVID-19 crude mortality rate was significantly and negatively associated with sex ratio. Conclusions: These results suggest that the transmission and impact of COVID-19 in a given population may be influenced by a number of variables, with demographic factors showing the most consistent association. %M 33147164 %R 10.2196/23083 %U http://publichealth.jmir.org/2020/4/e23083/ %U https://doi.org/10.2196/23083 %U http://www.ncbi.nlm.nih.gov/pubmed/33147164 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21672 %T Chinese Residents’ Perceptions of COVID-19 During the Pandemic: Online Cross-sectional Survey Study %A Cui,Tingting %A Yang,Guoping %A Ji,Lili %A Zhu,Lin %A Zhen,Shiqi %A Shi,Naiyang %A Xu,Yan %A Jin,Hui %+ Department of Epidemiology and Health Statistics, School of Public Health, Southeast University, No. 87 Dingjiaqiao, Nanjing, , China, 86 025 8327 2572, jinhuihld@seu.edu.cn %K COVID-19 %K perception %K China %K cross-sectional survey %K health education %K time-varying reproduction number %K knowledge %K skill %K behavior %K work resumption %K study resumption %D 2020 %7 25.11.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33152684 %R 10.2196/21672 %U http://www.jmir.org/2020/11/e21672/ %U https://doi.org/10.2196/21672 %U http://www.ncbi.nlm.nih.gov/pubmed/33152684 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e24505 %T Digital Health Technologies Respond to the COVID-19 Pandemic In a Tertiary Hospital in China: Development and Usability Study %A Lian,Wanmin %A Wen,Li %A Zhou,Qiru %A Zhu,Weijie %A Duan,Wenzhou %A Xiao,Xiongzhi %A Mhungu,Florence %A Huang,Wenchen %A Li,Chongchong %A Cheng,Weibin %A Tian,Junzhang %+ Institute for Healthcare Artificial Intelligence Application, Guangdong Second Provincial General Hospital, No 466 Xingangzhong Road, Haizhu District, Guangzhou, 510317, China, 86 13929587509, chwb817@gmail.com %K Internet hospital %K COVID-19 %K automated screening %K symptom %K monitoring %K web-based consultation %K psychological support %K emergency %K digital health %K hospital %K China %K screening %D 2020 %7 24.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The outbreak of COVID-19 has caused a continuing global pandemic. Hospitals are integral to the control and prevention of COVID-19; however, they are facing numerous challenges during the epidemic. Objective: Our study aimed to introduce the practical experience of the design and implementation of a web-based COVID-19 service platform at a tertiary hospital in China as well as the preliminary results of the implementation. Methods: The web-based COVID-19 service platform was deployed within the health care system of the Guangdong Second Provincial General Hospital and Internet Hospital; the function of the platform was to provide web-based medical services for both members of the public and lay health care workers. The focal functions of this system included automated COVID-19 screening, related symptom monitoring, web-based consultation, and psychological support; it also served as a COVID-19 knowledge hub. The design and process of each function are introduced. The usage data for the platform service were collected and are represented by three periods: the pre-epidemic period (December 22, 2019, to January 22, 2020, 32 days), the controlled period (January 23 to March 31, 2020, 69 days), and the postepidemic period (April 1 to June 30, 2020, 91 days). Results: By the end of June 2020, 96,642 people had used the automated COVID-19 screening and symptom monitoring systems 161,884 and 7,795,194 times, respectively. The number of general web-based consultation services per day increased from 30 visits in the pre-epidemic period to 122 visits during the controlled period, then dropped to 73 visits in the postepidemic period. The psychological counseling program served 636 clients during the epidemic period. For people who used the automated COVID-19 screening service, 160,916 (99.40%) of the total users were classified in the no risk category. 464 (0.29%) of the people were categorized as medium to high risk, and 12 people (0.01%) were recommended for further COVID-19 testing and treatment. Among the 96,642 individuals who used the COVID-19 related symptoms monitoring service, 6696 (6.93%) were symptomatic at some point during the monitoring period. Fever was the most frequently reported symptom, with 2684/6696 symptomatic people (40.1%) having had this symptom. Cough and sore throat were also relatively frequently reported by the 6696 symptomatic users (1657 people, 24.7%, and 1622 people, 24.2%, respectively). Conclusions: The web-based COVID-19 service platform implemented at a tertiary hospital in China is exhibited to be a role model for using digital health technologies to respond to the COVID-19 pandemic. The digital solutions of automated COVID-19 screening, daily symptom monitoring, web-based care, and knowledge propagation have plausible acceptability and feasibility for complementing offline hospital services and facilitating disease control and prevention. %M 33141679 %R 10.2196/24505 %U http://www.jmir.org/2020/11/e24505/ %U https://doi.org/10.2196/24505 %U http://www.ncbi.nlm.nih.gov/pubmed/33141679 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e24222 %T Virtual Cancer Care During the COVID-19 Pandemic and Beyond: A Call for Evaluation %A Levine,Oren Hannun %A McGillion,Michael %A Levine,Mark %+ Department of Oncology, McMaster University, Room 104, G Wing, 711 Concession Street, Hamilton, ON, L8V 1C3, Canada, 1 905 527 2299 ext 42176, mlevine@mcmaster.ca %K care %K patient-physician relationship %K patient-centered care %K oncology care delivery %K virtual visits %K telehealth %K virtual care %K cancer %K oncology %K evaluation %K COVID-19 %D 2020 %7 24.11.2020 %9 Viewpoint %J JMIR Cancer %G English %X The interplay of virtual care and cancer care in the context of the COVID-19 pandemic is unique and unprecedented. Patients with cancer are at increased risk of SARS-CoV-2 infection and have worse outcomes than patients with COVID-19 who do not have cancer. Virtual care has been introduced quickly and extemporaneously in cancer treatment centers worldwide to maintain COVID-19–free zones. The outbreak of COVID-19 in a cancer center could have devastating consequences. The virtual care intervention that was first used in our cancer center, as well as many others, was a landline telephone in an office or clinic that connected a clinician with a patient. There is a lack of virtual care evaluation from the perspectives of patients and oncology health care providers. A number of factors for assessing oncology care delivered through a virtual care intervention have been described, including patient rapport, frailty, delicate conversations, team-based care, resident education, patient safety, technical effectiveness, privacy, operational effectiveness, and resource utilization. These factors are organized according to the National Quality Forum framework for the assessment of telehealth in oncology. This includes the following 4 domains of assessing outcomes: experience, access to care, effectiveness, and financial impact or cost. In terms of virtual care and oncology, the pandemic has opened the door to change. The lessons learned during the initial period of the pandemic have given rise to opportunities for the evolution of long-term virtual care. The opportunity to evaluate and improve virtual care should be seized upon. %M 33180741 %R 10.2196/24222 %U http://cancer.jmir.org/2020/2/e24222/ %U https://doi.org/10.2196/24222 %U http://www.ncbi.nlm.nih.gov/pubmed/33180741 %0 Journal Article %@ 2369-1999 %I JMIR Publications %V 6 %N 2 %P e20288 %T Telehealth and Palliative Care for Patients With Cancer: Implications of the COVID-19 Pandemic %A Grewal,Udhayvir Singh %A Terauchi,Stephanie %A Beg,Muhammad Shaalan %+ Simmons Comprehensive Cancer Center, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, , United States, 1 5136416314, muhammad.beg@utsouthwestern.edu %K COVID-19 %K telehealth %K palliative care %K telepalliative care %K patients with cancer %K telemedicine %D 2020 %7 24.11.2020 %9 Viewpoint %J JMIR Cancer %G English %X It has been reported that the incidence of SARS-CoV-2 infection is higher in patients with cancer than in the general population and that patients with cancer are at an increased risk of developing severe life-threatening complications from COVID-19. Increased transmission and poor outcomes noted in emerging data on patients with cancer and COVID-19 call for aggressive isolation and minimization of nosocomial exposure. Palliative care and oncology providers are posed with unique challenges due to the ongoing COVID-19 pandemic. Telepalliative care is the use of telehealth services for remotely delivering palliative care to patients through videoconferencing, telephonic communication, or remote symptom monitoring. It offers great promise in addressing the palliative and supportive care needs of patients with advanced cancer during the ongoing pandemic. We discuss the case of a 75-year-old woman who was initiated on second-line chemotherapy, to highlight how innovations in technology and telehealth-based interventions can be used to address patients’ palliative and supportive care needs in the ongoing epidemic. %M 33049695 %R 10.2196/20288 %U http://cancer.jmir.org/2020/2/e20288/ %U https://doi.org/10.2196/20288 %U http://www.ncbi.nlm.nih.gov/pubmed/33049695 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22407 %T COVID-19–Related Internet Search Patterns Among People in the United States: Exploratory Analysis %A Shen,Tony S %A Chen,Aaron Z %A Bovonratwet,Patawut %A Shen,Carol L %A Su,Edwin P %+ Weill Cornell Medical College, 1300 York Avenue, New York, NY, 10065, United States, 1 8605196413, azc2001@med.cornell.edu %K COVID-19 %K pandemic %K internet %K infodemic %K infodemiology %K infoveillance %K natural language processing %K NLP %K health information %K information seeking %D 2020 %7 23.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The internet is a well-known source of information that patients use to better inform their opinions and to guide their conversations with physicians during clinic visits. The novelty of the recent COVID-19 outbreak has led patients to turn more frequently to the internet to gather more information and to alleviate their concerns about the virus. Objective: The aims of the study were to (1) determine the most commonly searched phrases related to COVID-19 in the United States and (2) identify the sources of information for these web searches. Methods: Search terms related to COVID-19 were entered into Google. Questions and websites from Google web search were extracted to a database using customized software. Each question was categorized into one of 6 topics: clinical signs and symptoms, treatment, transmission, cleaning methods, activity modification, and policy. Additionally, the websites were categorized according to source: World Health Organization (WHO), Centers for Disease Control and Prevention (CDC), non-CDC government, academic, news, and other media. Results: In total, 200 questions and websites were extracted. The most common question topic was transmission (n=63, 31.5%), followed by clinical signs and symptoms (n=54, 27.0%) and activity modification (n=31, 15.5%). Notably, the clinical signs and symptoms category captured questions about myths associated with the disease, such as whether consuming alcohol stops the coronavirus. The most common websites provided were maintained by the CDC, the WHO, and academic medical organizations. Collectively, these three sources accounted for 84.0% (n=168) of the websites in our sample. Conclusions: In the United States, the most commonly searched topics related to COVID-19 were transmission, clinical signs and symptoms, and activity modification. Reassuringly, a sizable majority of internet sources provided were from major health organizations or from academic medical institutions. %M 33147163 %R 10.2196/22407 %U http://www.jmir.org/2020/11/e22407/ %U https://doi.org/10.2196/22407 %U http://www.ncbi.nlm.nih.gov/pubmed/33147163 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20044 %T Impact of Trump's Promotion of Unproven COVID-19 Treatments and Subsequent Internet Trends: Observational Study %A Niburski,Kacper %A Niburski,Oskar %+ McGill University, 3655 Promenade Sir William Osler, Montreal, QC, H3G 0B1, Canada, 1 9055162020, kacperniburski@gmail.com %K COVID-19 %K behavioral economics %K public health %K behavior %K economics %K media %K influence %K infodemic %K infodemiology %K infoveillance %K Twitter %K analysis %K trend %D 2020 %7 20.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Individuals with large followings can influence public opinions and behaviors, especially during a pandemic. In the early days of the pandemic, US president Donald J Trump has endorsed the use of unproven therapies. Subsequently, a death attributed to the wrongful ingestion of a chloroquine-containing compound occurred. Objective: We investigated Donald J Trump’s speeches and Twitter posts, as well as Google searches and Amazon purchases, and television airtime for mentions of hydroxychloroquine, chloroquine, azithromycin, and remdesivir. Methods: Twitter sourcing was catalogued with Factba.se, and analytics data, both past and present, were analyzed with Tweet Binder to assess average analytics data on key metrics. Donald J Trump’s time spent discussing unverified treatments on the United States’ 5 largest TV stations was catalogued with the Global Database of Events, Language, and Tone, and his speech transcripts were obtained from White House briefings. Google searches and shopping trends were analyzed with Google Trends. Amazon purchases were assessed using Helium 10 software. Results: From March 1 to April 30, 2020, Donald J Trump made 11 tweets about unproven therapies and mentioned these therapies 65 times in White House briefings, especially touting hydroxychloroquine and chloroquine. These tweets had an impression reach of 300% above Donald J Trump’s average. Following these tweets, at least 2% of airtime on conservative networks for treatment modalities like azithromycin and continuous mentions of such treatments were observed on stations like Fox News. Google searches and purchases increased following his first press conference on March 19, 2020, and increased again following his tweets on March 21, 2020. The same is true for medications on Amazon, with purchases for medicine substitutes, such as hydroxychloroquine, increasing by 200%. Conclusions: Individuals in positions of power can sway public purchasing, resulting in undesired effects when the individuals’ claims are unverified. Public health officials must work to dissuade the use of unproven treatments for COVID-19. %M 33151895 %R 10.2196/20044 %U http://www.jmir.org/2020/11/e20044/ %U https://doi.org/10.2196/20044 %U http://www.ncbi.nlm.nih.gov/pubmed/33151895 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e21939 %T Leveraging a Cloud-Based Critical Care Registry for COVID-19 Pandemic Surveillance and Research in Low- and Middle-Income Countries %A , %A Hashmi,Madiha %A Beane,Abi %A Murthy,Srinivas %A Dondorp,Arjen M %A Haniffa,Rashan %+ Collaboration for Research, Improvement and Training in Critical Care in Asia, Mahidol Oxford Tropical Medicine Research Unit, Faculty of Tropical Medicine, Mahidol University, Bangkok, Thailand, 66 07841131252, abi@nicslk.com %K critical care %K registry %K informatics %K COVID-19 %K severe acute respiratory infection %K pandemic %K surveillance %K cloud-based %K research %K low-and-middle-income countries %D 2020 %7 23.11.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 pandemic has revealed limitations in real-time surveillance needed for responsive health care action in low- and middle-income countries (LMICs). The Pakistan Registry for Intensive CarE (PRICE) was adapted to enable International Severe Acute Respiratory and emerging Infections Consortium (ISARIC)–compliant real-time reporting of severe acute respiratory infection (SARI). The cloud-based common data model and standardized nomenclature of the registry platform ensure interoperability of data and reporting between regional and global stakeholders. Inbuilt analytics enable stakeholders to visualize individual and aggregate epidemiological, clinical, and operational data in real time. The PRICE system operates in 5 of 7 administrative regions of Pakistan. The same platform supports acute and critical care registries in eleven countries in South Asia and sub-Saharan Africa. ISARIC-compliant SARI reporting was successfully implemented by leveraging the existing PRICE infrastructure in all 49 member intensive care units (ICUs), enabling clinicians, operational leads, and established stakeholders with responsibilities for coordinating the pandemic response to access real-time information on suspected and confirmed COVID-19 cases (N=592 as of May 2020) via secure registry portals. ICU occupancy rates, use of ICU resources, mechanical ventilation, renal replacement therapy, and ICU outcomes were reported through registry dashboards. This information has facilitated coordination of critical care resources, health care worker training, and discussions on treatment strategies. The PRICE network is now being recruited to international multicenter clinical trials regarding COVID-19 management, leveraging the registry platform. Systematic and standardized reporting of SARI is feasible in LMICs. Existing registry platforms can be adapted for pandemic research, surveillance, and resource planning. %M 33147162 %R 10.2196/21939 %U http://publichealth.jmir.org/2020/4/e21939/ %U https://doi.org/10.2196/21939 %U http://www.ncbi.nlm.nih.gov/pubmed/33147162 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22924 %T Implementation of a Self-Triage Web Application for Suspected COVID-19 and Its Impact on Emergency Call Centers: Observational Study %A Galmiche,Simon %A Rahbe,Eve %A Fontanet,Arnaud %A Dinh,Aurélien %A Bénézit,François %A Lescure,François-Xavier %A Denis,Fabrice %+ Institut Inter-régional de Cancérologie Jean Bernard, 9 Rue Beauverger, Le Mans, 72100, France, 33 243475810, f.denis@cjb72.org %K COVID-19 %K emergency medical services %K emergency call center %K questionnaires %K application %K website %K self-triage %K digital health %K smartphone %K mobile phone %D 2020 %7 23.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: We developed a self-triage web application for COVID-19 symptoms, which was launched in France in March 2020, when French health authorities recommended all patients with suspected COVID-19 call an emergency phone number. Objective: Our objective was to determine if a self-triage tool could reduce the burden on emergency call centers and help predict increasing burden on hospitals. Methods: Users were asked questions about their underlying conditions, sociodemographic status, postal code, and main COVID-19 symptoms. Participants were advised to call an emergency call center if they reported dyspnea or complete loss of appetite for over 24 hours. Data on COVID-19–related calls were collected from 6 emergency call centers and data on COVID-19 hospitalizations were collected from Santé Publique France and the French Ministry of Health. We examined the change in the number of emergency calls before and after the launch of the web application. Results: From March 17 to April 2, 2020, 735,419 questionnaires were registered in the study area. Of these, 121,370 (16.5%) led to a recommendation to call an emergency center. The peak number of overall questionnaires and of questionnaires leading to a recommendation to call an emergency center were observed on March 22, 2020. In the 17 days preceding the launch of the web application, emergency call centers in the study area registered 66,925 COVID-19–related calls and local hospitals admitted 639 patients for COVID-19; the ratio of emergency calls to hospitalizations for COVID-19 was 104.7 to 1. In the 17 days following the launch of the web application, there were 82,347 emergency calls and 6009 new hospitalizations for COVID-19, a ratio of 13.7 calls to 1 hospitalization (chi-square test: P<.001). Conclusions: The self-triage web application launch was followed by a nearly 10-fold increase in COVID-19–related hospitalizations with only a 23% increase in emergency calls. The peak of questionnaire completions preceded the peak of COVID-19–related hospitalizations by 5 days. Although the design of this study does not allow us to conclude that the self-triage tool alone contributed to the alleviation of calls to the emergency call centers, it does suggest that it played a role, and may be used for predicting increasing burden on hospitals. Trial Registration: ClinicalTrials.gov NCT04331171; https://clinicaltrials.gov/ct2/show/NCT04331171 %M 33147165 %R 10.2196/22924 %U https://www.jmir.org/2020/11/e22924 %U https://doi.org/10.2196/22924 %U http://www.ncbi.nlm.nih.gov/pubmed/33147165 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e24248 %T A SARS-CoV-2 Surveillance System in Sub-Saharan Africa: Modeling Study for Persistence and Transmission to Inform Policy %A Post,Lori Ann %A Argaw,Salem T %A Jones,Cameron %A Moss,Charles B %A Resnick,Danielle %A Singh,Lauren Nadya %A Murphy,Robert Leo %A Achenbach,Chad J %A White,Janine %A Issa,Tariq Ziad %A Boctor,Michael J %A Oehmke,James Francis %+ Buehler Center for Health Policy & Economics and Departments of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 750 N Lake Shore Dr, 9th Floor, Suite 9-9035 Rubloff Building, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K global COVID-19 surveillance %K African public health surveillance %K sub-Saharan African COVID-19 %K African surveillance metrics %K dynamic panel data %K generalized method of the moments %K African econometrics %K African SARS-CoV-2 %K African COVID-19 surveillance system %K African COVID-19 transmission speed %K African COVID-19 transmission acceleration %K COVID-19 transmission deceleration %K COVID-19 transmission jerk %K COVID-19 7-day persistence %K Sao Tome and Principe %K Senegal %K Seychelles %K Sierra Leone %K Somalia %K South Africa %K South Sudan %K Sudan %K Suriname %K Swaziland %K Tanzania %K Togo %K Uganda %K Zambia %K Zimbabwe %K Gambia %K Ghana %K Guinea %K Guinea-Bissau %K Kenya %K Lesotho %K Liberia %K Madagascar %K Malawi %K Mali %K Mauritania %K Mauritius %K Mozambique %K Namibia %K Niger %K Nigeria %K Rwanda %K Angola %K Benin %K Botswana %K Burkina Faso %K Burundi %K Cameroon %K Central African Republic %K Chad %K Comoros %K Congo %K Cote d'Ivoire %K Democratic Republic of Congo %K Equatorial Guinea %K Eritrea %K Ethiopia %K Gabon %D 2020 %7 19.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the novel coronavirus emerged in late 2019, the scientific and public health community around the world have sought to better understand, surveil, treat, and prevent the disease, COVID-19. In sub-Saharan Africa (SSA), many countries responded aggressively and decisively with lockdown measures and border closures. Such actions may have helped prevent large outbreaks throughout much of the region, though there is substantial variation in caseloads and mortality between nations. Additionally, the health system infrastructure remains a concern throughout much of SSA, and the lockdown measures threaten to increase poverty and food insecurity for the subcontinent’s poorest residents. The lack of sufficient testing, asymptomatic infections, and poor reporting practices in many countries limit our understanding of the virus’s impact, creating a need for better and more accurate surveillance metrics that account for underreporting and data contamination. Objective: The goal of this study is to improve infectious disease surveillance by complementing standardized metrics with new and decomposable surveillance metrics of COVID-19 that overcome data limitations and contamination inherent in public health surveillance systems. In addition to prevalence of observed daily and cumulative testing, testing positivity rates, morbidity, and mortality, we derived COVID-19 transmission in terms of speed, acceleration or deceleration, change in acceleration or deceleration (jerk), and 7-day transmission rate persistence, which explains where and how rapidly COVID-19 is transmitting and quantifies shifts in the rate of acceleration or deceleration to inform policies to mitigate and prevent COVID-19 and food insecurity in SSA. Methods: We extracted 60 days of COVID-19 data from public health registries and employed an empirical difference equation to measure daily case numbers in 47 sub-Saharan countries as a function of the prior number of cases, the level of testing, and weekly shift variables based on a dynamic panel model that was estimated using the generalized method of moments approach by implementing the Arellano-Bond estimator in R. Results: Kenya, Ghana, Nigeria, Ethiopia, and South Africa have the most observed cases of COVID-19, and the Seychelles, Eritrea, Mauritius, Comoros, and Burundi have the fewest. In contrast, the speed, acceleration, jerk, and 7-day persistence indicate rates of COVID-19 transmissions differ from observed cases. In September 2020, Cape Verde, Namibia, Eswatini, and South Africa had the highest speed of COVID-19 transmissions at 13.1, 7.1, 3.6, and 3 infections per 100,0000, respectively; Zimbabwe had an acceleration rate of transmission, while Zambia had the largest rate of deceleration this week compared to last week, referred to as a jerk. Finally, the 7-day persistence rate indicates the number of cases on September 15, 2020, which are a function of new infections from September 8, 2020, decreased in South Africa from 216.7 to 173.2 and Ethiopia from 136.7 to 106.3 per 100,000. The statistical approach was validated based on the regression results; they determined recent changes in the pattern of infection, and during the weeks of September 1-8 and September 9-15, there were substantial country differences in the evolution of the SSA pandemic. This change represents a decrease in the transmission model R value for that week and is consistent with a de-escalation in the pandemic for the sub-Saharan African continent in general. Conclusions: Standard surveillance metrics such as daily observed new COVID-19 cases or deaths are necessary but insufficient to mitigate and prevent COVID-19 transmission. Public health leaders also need to know where COVID-19 transmission rates are accelerating or decelerating, whether those rates increase or decrease over short time frames because the pandemic can quickly escalate, and how many cases today are a function of new infections 7 days ago. Even though SSA is home to some of the poorest countries in the world, development and population size are not necessarily predictive of COVID-19 transmission, meaning higher income countries like the United States can learn from African countries on how best to implement mitigation and prevention efforts. International Registered Report Identifier (IRRID): RR2-10.2196/21955 %M 33211026 %R 10.2196/24248 %U https://www.jmir.org/2020/11/e24248 %U https://doi.org/10.2196/24248 %U http://www.ncbi.nlm.nih.gov/pubmed/33211026 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e23019 %T Threat, Coping, and Social Distance Adherence During COVID-19: Cross-Continental Comparison Using an Online Cross-Sectional Survey %A Al-Hasan,Abrar %A Khuntia,Jiban %A Yim,Dobin %+ Kuwait University, College of Business Administration, AlShadadiya University City, 13055, Kuwait, 965 51165005, abrar.alhasan@ku.edu.kw %K COVID-19 %K adherence %K coping appraisal %K threat appraisal %K protection motivation theory %K social distancing %K information sources %K social media %K knowledge %K coping %K threat %K protection %K motivation %K cross-sectional %K survey %D 2020 %7 18.11.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33119538 %R 10.2196/23019 %U http://www.jmir.org/2020/11/e23019/ %U https://doi.org/10.2196/23019 %U http://www.ncbi.nlm.nih.gov/pubmed/33119538 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e20656 %T Psychological Impact of Health Risk Communication and Social Media on College Students During the COVID-19 Pandemic: Cross-Sectional Study %A Li,Mengyao %A Liu,Li %A Yang,Yilong %A Wang,Yang %A Yang,Xiaoshi %A Wu,Hui %+ China Medical University, No 77 Puhe Road, Shenyang North New Area, Shenyang, 110122, China, 86 18900910568, hwu@cmu.edu.cn %K COVID-19 %K anxiety %K panic %K health risk %K communication %K social media %D 2020 %7 18.11.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33108308 %R 10.2196/20656 %U http://www.jmir.org/2020/11/e20656/ %U https://doi.org/10.2196/20656 %U http://www.ncbi.nlm.nih.gov/pubmed/33108308 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22205 %T Associations Between COVID-19 Misinformation Exposure and Belief With COVID-19 Knowledge and Preventive Behaviors: Cross-Sectional Online Study %A Lee,Jung Jae %A Kang,Kyung-Ah %A Wang,Man Ping %A Zhao,Sheng Zhi %A Wong,Janet Yuen Ha %A O'Connor,Siobhan %A Yang,Sook Ching %A Shin,Sunhwa %+ College of Nursing, Sahmyook University, 815 Hwarang-ro, Nowon-gu, Seoul, 01795, Republic of Korea, 82 2 3399 1595, shinsh@syu.ac.kr %K COVID-19 %K misinformation %K infodemic %K infodemiology %K anxiety %K depression %K PTSD %K knowledge %K preventive behaviors %K prevention %K behavior %D 2020 %7 13.11.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33048825 %R 10.2196/22205 %U http://www.jmir.org/2020/11/e22205/ %U https://doi.org/10.2196/22205 %U http://www.ncbi.nlm.nih.gov/pubmed/33048825 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e21372 %T 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 %A Xu,Hong %A Gan,Yong %A Zheng,Daikun %A Wu,Bo %A Zhu,Xian %A Xu,Chang %A Liu,Chenglu %A Tao,Zhou %A Hu,Yaoyue %A Chen,Min %A Li,Mingjing %A Lu,Zuxun %A Chen,Jack %+ School of Public Health, Tongji Medical College, Huazhong University of Science and Technology, 13 Hangkong Road, Hubei, PRC, Wuhai, 430030, China, 86 27 8754 2101, zuxunlu@yahoo.com %K COVID-19 %K nonpharmaceutical personal interventions %K NPI %K public health %K mask wearing %K intervention %K infection %K risk perception %K knowledge %K attitude %K online survey %K China %D 2020 %7 13.11.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33108317 %R 10.2196/21372 %U http://www.jmir.org/2020/11/e21372/ %U https://doi.org/10.2196/21372 %U http://www.ncbi.nlm.nih.gov/pubmed/33108317 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e24291 %T Analysis of the COVID-19 Epidemic Transmission Network in Mainland China: K-Core Decomposition Study %A Qin,Lei %A Wang,Yidan %A Sun,Qiang %A Zhang,Xiaomei %A Shia,Ben-Chang %A Liu,Chengcheng %+ School of Statistics, Capital University of Economics and Business, No 121 Huaxiang Zhangjia Road, Fengtai District, Beijing, 100070, China, 86 188 1152 1258, ccliu@cueb.edu.cn %K COVID-19 %K epidemic network %K prevention and control %K k-core decomposition %D 2020 %7 13.11.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Since the outbreak of COVID-19 in December 2019 in Wuhan, Hubei Province, China, frequent interregional contacts and the high rate of infection spread have catalyzed the formation of an epidemic network. Objective: The aim of this study was to identify influential nodes and highlight the hidden structural properties of the COVID-19 epidemic network, which we believe is central to prevention and control of the epidemic. Methods: We first constructed a network of the COVID-19 epidemic among 31 provinces in mainland China; after some basic characteristics were revealed by the degree distribution, the k-core decomposition method was employed to provide static and dynamic evidence to determine the influential nodes and hierarchical structure. We then exhibited the influence power of the above nodes and the evolution of this power. Results: Only a small fraction of the provinces studied showed relatively strong outward or inward epidemic transmission effects. The three provinces of Hubei, Beijing, and Guangzhou showed the highest out-degrees, and the three highest in-degrees were observed for the provinces of Beijing, Henan, and Liaoning. In terms of the hierarchical structure of the COVID-19 epidemic network over the whole period, more than half of the 31 provinces were located in the innermost core. Considering the correlation of the characteristics and coreness of each province, we identified some significant negative and positive factors. Specific to the dynamic transmission process of the COVID-19 epidemic, three provinces of Anhui, Beijing, and Guangdong always showed the highest coreness from the third to the sixth week; meanwhile, Hubei Province maintained the highest coreness until the fifth week and then suddenly dropped to the lowest in the sixth week. We also found that the out-strengths of the innermost nodes were greater than their in-strengths before January 27, 2020, at which point a reversal occurred. Conclusions: Increasing our understanding of how epidemic networks form and function may help reduce the damaging effects of COVID-19 in China as well as in other countries and territories worldwide. %M 33108309 %R 10.2196/24291 %U http://publichealth.jmir.org/2020/4/e24291/ %U https://doi.org/10.2196/24291 %U http://www.ncbi.nlm.nih.gov/pubmed/33108309 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22894 %T 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 %A Do,Binh N %A Tran,Tien V %A Phan,Dung T %A Nguyen,Hoang C %A Nguyen,Thao T P %A Nguyen,Huu C %A Ha,Tung H %A Dao,Hung K %A Trinh,Manh V %A Do,Thinh V %A Nguyen,Hung Q %A Vo,Tam T %A Nguyen,Nhan P T %A Tran,Cuong Q %A Tran,Khanh V %A Duong,Trang T %A Pham,Hai X %A Nguyen,Lam V %A Nguyen,Kien T %A Chang,Peter W S %A Duong,Tuyen Van %+ School of Nutrition and Health Sciences, Taipei Medical University, 250 Wuxing St, Taipei, 11031, Taiwan, 886 2 2736 1661 ext 6545, tvduong@tmu.edu.tw %K COVID-19 %K health literacy %K eHealth literacy %K health care workers %K personal protective equipment %K handwashing %K masks %K disposing %K lifestyle %K Vietnam %K eHealth %K adherence %K infection prevention %K control %D 2020 %7 12.11.2020 %9 Original Paper %J J Med Internet Res %G English %X 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 (ρ=0.42); satisfactory convergent validity with high item-scale correlations (ρ=0.80-0.84); and high internal consistency (Cronbach α=.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. %M 33122164 %R 10.2196/22894 %U https://www.jmir.org/2020/11/e22894 %U https://doi.org/10.2196/22894 %U http://www.ncbi.nlm.nih.gov/pubmed/33122164 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e23922 %T Relationship Between COVID-19 Information Sources and Attitudes in Battling the Pandemic Among the Malaysian Public: Cross-Sectional Survey Study %A Mohamad,Emma %A Tham,Jen Sern %A Ayub,Suffian Hadi %A Hamzah,Mohammad Rezal %A Hashim,Hasrul %A Azlan,Arina Anis %+ Centre for Research in Media and Communication, Faculty of Social Sciences and Humanities, Universiti Kebangsaan Malaysia, 43600 UKM, Bangi, Selangor, 43600, Malaysia, 60 389215456, arina@ukm.edu.my %K COVID-19 %K information source %K confidence %K media %K social media %K government %K Malaysia %K online information %K survey %D 2020 %7 12.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: There are multiple media platforms and various resources available for information on COVID-19. Identifying people’s preferences is key to building public confidence and planning for successful national health intervention strategies. Objective: This study examines the sources of information for COVID-19 used by the Malaysian public and identifies those that are associated with building public confidence and positive perceptions toward the Malaysian government. Methods: A cross-sectional online survey of 4850 Malaysian residents was conducted. Participant demographics, media use, information sources, and attitudes surrounding COVID-19 were assessed. Descriptive statistics and multiple logistic regression analyses were conducted to gauge the relationship between demographics, information sources, and attitudes toward COVID-19. Results: Malaysians primarily used television and internet news portals to access information on COVID-19. The Malaysian Ministry of Health was the most preferred source of COVID-19 information. Respondents who referred to the Ministry of Health, television, and the Malaysian National Security Council for information were more likely to believe that the country could win the battle against COVID-19 and that the government was handling the health crisis well compared to those who referred to other information sources. Those who used the World Health Organization, friends, YouTube, family, and radio as sources of information were less likely to harbor confidence and positive belief toward combating COVID-19. Conclusions: Managing information and sustaining public confidence is important during a pandemic. Health authorities should pay considerable attention to the use of appropriate media channels and sources to allow for more effective dissemination of critical information to the public. %M 33151897 %R 10.2196/23922 %U http://www.jmir.org/2020/11/e23922/ %U https://doi.org/10.2196/23922 %U http://www.ncbi.nlm.nih.gov/pubmed/33151897 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e23853 %T Impact of Systematic Factors on the Outbreak Outcomes of the Novel COVID-19 Disease in China: Factor Analysis Study %A Cao,Zicheng %A Tang,Feng %A Chen,Cai %A Zhang,Chi %A Guo,Yichen %A Lin,Ruizhen %A Huang,Zhihong %A Teng,Yi %A Xie,Ting %A Xu,Yutian %A Song,Yanxin %A Wu,Feng %A Dong,Peipei %A Luo,Ganfeng %A Jiang,Yawen %A Zou,Huachun %A Chen,Yao-Qing %A Sun,Litao %A Shu,Yuelong %A Du,Xiangjun %+ School of Public Health (Shenzhen), Sun Yat-sen University, 135 Xingang Xi Road, Guangzhou, 510275, China, 86 020 83226383, duxj9@mail.sysu.edu.cn %K COVID-19 %K new cases %K growth rate %K multidimensional factors %K statistical machine learning %D 2020 %7 11.11.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33098287 %R 10.2196/23853 %U http://www.jmir.org/2020/11/e23853/ %U https://doi.org/10.2196/23853 %U http://www.ncbi.nlm.nih.gov/pubmed/33098287 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e19154 %T Opportunities for Mobile App–Based Adherence Support for Children With Tuberculosis in South Africa %A Morse,Rachel M %A Myburgh,Hanlie %A Reubi,David %A Archey,Ava E %A Busakwe,Leletu %A Garcia-Prats,Anthony J %A Hesseling,Anneke C %A Jacobs,Stephanie %A Mbaba,Sharon %A Meyerson,Kyla %A Seddon,James A %A van der Zalm,Marieke M %A Wademan,Dillon T %A Hoddinott,Graeme %+ Desmond Tutu Tuberculosis Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Lower Level Clinical Building, Francie van Zijl Drive, Cape Town, 7505, South Africa, 27 823416810, hmyburgh@sun.ac.za %K eHealth %K mHealth %K tuberculosis %K pediatric tuberculosis %K adherence %D 2020 %7 11.11.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X Tuberculosis is the number one infectious cause of death globally. Young children, generally those younger than 5 years, are at the highest risk of progressing from tuberculosis infection to tuberculosis disease and of developing the most severe forms of tuberculosis. Most current tuberculosis drug formulations have poor acceptability among children and require consistent adherence for prolonged periods of time. These challenges complicate children’s adherence to treatment and caregivers’ daily administration of the drugs. Rapid developments in mobile technologies and apps present opportunities for using widely available technology to support national tuberculosis programs and patient treatment adherence. Pilot studies have demonstrated that mobile apps are a feasible and acceptable means of enhancing children’s treatment adherence for other chronic conditions. Despite this, no mobile apps that aim to promote adherence to tuberculosis treatment have been developed for children. In this paper, we draw on our experiences carrying out research in clinical pediatric tuberculosis studies in South Africa. We present hypothetical scenarios of children’s adherence to tuberculosis medication to suggest priorities for behavioral and educational strategies that a mobile app could incorporate to address some of the adherence support gaps faced by children diagnosed with tuberculosis. We argue that a mobile app has the potential to lessen some of the negative experiences that children associate with taking tuberculosis treatment and to facilitate a more positive treatment adherence experience for children and their caregivers. %M 33174850 %R 10.2196/19154 %U https://mhealth.jmir.org/2020/11/e19154 %U https://doi.org/10.2196/19154 %U http://www.ncbi.nlm.nih.gov/pubmed/33174850 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e22594 %T Citizen-Centered Mobile Health Apps Collecting Individual-Level Spatial Data for Infectious Disease Management: Scoping Review %A Wirth,Felix Nikolaus %A Johns,Marco %A Meurers,Thierry %A Prasser,Fabian %+ Berlin Institute of Health, Charitéplatz 1, Berlin, 10117, Germany, 49 15773326360, felix-nikolaus.wirth@charite.de %K pandemic %K epidemic %K infectious disease management %K mobile apps %K automated digital contact tracing %K mobility tracking %K outbreak detection %K location-based risk assessment %K public health %K informatics %K app %K infectious disease %K COVID-19 %K review %D 2020 %7 10.11.2020 %9 Review %J JMIR Mhealth Uhealth %G English %X Background: The novel coronavirus SARS-CoV-2 rapidly spread around the world, causing the disease COVID-19. To contain the virus, much hope is placed on participatory surveillance using mobile apps, such as automated digital contact tracing, but broad adoption is an important prerequisite for associated interventions to be effective. Data protection aspects are a critical factor for adoption, and privacy risks of solutions developed often need to be balanced against their functionalities. This is reflected by an intensive discussion in the public and the scientific community about privacy-preserving approaches. Objective: Our aim is to inform the current discussions and to support the development of solutions providing an optimal balance between privacy protection and pandemic control. To this end, we present a systematic analysis of existing literature on citizen-centered surveillance solutions collecting individual-level spatial data. Our main hypothesis is that there are dependencies between the following dimensions: the use cases supported, the technology used to collect spatial data, the specific diseases focused on, and data protection measures implemented. Methods: We searched PubMed and IEEE Xplore with a search string combining terms from the area of infectious disease management with terms describing spatial surveillance technologies to identify studies published between 2010 and 2020. After a two-step eligibility assessment process, 27 articles were selected for the final analysis. We collected data on the four dimensions described as well as metadata, which we then analyzed by calculating univariate and bivariate frequency distributions. Results: We identified four different use cases, which focused on individual surveillance and public health (most common: digital contact tracing). We found that the solutions described were highly specialized, with 89% (24/27) of the articles covering one use case only. Moreover, we identified eight different technologies used for collecting spatial data (most common: GPS receivers) and five different diseases covered (most common: COVID-19). Finally, we also identified six different data protection measures (most common: pseudonymization). As hypothesized, we identified relationships between the dimensions. We found that for highly infectious diseases such as COVID-19 the most common use case was contact tracing, typically based on Bluetooth technology. For managing vector-borne diseases, use cases require absolute positions, which are typically measured using GPS. Absolute spatial locations are also important for further use cases relevant to the management of other infectious diseases. Conclusions: We see a large potential for future solutions supporting multiple use cases by combining different technologies (eg, Bluetooth and GPS). For this to be successful, however, adequate privacy-protection measures must be implemented. Technologies currently used in this context can probably not offer enough protection. We, therefore, recommend that future solutions should consider the use of modern privacy-enhancing techniques (eg, from the area of secure multiparty computing and differential privacy). %M 33074833 %R 10.2196/22594 %U http://mhealth.jmir.org/2020/11/e22594/ %U https://doi.org/10.2196/22594 %U http://www.ncbi.nlm.nih.gov/pubmed/33074833 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e24225 %T An Easy-to-Use Machine Learning Model to Predict the Prognosis of Patients With COVID-19: Retrospective Cohort Study %A Kim,Hyung-Jun %A Han,Deokjae %A Kim,Jeong-Han %A Kim,Daehyun %A Ha,Beomman %A Seog,Woong %A Lee,Yeon-Kyeng %A Lim,Dosang %A Hong,Sung Ok %A Park,Mi-Jin %A Heo,JoonNyung %+ The Armed Forces Medical Command, 81 Saemaeul-ro 177beon-gil, Bundang-gu, Seongnam, , Republic of Korea, 82 31 725 5490, jnheo@jnheo.com %K COVID-19 %K machine learning %K prognosis %K SARS-CoV-2 %K severe acute respiratory syndrome coronavirus 2 %D 2020 %7 9.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Prioritizing patients in need of intensive care is necessary to reduce the mortality rate during the COVID-19 pandemic. Although several scoring methods have been introduced, many require laboratory or radiographic findings that are not always easily available. Objective: The purpose of this study was to develop a machine learning model that predicts the need for intensive care for patients with COVID-19 using easily obtainable characteristics—baseline demographics, comorbidities, and symptoms. Methods: A retrospective study was performed using a nationwide cohort in South Korea. Patients admitted to 100 hospitals from January 25, 2020, to June 3, 2020, were included. Patient information was collected retrospectively by the attending physicians in each hospital and uploaded to an online case report form. Variables that could be easily provided were extracted. The variables were age, sex, smoking history, body temperature, comorbidities, activities of daily living, and symptoms. The primary outcome was the need for intensive care, defined as admission to the intensive care unit, use of extracorporeal life support, mechanical ventilation, vasopressors, or death within 30 days of hospitalization. Patients admitted until March 20, 2020, were included in the derivation group to develop prediction models using an automated machine learning technique. The models were externally validated in patients admitted after March 21, 2020. The machine learning model with the best discrimination performance was selected and compared against the CURB-65 (confusion, urea, respiratory rate, blood pressure, and 65 years of age or older) score using the area under the receiver operating characteristic curve (AUC). Results: A total of 4787 patients were included in the analysis, of which 3294 were assigned to the derivation group and 1493 to the validation group. Among the 4787 patients, 460 (9.6%) patients needed intensive care. Of the 55 machine learning models developed, the XGBoost model revealed the highest discrimination performance. The AUC of the XGBoost model was 0.897 (95% CI 0.877-0.917) for the derivation group and 0.885 (95% CI 0.855-0.915) for the validation group. Both the AUCs were superior to those of CURB-65, which were 0.836 (95% CI 0.825-0.847) and 0.843 (95% CI 0.829-0.857), respectively. Conclusions: We developed a machine learning model comprising simple patient-provided characteristics, which can efficiently predict the need for intensive care among patients with COVID-19. %M 33108316 %R 10.2196/24225 %U http://www.jmir.org/2020/11/e24225/ %U https://doi.org/10.2196/24225 %U http://www.ncbi.nlm.nih.gov/pubmed/33108316 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e23081 %T Concerns and Misconceptions About the Australian Government’s COVIDSafe App: Cross-Sectional Survey Study %A Thomas,Rae %A Michaleff,Zoe A %A Greenwood,Hannah %A Abukmail,Eman %A Glasziou,Paul %+ Institute for Evidence-Based Healthcare, Bond University, University Drive, Robina, 4229, Australia, 61 5595 5521, rthomas@bond.edu.au %K health %K policy %K COVID-19 %K digital tracing app %K COVIDSafe %D 2020 %7 4.11.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Timely and effective contact tracing is an essential public health measure for curbing the transmission of COVID-19. App-based contact tracing has the potential to optimize the resources of overstretched public health departments. However, its efficiency is dependent on widespread adoption. Objective: This study aimed to investigate the uptake of the Australian Government’s COVIDSafe app among Australians and examine the reasons why some Australians have not downloaded the app. Methods: An online national survey, with representative quotas for age and gender, was conducted between May 8 and May 11, 2020. Participants were excluded if they were a health care professional or had been tested for COVID-19. Results: Of the 1802 potential participants contacted, 289 (16.0%) were excluded prior to completing the survey, 13 (0.7%) declined, and 1500 (83.2%) participated in the survey. Of the 1500 survey participants, 37.3% (n=560) had downloaded the COVIDSafe app, 18.7% (n=280) intended to do so, 27.7% (n=416) refused to do so, and 16.3% (n=244) were undecided. Equally proportioned reasons for not downloading the app included privacy (165/660, 25.0%) and technical concerns (159/660, 24.1%). Other reasons included the belief that social distancing was sufficient and the app was unnecessary (111/660, 16.8%), distrust in the government (73/660, 11.1%), and other miscellaneous responses (eg, apathy and following the decisions of others) (73/660, 11.1%). In addition, knowledge about COVIDSafe varied among participants, as some were confused about its purpose and capabilities. Conclusions: For the COVIDSafe app to be accepted by the public and used correctly, public health messages need to address the concerns of citizens, specifically privacy, data storage, and technical capabilities. Understanding the specific barriers preventing the uptake of contact tracing apps provides the opportunity to design targeted communication strategies aimed at strengthening public health initiatives, such as downloading and correctly using contact tracing apps. %M 33048826 %R 10.2196/23081 %U http://publichealth.jmir.org/2020/4/e23081/ %U https://doi.org/10.2196/23081 %U http://www.ncbi.nlm.nih.gov/pubmed/33048826 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 11 %P e22131 %T COVID-19 Outcome Prediction and Monitoring Solution for Military Hospitals in South Korea: Development and Evaluation of an Application %A Heo,JoonNyung %A Park,Ji Ae %A Han,Deokjae %A Kim,Hyung-Jun %A Ahn,Daeun %A Ha,Beomman %A Seog,Woong %A Park,Yu Rang %+ Department of Biomedical Systems Informatics, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul, 03722, Republic of Korea, 82 2 2228 2493, yurangpark@yuhs.ac %K COVID-19 %K patient management %K prediction model %K military medicine %K proportional hazards models %K outcome %K prediction %K monitoring %K app %K usability %K prediction %K modeling %D 2020 %7 4.11.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 has officially been declared as a pandemic, and the spread of the virus is placing sustained demands on public health systems. There are speculations that the COVID-19 mortality differences between regions are due to the disparities in the availability of medical resources. Therefore, the selection of patients for diagnosis and treatment is essential in this situation. Military personnel are especially at risk for infectious diseases; thus, patient selection with an evidence-based prognostic model is critical for them. Objective: This study aims to assess the usability of a novel platform used in the military hospitals in Korea to gather data and deploy patient selection solutions for COVID-19. Methods: The platform’s structure was developed to provide users with prediction results and to use the data to enhance the prediction models. Two applications were developed: a patient’s application and a physician’s application. The primary outcome was requiring an oxygen supplement. The outcome prediction model was developed with patients from four centers. A Cox proportional hazards model was developed. The outcome of the model for the patient’s application was the length of time from the date of hospitalization to the date of the first oxygen supplement use. The demographic characteristics, past history, patient symptoms, social history, and body temperature were considered as risk factors. A usability study with the Post-Study System Usability Questionnaire (PSSUQ) was conducted on the physician’s application on 50 physicians. Results: The patient’s application and physician’s application were deployed on the web for wider availability. A total of 246 patients from four centers were used to develop the outcome prediction model. A small percentage (n=18, 7.32%) of the patients needed professional care. The variables included in the developed prediction model were age; body temperature; predisease physical status; history of cardiovascular disease; hypertension; visit to a region with an outbreak; and symptoms of chills, feverishness, dyspnea, and lethargy. The overall C statistic was 0.963 (95% CI 0.936-0.99), and the time-dependent area under the receiver operating characteristic curve ranged from 0.976 at day 3 to 0.979 at day 9. The usability of the physician’s application was good, with an overall average of the responses to the PSSUQ being 2.2 (SD 1.1). Conclusions: The platform introduced in this study enables evidence-based patient selection in an effortless and timely manner, which is critical in the military. With a well-designed user experience and an accurate prediction model, this platform may help save lives and contain the spread of the novel virus, COVID-19. %M 33048824 %R 10.2196/22131 %U https://www.jmir.org/2020/11/e22131 %U https://doi.org/10.2196/22131 %U http://www.ncbi.nlm.nih.gov/pubmed/33048824 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 11 %P e18156 %T Patients and Medical Staff Attitudes Toward the Future Inclusion of eHealth in Tuberculosis Management: Perspectives From Six Countries Evaluated using a Qualitative Framework %A Margineanu,Ioana %A Louka,Christina %A Vincenti-Gonzalez,Maria %A Saktiawati,Antonia Morita Iswari %A Schierle,Johannes %A Abass,Kabiru Mohammed %A Akkerman,Onno %A Alffenaar,Jan-Willem %A Ranchor,Adelita V %A Stienstra,Ymkje %+ Department of Clinical Pharmacy and Pharmacology, University Medical Centrum Groningen, University of Groningen, Hanzeplein 1, Groningen, Netherlands, 1 61 496 3518, ismargineanu@gmail.com %K eHealth %K tuberculosis %K policy %K clinical %K patient %K perspective %D 2020 %7 2.11.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Digitally delivering healthcare services is very attractive for tuberculosis (TB) management as this disease has a complex diagnosis and lengthy management and involves multiple medical and nonmedical specialists. Especially in low- and middle-income countries, eHealth could potentially offer cost-effective solutions to bridge financial, social, time, and distance challenges. Objective: The goal of the research is to understand what would make eHealth globally applicable and gain insight into different TB situations, opportunities, and challenges. Methods: We performed focus group interviews with TB experts and patients from 6 different countries on 4 different continents. The focus group interviews followed the theory of planned behavior framework to offer structured recommendations for a versatile eHealth solution. The focus group interviews were preceded by a general demographic and technology use questionnaire. Questionnaire results were analyzed using basic statistics in Excel (Microsoft Corporation). Focus group interview data were analyzed using ATLAS.ti 8 (ATLAS.ti Scientific Software Development GmbH) by assigning codes to quotations and grouping codes into the 5 domains within the framework. Results: A total of 29 patients and 32 medical staff members were included in our study. All medical staff had used the internet, whereas 31% (9/61) of patients had never been online. The codes with the most quotations were information in relation to eHealth (144 quotations) and communication (67 quotations). The consensus among all participants from all countries is that there are important communication and information gaps that could be bridged by an eHealth app. Participants from different countries also highlighted different challenges, such as a majority of asylum-seeker patients or lack of infrastructure that could be addressed with an eHealth app. Conclusions: Within the 6 countries interviewed, there is high enthusiasm toward eHealth in TB. A potential app could first target information and communication gaps in TB, with additional modules aimed at setting-specific challenges. %M 33136052 %R 10.2196/18156 %U https://mhealth.jmir.org/2020/11/e18156 %U https://doi.org/10.2196/18156 %U http://www.ncbi.nlm.nih.gov/pubmed/33136052 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e23241 %T Harmonized One Health Trans-Species and Community Surveillance for Tackling Antibacterial Resistance in India: Protocol for a Mixed Methods Study %A , %A Das,Manoja Kumar %A Mahapatra,Ashoka %A Pathi,Basanti %A Panigrahy,Rajashree %A Pattnaik,Swetalona %A Mishra,Sudhansu Shekhar %A Mahapatro,Samarendra %A Swain,Priyabrat %A Das,Jayakrushna %A Dixit,Shikha %A Sahoo,Satya Narayan %A Pillai,Rakesh N %+ Department of Public Health, The INCLEN Trust International, F 1/5, 2nd Floor, Okhla Industrial Area, Phase 1, New Delhi, 110020, India, 91 1147730000, manoj@inclentrust.org %K bacterial infection %K antibiotics resistance %K sentinel surveillance %K drug prescriptions %K One Health %K India %D 2020 %7 30.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: India has the largest burden of drug‑resistant organisms compared with other countries around the world, including multiresistant and extremely drug‑resistant tuberculosis and resistant Gram‑negative and Gram‑positive bacteria. Antibiotic resistant bacteria are found in all living hosts and in the environment and move between hosts and ecosystems. An intricate interplay of infections, exposure to antibiotics, and disinfectants at individual and community levels among humans, animals, birds, and fishes triggers evolution and spread of resistance. The One Health framework proposes addressing antibiotic resistance as a complex multidisciplinary problem. However, the evidence base in the Indian context is limited. Objective: This multisectoral, trans-species surveillance project aims to document the infection and resistance patterns of 7 resistant-priority bacteria and the risk factors for resistance following the One Health framework and geospatial epidemiology. Methods: This hospital- and community-based surveillance adopts a cross-sectional design with mixed methodology (quantitative, qualitative, and spatial) data collection. This study is being conducted at 6 microbiology laboratories and communities in Khurda district, Odisha, India. The laboratory surveillance collects data on bacteria isolates from different hosts and their resistance patterns. The hosts for infection surveillance include humans, animals (livestock, food chain, and pet animals), birds (poultry), and freshwater fishes (not crustaceans). For eligible patients, animals, birds and fishes, detailed data from their households or farms on health care seeking (for animals, birds and fishes, the illness, and care seeking of the caretakers), antibiotic use, disinfection practices, and neighborhood exposure to infection risks will be collected. Antibiotic prescription and use patterns at hospitals and clinics, and therapeutic and nontherapeutic antibiotic and disinfectant use in farms will also be collected. Interviews with key informants from animal breeding, agriculture, and food processing will explore the perceptions, attitudes, and practices related to antibiotic use. The data analysis will follow quantitative (descriptive and analytical), qualitative, and geospatial epidemiology principles. Results: The study was funded in May 2019 and approved by Institute Ethics Committees in March 2019. The data collection started in September 2019 and shall continue till March 2021. As of June 2020, data for 56 humans, 30 animals and birds, and fishes from 10 ponds have been collected. Data analysis is yet to be done. Conclusions: This study will inform about the bacterial infection and resistance epidemiology among different hosts, the risk factors for infection, and resistance transmission. In addition, it will identify the potential triggers and levers for further exploration and action. International Registered Report Identifier (IRRID): DERR1-10.2196/23241 %M 33124993 %R 10.2196/23241 %U http://www.researchprotocols.org/2020/10/e23241/ %U https://doi.org/10.2196/23241 %U http://www.ncbi.nlm.nih.gov/pubmed/33124993 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 10 %P e23148 %T Performance of Digital Contact Tracing Tools for COVID-19 Response in Singapore: Cross-Sectional Study %A Huang,Zhilian %A Guo,Huiling %A Lee,Yee-Mun %A Ho,Eu Chin %A Ang,Hou %A Chow,Angela %+ Department of Clinical Epidemiology, Office of Clinical Epidemiology, Analytics, and Knowledge, Tan Tock Seng Hospital, 11 Jalan Tan Tock Seng, Singapore, 308433, Singapore, 65 63577477, angela_chow@ttsh.com.sg %K infectious disease %K real-time locating systems %K electronic medical records %K COVID-19 %K contact tracing %K public health %D 2020 %7 29.10.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 33006944 %R 10.2196/23148 %U http://mhealth.jmir.org/2020/10/e23148/ %U https://doi.org/10.2196/23148 %U http://www.ncbi.nlm.nih.gov/pubmed/33006944 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 10 %P e16901 %T Automated Cluster Detection of Health Care–Associated Infection Based on the Multisource Surveillance of Process Data in the Area Network: Retrospective Study of Algorithm Development and Validation %A Fan,Yunzhou %A Wu,Yanyan %A Cao,Xiongjing %A Zou,Junning %A Zhu,Ming %A Dai,Di %A Lu,Lin %A Yin,Xiaoxv %A Xiong,Lijuan %+ Department of Nosocomial Infection Management, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 JieFang Avenue, Wuhan, 430022, China, 1 86 02785726293, lijuanxiong2016@126.com %K health care–associated infection %K cluster detection %K early warning %K multi sources surveillance %K process data %D 2020 %7 23.10.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: The cluster detection of health care–associated infections (HAIs) is crucial for identifying HAI outbreaks in the early stages. Objective: We aimed to verify whether multisource surveillance based on the process data in an area network can be effective in detecting HAI clusters. Methods: We retrospectively analyzed the incidence of HAIs and 3 indicators of process data relative to infection, namely, antibiotic utilization rate in combination, inspection rate of bacterial specimens, and positive rate of bacterial specimens, from 4 independent high-risk units in a tertiary hospital in China. We utilized the Shewhart warning model to detect the peaks of the time-series data. Subsequently, we designed 5 surveillance strategies based on the process data for the HAI cluster detection: (1) antibiotic utilization rate in combination only, (2) inspection rate of bacterial specimens only, (3) positive rate of bacterial specimens only, (4) antibiotic utilization rate in combination + inspection rate of bacterial specimens + positive rate of bacterial specimens in parallel, and (5) antibiotic utilization rate in combination + inspection rate of bacterial specimens + positive rate of bacterial specimens in series. We used the receiver operating characteristic (ROC) curve and Youden index to evaluate the warning performance of these surveillance strategies for the detection of HAI clusters. Results: The ROC curves of the 5 surveillance strategies were located above the standard line, and the area under the curve of the ROC was larger in the parallel strategy than in the series strategy and the single-indicator strategies. The optimal Youden indexes were 0.48 (95% CI 0.29-0.67) at a threshold of 1.5 in the antibiotic utilization rate in combination–only strategy, 0.49 (95% CI 0.45-0.53) at a threshold of 0.5 in the inspection rate of bacterial specimens–only strategy, 0.50 (95% CI 0.28-0.71) at a threshold of 1.1 in the positive rate of bacterial specimens–only strategy, 0.63 (95% CI 0.49-0.77) at a threshold of 2.6 in the parallel strategy, and 0.32 (95% CI 0.00-0.65) at a threshold of 0.0 in the series strategy. The warning performance of the parallel strategy was greater than that of the single-indicator strategies when the threshold exceeded 1.5. Conclusions: The multisource surveillance of process data in the area network is an effective method for the early detection of HAI clusters. The combination of multisource data and the threshold of the warning model are 2 important factors that influence the performance of the model. %M 32965228 %R 10.2196/16901 %U http://medinform.jmir.org/2020/10/e16901/ %U https://doi.org/10.2196/16901 %U http://www.ncbi.nlm.nih.gov/pubmed/32965228 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e20748 %T Covidom, a Telesurveillance Solution for Home Monitoring Patients With COVID-19 %A Yordanov,Youri %A Dechartres,Agnes %A Lescure,Xavier %A Apra,Caroline %A Villie,Pascaline %A Marchand-Arvier,Jerome %A Debuc,Erwan %A Dinh,Aurélien %A Jourdain,Patrick %A , %+ Sorbonne Université, AP-HP, Hôpital Saint Antoine, Service d'Accueil des Urgences, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique, UMR-S 1136, 34 rue Crozatier, Paris, France, 33 171970869, youri.yordanov@aphp.fr %K COVID-19 %K coronavirus disease %K home monitoring %K telesurveillance %K monitoring %K patient %K infectious disease %K app %D 2020 %7 22.10.2020 %9 Viewpoint %J J Med Internet Res %G English %X In a matter of months, COVID-19 has escalated from a cluster of cases in Wuhan, China, to a global pandemic. As the number of patients with COVID-19 grew, solutions for the home monitoring of infected patients became critical. This viewpoint presents a telesurveillance solution—Covidom—deployed in the greater Paris area to monitor patients with COVID-19 in their homes. The system was rapidly developed and is being used on a large scale with more than 65,000 registered patients to date. The Covidom solution combines an easy-to-use and free web application for patients (through which patients fill out short questionnaires on their health status) with a regional control center that monitors and manages alerts (triggered by questionnaire responses) from patients whose health may be deteriorating. This innovative solution could alleviate the burden of health care professionals and systems while allowing for rapid response when patients trigger an alert. %M 33006938 %R 10.2196/20748 %U http://www.jmir.org/2020/10/e20748/ %U https://doi.org/10.2196/20748 %U http://www.ncbi.nlm.nih.gov/pubmed/33006938 %0 Journal Article %@ 2563-6316 %I JMIR Publications %V 1 %N 1 %P e23582 %T A Machine Learning Explanation of the Pathogen-Immune Relationship of SARS-CoV-2 (COVID-19), and a Model to Predict Immunity and Therapeutic Opportunity: A Comparative Effectiveness Research Study %A Luellen,Eric %+ Bioinformatix, Faculty Lane, Box 3628, Interlochen, MI, 49643, United States, 1 4129157468, eluellen@bioinformatix.io %K infectious disease %K SARS-CoV-2 %K COVID-19 %K public health %K immunity %K mass vaccinations %K therapeutics %K stem-cell growth factor-beta %D 2020 %7 19.10.2020 %9 Original Paper %J JMIRx Med %G English %X Background: Approximately 80% of those infected with COVID-19 are immune. They are asymptomatic unknown carriers who can still infect those with whom they come into contact. Understanding what makes them immune could inform public health policies as to who needs to be protected and why, and possibly lead to a novel treatment for those who cannot, or will not, be vaccinated once a vaccine is available. Objective: The primary objectives of this study were to learn if machine learning could identify patterns in the pathogen-host immune relationship that differentiate or predict COVID-19 symptom immunity and, if so, which ones and at what levels. The secondary objective was to learn if machine learning could take such differentiators to build a model that could predict COVID-19 immunity with clinical accuracy. The tertiary purpose was to learn about the relevance of other immune factors. Methods: This was a comparative effectiveness research study on 53 common immunological factors using machine learning on clinical data from 74 similarly grouped Chinese COVID-19–positive patients, 37 of whom were symptomatic and 37 asymptomatic. The setting was a single-center primary care hospital in the Wanzhou District of China. Immunological factors were measured in patients who were diagnosed as SARS-CoV-2 positive by reverse transcriptase-polymerase chain reaction (RT-PCR) in the 14 days before observations were recorded. The median age of the 37 asymptomatic patients was 41 years (range 8-75 years); 22 were female, 15 were male. For comparison, 37 RT-PCR test–positive patients were selected and matched to the asymptomatic group by age, comorbidities, and sex. Machine learning models were trained and compared to understand the pathogen-immune relationship and predict who was immune to COVID-19 and why, using the statistical programming language R. Results: When stem cell growth factor-beta (SCGF-β) was included in the machine learning analysis, a decision tree and extreme gradient boosting algorithms classified and predicted COVID-19 symptom immunity with 100% accuracy. When SCGF-β was excluded, a random-forest algorithm classified and predicted asymptomatic and symptomatic cases of COVID-19 with 94.8% AUROC (area under the receiver operating characteristic) curve accuracy (95% CI 90.17%-100%). In total, 34 common immune factors have statistically significant associations with COVID-19 symptoms (all c<.05), and 19 immune factors appear to have no statistically significant association. Conclusions: The primary outcome was that asymptomatic patients with COVID-19 could be identified by three distinct immunological factors and levels: SCGF-β (>127,637), interleukin-16 (IL-16) (>45), and macrophage colony-stimulating factor (M-CSF) (>57). The secondary study outcome was the suggestion that stem-cell therapy with SCGF-β may be a novel treatment for COVID-19. Individuals with an SCGF-β level >127,637, or an IL-16 level >45 and an M-CSF level >57, appear to be predictively immune to COVID-19 100% and 94.8% (AUROC) of the time, respectively. Testing levels of these three immunological factors may be a valuable tool at the point of care for managing and preventing outbreaks. Further, stem-cell therapy via SCGF-β and M-CSF appear to be promising novel therapeutics for patients with COVID-19. %M 33711083 %R 10.2196/23582 %U https://med.jmirx.org/2020/1/e23582/ %U https://doi.org/10.2196/23582 %U http://www.ncbi.nlm.nih.gov/pubmed/33711083 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e22678 %T Transmission Dynamics of the COVID-19 Epidemic at the District Level in India: Prospective Observational Study %A Saurabh,Suman %A Verma,Mahendra Kumar %A Gautam,Vaishali %A Kumar,Nitesh %A Goel,Akhil Dhanesh %A Gupta,Manoj Kumar %A Bhardwaj,Pankaj %A Misra,Sanjeev %+ Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, 2nd Floor, Academic Building, 342005, Jodhpur, India, 91 7766906623, drsumansaurabh@gmail.com %K Epidemiology %K SARS-CoV-2 %K COVID-19 %K serial interval %K basic reproduction number %K projection %K outbreak response %K India %K mathematical modeling %K infectious disease %D 2020 %7 15.10.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: On March 9, 2020, the first COVID-19 case was reported in Jodhpur, Rajasthan, in the northwestern part of India. Understanding the epidemiology of COVID-19 at a local level is becoming increasingly important to guide measures to control the pandemic. Objective: The aim of this study was to estimate the serial interval and basic reproduction number (R0) to understand the transmission dynamics of the COVID-19 outbreak at a district level. We used standard mathematical modeling approaches to assess the utility of these factors in determining the effectiveness of COVID-19 responses and projecting the size of the epidemic. Methods: Contact tracing of individuals infected with SARS-CoV-2 was performed to obtain the serial intervals. The median and 95th percentile values of the SARS-CoV-2 serial interval were obtained from the best fits with the weibull, log-normal, log-logistic, gamma, and generalized gamma distributions. Aggregate and instantaneous R0 values were derived with different methods using the EarlyR and EpiEstim packages in R software. Results: The median and 95th percentile values of the serial interval were 5.23 days (95% CI 4.72-5.79) and 13.20 days (95% CI 10.90-18.18), respectively. R0 during the first 30 days of the outbreak was 1.62 (95% CI 1.07-2.17), which subsequently decreased to 1.15 (95% CI 1.09-1.21). The peak instantaneous R0 values obtained using a Poisson process developed by Jombert et al were 6.53 (95% CI 2.12-13.38) and 3.43 (95% CI 1.71-5.74) for sliding time windows of 7 and 14 days, respectively. The peak R0 values obtained using the method by Wallinga and Teunis were 2.96 (95% CI 2.52-3.36) and 2.92 (95% CI 2.65-3.22) for sliding time windows of 7 and 14 days, respectively. R0 values of 1.21 (95% CI 1.09-1.34) and 1.12 (95% CI 1.03-1.21) for the 7- and 14-day sliding time windows, respectively, were obtained on July 6, 2020, using method by Jombert et al. Using the method by Wallinga and Teunis, values of 0.32 (95% CI 0.27-0.36) and 0.61 (95% CI 0.58-0.63) were obtained for the 7- and 14-day sliding time windows, respectively. The projection of cases over the next month was 2131 (95% CI 1799-2462). Reductions of transmission by 25% and 50% corresponding to reasonable and aggressive control measures could lead to 58.7% and 84.0% reductions in epidemic size, respectively. Conclusions: The projected transmission reductions indicate that strengthening control measures could lead to proportionate reductions of the size of the COVID-19 epidemic. Time-dependent instantaneous R0 estimation based on the process by Jombart et al was found to be better suited for guiding COVID-19 response at the district level than overall R0 or instantaneous R0 estimation by the Wallinga and Teunis method. A data-driven approach at the local level is proposed to be useful in guiding public health strategy and surge capacity planning. %M 33001839 %R 10.2196/22678 %U http://publichealth.jmir.org/2020/4/e22678/ %U https://doi.org/10.2196/22678 %U http://www.ncbi.nlm.nih.gov/pubmed/33001839 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22628 %T Knowledge, Awareness, and Attitudes Relating to the COVID-19 Pandemic Among Different Populations in Central China: Cross-Sectional Survey %A Xu,Huifang %A Gonzalez Mendez,Maria Jose %A Guo,Lanwei %A Chen,Qiong %A Zheng,Liyang %A Chen,Peipei %A Cao,Xiaoqin %A Liu,Shuzheng %A Sun,Xibin %A Zhang,Shaokai %A Qiao,Youlin %+ Department of Cancer Epidemiology, Affiliated Cancer Hospital of Zhengzhou University/Henan Cancer Hospital, 127 Dongming Rd, Jinshui District, Zhengzhou, China, 86 037165587346, shaokaizhang@126.com %K COVID-19 %K knowledge %K awareness %K attitude %D 2020 %7 15.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has threatened the health systems of many countries worldwide. Several studies have suggested that the pandemic affects not only physical health but also all aspects of society. A lot of information has been reported about the disease since the beginning of the outbreak. For that reason, it is essential to investigate the attitudes and level of knowledge and awareness that different populations had regarding COVID-19 during the critical period of the outbreak. Objective: This study aimed to assess the knowledge and awareness of and attitudes toward the COVID-19 pandemic among different populations in Central China during the critical period of the outbreak. Methods: A cross-sectional web-based survey was conducted in Central China from February to March 2020. The study participants included three different populations: medical workers, students, and those with other occupations. In this study, a questionnaire was designed to collect information on the following four aspects: sociodemographic information, knowledge related to COVID-19, awareness of COVID-19, and attitude toward COVID-19. The chi-square test and Fisher test were used for comparison among groups. The level of significance was set at P<.05. Results: This study enrolled a total of 508 participants. Among them, there were 380 students (74.8%), 39 medical workers (7.7%), and 89 people with other occupations (17.5%). Most of the participants were female (n=272, 53.5%), lived in rural areas (n=258, 50.8%), and were single (n=423, 86.9%). The majority of the respondents had attended college (n=454, 89.4%). Most of the participants said they had heard about COVID-19 by January, and most of them looked for information on social media (Sina Weibo, 84.7%), and WeChat and QQ groups (74.2%). The participants showed an adequate level of knowledge about COVID-19 with no significant differences among the groups. However, medical workers demonstrated a slightly advanced knowledge in their responses to professional questions such as the potential susceptible population, possible host, treatment of COVID-19, and disease category. A higher proportion of medical workers (71.8%) and those in the other occupations group (52.8%) were highly concerned about the COVID-19 pandemic. More than 43% of the participants stated that the lockdown of their village/city had a significant impact on their lives. Nevertheless, the majority of respondents had an overall optimistic attitude toward the control of the disease (92.1% of students [n=350], 94.9% of medical workers [n=37], and 92.3% of those in other occupations [n=83]). Conclusions: All three groups reported an adequate background knowledge about COVID-19 but medical workers showed a slightly advanced knowledge in their responses to professional questions. Most of the participants were highly concerned about COVID-19 during the critical period of the outbreak. The majority of respondents declared that the village/city lockdown policy had a significant impact on their daily life but most of them held an optimistic attitude toward the control of COVID-19. %M 32886623 %R 10.2196/22628 %U https://www.jmir.org/2020/10/e22628 %U https://doi.org/10.2196/22628 %U http://www.ncbi.nlm.nih.gov/pubmed/32886623 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21081 %T How Data Analytics and Big Data Can Help Scientists in Managing COVID-19 Diffusion: Modeling Study to Predict the COVID-19 Diffusion in Italy and the Lombardy Region %A Tosi,Davide %A Campi,Alessandro %+ Politecnico di Milano, Piazza Leonardo da Vinci 32, Milano, Italy, 39 0223993644, alessandro.campi@polimi.it %K COVID-19 %K SARS-CoV-2 %K big data %K data analytics %K predictive models %K prediction %K modeling %K Italy %K diffusion %D 2020 %7 14.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is the most widely discussed topic worldwide in 2020, and at the beginning of the Italian epidemic, scientists tried to understand the virus diffusion and the epidemic curve of positive cases with controversial findings and numbers. Objective: In this paper, a data analytics study on the diffusion of COVID-19 in Italy and the Lombardy Region is developed to define a predictive model tailored to forecast the evolution of the diffusion over time. Methods: Starting with all available official data collected worldwide about the diffusion of COVID-19, we defined a predictive model at the beginning of March 2020 for the Italian country. Results: This paper aims at showing how this predictive model was able to forecast the behavior of the COVID-19 diffusion and how it predicted the total number of positive cases in Italy over time. The predictive model forecasted, for the Italian country, the end of the COVID-19 first wave by the beginning of June. Conclusions: This paper shows that big data and data analytics can help medical experts and epidemiologists in promptly designing accurate and generalized models to predict the different COVID-19 evolutionary phases in other countries and regions, and for second and third possible epidemic waves. %M 33027038 %R 10.2196/21081 %U http://www.jmir.org/2020/10/e21081/ %U https://doi.org/10.2196/21081 %U http://www.ncbi.nlm.nih.gov/pubmed/33027038 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19878 %T Application of an Artificial Intelligence Trilogy to Accelerate Processing of Suspected Patients With SARS-CoV-2 at a Smart Quarantine Station: Observational Study %A Liu,Ping-Yen %A Tsai,Yi-Shan %A Chen,Po-Lin %A Tsai,Huey-Pin %A Hsu,Ling-Wei %A Wang,Chi-Shiang %A Lee,Nan-Yao %A Huang,Mu-Shiang %A Wu,Yun-Chiao %A Ko,Wen-Chien %A Yang,Yi-Ching %A Chiang,Jung-Hsien %A Shen,Meng-Ru %+ Department of Obstetrics and Gynecology, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, 138 Sheng-Li Rd, Tainan, 70401, Taiwan, 886 6 2353535 ext 5505, mrshen@mail.ncku.edu.tw %K SARS-CoV-2 %K COVID-19 %K artificial intelligence %K smart device assisted decision making %K quarantine station %D 2020 %7 14.10.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 33001832 %R 10.2196/19878 %U http://www.jmir.org/2020/10/e19878/ %U https://doi.org/10.2196/19878 %U http://www.ncbi.nlm.nih.gov/pubmed/33001832 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e23532 %T Impact of Chronic Use of Antimalarials on SARS-CoV-2 Infection in Patients With Immune-Mediated Rheumatic Diseases: Protocol for a Multicentric Observational Cohort Study %A Gomides,Ana %A Ferreira,Gilda %A Kakehasi,Adriana %A Lacerda,Marcus %A Marques,Cláudia %A Mota,Licia %A Paiva,Eduardo %A Pileggi,Gecilmara %A Provenza,José %A Reis-Neto,Edgard %A Sampaio,Vanderson %A Xavier,Ricardo %A Pinheiro,Marcelo %+ Federal University of São Paulo, Hospital São Paulo, São Paulo, , Brazil, 55 6135480162, mpinheiro@uol.com.br %K COVID-19 %K SARS-CoV-2 %K coronavirus %K antimalarial %K rheumatic diseases %K mortality %K immune system %K immunology %K protocol %K observational %K pharmacological %K drug %D 2020 %7 14.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: COVID-19, caused by the virus SARS-CoV-2, has brought extensive challenges to the scientific community in recent months. Several studies have been undertaken in an attempt to minimize the impact of the disease worldwide. Although new knowledge has been quickly disseminated, including viral mechanisms, pathophysiology, and clinical findings, there is a lack of information on the effective pharmacological management of this disease. In vitro studies have shown some benefits related to the use of antimalarials (chloroquine and hydroxychloroquine) for inhibiting SARS-CoV-2. However, the data from open clinical trials on COVID-19 patients are controversial. Objective: We present the protocol for a research project that compares the potential protective effect of antimalarials in preventing moderate-to-severe forms of COVID-19 in two groups: (1) patients treated chronically with antimalarials for rheumatic diseases and (2) other members of the patients’ household who have not been diagnosed with rheumatic diseases and are not taking antimalarials. Methods: This is a 24-week, prospective, observational cohort study comprising patients from public and private health services across Brazil, who chronically use antimalarials for the treatment of immune-mediated rheumatic diseases, osteoarthritis, or chikungunya-related arthropathy. A total of six sequential phone interviews were scheduled during the COVID-19 outbreak in five different regions of Brazil. Information regarding social, epidemiological, and demographic data, as well as details about rheumatic diseases, antimalarials, comorbidities, and concomitant medication, is being recorded using a specific online form in the REDCap database. Symptoms suggestive of COVID-19, including fever, cough, dyspnea, anosmia, and dysgeusia, are being self-reported and collected via phone interviews. Our main outcomes are hospitalization, need of intensive care unit, and death. Results: Recruitment began at the end of March 2020, and the inclusion was done during an 8-week period (from March 29 to May 17) with a total of 10,443 individuals enrolled at baseline, 5166 of whom have rheumatic diseases, from 23 tertiary rheumatology centers across 97 Brazilian cities. Data analysis is scheduled to begin after all inclusion data have been collected. Conclusions: This study, which includes a large sample of chronic antimalarial users, will allow us to explore whether SARS-CoV-2 infection may be associated with immune-mediated rheumatic diseases and long-term antimalarial usage. Trial Registration: Brazilian Registry of Clinical Trials RBR–9KTWX6; http://www.ensaiosclinicos.gov.br/rg/RBR-9ktwx6/ International Registered Report Identifier (IRRID): DERR1-10.2196/23532 %M 32924956 %R 10.2196/23532 %U http://www.researchprotocols.org/2020/10/e23532/ %U https://doi.org/10.2196/23532 %U http://www.ncbi.nlm.nih.gov/pubmed/32924956 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19994 %T Epidemiological Parameters of COVID-19: Case Series Study %A Ma,Shujuan %A Zhang,Jiayue %A Zeng,Minyan %A Yun,Qingping %A Guo,Wei %A Zheng,Yixiang %A Zhao,Shi %A Wang,Maggie H %A Yang,Zuyao %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong, 852 2252 8739, zyang@cuhk.edu.hk %K coronavirus disease 2019 %K COVID-19 %K incubation period %K serial interval %K basic reproduction number %K presymptomatic transmission %D 2020 %7 12.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The estimates of several key epidemiological parameters of the COVID-19 pandemic are often based on small sample sizes or are inaccurate for various reasons. Objective: The aim of this study is to obtain more robust estimates of the incubation period, serial interval, frequency of presymptomatic transmission, and basic reproduction number (R0) of COVID-19 based on a large case series. Methods: We systematically retrieved and screened 20,658 reports of laboratory-confirmed COVID-19 cases released by the health authorities of China, Japan, and Singapore. In addition, 9942 publications were retrieved from PubMed and China National Knowledge Infrastructure (CNKI) through April 8, 2020. To be eligible, a report had to contain individual data that allowed for accurate estimation of at least one parameter. Widely used models such as gamma distributions were fitted to the data sets and the results with the best-fitting values were presented. Results: In total, 1591 cases were included for the final analysis. The mean incubation period (n=687) and mean serial interval (n=1015 pairs) were estimated to be 7.04 (SD 4.27) days and 6.49 (SD 4.90) days, respectively. In 40 cases (5.82%), the incubation period was longer than 14 days. In 32 infector-infectee pairs (3.15%), infectees’ symptom onsets occurred before those of infectors. Presymptomatic transmission occurred in 129 of 296 infector-infectee pairs (43.58%). R0 was estimated to be 1.85 (95% CI 1.37-2.60). Conclusions: This study provides robust estimates of several epidemiological parameters of COVID-19. The findings support the current practice of 14-day quarantine of persons with potential exposure, but also suggest the need for additional measures. Presymptomatic transmission together with the asymptomatic transmission reported by previous studies highlight the importance of adequate testing, strict quarantine, and social distancing. %M 33001833 %R 10.2196/19994 %U http://www.jmir.org/2020/10/e19994/ %U https://doi.org/10.2196/19994 %U http://www.ncbi.nlm.nih.gov/pubmed/33001833 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e19684 %T Social Media Use, eHealth Literacy, Disease Knowledge, and Preventive Behaviors in the COVID-19 Pandemic: Cross-Sectional Study on Chinese Netizens %A Li,Xiaojing %A Liu,Qinliang %+ Center for Health and Medical Communication, School of Media & Communication, Shanghai Jiao Tong University, 800 Dongchuan Rd, Shanghai, 200240, China, 86 13918611103, lixiaojing@sjtu.edu.cn %K social media %K media use %K COVID-19 %K pandemic %K disease knowledge %K eHealth literacy %K public health %K preventive behaviors %D 2020 %7 9.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since its outbreak in January 2020, COVID-19 has quickly spread worldwide and has become a global pandemic. Social media platforms have been recognized as important tools for health-promoting practices in public health, and the use of social media is widespread among the public. However, little is known about the effects of social media use on health promotion during a pandemic such as COVID-19. Objective: In this study, we aimed to explore the predictive role of social media use on public preventive behaviors in China during the COVID-19 pandemic and how disease knowledge and eHealth literacy moderated the relationship between social media use and preventive behaviors. Methods: A national web-based cross-sectional survey was conducted by a proportionate probability sampling among 802 Chinese internet users (“netizens”) in February 2020. Descriptive statistics, Pearson correlations, and hierarchical multiple regressions were employed to examine and explore the relationships among all the variables. Results: Almost half the 802 study participants were male (416, 51.9%), and the average age of the participants was 32.65 years. Most of the 802 participants had high education levels (624, 77.7%), had high income >¥5000 (US $736.29) (525, 65.3%), were married (496, 61.8%), and were in good health (486, 60.6%). The average time of social media use was approximately 2 to 3 hours per day (mean 2.34 hours, SD 1.11), and the most frequently used media types were public social media (mean score 4.49/5, SD 0.78) and aggregated social media (mean score 4.07/5, SD 1.07). Social media use frequency (β=.20, P<.001) rather than time significantly predicted preventive behaviors for COVID-19. Respondents were also equipped with high levels of disease knowledge (mean score 8.15/10, SD 1.43) and eHealth literacy (mean score 3.79/5, SD 0.59). Disease knowledge (β=.11, P=.001) and eHealth literacy (β=.27, P<.001) were also significant predictors of preventive behaviors. Furthermore, eHealth literacy (P=.038) and disease knowledge (P=.03) positively moderated the relationship between social media use frequency and preventive behaviors, while eHealth literacy (β=.07) affected this relationship positively and disease knowledge (β=–.07) affected it negatively. Different social media types differed in predicting an individual’s preventive behaviors for COVID-19. Aggregated social media (β=.22, P<.001) was the best predictor, followed by public social media (β=.14, P<.001) and professional social media (β=.11, P=.002). However, official social media (β=.02, P=.597) was an insignificant predictor. Conclusions: Social media is an effective tool to promote behaviors to prevent COVID-19 among the public. Health literacy is essential for promotion of individual health and influences the extent to which the public engages in preventive behaviors during a pandemic. Our results not only enrich the theoretical paradigm of public health management and health communication but also have practical implications in pandemic control for China and other countries. %M 33006940 %R 10.2196/19684 %U http://www.jmir.org/2020/10/e19684/ %U https://doi.org/10.2196/19684 %U http://www.ncbi.nlm.nih.gov/pubmed/33006940 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e22596 %T Associations of Mental Health and Personal Preventive Measure Compliance With Exposure to COVID-19 Information During Work Resumption Following the COVID-19 Outbreak in China: Cross-Sectional Survey Study %A Pan,Yihang %A Xin,Meiqi %A Zhang,Changhua %A Dong,Willa %A Fang,Yuan %A Wu,Wenhui %A Li,Mingzhe %A Pang,Jun %A Zheng,Zilong %A Wang,Zixin %A Yuan,Jinqiu %A He,Yulong %+ JC School of Public Health and Primary Care, The Chinese University of Hong Kong, Room 508, School of Public Health, Prince of Wales Hospital, Shatin, NT, 666888, Hong Kong, 852 22528740, wangzx@cuhk.edu.hk %K COVID-19 %K information exposure %K risk %K communication %K mental health %K personal preventive measures %K China %K cross-sectional %K public health %K prevention %D 2020 %7 8.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Risk and crisis communication plays an essential role in public health emergency responses. The COVID-19 pandemic has triggered spontaneous and intensive media attention, which has affected people’s adoption of personal preventive measures and their mental health. Objective: The aim of this study was to investigate the associations between exposure to COVID-19–specific information and mental health (depression and sleep quality) and self-reported compliance with personal preventive measures (face mask wearing and hand sanitizing). We also tested whether these associations were moderated by thoughtful consideration of the veracity of the information to which people were exposed. Methods: A cross-sectional, closed web-based survey was conducted among a sample of 3035 factory workers at the beginning of work resumption following the COVID-19 outbreak in Shenzhen, China. A stratified two-stage cluster sampling design was used for recruitment. Multivariate linear and logistic regression models were used for the analyses. Results: The prevalence of probable moderate-to-severe depression was 170/3035 (5.6%), while that of good or excellent sleep quality was 2110/3035 (69.5%). The prevalence of self-reported consistent face mask wearing in public places was 2903/3035 (95.7%), while that of sanitizing hands every time after returning from public spaces or touching public installations was 2151/3035 (70.9%). Of the 3035 respondents, 1013 to 1638 (33.3% to 54.0%) reported >1 hour of daily exposure to COVID-19–specific information through web-based media and television. After controlling for significant background variables, higher information exposure via television and via newspapers and magazines was associated with better sleep quality and higher compliance with hand sanitizing. Higher exposure via unofficial web-based media was associated with higher compliance with hand sanitizing but was also associated with higher depressive symptoms. In contrast, higher exposure through face-to-face communication was associated with higher depressive symptoms, worse sleep quality, and lower compliance with hand sanitizing. Exposure to information about positive outcomes for patients with COVID-19, development of vaccines and effective treatments, and heroic stories about frontline health care workers were associated with both better mental health and higher compliance with preventive measures. Higher overall information exposure was associated with higher depressive symptoms among participants who were less likely to carefully consider the veracity of the information to which they were exposed; it was also associated with better sleep quality among people who reported more thoughtful consideration of information veracity. Conclusions: This study provides empirical evidence of how the amount, sources, and contents of information to which people were exposed influenced their mental health and compliance with personal preventive measures at the initial phase of work resumption in China. Thoughtful consideration of information quality was found to play an important moderating role. Our findings may inform strategic risk communication by government and public health authorities during the COVID-19 pandemic. %M 32936776 %R 10.2196/22596 %U http://www.jmir.org/2020/10/e22596/ %U https://doi.org/10.2196/22596 %U http://www.ncbi.nlm.nih.gov/pubmed/32936776 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e21071 %T Trends and Predictors of COVID-19 Information Sources and Their Relationship With Knowledge and Beliefs Related to the Pandemic: Nationwide Cross-Sectional Study %A Ali,Shahmir H %A Foreman,Joshua %A Tozan,Yesim %A Capasso,Ariadna %A Jones,Abbey M %A DiClemente,Ralph J %+ Department of Social & Behavioral Sciences, School of Global Public Health, New York University, 715 Broadway, New York, NY, 10003, United States, 1 (212) 992 3709, rjd438@nyu.edu %K COVID-19 %K coronavirus %K pandemic %K outbreak %K infectious disease %K social media %K information seeking behaviors %K surveillance %D 2020 %7 8.10.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: During the COVID-19 pandemic, there is a heightened need to understand health information seeking behaviors to address disparities in knowledge and beliefs about the crisis. Objective: This study assessed sociodemographic predictors of the use and trust of different COVID-19 information sources, as well as the association between information sources and knowledge and beliefs about the pandemic. Methods: An online survey was conducted among US adults in two rounds during March and April 2020 using advertisement-based recruitment on social media. Participants were asked about their use of 11 different COVID-19 information sources as well as their most trusted source of information. The selection of COVID-related knowledge and belief questions was based on past empirical literature and salient concerns at the time of survey implementation. Results: The sample consisted of 11,242 participants. When combined, traditional media sources (television, radio, podcasts, or newspapers) were the largest sources of COVID-19 information (91.2%). Among those using mainstream media sources for COVID-19 information (n=7811, 69.5%), popular outlets included CNN (24.0%), Fox News (19.3%), and other local or national networks (35.2%). The largest individual information source was government websites (87.6%). They were also the most trusted source of information (43.3%), although the odds of trusting government websites were lower among males (adjusted odds ratio [AOR] 0.58, 95% CI 0.53-0.63) and those aged 40-59 years and ≥60 years compared to those aged 18-39 years (AOR 0.83, 95% CI 0.74-0.92; AOR 0.62, 95% CI 0.54-0.71). Participants used an average of 6.1 sources (SD 2.3). Participants who were male, aged 40-59 years or ≥60 years; not working, unemployed, or retired; or Republican were likely to use fewer sources while those with children and higher educational attainment were likely to use more sources. Participants surveyed in April were markedly less likely to use (AOR 0.41, 95% CI 0.35-0.46) and trust (AOR 0.51, 95% CI 0.47-0.56) government sources. The association between information source and COVID-19 knowledge was mixed, while many COVID-19 beliefs were significantly predicted by information source; similar trends were observed with reliance on different types of mainstream media outlets. Conclusions: COVID-19 information source was significantly determined by participant sociodemographic characteristics and was also associated with both knowledge and beliefs about the pandemic. Study findings can help inform COVID-19 health communication campaigns and highlight the impact of using a variety of different and trusted information sources. %M 32936775 %R 10.2196/21071 %U http://publichealth.jmir.org/2020/4/e21071/ %U https://doi.org/10.2196/21071 %U http://www.ncbi.nlm.nih.gov/pubmed/32936775 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e18200 %T Applying Digital Information Delivery to Convert Habits of Antibiotic Use in Primary Care in Germany: Mixed-Methods Study %A Poss-Doering,Regina %A Kuehn,Lukas %A Kamradt,Martina %A Glassen,Katharina %A Wensing,Michel %+ Department of General Practice and Health Services Research, University Hospital Heidelberg, Im Neuenheimer Feld 130.3, Heidelberg, 69120, Germany, 49 6221 56 ext 38643, regina.poss-doering@med.uni-heidelberg.de %K antimicrobial resistance %K educative digital solutions %K health literacy %K diffusion of innovations %D 2020 %7 7.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Antimicrobial resistance is an important global health issue. In Germany, the national agenda supports various interventions to convert habits of antibiotic use. In the CHANGE-3 (Converting Habits of Antibiotic Use for Respiratory Tract Infections in German Primary Care) study, digital tools were applied for information delivery: tablet computers in primary care practices, e-learning platforms for medical professionals, and a public website to promote awareness and health literacy among primary care physicians, their teams, and their patients. Objective: This study is embedded in the process evaluation of the CHANGE-3 study. The aim of this study was to evaluate the acceptance and uptake of digital devices for the delivery of health-related information to enhance awareness and change habits of antibiotic use in primary care in Germany. Methods: This study used a convergent-parallel mixed-methods design. Audio-recorded semistructured telephone interviews were conducted with physicians, nonphysician health professionals, and patients in the CHANGE-3 program. Pseudonymized verbatim transcripts were coded using thematic analysis. In-depth analysis was performed based on the inductive category of information provision via digital information tools. Identified themes were related to the main postulates of Diffusion of Innovations theory (DIT) to provide an explanatory frame. In addition, data generated through a structured survey with physicians and nonphysician health professionals in the program were analyzed descriptively and integrated with the qualitative data to explore the complementarity of the findings. Results: Findings regarding the acceptance and uptake of digital devices were related to three postulates of DIT: innovation characteristics, communication channels, and unanticipated consequences. Participants considered the provided digital educative solutions to be supportive for promoting health literacy regarding conversion of habits of antibiotic use. However, health care professionals found it challenging to integrate these solutions into existing routines in primary care and to align them with their professional values. Low technology affinity was a major barrier to the use of digital information in primary care. Patients welcomed the general idea of introducing health-related information in digital formats; however, they expressed concerns about device-related hygiene and the appropriateness of the digital tools for older patients. Conclusions: Patients and medical professionals in German primary care are reluctant to use digital devices for information and education. Using a Diffusion of Innovations approach can support assessment of existing barriers and provide information about setting-specific preconditions that are necessary for future tailoring of implementation strategies. Trial Registration: International Standard Randomized Controlled Trial Number (ISRCTN) 15061174; http://www.isrctn.com/ISRCTN15061174. %M 32960773 %R 10.2196/18200 %U http://www.jmir.org/2020/10/e18200/ %U https://doi.org/10.2196/18200 %U http://www.ncbi.nlm.nih.gov/pubmed/32960773 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 4 %P e22117 %T Human-Animal Interaction and the Emergence of SARS-CoV-2 %A Hassani,Asma %A Khan,Gulfaraz %+ Department of Medical Microbiology and Immunology, College of Medicine and Health Sciences, United Arab Emirates University, Tawam Hospital Campus, Al Ain, United Arab Emirates, 971 3 7137482, g_khan@uaeu.ac.ae %K zoonosis %K human-animal interface %K COVID-19 %K SARS-CoV-1 %K outbreak %K virus %K transmission %K pathogen %K emergence %K reservoir %D 2020 %7 7.10.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The COVID-19 pandemic has affected all sectors of society, from health and economics to socialization and travel. The level and extent of this impact are unprecedented. Although the cause of COVID-19 was quickly identified to be a new coronavirus (SARS-CoV-2), the world was poorly prepared for preventing its spread. One important pillar of preparedness is surveillance of the sources of emerging pathogens and responding appropriately to prevent their spread in the human population. The ever-increasing interaction between humans and animals is one leading factor in facilitating the emergence of new pathogens. In this viewpoint, we discuss the possibility of the zoonotic origin of SARS-CoV-2, highlight the importance of understanding human-animal interaction to improve preparedness for future outbreaks, and outline recommendations for prevention. %M 33001837 %R 10.2196/22117 %U http://publichealth.jmir.org/2020/4/e22117/ %U https://doi.org/10.2196/22117 %U http://www.ncbi.nlm.nih.gov/pubmed/33001837 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21439 %T Clinical Predictive Models for COVID-19: Systematic Study %A Schwab,Patrick %A DuMont Schütte,August %A Dietz,Benedikt %A Bauer,Stefan %+ F Hoffmann-La Roche Ltd, Grenzacherstrasse 124, Basel, 4070, Switzerland, 41 793093361, patrick.schwab@icloud.com %K SARS-CoV-2 %K COVID-19 %K machine learning %K clinical prediction %K prediction %K infectious disease %K clinical data %K testing %K hospitalization %K intensive care %D 2020 %7 6.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: COVID-19 is a rapidly emerging respiratory disease caused by SARS-CoV-2. Due to the rapid human-to-human transmission of SARS-CoV-2, many health care systems are at risk of exceeding their health care capacities, in particular in terms of SARS-CoV-2 tests, hospital and intensive care unit (ICU) beds, and mechanical ventilators. Predictive algorithms could potentially ease the strain on health care systems by identifying those who are most likely to receive a positive SARS-CoV-2 test, be hospitalized, or admitted to the ICU. Objective: The aim of this study is to develop, study, and evaluate clinical predictive models that estimate, using machine learning and based on routinely collected clinical data, which patients are likely to receive a positive SARS-CoV-2 test or require hospitalization or intensive care. Methods: Using a systematic approach to model development and optimization, we trained and compared various types of machine learning models, including logistic regression, neural networks, support vector machines, random forests, and gradient boosting. To evaluate the developed models, we performed a retrospective evaluation on demographic, clinical, and blood analysis data from a cohort of 5644 patients. In addition, we determined which clinical features were predictive to what degree for each of the aforementioned clinical tasks using causal explanations. Results: Our experimental results indicate that our predictive models identified patients that test positive for SARS-CoV-2 a priori at a sensitivity of 75% (95% CI 67%-81%) and a specificity of 49% (95% CI 46%-51%), patients who are SARS-CoV-2 positive that require hospitalization with 0.92 area under the receiver operator characteristic curve (AUC; 95% CI 0.81-0.98), and patients who are SARS-CoV-2 positive that require critical care with 0.98 AUC (95% CI 0.95-1.00). Conclusions: Our results indicate that predictive models trained on routinely collected clinical data could be used to predict clinical pathways for COVID-19 and, therefore, help inform care and prioritize resources. %M 32976111 %R 10.2196/21439 %U http://www.jmir.org/2020/10/e21439/ %U https://doi.org/10.2196/21439 %U http://www.ncbi.nlm.nih.gov/pubmed/32976111 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21299 %T Diagnostic Accuracy of Web-Based COVID-19 Symptom Checkers: Comparison Study %A Munsch,Nicolas %A Martin,Alistair %A Gruarin,Stefanie %A Nateqi,Jama %A Abdarahmane,Isselmou %A Weingartner-Ortner,Rafael %A Knapp,Bernhard %+ Data Science Department, Symptoma, Landstraßer Gürtel 3, Vienna, 1030, Austria, 43 662458206, science@symptoma.com %K COVID-19 %K symptom checkers %K benchmark %K digital health %K symptom %K chatbot %K accuracy %D 2020 %7 6.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: A large number of web-based COVID-19 symptom checkers and chatbots have been developed; however, anecdotal evidence suggests that their conclusions are highly variable. To our knowledge, no study has evaluated the accuracy of COVID-19 symptom checkers in a statistically rigorous manner. Objective: The aim of this study is to evaluate and compare the diagnostic accuracies of web-based COVID-19 symptom checkers. Methods: We identified 10 web-based COVID-19 symptom checkers, all of which were included in the study. We evaluated the COVID-19 symptom checkers by assessing 50 COVID-19 case reports alongside 410 non–COVID-19 control cases. A bootstrapping method was used to counter the unbalanced sample sizes and obtain confidence intervals (CIs). Results are reported as sensitivity, specificity, F1 score, and Matthews correlation coefficient (MCC). Results: The classification task between COVID-19–positive and COVID-19–negative for “high risk” cases among the 460 test cases yielded (sorted by F1 score): Symptoma (F1=0.92, MCC=0.85), Infermedica (F1=0.80, MCC=0.61), US Centers for Disease Control and Prevention (CDC) (F1=0.71, MCC=0.30), Babylon (F1=0.70, MCC=0.29), Cleveland Clinic (F1=0.40, MCC=0.07), Providence (F1=0.40, MCC=0.05), Apple (F1=0.29, MCC=-0.10), Docyet (F1=0.27, MCC=0.29), Ada (F1=0.24, MCC=0.27) and Your.MD (F1=0.24, MCC=0.27). For “high risk” and “medium risk” combined the performance was: Symptoma (F1=0.91, MCC=0.83) Infermedica (F1=0.80, MCC=0.61), Cleveland Clinic (F1=0.76, MCC=0.47), Providence (F1=0.75, MCC=0.45), Your.MD (F1=0.72, MCC=0.33), CDC (F1=0.71, MCC=0.30), Babylon (F1=0.70, MCC=0.29), Apple (F1=0.70, MCC=0.25), Ada (F1=0.42, MCC=0.03), and Docyet (F1=0.27, MCC=0.29). Conclusions: We found that the number of correctly assessed COVID-19 and control cases varies considerably between symptom checkers, with different symptom checkers showing different strengths with respect to sensitivity and specificity. A good balance between sensitivity and specificity was only achieved by two symptom checkers. %M 33001828 %R 10.2196/21299 %U http://www.jmir.org/2020/10/e21299/ %U https://doi.org/10.2196/21299 %U http://www.ncbi.nlm.nih.gov/pubmed/33001828 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 10 %P e21955 %T Dynamic Panel Surveillance of COVID-19 Transmission in the United States to Inform Health Policy: Observational Statistical Study %A Oehmke,James Francis %A Moss,Charles B %A Singh,Lauren Nadya %A Oehmke,Theresa Bristol %A Post,Lori Ann %+ Buehler Center for Health Policy and Economics, Feinberg School of Medicine, Northwestern University, 420 E Superior St, Chicago, IL, , United States, 1 203 980 7107, lori.post@northwestern.edu %K COVID-19 %K models %K surveillance %K reopening America %K contagion %K metrics %K surveillance %K health policy %K public health %D 2020 %7 5.10.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The Great COVID-19 Shutdown aimed to eliminate or slow the spread of SARS-CoV-2, the virus that causes COVID-19. The United States has no national policy, leaving states to independently implement public health guidelines that are predicated on a sustained decline in COVID-19 cases. Operationalization of “sustained decline” varies by state and county. Existing models of COVID-19 transmission rely on parameters such as case estimates or R0 and are dependent on intensive data collection efforts. Static statistical models do not capture all of the relevant dynamics required to measure sustained declines. Moreover, existing COVID-19 models use data that are subject to significant measurement error and contamination. Objective: This study will generate novel metrics of speed, acceleration, jerk, and 7-day lag in the speed of COVID-19 transmission using state government tallies of SARS-CoV-2 infections, including state-level dynamics of SARS-CoV-2 infections. This study provides the prototype for a global surveillance system to inform public health practice, including novel standardized metrics of COVID-19 transmission, for use in combination with traditional surveillance tools. Methods: Dynamic panel data models were estimated with the Arellano-Bond estimator using the generalized method of moments. This statistical technique allows for the control of a variety of deficiencies in the existing data. Tests of the validity of the model and statistical techniques were applied. Results: The statistical approach was validated based on the regression results, which determined recent changes in the pattern of infection. During the weeks of August 17-23 and August 24-30, 2020, there were substantial regional differences in the evolution of the US pandemic. Census regions 1 and 2 were relatively quiet with a small but significant persistence effect that remained relatively unchanged from the prior 2 weeks. Census region 3 was sensitive to the number of tests administered, with a high constant rate of cases. A weekly special analysis showed that these results were driven by states with a high number of positive test reports from universities. Census region 4 had a high constant number of cases and a significantly increased persistence effect during the week of August 24-30. This change represents an increase in the transmission model R value for that week and is consistent with a re-emergence of the pandemic. Conclusions: Reopening the United States comes with three certainties: (1) the “social” end of the pandemic and reopening are going to occur before the “medical” end even while the pandemic is growing. We need improved standardized surveillance techniques to inform leaders when it is safe to open sections of the country; (2) varying public health policies and guidelines unnecessarily result in varying degrees of transmission and outbreaks; and (3) even those states most successful in containing the pandemic continue to see a small but constant stream of new cases daily. %M 32924962 %R 10.2196/21955 %U https://www.jmir.org/2020/10/e21955 %U https://doi.org/10.2196/21955 %U http://www.ncbi.nlm.nih.gov/pubmed/32924962 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 10 %P e23543 %T Safety and Efficacy of Convalescent Plasma to Treat Severe COVID-19: Protocol for the Saudi Collaborative Multicenter Phase II Study %A Albalawi,Mohammed %A Zaidi,Syed Ziauddin Ahmed %A AlShehry,Nawal %A AlAskar,Ahmed %A Zaidi,Abdul Rehman Zia %A Abdallah,Rania Nagib Mohammed %A Salam,Abdul %A AlSagheir,Ahmed %A AlMozain,Nour %A Elgohary,Ghada %A Batarfi,Khalid %A Alfaraedi,Alia %A Khojah,Osamah %A Al-Ansari,Rehab %A Alfaraj,Mona %A Dayel,Afra %A Al Bahrani,Ahmed %A Abdelhameed,Arwa Nabhan %A Alhumaidan,Hind %A Al-Otaibi,Jawaher M %A Radwi,Ghazala %A Raizah,Abdulrahman %A Shatry,Hind %A Alsaleh,Sara %A AlZahrani,Hazzaa %A Al-Hashmi,Hani %+ Adult Hematology & Stem Cell Transplantation Department, Oncology Centre, King Fahad Specialist Hospital, Amr Bin Thabet, P.O. Box 15373, Dammam, 31444, Saudi Arabia, 966 564773377, hashmih@yahoo.com %K coronaviruses %K SARS-CoV-2 %K COVID-19 %K antibodies %K convalescent plasma %K treatment %K immunology %K feasibility %K safety %K efficacy %K infectious disease %D 2020 %7 2.10.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: The COVID-19 pandemic is expected to cause significant morbidity and mortality. The development of an effective vaccine will take several months to become available, and its affordability is unpredictable. Transfusion of convalescent plasma (CP) may provide passive immunity. Based on initial data from China, a group of hematologists, infectious disease specialists, and intensivists drafted this protocol in March 2020. Objective: The aim of this study is to test the feasibility, safety, and efficacy of CP in treating patients with COVID-19 across Saudi Arabia. Methods: Eligible patients with COVID-19 will be recruited for CP infusion according to the inclusion criteria. As COVID-19 has proven to be a moving target as far as its management is concerned, we will use current definitions according to the Ministry of Health (MOH) guidelines for diagnosis, treatment, and recovery. All CP recipients will receive supportive management including all available recommended therapies according to the available MOH guidelines. Eligible CP donors will be patients with COVID-19 who have fully recovered from their disease according to MOH recovery criteria as detailed in the inclusion criteria. CP donors have to qualify as blood donors according to MOH regulations except for the history of COVID-19 in the recent past. We will also test the CP donors for the presence of SARS-CoV-2 antibodies by a rapid test, and aliquots will be archived for future antibody titration. Due to the perceived benefit of CP, randomization was not considered. However, we will compare the outcome of the cohort treated with CP with those who did not receive CP due to a lack of consent or lack of availability. In this national collaborative study, there is a likelihood of not finding exactly matched control group patients. Hence, we plan to perform a propensity score matching of the CP recipients with the comparator group patients for the major characteristics. We plan to collect demographic, clinical, and laboratory characteristics of both groups and compare the outcomes. A total sample size of 575 patients, 115 CP recipients and 460 matched controls (1:4 ratio), will be sufficient to detect a clinically important hospital stay and 30-day mortality difference between the two groups with 80% power and a 5% level of significance. Results: At present, patient recruitment is still ongoing, and the interim analysis of the first 40 patients will be shared soon. Conclusions: In this paper, we present a protocol for a national collaborative multicenter phase II study in Saudi Arabia for assessing the feasibility, safety, and potential efficacy of CP in treating patients with severe COVID-19. We plan to publish an interim report of the first 40 CP recipients and their matched comparators soon. Trial Registration: ClinicalTrials.gov NCT04347681; https://clinicaltrials.gov/ct2/show/NCT04347681 International Registered Report Identifier (IRRID): PRR1-10.2196/23543 %M 32903199 %R 10.2196/23543 %U https://www.researchprotocols.org/2020/10/e23543 %U https://doi.org/10.2196/23543 %U http://www.ncbi.nlm.nih.gov/pubmed/32903199 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 10 %P e21628 %T A Computer-Interpretable Guideline for COVID-19: Rapid Development and Dissemination %A Nan,Shan %A Tang,Tianhua %A Feng,Hongshuo %A Wang,Yijie %A Li,Mengyang %A Lu,Xudong %A Duan,Huilong %+ College of Biomedical Engineering and Instrumental Science, Zhejiang University, Zhouyiqing Building, 512, 38 Zheda Road, Hangzhou, Hangzhou, 310027, China, 86 13957118891, lvxd@zju.edu.cn %K COVID-19 %K guideline %K CDSS %K openEHR %K Guideline Definition Language %K development %K dissemination %K electronic health record %K algorithm %D 2020 %7 1.10.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: COVID-19 is a global pandemic that is affecting more than 200 countries worldwide. Efficient diagnosis and treatment are crucial to combat the disease. Computer-interpretable guidelines (CIGs) can aid the broad global adoption of evidence-based diagnosis and treatment knowledge. However, currently, no internationally shareable CIG exists. Objective: The aim of this study was to establish a rapid CIG development and dissemination approach and apply it to develop a shareable CIG for COVID-19. Methods: A 6-step rapid CIG development and dissemination approach was designed and applied. Processes, roles, and deliverable artifacts were specified in this approach to eliminate ambiguities during development of the CIG. The Guideline Definition Language (GDL) was used to capture the clinical rules. A CIG for COVID-19 was developed by translating, interpreting, annotating, extracting, and formalizing the Chinese COVID-19 diagnosis and treatment guideline. A prototype application was implemented to validate the CIG. Results: We used 27 archetypes for the COVID-19 guideline. We developed 18 GDL rules to cover the diagnosis and treatment suggestion algorithms in the narrative guideline. The CIG was further translated to object data model and Drools rules to facilitate its use by people who do not employ the non-openEHR archetype. The prototype application validated the correctness of the CIG with a public data set. Both the GDL rules and Drools rules have been disseminated on GitHub. Conclusions: Our rapid CIG development and dissemination approach accelerated the pace of COVID-19 CIG development. A validated COVID-19 CIG is now available to the public. %M 32931443 %R 10.2196/21628 %U https://medinform.jmir.org/2020/10/e21628 %U https://doi.org/10.2196/21628 %U http://www.ncbi.nlm.nih.gov/pubmed/32931443 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e23565 %T Clinical Mortality in a Large COVID-19 Cohort: Observational Study %A Jarrett,Mark %A Schultz,Susanne %A Lyall,Julie %A Wang,Jason %A Stier,Lori %A De Geronimo,Marcella %A Nelson,Karen %+ Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Hofstra University, 500 Hofstra University, Hempstead, NY, 11549, United States, 1 5163216044, MJarrett@northwell.edu %K COVID-19 %K mortality %K respiratory failure %K hypoxemia %K observational %K review %K cohort %K ICU %K intensive care unit %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Northwell Health, an integrated health system in New York, has treated more than 15,000 inpatients with COVID-19 at the US epicenter of the SARS-CoV-2 pandemic. Objective: We describe the demographic characteristics of patients who died of COVID-19, observation of frequent rapid response team/cardiac arrest (RRT/CA) calls for non–intensive care unit (ICU) patients, and factors that contributed to RRT/CA calls. Methods: A team of registered nurses reviewed the medical records of inpatients who tested positive for SARS-CoV-2 via polymerase chain reaction before or on admission and who died between March 13 (first Northwell Health inpatient expiration) and April 30, 2020, at 15 Northwell Health hospitals. The findings for these patients were abstracted into a database and statistically analyzed. Results: Of 2634 patients who died of COVID-19, 1478 (56.1%) had oxygen saturation levels ≥90% on presentation and required no respiratory support. At least one RRT/CA was called on 1112/2634 patients (42.2%) at a non-ICU level of care. Before the RRT/CA call, the most recent oxygen saturation levels for 852/1112 (76.6%) of these non-ICU patients were at least 90%. At the time the RRT/CA was called, 479/1112 patients (43.1%) had an oxygen saturation of <80%. Conclusions: This study represents one of the largest reviewed cohorts of mortality that also captures data in nonstructured fields. Approximately 50% of deaths occurred at a non-ICU level of care despite admission to the appropriate care setting with normal staffing. The data imply a sudden, unexpected deterioration in respiratory status requiring RRT/CA in a large number of non-ICU patients. Patients admitted at a non-ICU level of care suffered rapid clinical deterioration, often with a sudden decrease in oxygen saturation. These patients could benefit from additional monitoring (eg, continuous central oxygenation saturation), although this approach warrants further study. %M 32930099 %R 10.2196/23565 %U http://www.jmir.org/2020/9/e23565/ %U https://doi.org/10.2196/23565 %U http://www.ncbi.nlm.nih.gov/pubmed/32930099 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22767 %T Intergroup Contact, COVID-19 News Consumption, and the Moderating Role of Digital Media Trust on Prejudice Toward Asians in the United States: Cross-Sectional Study %A Tsai,Jiun-Yi %A Phua,Joe %A Pan,Shuya %A Yang,Chia-chen %+ School of Journalism and Communication, Renmin University of China, No. 59 Zhongguancun Street, Haidian District, Beijing, 100872, China, 86 10 62511081, shuya@ruc.edu.cn %K COVID-19 %K prejudice %K news exposure %K news trust %K infodemic %K media bias %K racism %K social media use %K intergroup contact %K regression %K moderation analysis %K cross-sectional survey %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The perceived threat of a contagious virus may lead people to be distrustful of immigrants and out-groups. Since the COVID-19 outbreak, the salient politicized discourses of blaming Chinese people for spreading the virus have fueled over 2000 reports of anti-Asian racial incidents and hate crimes in the United States. Objective: The study aims to investigate the relationships between news consumption, trust, intergroup contact, and prejudicial attitudes toward Asians and Asian Americans residing in the United States during the COVID-19 pandemic. We compare how traditional news, social media use, and biased news exposure cultivate racial attitudes, and the moderating role of media use and trust on prejudice against Asians is examined. Methods: A cross-sectional study was completed in May 2020. A total of 430 US adults (mean age 36.75, SD 11.49 years; n=258, 60% male) participated in an online survey through Amazon’s Mechanical Turk platform. Respondents answered questions related to traditional news exposure, social media use, perceived trust, and their top three news channels for staying informed about the novel coronavirus. In addition, intergroup contact and racial attitudes toward Asians were assessed. We performed hierarchical regression analyses to test the associations. Moderation effects were estimated using simple slopes testing with a 95% bootstrap confidence interval approach. Results: Participants who identified as conservatives (β=.08, P=.02), had a personal infection history (β=.10, P=.004), and interacted with Asian people frequently in their daily lives (β=.46, P<.001) reported more negative attitudes toward Asians after controlling for sociodemographic variables. Relying more on traditional news media (β=.08, P=.04) and higher levels of trust in social media (β=.13, P=.007) were positively associated with prejudice against Asians. In contrast, consuming news from left-leaning outlets (β=–.15, P=.001) and neutral outlets (β=–.13, P=.003) was linked to less prejudicial attitudes toward Asians. Among those who had high trust in social media, exposure had a negative relationship with prejudice. At high levels of trust in digital websites and apps, frequent use was related to less unfavorable attitudes toward Asians. Conclusions: Experiencing racial prejudice among the Asian population during a challenging pandemic can cause poor psychological outcomes and exacerbate health disparities. The results suggest that conservative ideology, personal infection history, frequency of intergroup contact, traditional news exposure, and trust in social media emerge as positive predictors of prejudice against Asians and Asian Americans, whereas people who get COVID-19 news from left-leaning and balanced outlets show less prejudice. For those who have more trust in social media and digital news, frequent use of these two sources is associated with lower levels of prejudice. Our findings highlight the need to reshape traditional news discourses and use social media and mobile news apps to develop credible messages for combating racial prejudice against Asians. %M 32924948 %R 10.2196/22767 %U http://www.jmir.org/2020/9/e22767/ %U https://doi.org/10.2196/22767 %U http://www.ncbi.nlm.nih.gov/pubmed/32924948 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22142 %T The Relation Between Official WhatsApp-Distributed COVID-19 News Exposure and Psychological Symptoms: Cross-Sectional Survey Study %A Liu,Jean C J %A Tong,Eddie M W %+ Yale-NUS College, 02-221, 16 College Avenue West, Singapore, 138527, Singapore, 65 66013694, jeanliu@yale-nus.edu.sg %K mental health %K social media %K pandemic %K depression %K anxiety %K stress %K COVID-19 %K app %K risk factor %K psychology %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In a global pandemic, digital technology offers innovative methods to disseminate public health messages. As an example, the messenger app WhatsApp was adopted by both the World Health Organization and government agencies to provide updates on the coronavirus disease (COVID-19). During a time when rumors and excessive news threaten psychological well-being, these services allow for rapid transmission of information and may boost resilience. Objective: In this study, we sought to accomplish the following: (1) assess well-being during the pandemic; (2) replicate prior findings linking exposure to COVID-19 news with psychological distress; and (3) examine whether subscription to an official WhatsApp channel can mitigate this risk. Methods: Across 8 weeks of the COVID-19 outbreak (March 7 to April 21, 2020), we conducted a survey of 1145 adults in Singapore. As the primary outcome measure, participants completed the Depression, Anxiety, and Stress Scale (DASS-21). As predictor variables, participants also answered questions pertaining to the following: (1) their exposure to COVID-19 news; (2) their use of the Singapore government’s WhatsApp channel; and (3) their demographics. Results: Within the sample, 7.9% of participants had severe or extremely severe symptoms on at least one DASS-21 subscale. Depression scores were associated with increased time spent receiving COVID-19 updates, whereas use of the official WhatsApp channel emerged as a protective factor (b=–0.07, t[863]=–2.04, P=.04). Similarly, increased anxiety scores were associated with increased exposure to both updates and rumors, but this risk was mitigated by trust in the government’s WhatsApp messages (b=–0.05, t[863]=–2.13, P=.03). Finally, although stress symptoms increased with the amount of time spent receiving updates, these symptoms were not significantly related to WhatsApp use. Conclusions: Our findings suggest that messenger apps may be an effective medium for disseminating pandemic-related information, allowing official agencies to reach a broad sector of the population rapidly. In turn, this use may promote public well-being amid an “infodemic.” Trial Registration: ClinicalTrials.gov NCT04305574; https://clinicaltrials.gov/ct2/show/NCT04305574 %M 32877349 %R 10.2196/22142 %U http://www.jmir.org/2020/9/e22142/ %U https://doi.org/10.2196/22142 %U http://www.ncbi.nlm.nih.gov/pubmed/32877349 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19992 %T Using Smartphones and Wearable Devices to Monitor Behavioral Changes During COVID-19 %A Sun,Shaoxiong %A Folarin,Amos A %A Ranjan,Yatharth %A Rashid,Zulqarnain %A Conde,Pauline %A Stewart,Callum %A Cummins,Nicholas %A Matcham,Faith %A Dalla Costa,Gloria %A Simblett,Sara %A Leocani,Letizia %A Lamers,Femke %A Sørensen,Per Soelberg %A Buron,Mathias %A Zabalza,Ana %A Guerrero Pérez,Ana Isabel %A Penninx,Brenda WJH %A Siddi,Sara %A Haro,Josep Maria %A Myin-Germeys,Inez %A Rintala,Aki %A Wykes,Til %A Narayan,Vaibhav A %A Comi,Giancarlo %A Hotopf,Matthew %A Dobson,Richard JB %A , %+ The Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, Social Genetic and Developmental Psychiatry Centre, Institute of Psychiatry, Psychology & Neuroscience, King's College London, PO Box 80 De Crespigny Park, Denmark Hill, London, SE58AF, United Kingdom, 44 02078480951, shaoxiong.sun@kcl.ac.uk %K mobile health %K COVID-19 %K behavioral monitoring %K smartphones %K wearable devices %K mobility %K phone use %D 2020 %7 25.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32877352 %R 10.2196/19992 %U https://www.jmir.org/2020/9/e19992 %U https://doi.org/10.2196/19992 %U http://www.ncbi.nlm.nih.gov/pubmed/32877352 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20924 %T Dynamic Panel Estimate–Based Health Surveillance of SARS-CoV-2 Infection Rates to Inform Public Health Policy: Model Development and Validation %A Oehmke,James Francis %A Oehmke,Theresa B %A Singh,Lauren Nadya %A Post,Lori Ann %+ Department of Emergency Medicine, Feinberg School of Medicine, Northwestern University, 420 E. Superior St, Chicago, IL, 60611, United States, 1 203 980 7107, lori.post@northwestern.edu %K COVID-19 %K models %K surveillance %K COVID-19 surveillance system %K dynamic panel data %K infectious disease modeling %K reopening America %K COVID-19 guidelines %K COVID-19 health policy %D 2020 %7 22.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: SARS-CoV-2, the novel coronavirus that causes COVID-19, is a global pandemic with higher mortality and morbidity than any other virus in the last 100 years. Without public health surveillance, policy makers cannot know where and how the disease is accelerating, decelerating, and shifting. Unfortunately, existing models of COVID-19 contagion rely on parameters such as the basic reproduction number and use static statistical methods that do not capture all the relevant dynamics needed for surveillance. Existing surveillance methods use data that are subject to significant measurement error and other contaminants. Objective: The aim of this study is to provide a proof of concept of the creation of surveillance metrics that correct for measurement error and data contamination to determine when it is safe to ease pandemic restrictions. We applied state-of-the-art statistical modeling to existing internet data to derive the best available estimates of the state-level dynamics of COVID-19 infection in the United States. Methods: Dynamic panel data (DPD) models were estimated with the Arellano-Bond estimator using the generalized method of moments. This statistical technique enables control of various deficiencies in a data set. The validity of the model and statistical technique was tested. Results: A Wald chi-square test of the explanatory power of the statistical approach indicated that it is valid (χ210=1489.84, P<.001), and a Sargan chi-square test indicated that the model identification is valid (χ2946=935.52, P=.59). The 7-day persistence rate for the week of June 27 to July 3 was 0.5188 (P<.001), meaning that every 10,000 new cases in the prior week were associated with 5188 cases 7 days later. For the week of July 4 to 10, the 7-day persistence rate increased by 0.2691 (P=.003), indicating that every 10,000 new cases in the prior week were associated with 7879 new cases 7 days later. Applied to the reported number of cases, these results indicate an increase of almost 100 additional new cases per day per state for the week of July 4-10. This signifies an increase in the reproduction parameter in the contagion models and corroborates the hypothesis that economic reopening without applying best public health practices is associated with a resurgence of the pandemic. Conclusions: DPD models successfully correct for measurement error and data contamination and are useful to derive surveillance metrics. The opening of America involves two certainties: the country will be COVID-19–free only when there is an effective vaccine, and the “social” end of the pandemic will occur before the “medical” end. Therefore, improved surveillance metrics are needed to inform leaders of how to open sections of the United States more safely. DPD models can inform this reopening in combination with the extraction of COVID-19 data from existing websites. %M 32915762 %R 10.2196/20924 %U http://www.jmir.org/2020/9/e20924/ %U https://doi.org/10.2196/20924 %U http://www.ncbi.nlm.nih.gov/pubmed/32915762 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19923 %T Determinants of Scale-up From a Small Pilot to a National Electronic Immunization Registry in Vietnam: Qualitative Evaluation %A Dang,Huyen %A Dao,Sang %A Carnahan,Emily %A Kawakyu,Nami %A Duong,Hong %A Nguyen,Trung %A Nguyen,Doan %A Nguyen,Linh %A Rivera,Maya %A Ngo,Tuan %A Werner,Laurie %A Nguyen,Nga %+ PATH, #1101, 11th Floor, Hanoi Towers, 49 Hai Bai Trung Street, Hoan Kiem District, Hanoi, , Vietnam, 84 24 3936 2216 ext 105, ntnguyen@path.org %K immunization %K immunization information system %K electronic immunization registry %K scale-up %K digital health intervention %K mHealth %K eHealth %D 2020 %7 22.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Digital health innovations can improve health system performance, yet previous experience has shown that many innovations do not advance beyond the pilot stage to achieve scale. Vietnam’s National Immunization Information System (NIIS) began as a series of digital health pilots, first initiated in 2010, and was officially launched nationwide in 2017. The NIIS is one of the few examples of an electronic immunization registry (EIR) at national scale in low- and middle-income countries. Objective: The aim of this study was to understand the determinants of scale-up of the national EIR in Vietnam. Methods: This qualitative study explored the facilitators and barriers to national scale-up of the EIR in Vietnam. Qualitative data were collected from October to December 2019 through in-depth key informant interviews and desk review. The mHealth Assessment and Planning for Scale (MAPS) Toolkit guided the development of the study design, interview guides, and analytic framework. MAPS defines the key determinants of success, or the “axes of scale,” to be groundwork, partnerships, financial health, technology and architecture, operations, and monitoring and evaluation. Results: The partnership and operations axes were critical to the successful scale-up of the EIR in Vietnam, while the groundwork and monitoring and the evaluation axes were considered to be strong contributors in the success of all the other axes. The partnership model leveraged complementary strengths of the technical working group partners: the Ministry of Health General Department of Preventive Medicine, the National Expanded Program on Immunization, Viettel (the mobile network operator), and PATH. The operational approach to introducing the NIIS with lean, iterative, and integrated training and supervision was also a key facilitator to successful scale-up. The financial health, technology and architecture, and operations axes were identified as barriers to successful deployment and scale-up. Key barriers to scale-up included insufficient estimates of operational costs, unanticipated volume of data storage and transmission, lack of a national ID to support interoperability, and operational challenges among end users. Overall, the multiple phases of EIR deployment and scale-up from 2010 to 2017 allowed for continuous learning and improvement that strengthened all the axes and contributed to successful scale-up. Conclusions: The results highlight the importance of the measured, iterative approach that was taken to gradually expand a series of small pilots to nationwide scale. The findings from this study can be used to inform other countries considering, introducing, or in the process of scaling an EIR or other digital health innovations. %M 32960184 %R 10.2196/19923 %U http://www.jmir.org/2020/9/e19923/ %U https://doi.org/10.2196/19923 %U http://www.ncbi.nlm.nih.gov/pubmed/32960184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22181 %T Increased Internet Searches for Insomnia as an Indicator of Global Mental Health During the COVID-19 Pandemic: Multinational Longitudinal Study %A Lin,Yu-Hsuan %A Chiang,Ting-Wei %A Lin,Yu-Lun %+ Institute of Population Health Sciences, National Health Research Institutes, Room A3234, No 35 Keyan Road, Zhunan Town, Miaoli County, 35053, Taiwan, 1 886 37206166 ext 36383, yuhsuanlin@nhri.edu.tw %K internet search %K Google Trends %K infodemiology %K infoveillance %K COVID-19 %K insomnia %K mental health %D 2020 %7 21.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Real-time global mental health surveillance is urgently needed for tracking the long-term impact of the COVID-19 pandemic. Objective: This study aimed to use Google Trends data to investigate the impact of the pandemic on global mental health by analyzing three keywords indicative of mental distress: “insomnia,” “depression,” and “suicide.” Methods: We examined increases in search queries for 19 countries. Significant increases were defined as the actual daily search value (from March 20 to April 19, 2020) being higher than the 95% CIs of the forecast from the 3-month baseline via ARIMA (autoregressive integrated moving average) modeling. We examined the correlation between increases in COVID-19–related deaths and the number of days with significant increases in search volumes for insomnia, depression, and suicide across multiple nations. Results: The countries with the greatest increases in searches for insomnia were Iran, Spain, the United States, and Italy; these countries exhibited a significant increase in insomnia searches on more than 10 of the 31 days observed. The number of COVID-19–related deaths was positively correlated to the number of days with an increase in searches for insomnia in the 19 countries (ρ=0.64, P=.003). By contrast, there was no significant correlation between the number of deaths and increases in searches for depression (ρ=–0.12, P=.63) or suicide (ρ=–0.07, P=.79). Conclusions: Our analysis suggests that insomnia could be a part of routine mental health screening during the COVID-19 pandemic. %M 32924951 %R 10.2196/22181 %U http://www.jmir.org/2020/9/e22181/ %U https://doi.org/10.2196/22181 %U http://www.ncbi.nlm.nih.gov/pubmed/32924951 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e21653 %T Hospital Epidemics Tracker (HEpiTracker): Description and Pilot Study of a Mobile App to Track COVID-19 in Hospital Workers %A Soriano,Joan B %A Fernández,Esteve %A de Astorza,Álvaro %A Pérez de Llano,Luis A %A Fernández-Villar,Alberto %A Carnicer-Pont,Dolors %A Alcázar-Navarrete,Bernardino %A García,Arturo %A Morales,Aurelio %A Lobo,María %A Maroto,Marcos %A Ferreras,Eloy %A Soriano,Cecilia %A Del Rio-Bermudez,Carlos %A Vega-Piris,Lorena %A Basagaña,Xavier %A Muncunill,Josep %A Cosio,Borja G %A Lumbreras,Sara %A Catalina,Carlos %A Alzaga,José María %A Gómez Quilón,David %A Valdivia,Carlos Alberto %A de Lara,Celia %A Ancochea,Julio %+ Hospital Universitario La Princesa, Universidad Autónoma de Madrid, Planta 6, Servicio de Neumología, Diego de León 62, Madrid, 28006, Spain, +34 915202200, jbsoriano2@gmail.com %K app %K COVID-19 %K coronavirus %K e-medicine %K monitoring %K symptoms %K surveillance %D 2020 %7 21.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Hospital workers have been the most frequently and severely affected professional group during the COVID-19 pandemic, and have a big impact on transmission. In this context, innovative tools are required to measure the symptoms compatible with COVID-19, the spread of infection, and testing capabilities within hospitals in real time. Objective: We aimed to develop and test an effective and user-friendly tool to identify and track symptoms compatible with COVID-19 in hospital workers. Methods: We developed and pilot tested Hospital Epidemics Tracker (HEpiTracker), a newly designed app to track the spread of COVID-19 among hospital workers. Hospital staff in 9 hospital centers across 5 Spanish regions (Andalusia, Balearics, Catalonia, Galicia, and Madrid) were invited to download the app on their phones and to register their daily body temperature, COVID-19–compatible symptoms, and general health score, as well as any polymerase chain reaction and serological test results. Results: A total of 477 hospital staff participated in the study between April 8 and June 2, 2020. Of note, both health-related (n=329) and non–health-related (n=148) professionals participated in the study; over two-thirds of participants (68.8%) were health workers (43.4% physicians and 25.4% nurses), while the proportion of non–health-related workers by center ranged from 40% to 85%. Most participants were female (n=323, 67.5%), with a mean age of 45.4 years (SD 10.6). Regarding smoking habits, 13.0% and 34.2% of participants were current or former smokers, respectively. The daily reporting of symptoms was highly variable across participating hospitals; although we observed a decline in adherence after an initial participation peak in some hospitals, other sites were characterized by low participation rates throughout the study period. Conclusions: HEpiTracker is an already available tool to monitor COVID-19 and other infectious diseases in hospital workers. This tool has already been tested in real conditions. HEpiTracker is available in Spanish, Portuguese, and English. It has the potential to become a customized asset to be used in future COVID-19 pandemic waves and other environments. Trial Registration: ClinicalTrials.gov NCT04326400; https://clinicaltrials.gov/ct2/show/NCT04326400 %M 32845852 %R 10.2196/21653 %U http://publichealth.jmir.org/2020/3/e21653/ %U https://doi.org/10.2196/21653 %U http://www.ncbi.nlm.nih.gov/pubmed/32845852 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e21866 %T Self-Reported Symptoms of SARS-CoV-2 Infection in a Nonhospitalized Population in Italy: Cross-Sectional Study of the EPICOVID19 Web-Based Survey %A Adorni,Fulvio %A Prinelli,Federica %A Bianchi,Fabrizio %A Giacomelli,Andrea %A Pagani,Gabriele %A Bernacchia,Dario %A Rusconi,Stefano %A Maggi,Stefania %A Trevisan,Caterina %A Noale,Marianna %A Molinaro,Sabrina %A Bastiani,Luca %A Fortunato,Loredana %A Jesuthasan,Nithiya %A Sojic,Aleksandra %A Pettenati,Carla %A Tavio,Marcello %A Andreoni,Massimo %A Mastroianni,Claudio %A Antonelli Incalzi,Raffaele %A Galli,Massimo %+ Infectious Diseases Unit, Department of Biomedical and Clinical Sciences L. Sacco, University of Milan, Via G.B. Grassi 74, Milan, 20157, Italy, 39 02 50319761, massimo.galli@unimi.it %K SARS-CoV-2 %K COVID-19 %K voluntary respondents %K web-based survey %K self-reported symptom %K nasopharyngeal swab testing %K cross-sectional %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Understanding the occurrence of symptoms resembling those of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in a large nonhospitalized population at the peak of the epidemic in Italy is of paramount importance; however, data are currently scarce. Objective: The aims of this study were to evaluate the association of self-reported symptoms with SARS-CoV-2 nasopharyngeal swab (NPS) test results in nonhospitalized individuals and to estimate the occurrence of symptoms associated with coronavirus disease (COVID-19) in a larger nontested population. Methods: EPICOVID19 is a self-administered cross-sectional voluntary web-based survey of adults throughout Italy who completed an anonymous questionnaire in the period of April 13 to 21, 2020. The associations between symptoms potentially related to SARS-CoV-2 infection and NPS results were calculated as adjusted odds ratios (aORs) with 95% CIs by multiple logistic regression analysis controlling for age, sex, education, smoking habits, and number of comorbidities. Thereafter, for each symptom and for combinations of the symptoms, we calculated the sensitivity, specificity, accuracy, and areas under the curve (AUCs) in a receiver operating characteristic (ROC) analysis to estimate the occurrence of COVID-19–like infection in the nontested population. Results: A total of 171,310 people responded to the survey, of whom 102,543 (59.9%) were women; mean age 47.4 years. Out of the 4785 respondents with known NPS test results, 4392 were not hospitalized. Among the 4392 nonhospitalized respondents, those with positive NPS tests (856, 19.5%) most frequently reported myalgia (527, 61.6%), olfactory and taste disorders (507, 59.2%), cough (466, 54.4%), and fever (444, 51.9%), whereas 7.7% were asymptomatic. Multiple regression analysis showed that olfactory and taste disorders (aOR 10.3, 95% CI 8.4-12.7), fever (aOR 2.5, 95% CI 2.0-3.1), myalgia (aOR 1.5, 95% CI 1.2-1.8), and cough (aOR 1.3, 95% CI 1.0-1.6) were associated with NPS positivity. Having two to four of these symptoms increased the aOR from 7.4 (95% CI 5.6-9.7) to 35.5 (95% CI 24.6-52.2). The combination of the four symptoms showed an AUC of 0.810 (95% CI 0.795-0.825) in classifying positive NPS test results and then was applied to the nonhospitalized and nontested sample (n=165,782). We found that 7739 to 20,103 of these 165,782 respondents (4.4% to 12.1%) had experienced symptoms suggestive of COVID-19 infection. Conclusions: Our results suggest that self-reported symptoms are reliable indicators of SARS-CoV-2 infection in a pandemic context. A nonnegligible number of symptomatic respondents (up to 12.1%) were undiagnosed and potentially contributed to the spread of the infection. Trial Registration: ClinicalTrials.gov NCT04471701; https://clinicaltrials.gov/ct2/show/NCT04471701 %M 32650305 %R 10.2196/21866 %U http://publichealth.jmir.org/2020/3/e21866/ %U https://doi.org/10.2196/21866 %U http://www.ncbi.nlm.nih.gov/pubmed/32650305 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e21152 %T Prediction of the Transition From Subexponential to the Exponential Transmission of SARS-CoV-2 in Chennai, India: Epidemic Nowcasting %A Krishnamurthy,Kamalanand %A Ambikapathy,Bakiya %A Kumar,Ashwani %A Britto,Lourduraj De %+ Vector Control Research Centre, Indian Council for Medical Research, Indra Nagar, Puducherry, 605006, India, 91 4132272841, rljbritto@gmail.com %K COVID-19 %K epidemic %K mathematical modeling %K probabilistic models %K public transport %K exponential transmission %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Several countries adopted lockdown to slowdown the exponential transmission of the coronavirus disease (COVID-19) epidemic. Disease transmission models and the epidemic forecasts at the national level steer the policy to implement appropriate intervention strategies and budgeting. However, it is critical to design a data-driven reliable model for nowcasting for smaller populations, in particular metro cities. Objective: The aim of this study is to analyze the transition of the epidemic from subexponential to exponential transmission in the Chennai metro zone and to analyze the probability of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) secondary infections while availing the public transport systems in the city. Methods: A single geographical zone “Chennai-Metro-Merge” was constructed by combining Chennai District with three bordering districts. Subexponential and exponential models were developed to analyze and predict the progression of the COVID-19 epidemic. Probabilistic models were applied to assess the probability of secondary infections while availing public transport after the release of the lockdown. Results: The model predicted that transition from subexponential to exponential transmission occurs around the eighth week after the reporting of a cluster of cases. The probability of secondary infections with a single index case in an enclosure of the city bus, the suburban train general coach, and the ladies coach was found to be 0.192, 0.074, and 0.114, respectively. Conclusions: Nowcasting at the early stage of the epidemic predicts the probable time point of the exponential transmission and alerts the public health system. After the lockdown release, public transportation will be the major source of SARS-CoV-2 transmission in metro cities, and appropriate strategies based on nowcasting are needed. %M 32609621 %R 10.2196/21152 %U https://publichealth.jmir.org/2020/3/e21152 %U https://doi.org/10.2196/21152 %U http://www.ncbi.nlm.nih.gov/pubmed/32609621 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 9 %P e20606 %T Knowledge and Psychological Stress Related to COVID-19 Among Nursing Staff in a Hospital in China: Cross-Sectional Survey Study %A Huang,Huaping %A Zhao,Wen-Jun %A Li,Gui-Rong %+ Department of Nursing, Mianyang Central Hospital, No.12, Changjia Alley, Jingzhogn Street, Fucheng District, Mianyang, 621000, China, 86 0816 2239671, 384895848@qq.com %K COVID-19 %K nursing staff %K knowledge %K psychological stress %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: Since December 2019, coronavirus disease (COVID-19) has been rapidly spreading worldwide. Nurses play a key role in fighting this disease and are at risk of COVID-19 infection. Therefore, there is an urgent need to assess the mental health condition of nurses and establish appropriate interventions to reduce the negative psychiatric outcomes of the pandemic. Objective: The objectives of this study were to evaluate the knowledge and psychological stress related to COVID-19 among nursing staff and to provide evidence of the need for targeted training and psychological intervention. Methods: This cross-sectional web-based survey study was performed in a class 3 grade A general hospital in a southwest province of China from March 1 to March 15, 2020. A self-designed questionnaire with questions about COVID-19–related prevention and control knowledge and the Triage Assessment Form (TAF) were used to assess nursing staff’s knowledge of COVID-19 and their degree of psychological stress, respectively. SPSS 23.0 was applied for statistical analysis of the collected data. Results: A total of 979 nurses completed the questionnaire. The results showed that the nursing staff provided the fewest correct answers to questions about continuous viral nucleic acid testing specifications (379/979 correct answers, 38.7%), isolation/discharge criteria (539/979 correct answers, 55.1%), and management measures for patients with suspected symptoms (713/979 correct answers, 72.8%). The median total score of the TAF was 7.0 (IQR 5.0-12.0), and there were statistically significant differences in scores between different nursing roles, years of work experience, and hospital departments (P<.05). Conclusions: This study indicated that nursing staff have insufficient knowledge about COVID-19. Meanwhile, although the psychological damage to nurses during the pandemic was found to be low, nurse managers must continue to monitor the mental health of nursing staff and perform timely interventions. %M 32640419 %R 10.2196/20606 %U https://formative.jmir.org/2020/9/e20606 %U https://doi.org/10.2196/20606 %U http://www.ncbi.nlm.nih.gov/pubmed/32640419 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e20156 %T Digital Media’s Role in the COVID-19 Pandemic %A Bao,Huanyu %A Cao,Bolin %A Xiong,Yuan %A Tang,Weiming %+ UNC Project-China, No. 2 Lujing Road, Guangzhou, 510095, China, 86 15920567132, weimingtangscience@gmail.com %K COVID-19 %K digital health %K media %K pandemic %K public health %K social media %K dissemination %K health information %K mobile health %D 2020 %7 18.9.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X The severe acute respiratory syndrome coronavirus 2 outbreak has had a significant impact on global health, the economy, and society as a whole. Various measures are being taken to respond to the pandemic, with digital media playing a pivotal role, especially in the use of visual data to disseminate information, mobile health to coordinate medical resources, social media to promote public health campaigns, and digital tools to assist population management and disease tracing. However, digital media also faces some challenges like misinformation, lack of guidance, and information leakage. We encourage the increased use of digital media with a focus on improving trust, building social solidarity, reducing chaos, educating the public on prevention measures, and reducing the medical burden in facility-based sites. %M 32530817 %R 10.2196/20156 %U https://mhealth.jmir.org/2020/9/e20156 %U https://doi.org/10.2196/20156 %U http://www.ncbi.nlm.nih.gov/pubmed/32530817 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19630 %T Global Changes and Factors of Increase in Caloric/Salty Food Intake, Screen Use, and Substance Use During the Early COVID-19 Containment Phase in the General Population in France: Survey Study %A Rolland,Benjamin %A Haesebaert,Frédéric %A Zante,Elodie %A Benyamina,Amine %A Haesebaert,Julie %A Franck,Nicolas %+ Service Universitaire d'Addictologie de Lyon, CH Le Vinatier, Hospices Civils de Lyon, Bâtiment 502, Bron, 69500, France, 33 0437915075, benjrolland@gmail.com %K COVID-19 %K containment %K eating behaviors %K screen use %K internet use %K substance use %K public health %K mental health %K pandemic %K lifestyle %K online survey %K addiction %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The international outbreak of coronavirus disease (COVID-19) has led many countries to enforce drastic containment measures. It has been suggested that this abrupt lockdown of populations will foster addiction-related habits such as caloric/salty food intake, screen use, and substance use. Objective: Our aim was to assess the global changes and factors of increase in addiction-related habits during the early COVID-19 containment phase in France. Methods: A web-based survey was provided from day 8 to day 13 of the containment and was completed by 11,391 participants. The questions explored sociodemographic features, psychiatric/addiction history, material conditions of lockdown, general stress, mental well-being, and reported changes in several addiction-related behaviors. Global changes were described and factors of increase were explored using population-weighted and adjusted logistic regression models, providing adjusted odds ratios (aORs) and their 95% confidence intervals. Results: Overall, the respondents reported more increases in addiction-related habits than decreases, specifically 28.4% (caloric/salty food intake), 64.6% (screen use), 35.6% (tobacco use), 24.8% (alcohol use), and 31.2% (cannabis use). Reduced well-being scores and increased stress scores were general factors of increase in addiction-related habits (P<.001 for all habits). Factors of increase in caloric/salty food intake (n=10,771) were female gender (aOR 1.62, 95% CI 1.48-1.77), age less than 29 years (P<.001), having a partner (aOR 1.19, 95% CI 1.06-1.35), being locked down in a more confined space (per 1 square meter/person decrease: aOR 1.02, 95% CI 1.01-1.03), being locked down alone (aOR 1.29, 95% CI 1.11-1.49), and reporting current (aOR 1.94, 95% CI 1.62-2.31) or past (aOR 1.27, 95% CI 1.09-1.47) psychiatric treatment. Factors of increase in screen use (n=11,267) were female gender (aOR 1.31, 95% CI 1.21-1.43), age less than 29 years (P<.001), having no partner (aOR 1.18, 95% CI 1.06-1.32), being employed (P<.001), intermediate/high education level (P<.001), being locked down with no access to an outdoor space (aOR 1.16, 95% CI 1.05-1.29), being locked down alone (aOR 1.15, 95% CI 1.01-1.32), living in an urban environment (P<.01), and not working (P<.001). Factors of increase in tobacco use (n=2787) were female gender (aOR 1.31, 95% CI 1.11-1.55), having no partner (aOR 1.30, 95% CI 1.06-1.59), intermediate/low education level (P<.01), and still working in the workplace (aOR 1.47, 95% CI 1.17-1.86). Factors of increase in alcohol use (n=7108) were age 30-49 years (P<.05), a high level of education (P<.001), and current psychiatric treatment (aOR 1.44, 95% CI 1.10-1.88). The only significant factor of increase in cannabis use (n=620) was intermediate/low level of education (P<.001). Conclusions: The early phase of COVID-19 containment in France led to widespread increases in addiction-related habits in the general population. Reduced well-being and increased stress were universal factors of increase. More specific factors were associated with increases in each of the explored habits. %M 32589149 %R 10.2196/19630 %U http://publichealth.jmir.org/2020/3/e19630/ %U https://doi.org/10.2196/19630 %U http://www.ncbi.nlm.nih.gov/pubmed/32589149 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 6 %N 1 %P e19047 %T Awareness and Preparedness of Field Epidemiology Training Program Graduates to Respond to COVID-19 in the Eastern Mediterranean Region: Cross-Sectional Study %A Al Nsour,Mohannad %A Khader,Yousef %A Al Serouri,Abdulwahed %A Bashier,Haitham %A Osman,Shahd %+ Jordan University of Science and Technology, Alramtha-Amman Street, Irbid, 22110, Jordan, 962 796802040, yskhader@just.edu.jo %K COVID-19 %K infection %K preparedness %K awareness %K Jordan %K Yemen %K Sudan %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Med Educ %G English %X Background: The Field Epidemiology Training Program (FETP) is a 2-year training program in applied epidemiology. FETP graduates have contributed significantly to improvements in surveillance systems, control of infectious diseases, and outbreak investigations in the Eastern Mediterranean Region (EMR). Objective: Considering the instrumental roles of FETP graduates during the coronavirus disease (COVID-19) crisis, this study aimed to assess their awareness and preparedness to respond to the COVID-19 pandemic in three EMR countries. Methods: An online survey was sent to FETP graduates in the EMR in March 2020. The FETP graduates were contacted by email and requested to fill out an online survey. Sufficient number of responses were received from only three countries—Jordan, Sudan, and Yemen. A few responses were received from other countries, and therefore, they were excluded from the analysis. The questionnaire comprised a series of questions pertaining to sociodemographic characteristics, knowledge of the epidemiology of COVID-19, and preparedness to respond to COVID-19. Results: This study included a total of 57 FETP graduates (20 from Jordan, 13 from Sudan, and 24 from Yemen). A total of 31 (54%) graduates had attended training on COVID-19, 29 (51%) were members of a rapid response team against COVID-19, and 54 (95%) had previous experience in response to disease outbreaks or health emergencies. The vast majority were aware of the main symptoms, mode of transmission, high-risk groups, and how to use personal protective equipment. A total of 46 (81%) respondents considered themselves well prepared for the COVID-19 outbreak, and 40 (70%) reported that they currently have a role in supporting the country’s efforts in the management of COVID-19 outbreak. Conclusions: The FETP graduates in Jordan, Sudan, and Yemen were fully aware of the epidemiology of COVID-19 and the safety measures required, and they are well positioned to investigate and respond to the COVID-19 pandemic. Therefore, they should be properly and efficiently utilized by the Ministries of Health to investigate and respond to the current COVID-19 crisis where the needs are vastly growing and access to outside experts is becoming limited. %M 32406852 %R 10.2196/19047 %U http://mededu.jmir.org/2020/1/e19047/ %U https://doi.org/10.2196/19047 %U http://www.ncbi.nlm.nih.gov/pubmed/32406852 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e18965 %T Flexible, Freely Available Stochastic Individual Contact Model for Exploring COVID-19 Intervention and Control Strategies: Development and Simulation %A Churches,Timothy %A Jorm,Louisa %+ Ingham Institute for Applied Medical Research, South Western Sydney Clinical School, Faculty of Medicine, University of New South Wales Sydney, 1 Campbell St, Liverpool, 2071, Australia, 61 468819609, timothy.churches@unsw.edu.au %K COVID-19 %K epidemic curve %K infection dynamics %K public health interventions %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Throughout March 2020, leaders in countries across the world were making crucial decisions about how and when to implement public health interventions to combat the coronavirus disease (COVID-19). They urgently needed tools to help them to explore what will work best in their specific circumstances of epidemic size and spread, and feasible intervention scenarios. Objective: We sought to rapidly develop a flexible, freely available simulation model for use by modelers and researchers to allow investigation of how various public health interventions implemented at various time points might change the shape of the COVID-19 epidemic curve. Methods: “COVOID” (COVID-19 Open-Source Infection Dynamics) is a stochastic individual contact model (ICM), which extends the ICMs provided by the open-source EpiModel package for the R statistical computing environment. To demonstrate its use and inform urgent decisions on March 30, 2020, we modeled similar intervention scenarios to those reported by other investigators using various model types, as well as novel scenarios. The scenarios involved isolation of cases, moderate social distancing, and stricter population “lockdowns” enacted over varying time periods in a hypothetical population of 100,000 people. On April 30, 2020, we simulated the epidemic curve for the three contiguous local areas (population 287,344) in eastern Sydney, Australia that recorded 5.3% of Australian cases of COVID-19 through to April 30, 2020, under five different intervention scenarios and compared the modeled predictions with the observed epidemic curve for these areas. Results: COVOID allocates each member of a population to one of seven compartments. The number of times individuals in the various compartments interact with each other and their probability of transmitting infection at each interaction can be varied to simulate the effects of interventions. Using COVOID on March 30, 2020, we were able to replicate the epidemic response patterns to specific social distancing intervention scenarios reported by others. The simulated curve for three local areas of Sydney from March 1 to April 30, 2020, was similar to the observed epidemic curve in terms of peak numbers of cases, total numbers of cases, and duration under a scenario representing the public health measures that were actually enacted, including case isolation and ramp-up of testing and social distancing measures. Conclusions: COVOID allows rapid modeling of many potential intervention scenarios, can be tailored to diverse settings, and requires only standard computing infrastructure. It replicates the epidemic curves produced by other models that require highly detailed population-level data, and its predicted epidemic curve, using parameters simulating the public health measures that were enacted, was similar in form to that actually observed in Sydney, Australia. Our team and collaborators are currently developing an extended open-source COVOID package comprising of a suite of tools to explore intervention scenarios using several categories of models. %M 32568729 %R 10.2196/18965 %U https://publichealth.jmir.org/2020/3/e18965 %U https://doi.org/10.2196/18965 %U http://www.ncbi.nlm.nih.gov/pubmed/32568729 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e18939 %T Using Open-Source Intelligence to Detect Early Signals of COVID-19 in China: Descriptive Study %A Kpozehouen,Elizabeth Benedict %A Chen,Xin %A Zhu,Mengyao %A Macintyre,C Raina %+ Biosecurity Program, The Kirby Institute for Infection and Immunity, University of New South Wales, Level 6 Wallace Wurth Building, University of New South Wales, Sydney, 2052, Australia, 61 93850082, bettysanga@protonmail.com %K COVID-19 %K infectious disease %K surveillance %K epidemiology %K biosecurity %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) outbreak in China was first reported to the World Health Organization (WHO) on December 31, 2019, and the first cases were officially identified around December 8, 2019. Although the origin of COVID-19 has not been confirmed, approximately half of the early cases were linked to a seafood market in Wuhan. However, the first two documented patients did not visit the seafood market. News reports, social media, and informal sources may provide information about outbreaks prior to formal notification. Objective: The aim of this study was to identify early signals of pneumonia or severe acute respiratory illness (SARI) in China prior to official recognition of the COVID-19 outbreak in December 2019 using open-source data. Methods: To capture early reports, we searched an open source epidemic observatory, EpiWatch, for SARI or pneumonia-related illnesses in China from October 1, 2019. The searches were conducted using Google and the Chinese search engine Baidu. Results: There was an increase in reports following the official notification of COVID-19 to the WHO on December 31, 2019, and a report that appeared on December 26, 2019 was retracted. A report of severe pneumonia on November 22, 2019, in Xiangyang was identified, and a potential index patient was retrospectively identified on November 17. Conclusions: The lack of reports of SARI outbreaks prior to December 31, 2019, with a retracted report on December 26, suggests media censorship, given that formal reports indicate that cases began appearing on December 8. However, the findings also support a relatively recent origin of COVID-19 in November 2019. The case reported on November 22 was transferred to Wuhan approximately one incubation period before the first identified cases on December 8; this case should be further investigated, as only half of the early cases were exposed to the seafood market in Wuhan. Another case of COVID-19 has since been retrospectively identified in Hubei on November 17, 2019, suggesting that the infection was present prior to December. %M 32598290 %R 10.2196/18939 %U http://publichealth.jmir.org/2020/3/e18939/ %U https://doi.org/10.2196/18939 %U http://www.ncbi.nlm.nih.gov/pubmed/32598290 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e21845 %T Communication Technology Preferences of Hospitalized and Institutionalized Frail Older Adults During COVID-19 Confinement: Cross-Sectional Survey Study %A Sacco,Guillaume %A Lléonart,Sébastien %A Simon,Romain %A Noublanche,Frédéric %A Annweiler,Cédric %A , %+ Department of Geriatric Medicine and Memory Clinic, University Hospital of Angers, 4 Rue Larey, Angers , France, 33 609733254, yogisacco@gmail.com %K video communication %K telephone %K older adults %K nursing home %K hospital %K confinement %K elderly %K COVID-19 %K communication %K technology %K social isolation %K loneliness %D 2020 %7 18.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Technological communication methods such as telephone calls and video calls can help prevent social isolation and loneliness in frail older adults during confinement. Objective: Our objectives were to determine which virtual communication method (ie, telephone call or video call) was preferred by confined older hospital patients and nursing home residents and the variables influencing this preference. Methods: The TOVID (Telephony Or Videophony for Isolated elDerly) study was a cross-sectional study that was designed to examine the preference between telephone calls and video calls among frail older adults who were either hospitalized in a geriatric acute care unit or institutionalized in a long-term care and nursing home during the COVID-19 confinement period. Results: A total of 132 older people were surveyed between March 25 and May 11, 2020 (mean age 88.2 years, SD 6.2); 79 (59.8%) were women. Patients hospitalized in the geriatric acute care unit were more able to establish communication independently than residents institutionalized in the long-term care and nursing home (P=.03) and were more satisfied with their communication experiences (P=.02). Overall, older people tended to favor telephone calls (73/132, 55.3%) over video calls (59/132, 44.7%); however, their satisfaction degree was similar regardless of the chosen method (P=.1), with no effect of age (P=.97) or gender (P=.2). In the geriatric acute care unit, the satisfaction degrees were similar for telephone calls (40/41, 98%) and video calls (33/38, 87%) in older patients (P=.10). Conversely, in the long-term care and nursing home, residents were more satisfied with the use of video calls to communicate with their relatives (14/15, 93%) versus the use of telephone calls (6/12, 50%; P=.02). Conclusions: Older people confined to health care settings were able to complete telephone calls more independently than video calls, and they tended to use telephone calls more often than video calls. The satisfaction degrees were similar with both modalities and even greater with video calls among long-term care and nursing home residents when they were given assistance to establish communication. Trial Registration: ClinicalTrials.gov NCT04333849: https://www.clinicaltrials.gov/ct2/show/NCT04333849. %M 32896832 %R 10.2196/21845 %U http://mhealth.jmir.org/2020/9/e21845/ %U https://doi.org/10.2196/21845 %U http://www.ncbi.nlm.nih.gov/pubmed/32896832 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20548 %T New York Inner City Hospital COVID-19 Experience and Current Data: Retrospective Analysis at the Epicenter of the American Coronavirus Outbreak %A Mani,Vishnu R %A Kalabin,Aleksandr %A Valdivieso,Sebastian C %A Murray-Ramcharan,Max %A Donaldson,Brian %+ Columbia University College of Physicians and Surgeons at Harlem Hospital, 506 Lenox Avenue, New York, NY, , United States, 1 2129391000 ext 1641, vishnu.mani@duke.edu %K SARS-CoV-2 %K COVID-19 %K pandemic %K New York City %K coronavirus outbreak %K American minority %K outbreak %K minority %K mortality %K patient %K characteristic %K mechanical ventilation %D 2020 %7 18.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In the midst of the coronavirus disease pandemic, emerging clinical data across the world has equipped frontline health care workers, policy makers, and researchers to better understand and combat the illness. Objective: The aim of this study is to report the correlation of clinical and laboratory parameters with patients requiring mechanical ventilation and the mortality in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Methods: We did a review of patients with SARS-CoV-2 confirmed infection admitted and managed by our institution during the last month. Patients were grouped into intubated and nonintubated, and subgrouped to alive and deceased. A comprehensive analysis using the following parameters were performed: age, sex, ethnicity, BMI, comorbidities, inflammatory markers, laboratory values, cardiac and renal function, electrocardiogram (EKG), chest x-ray findings, temperature, treatment groups, and hospital-acquired patients with SARS-CoV-2. Results: A total of 184 patients were included in our study with ages ranging from 28-97 years (mean 64.72 years) and including 73 females (39.67%) and 111 males (60.33%) with a mean BMI of 29.10. We had 114 African Americans (61.96%), 58 Hispanics (31.52%), 11 Asians (5.98%), and 1 Caucasian (0.54%), with a mean of 1.70 comorbidities. Overall, the mortality rate was 17.39% (n=32), 16.30% (n=30) of our patients required mechanical ventilation, and 11.41% (n=21) had hospital-acquired SARS-CoV-2 infection. Pertinent and statistically significant results were found in the intubated versus nonintubated patients with confirmed SARS-CoV-2 for the following parameters: age (P=.01), BMI (P=.07), African American ethnicity (P<.001), Hispanic ethnicity (P=.02), diabetes mellitus (P=.001), creatinine (P=.29), blood urea nitrogen (BUN; P=.001), procalcitonin (P=.03), C-reactive protein (CRP; P=.007), lactate dehydrogenase (LDH; P=.001), glucose (P=.01), temperature (P=.004), bilateral pulmonary infiltrates in chest x-rays (P<.001), and bilateral patchy opacity (P=.02). The results between the living and deceased subgroups of patients with confirmed SARS-CoV-2 (linking to or against mortality) were BMI (P=.04), length of stay (P<.001), hypertension (P=.02), multiple comorbidity (P=.045), BUN (P=.04), and EKG findings with arrhythmias or blocks (P=.02). Conclusions: We arrived at the following conclusions based on a comprehensive review of our study group, data collection, and statistical analysis. Parameters that were strongly correlated with the need for mechanical ventilation were younger age group, overweight, Hispanic ethnicity, higher core body temperature, EKG findings with sinus tachycardia, and bilateral diffuse pulmonary infiltrates on the chest x-rays. Those intubated exhibited increased disease severity with significantly elevated levels of serum procalcitonin, CRP, LDH, mean glucose, creatinine, and BUN. Mortality was strongly correlated with BMI, African American ethnicity, hypertension, presence of multiple comorbidities (with a mean of 2.32), worsening renal function with acute kidney injury or acute chronic kidney injury, and EKG findings of arrhythmias and heart blocks. %M 32540837 %R 10.2196/20548 %U https://www.jmir.org/2020/9/e20548 %U https://doi.org/10.2196/20548 %U http://www.ncbi.nlm.nih.gov/pubmed/32540837 %0 Journal Article %@ 2368-7959 %I JMIR Publications %V 7 %N 9 %P e20157 %T Pediatric Telebehavioral Health: A Transformational Shift in Care Delivery in the Era of COVID-19 %A Ramtekkar,Ujjwal %A Bridge,Jeffrey A %A Thomas,Glenn %A Butter,Eric %A Reese,Jennifer %A Logan,Erica %A Lin,Simon %A Axelson,David %+ Department of Psychiatry, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Drive, Columbus, OH, 43205, United States, 1 614 722 6811, ujjwal.ramtekkar@nationwidechildrens.org %K telepsychiatry %K telebehavioral health %K child and adolescent psychiatry %K COVID-19 %D 2020 %7 18.9.2020 %9 Viewpoint %J JMIR Ment Health %G English %X The use of telebehavioral health has been expanding in the past decade to improve access to psychiatric care and address critical shortages in the psychiatric workforce. The coronavirus (COVID-19) pandemic forced a sudden shift from traditional in-person visits to alternative modalities. There are key factors associated with successful transitional and large-scale implementation of telehealth with existing resources. We describe the experience of a large health care system using telehealth technology, and we identify strategies and discuss considerations for long-term sustainability after the pandemic. %M 32525485 %R 10.2196/20157 %U https://mental.jmir.org/2020/9/e20157 %U https://doi.org/10.2196/20157 %U http://www.ncbi.nlm.nih.gov/pubmed/32525485 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20896 %T Can Disinfection Robots Reduce the Risk of Transmission of SARS-CoV-2 in Health Care and Educational Settings? %A Cresswell,Kathrin %A Sheikh,Aziz %+ Usher Institute, The University of Edinburgh, Teviot Place, Edinburgh, United Kingdom, 44 131 650 8102, kathrin.cresswell@ed.ac.uk %K robotics %K disinfection %K SARS-CoV-2 %K COVID-19 %K risk %K transmission %K virus %D 2020 %7 15.9.2020 %9 Viewpoint %J J Med Internet Res %G English %X We explore the opportunities and challenges surrounding the use of disinfection robots to reduce the risk of SARS-CoV-2 transmission in health care and educational settings. Although there is some potential for deploying robots to help with manual cleaning, the evidence base is mixed, and we highlight that there needs to be work to establish and enhance the effectiveness of these robots in inactivating the virus. %M 32903196 %R 10.2196/20896 %U http://www.jmir.org/2020/9/e20896/ %U https://doi.org/10.2196/20896 %U http://www.ncbi.nlm.nih.gov/pubmed/32903196 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20955 %T Excessive Media Consumption About COVID-19 is Associated With Increased State Anxiety: Outcomes of a Large Online Survey in Russia %A Nekliudov,Nikita A %A Blyuss,Oleg %A Cheung,Ka Yan %A Petrou,Loukia %A Genuneit,Jon %A Sushentsev,Nikita %A Levadnaya,Anna %A Comberiati,Pasquale %A Warner,John O %A Tudor-Williams,Gareth %A Teufel,Martin %A Greenhawt,Matthew %A DunnGalvin,Audrey %A Munblit,Daniel %+ Department of Infectious Disease, Faculty of Medicine, Imperial College London, Wright Fleming Building, Norfolk Place, Paddington, London, W2 1PG, United Kingdom, 44 (0) 7898257151, daniel.munblit08@imperial.ac.uk %K anxiety %K COVID-19 %K media consumption %K SARS-CoV-2 %K STAI %K state anxiety %K trait anxiety %K trust to government %K trust %K mental health %K social media %K survey %D 2020 %7 11.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has potentially had a negative impact on the mental health and well-being of individuals and families. Anxiety levels and risk factors within particular populations are poorly described. Objective: This study aims to evaluate confidence, understanding, trust, concerns, and levels of anxiety during the COVID-19 pandemic in the general population and assess risk factors for increased anxiety. Methods: We launched a cross-sectional online survey of a large Russian population between April 6 and 15, 2020, using multiple social media platforms. A set of questions targeted confidence, understanding, trust, and concerns in respondents. The State-Trait Anxiety Inventory was used to measure anxiety. Multiple linear regressions were used to model predictors of COVID-19–related anxiety. Results: The survey was completed by 23,756 out of 53,966 (44.0% response rate) unique visitors; of which, 21,364 were residing in 62 areas of Russia. State Anxiety Scale (S-Anxiety) scores were higher than Trait Anxiety Scale scores across all regions of Russia (median S-Anxiety score 52, IQR 44-60), exceeding published norms. Time spent following news on COVID-19 was strongly associated with an increased S-Anxiety adjusted for baseline anxiety level. One to two hours spent reading COVID-19 news was associated with a 5.46 (95% CI 5.03-5.90) point difference, 2-3 hours with a 7.06 (95% CI 6.37-7.74) point difference, and more than three hours with an 8.65 (95% CI 7.82-9.47) point difference, all compared to less than 30 minutes per day. Job loss during the pandemic was another important factor associated with higher S-Anxiety scores (3.95, 95% CI 3.31-4.58). Despite survey respondents reporting high confidence in information regarding COVID-19 as well as an understanding of health care guidance, they reported low overall trust in state and local authorities, and perception of country readiness. Conclusions: Among Russian respondents from multiple social media platforms, there was evidence of higher levels of state anxiety associated with recent job loss and increased news consumption, as well as lower than expected trust in government agencies. These findings can help inform the development of key public health messages to help reduce anxiety and raise perceived trust in governmental response to this current national emergency. Using a similar methodology, comparative surveys are ongoing in other national populations. %M 32788143 %R 10.2196/20955 %U https://www.jmir.org/2020/9/e20955 %U https://doi.org/10.2196/20955 %U http://www.ncbi.nlm.nih.gov/pubmed/32788143 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e22288 %T Association of Socioeconomic Changes due to the COVID-19 Pandemic With Health Outcomes in Patients With Skin Diseases: Cross-Sectional Survey Study %A Guo,Yeye %A Shen,Minxue %A Zhang,Xu %A Xiao,Yi %A Zhao,Shuang %A Yin,Mingzhu %A Bu,Wenbo %A Wang,Yan %A Chen,Xiang %A Su,Juan %+ Department of Dermatology, Xiangya Hospital, Central South University, Xiangya Road #87, Changsha, 410008, China, 86 731 84327377, sujuanderm@csu.edu.cn %K skin diseases %K coronavirus disease 2019 %K unemployment %K quality of life %K web-based %K survey %K dermatology %K COVID-19 %K lifestyle %K impact %K outcome %K isolation %D 2020 %7 11.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The outbreak of COVID-19 has profoundly influenced people’s lifestyles; these impacts have varied across subgroups of people. The pandemic-related impacts on the health outcomes of people with dermatological conditions are unknown. Objective: The aim of this paper was to study the association of COVID-19 pandemic–related impacts with health-related quality of life in patients with skin diseases. Methods: This was a cross-sectional study among Chinese patients with skin diseases. A self-administered web-based questionnaire was distributed through social media. Demographic and clinical data and pandemic-related impacts (isolation status, income changes, and employment status) were collected. The main outcomes included perceived stress (Visual Analog Scale), symptoms of anxiety (Generalized Anxiety Disorder-7) and depression (9-Item Patient Health Questionnaire), quality of life (Dermatology Life Quality Index), and health utility mapping based on the EQ-5D-3L descriptive system. Multivariable logistic regression was used to investigate the associations. Results: A total of 506 patients with skin diseases completed the survey. The mean age of the patients was 33.5 years (SD 14.0), and 217/506 patients (42.9%) were male. Among the 506 respondents, 128 (25.3%) were quarantined, 102 (20.2%) reported unemployment, and 317 (62.6%) reported decrease or loss of income since the pandemic. The pandemic-related impacts were significantly associated with impaired mental well-being and quality of life with different effects. Unemployment and complete loss of income were associated with the highest risks of adverse outcomes, with increases of 110% to 162% in the prevalence of anxiety, depression, and impaired quality of life. Conclusions: Isolation, income loss, and unemployment are associated with impaired health-related quality of life in patients with skin diseases during the COVID-19 pandemic. %M 32845850 %R 10.2196/22288 %U http://www.jmir.org/2020/9/e22288/ %U https://doi.org/10.2196/22288 %U http://www.ncbi.nlm.nih.gov/pubmed/32845850 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19446 %T Early Stage Machine Learning–Based Prediction of US County Vulnerability to the COVID-19 Pandemic: Machine Learning Approach %A Mehta,Mihir %A Julaiti,Juxihong %A Griffin,Paul %A Kumara,Soundar %+ Purdue University, Regenstrief Center for Healthcare Engineering, West Lafayette, IN, 47907, United States, 1 765 496 7395, paulgriffin@purdue.edu %K COVID-19 %K coronavirus %K prediction model %K county-level vulnerability %K machine learning %K XGBoost %D 2020 %7 11.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The rapid spread of COVID-19 means that government and health services providers have little time to plan and design effective response policies. It is therefore important to quickly provide accurate predictions of how vulnerable geographic regions such as counties are to the spread of this virus. Objective: The aim of this study is to develop county-level prediction around near future disease movement for COVID-19 occurrences using publicly available data. Methods: We estimated county-level COVID-19 occurrences for the period March 14 to 31, 2020, based on data fused from multiple publicly available sources inclusive of health statistics, demographics, and geographical features. We developed a three-stage model using XGBoost, a machine learning algorithm, to quantify the probability of COVID-19 occurrence and estimate the number of potential occurrences for unaffected counties. Finally, these results were combined to predict the county-level risk. This risk was then used as an estimated after-five-day-vulnerability of the county. Results: The model predictions showed a sensitivity over 71% and specificity over 94% for models built using data from March 14 to 31, 2020. We found that population, population density, percentage of people aged >70 years, and prevalence of comorbidities play an important role in predicting COVID-19 occurrences. We observed a positive association at the county level between urbanicity and vulnerability to COVID-19. Conclusions: The developed model can be used for identification of vulnerable counties and potential data discrepancies. Limited testing facilities and delayed results introduce significant variation in reported cases, which produces a bias in the model. %M 32784193 %R 10.2196/19446 %U http://publichealth.jmir.org/2020/3/e19446/ %U https://doi.org/10.2196/19446 %U http://www.ncbi.nlm.nih.gov/pubmed/32784193 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21562 %T Excess Patient Visits for Cough and Pulmonary Disease at a Large US Health System in the Months Prior to the COVID-19 Pandemic: Time-Series Analysis %A Elmore,Joann G %A Wang,Pin-Chieh %A Kerr,Kathleen F %A Schriger,David L %A Morrison,Douglas E %A Brookmeyer,Ron %A Pfeffer,Michael A %A Payne,Thomas H %A Currier,Judith S %+ Department of Medicine, David Geffen School of Medicine, UCLA, 1100 Glendon Ave, Suite 900, Los Angeles, CA, 90024, United States, 1 310 794 9505, jelmore@mednet.ucla.edu %K COVID-19 %K pandemic %K electronic health record %K time-series analysis %K prediction %K forecast %D 2020 %7 10.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Accurately assessing the regional activity of diseases such as COVID-19 is important in guiding public health interventions. Leveraging electronic health records (EHRs) to monitor outpatient clinical encounters may lead to the identification of emerging outbreaks. Objective: The aim of this study is to investigate whether excess visits where the word “cough” was present in the EHR reason for visit, and hospitalizations with acute respiratory failure were more frequent from December 2019 to February 2020 compared with the preceding 5 years. Methods: A retrospective observational cohort was identified from a large US health system with 3 hospitals, over 180 clinics, and 2.5 million patient encounters annually. Data from patient encounters from July 1, 2014, to February 29, 2020, were included. Seasonal autoregressive integrated moving average (SARIMA) time-series models were used to evaluate if the observed winter 2019/2020 rates were higher than the forecast 95% prediction intervals. The estimated excess number of visits and hospitalizations in winter 2019/2020 were calculated compared to previous seasons. Results: The percentage of patients presenting with an EHR reason for visit containing the word “cough” to clinics exceeded the 95% prediction interval the week of December 22, 2019, and was consistently above the 95% prediction interval all 10 weeks through the end of February 2020. Similar trends were noted for emergency department visits and hospitalizations starting December 22, 2019, where observed data exceeded the 95% prediction interval in 6 and 7 of the 10 weeks, respectively. The estimated excess over the 3-month 2019/2020 winter season, obtained by either subtracting the maximum or subtracting the average of the five previous seasons from the current season, was 1.6 or 2.0 excess visits for cough per 1000 outpatient visits, 11.0 or 19.2 excess visits for cough per 1000 emergency department visits, and 21.4 or 39.1 excess visits per 1000 hospitalizations with acute respiratory failure, respectively. The total numbers of excess cases above the 95% predicted forecast interval were 168 cases in the outpatient clinics, 56 cases for the emergency department, and 18 hospitalized with acute respiratory failure. Conclusions: A significantly higher number of patients with respiratory complaints and diseases starting in late December 2019 and continuing through February 2020 suggests community spread of SARS-CoV-2 prior to established clinical awareness and testing capabilities. This provides a case example of how health system analytics combined with EHR data can provide powerful and agile tools for identifying when future trends in patient populations are outside of the expected ranges. %M 32791492 %R 10.2196/21562 %U https://www.jmir.org/2020/9/e21562 %U https://doi.org/10.2196/21562 %U http://www.ncbi.nlm.nih.gov/pubmed/32791492 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21490 %T Association Between Generalized Anxiety Disorder Scores and Online Activity Among US Adults During the COVID-19 Pandemic: Cross-Sectional Analysis %A Singh,Parvati %A Cumberland,William G %A Ugarte,Dominic %A Bruckner,Tim-Allen %A Young,Sean D %+ University of California Institute for Prediction Technology, University of California, Irvine, Irvine, CA, United States, 1 310 794 8530, parvatis@uci.edu %K online activity %K COVID-19 %K anxiety %K generalized anxiety disorder %K GAD %K scores %K stress %K anxiety %K internet %K survey %K cross-sectional %D 2020 %7 10.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32841152 %R 10.2196/21490 %U http://www.jmir.org/2020/9/e21490/ %U https://doi.org/10.2196/21490 %U http://www.ncbi.nlm.nih.gov/pubmed/32841152 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21319 %T Assessing the Impact of the COVID-19 Pandemic in Spain: Large-Scale, Online, Self-Reported Population Survey %A Oliver,Nuria %A Barber,Xavier %A Roomp,Kirsten %A Roomp,Kristof %+ The Institute for Human(ity)-Centric Artificial Intelligence, ELLIS Unit Alicante Foundation, Avenida Universidad, Alicante, 03690, Spain, 34 630726085, nuria@alum.mit.edu %K COVID-19 %K SARS-CoV-2 %K public health authorities %K large-scale online surveys %K infectious disease %K outbreak %K public engagement %K disease prevalence %K impact %K survey %K spain %K public health %K perception %D 2020 %7 10.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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 ±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. %M 32870159 %R 10.2196/21319 %U http://www.jmir.org/2020/9/e21319/ %U https://doi.org/10.2196/21319 %U http://www.ncbi.nlm.nih.gov/pubmed/32870159 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e17242 %T An Online Influenza Surveillance System for Primary Care Workers in Switzerland: Observational Prospective Pilot Study %A Martin,Sébastien %A Maeder,Muriel Nirina %A Gonçalves,Ana Rita %A Pedrazzini,Baptiste %A Perdrix,Jean %A Rochat,Carine %A Senn,Nicolas %A Mueller,Yolanda %+ Center for Primary Care and Public Health (Unisanté), Lausanne, Department of Family Medicine, University of Lausanne, Rue du Bugnon 44, Lausanne, 1011, Switzerland, 41 21 314 60 63, sebastien.martin@unisante.ch %K influenza %K surveillance system %K primary care %K online %K nosocomial %K transmission %D 2020 %7 10.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 32909955 %R 10.2196/17242 %U http://publichealth.jmir.org/2020/3/e17242/ %U https://doi.org/10.2196/17242 %U http://www.ncbi.nlm.nih.gov/pubmed/32909955 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21956 %T App-Based Tracking of Self-Reported COVID-19 Symptoms: Analysis of Questionnaire Data %A Zens,Martin %A Brammertz,Arne %A Herpich,Juliane %A Südkamp,Norbert %A Hinterseer,Martin %+ Department of Medicine, Kliniken Ostallgaeu-Kaufbeuren, Stadtbleiche 1, Fuessen, 87629, Germany, 49 8362 500 726, martin.zens@me.com %K COVID-19 %K self-reporting %K symptom %K tracking %K app %K surveillance %K distribution %K digital tool %K screening %D 2020 %7 9.9.2020 %9 Short Paper %J J Med Internet Res %G English %X 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. %M 32791493 %R 10.2196/21956 %U http://www.jmir.org/2020/9/e21956/ %U https://doi.org/10.2196/21956 %U http://www.ncbi.nlm.nih.gov/pubmed/32791493 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19907 %T Real-World Implications of a Rapidly Responsive COVID-19 Spread Model with Time-Dependent Parameters via Deep Learning: Model Development and Validation %A Jung,Se Young %A Jo,Hyeontae %A Son,Hwijae %A Hwang,Hyung Ju %+ Department of Mathematics, Pohang University of Science and Technology, 77, Cheongam-ro, Nam-gu, Pohang-si, Gyeongsangbuk-do, Pohang, 37673, Republic of Korea, 82 542792056, hjhwang@postech.ac.kr %K epidemic models %K SIR models %K time-dependent parameters %K neural networks %K deep learning %K COVID-19 %K modeling %K spread %K outbreak %D 2020 %7 9.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The COVID-19 pandemic has caused major disruptions worldwide since March 2020. The experience of the 1918 influenza pandemic demonstrated that decreases in the infection rates of COVID-19 do not guarantee continuity of the trend. Objective: The aim of this study was to develop a precise spread model of COVID-19 with time-dependent parameters via deep learning to respond promptly to the dynamic situation of the outbreak and proactively minimize damage. Methods: In this study, we investigated a mathematical model with time-dependent parameters via deep learning based on forward-inverse problems. We used data from the Korea Centers for Disease Control and Prevention (KCDC) and the Center for Systems Science and Engineering (CSSE) at Johns Hopkins University for Korea and the other countries, respectively. Because the data consist of confirmed, recovered, and deceased cases, we selected the susceptible-infected-recovered (SIR) model and found approximated solutions as well as model parameters. Specifically, we applied fully connected neural networks to the solutions and parameters and designed suitable loss functions. Results: We developed an entirely new SIR model with time-dependent parameters via deep learning methods. Furthermore, we validated the model with the conventional Runge-Kutta fourth order model to confirm its convergent nature. In addition, we evaluated our model based on the real-world situation reported from the KCDC, the Korean government, and news media. We also crossvalidated our model using data from the CSSE for Italy, Sweden, and the United States. Conclusions: The methodology and new model of this study could be employed for short-term prediction of COVID-19, which could help the government prepare for a new outbreak. In addition, from the perspective of measuring medical resources, our model has powerful strength because it assumes all the parameters as time-dependent, which reflects the exact status of viral spread. %M 32877350 %R 10.2196/19907 %U http://www.jmir.org/2020/9/e19907/ %U https://doi.org/10.2196/19907 %U http://www.ncbi.nlm.nih.gov/pubmed/32877350 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19913 %T Perceptions, Knowledge, and Behaviors Related to COVID-19 Among Social Media Users: Cross-Sectional Study %A Ali,Khawla F %A Whitebridge,Simon %A Jamal,Mohammad H %A Alsafy,Mohammad %A Atkin,Stephen L %+ Royal College of Surgeons in Ireland-Medical University of Bahrain, PO Box 15503, Adliya, Bahrain, 974 973 34611722, khawlafouad@hotmail.com %K COVID-19 %K social media %K public health %K perception %K knowledge %K health information %K health education %K virus %D 2020 %7 8.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32841153 %R 10.2196/19913 %U http://www.jmir.org/2020/9/e19913/ %U https://doi.org/10.2196/19913 %U http://www.ncbi.nlm.nih.gov/pubmed/32841153 %0 Journal Article %@ 2561-3278 %I JMIR Publications %V 5 %N 1 %P e19623 %T Fingerprint Biometric System Hygiene and the Risk of COVID-19 Transmission %A Okereafor,Kenneth %A Ekong,Iniobong %A Okon Markson,Ini %A Enwere,Kingsley %+ Department of Information & Communications Technology, National Health Insurance Scheme, NHIS Data Centre, Abuja, Nigeria, 234 8023148494, nitelken@yahoo.com %K biometric %K contact %K contaminate %K coronavirus %K COVID-19 %K cybersecurity %K disease %K fingerprint %K hygienic %K infectious %K pathogen %K scanner %K surface %K verification %D 2020 %7 8.9.2020 %9 Viewpoint %J JMIR Biomed Eng %G English %X Biometric systems use scanners to verify the identity of human beings by measuring the patterns of their behavioral or physiological characteristics. Some biometric systems are contactless and do not require direct touch to perform these measurements; others, such as fingerprint verification systems, require the user to make direct physical contact with the scanner for a specified duration for the biometric pattern of the user to be properly read and measured. This may increase the possibility of contamination with harmful microbial pathogens or of cross-contamination of food and water by subsequent users. Physical contact also increases the likelihood of inoculation of harmful microbial pathogens into the respiratory tract, thereby triggering infectious diseases. In this viewpoint, we establish the likelihood of infectious disease transmission through touch-based fingerprint biometric devices and discuss control measures to curb the spread of infectious diseases, including COVID-19. %R 10.2196/19623 %U http://biomedeng.jmir.org/2020/1/e19623/ %U https://doi.org/10.2196/19623 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e22321 %T A QR Code–Based Contact Tracing Framework for Sustainable Containment of COVID-19: Evaluation of an Approach to Assist the Return to Normal Activity %A Nakamoto,Ichiro %A Wang,Sheng %A Guo,Yan %A Zhuang,Weiqing %+ School of Internet Economics and Business, Fujian University of Technology, 999 Dongsanhuang Road, JinAn District, Fuzhou , China, 86 132 550 66365, fw107@foxmail.com %K COVID-19 %K coronavirus %K symptom-based %K quick response %K eHealth %K digital health %K telesurveillance %K pandemic %K epidemic %K interoperability %D 2020 %7 7.9.2020 %9 Viewpoint %J JMIR Mhealth Uhealth %G English %X We discuss a pandemic management framework using symptom-based quick response (QR) codes to contain the spread of COVID-19. In this approach, symptom-based QR health codes are issued by public health authorities. The codes do not retrieve the location data of the users; instead, two different colors are displayed to differentiate the health status of individuals. The QR codes are officially regarded as electronic certificates of individuals’ health status, and can be used for contact tracing, exposure risk self-triage, self-update of health status, health care appointments, and contact-free psychiatric consultations. This approach can be effectively deployed as a uniform platform interconnecting a variety of responders (eg, individuals, institutions, and public authorities) who are affected by the pandemic, which minimizes the errors of manual operation and the costs of fragmented coordination. At the same time, this approach enhances the promptness, interoperability, credibility, and traceability of containment measures. The proposed approach not only provides a supplemental mechanism for manual control measures but also addresses the partial failures of pandemic management tools in the abovementioned facets. The QR tool has been formally deployed in Fujian, a province located in southeast China that has a population of nearly 40 million people. All individuals aged ≥3 years were officially requested to present their QR code during daily public activities, such as when using public transportation systems, working at institutions, and entering or exiting schools. The deployment of this approach has achieved sizeable containment effects and played remarkable roles in shifting the negative gross domestic product (–6.8%) to a positive value by July 2020. The number of cumulative patients with COVID-19 in this setting was confined to 363, of whom 361 had recovered (recovery rate 99.4%) as of July 12, 2020. A simulation showed that if only partial measures of the framework were followed, the number of cumulative cases of COVID-19 could potentially increase ten-fold. This approach can serve as a reliable solution to counteract the emergency of a public health crisis; as a routine tool to enhance the level of public health; to accelerate the recovery of social activities; to assist decision making for policy makers; and as a sustainable measure that enables scalability. %M 32841151 %R 10.2196/22321 %U http://mhealth.jmir.org/2020/9/e22321/ %U https://doi.org/10.2196/22321 %U http://www.ncbi.nlm.nih.gov/pubmed/32841151 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 9 %P e18782 %T Feasibility of a Novel Mobile C-Reactive Protein–Testing Device Using Gold-Linked Electrochemical Immunoassay: Clinical Performance Study %A Gondoh-Noda,Yuko %A Kometani,Mitsuhiro %A Nomura,Akihiro %A Aono,Daisuke %A Karashima,Shigehiro %A Ushijima,Hiromi %A Tamiya,Eiichi %A Murayama,Toshinori %A Yoneda,Takashi %+ Division of Endocrinology and Hypertension, Department of Cardiovascular and Internal Medicine, Graduate School of Medical Sciences, Kanazawa University, 13-1 Takara-machi, Kanazawa, 920-8641, Japan, 81 76 265 2778, endocrin@med.kanazawa-u.ac.jp %K gold-linked electrochemical immunoassay (GLEIA) %K home-based care %K mobile CRP testing device %K mHealth %K diagnostic %K infection %K assay %K CRP %K c-reactive protein %K immunoassay %D 2020 %7 7.9.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Home-based care is one of the most promising solutions to provide sufficient medical care for several older patients in Japan. However, because of insufficient diagnostic devices, it is sometimes difficult to detect early signs of the occurrence or worsening of diseases, such as infections under home-based care settings. C-reactive protein (CRP) is highly sensitive to diagnosing infections, and its elevation can help diagnose acute infection in older patients. Therefore, a CRP-measuring device that can be used in such a specific occasion is needed for home-based care. However, aspects such as its size, weight, and procedure are still challenging with respect to the practical use of mobile devices that quantitatively measure CRP levels easily and quickly under home-based care settings. Objective: We developed a new mobile, rapid CRP measurement device using a gold-linked electrochemical immunoassay (GLEIA) system. The aim of this study was to evaluate the feasibility of this mobile CRP-testing device. Methods: First, we assessed the performance of bare GLEIA-based electrode chips as the foundation of the device. After embedding the bare GLEIA-based electrode chips in a special plastic case and developing the mobile CRP-testing device, we further tested the device prototype using clinical blood samples. Finally, we evaluated the intra-assay variability for precision in the same condition and inter-assay variability for reproducibility in different conditions. Results: Blood samples for analysis were obtained by direct vein puncture from outpatients (N=85; females: 57/85; males: 28/85; age: 19-88 years) at Kanazawa University Hospital in Japan. For performance evaluation of bare GLEIA-based electrode chips, we used 85 clinical blood samples. There was a significant positive correlation between the electrode-predicted CRP levels and the reference CRP concentrations (R2=0.947; P<.001). The assembled device was mobile (size 45×90×2.4 mm; weight 10 g) and disposable. The minimum volume of the sample needed for measuring CRP was 1.4 µL. The estimated preanalytical time was approximately 7 minutes and 40 seconds, and analysis time was approximately 1 minute and 10 seconds. Subsequently, for performance evaluation of the mobile CRP-testing device using GLEIA-based electrode chips, we used 26 clinical blood samples and found a significant positive correlation between the mobile device-predicted CRP levels and the reference CRP concentrations (R2=0.866, P<.001). The intra-assay variabilities were 34.2%, 40.8%, and 24.5% for low, medium, and high CRP concentrations, respectively. The inter-assay variabilities were 46.5%, 38.3%, and 64.1% for low, medium, and high CRP concentrations, respectively. Conclusions: Our findings suggest that this new mobile CRP-testing device might be suitable for use in home-based care settings. %M 32894233 %R 10.2196/18782 %U http://mhealth.jmir.org/2020/9/e18782/ %U https://doi.org/10.2196/18782 %U http://www.ncbi.nlm.nih.gov/pubmed/32894233 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19578 %T COVID-19 and Slums: A Pandemic Highlights Gaps in Knowledge About Urban Poverty %A Friesen,John %A Pelz,Peter F %+ Chair of Fluid Systems, Technical University of Darmstadt, Otto-Berndt-Str 2, Darmstadt, 64287, Germany, 49 06151 1627100, john.friesen@fst.tu-darmstadt.de %K slums %K informal settlements %K COVID-19, pandemic %K infectious disease %K living conditions %K lifestyle %K risk %K risk group %K health information %D 2020 %7 4.9.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X According to the United Nations, about 1 billion persons live in so-called slums. Numerous studies have shown that this population is particularly vulnerable to infectious diseases. The current COVID-19 pandemic, caused by the novel coronavirus SARS-CoV-2, emphatically underlines this problem. The often high-density living quarters coupled with a large number of persons per dwelling and the lack of adequate sanitation are reasons why measures to contain the pandemic only work to a limited extent in slums. Furthermore, assignment to risk groups for severe courses of COVID-19 caused by noncommunicable diseases (eg, cardiovascular diseases) is not possible due to inadequate data availability. Information on people living in slums and their health status is either unavailable or only exists for specific regions (eg, Nairobi). We argue that one of the greatest problems with regard to the COVID-19 pandemic in the context of slums in the Global South is the lack of data on the number of people, their living conditions, and their health status. %M 32877347 %R 10.2196/19578 %U http://publichealth.jmir.org/2020/3/e19578/ %U https://doi.org/10.2196/19578 %U http://www.ncbi.nlm.nih.gov/pubmed/32877347 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e20143 %T Rapid Implementation and Innovative Applications of a Virtual Intensive Care Unit During the COVID-19 Pandemic: Case Study %A Dhala,Atiya %A Sasangohar,Farzan %A Kash,Bita %A Ahmadi,Nima %A Masud,Faisal %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843, United States, 1 9794582337, sasangohar@tamu.edu %K intensive care units %K critical care %K pandemics %K SARS-CoV-2 %K telemedicine %K infection control %K COVID-19 %D 2020 %7 3.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32795997 %R 10.2196/20143 %U http://www.jmir.org/2020/9/e20143/ %U https://doi.org/10.2196/20143 %U http://www.ncbi.nlm.nih.gov/pubmed/32795997 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21279 %T Effects of COVID-19 on College Students’ Mental Health in the United States: Interview Survey Study %A Son,Changwon %A Hegde,Sudeep %A Smith,Alec %A Wang,Xiaomei %A Sasangohar,Farzan %+ Department of Industrial and Systems Engineering, Texas A&M University, 3131 TAMU, College Station, TX, 77843, United States, 1 979 458 2337, sasangohar@tamu.edu %K COVID-19 %K pandemic %K college student %K mental health %K stress %K anxiety %K self-management %D 2020 %7 3.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Student mental health in higher education has been an increasing concern. The COVID-19 pandemic situation has brought this vulnerable population into renewed focus. Objective: Our study aims to conduct a timely assessment of the effects of the COVID-19 pandemic on the mental health of college students. Methods: We conducted interview surveys with 195 students at a large public university in the United States to understand the effects of the pandemic on their mental health and well-being. The data were analyzed through quantitative and qualitative methods. Results: Of the 195 students, 138 (71%) indicated increased stress and anxiety due to the COVID-19 outbreak. Multiple stressors were identified that contributed to the increased levels of stress, anxiety, and depressive thoughts among students. These included fear and worry about their own health and of their loved ones (177/195, 91% reported negative impacts of the pandemic), difficulty in concentrating (173/195, 89%), disruptions to sleeping patterns (168/195, 86%), decreased social interactions due to physical distancing (167/195, 86%), and increased concerns on academic performance (159/195, 82%). To cope with stress and anxiety, participants have sought support from others and helped themselves by adopting either negative or positive coping mechanisms. Conclusions: Due to the long-lasting pandemic situation and onerous measures such as lockdown and stay-at-home orders, the COVID-19 pandemic brings negative impacts on higher education. The findings of our study highlight the urgent need to develop interventions and preventive strategies to address the mental health of college students. %M 32805704 %R 10.2196/21279 %U https://www.jmir.org/2020/9/e21279 %U https://doi.org/10.2196/21279 %U http://www.ncbi.nlm.nih.gov/pubmed/32805704 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e19471 %T Willingness to Use Home Collection Methods to Provide Specimens for SARS-CoV-2/COVID-19 Research: Survey Study %A Hall,Eric William %A Luisi,Nicole %A Zlotorzynska,Maria %A Wilde,Gretchen %A Sullivan,Patrick %A Sanchez,Travis %A Bradley,Heather %A Siegler,Aaron J %+ Department of Behavioral, Social and Health Education Sciences, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 404 712 9733, asiegle@emory.edu %K COVID-19 %K SARS-CoV-2 %K specimen collection %K survey %K research %K public health %K infectious disease %K virus %K test %D 2020 %7 3.9.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Innovative laboratory testing approaches for SARS-CoV-2 infection and immune response are needed to conduct research to establish estimates of prevalence and incidence. Self-specimen collection methods have been successfully used in HIV and sexually transmitted infection research and can provide a feasible opportunity to scale up SARS-CoV-2 testing for research purposes. Objective: The aim of this study was to assess the willingness of adults to use different specimen collection modalities for themselves and children as part of a COVID-19 research study. Methods: Between March 27 and April 1, 2020, we recruited 1435 adults aged 18 years or older though social media advertisements. Participants completed a survey that included 5-point Likert scale items stating how willing they were to use the following specimen collection testing modalities as part of a research study: home collection of a saliva sample, home collection of a throat swab, home finger-prick blood collection, drive-through site throat swab, clinic throat swab, and clinic blood collection. Additionally, participants indicated how the availability of home-based collection methods would impact their willingness to participate compared to drive-through and clinic-based specimen collection. We used Kruskal-Wallis tests and Spearman rank correlations to assess if willingness to use each testing modality differed by demographic variables and characteristics of interest. We compared the overall willingness to use each testing modality and estimated effect sizes with Cohen d. Results: We analyzed responses from 1435 participants with a median age of 40.0 (SD=18.2) years and over half of which were female (761/1435, 53.0%). Most participants agreed or strongly agreed that they would be willing to use specimens self-collected at home to participate in research, including willingness to collect a saliva sample (1259/1435, 87.7%) or a throat swab (1191/1435, 83.1%). Willingness to collect a throat swab sample was lower in both a drive-through setting (64%) and clinic setting (53%). Overall, 69.0% (990/1435) of participants said they would be more likely to participate in a research study if they could provide a saliva sample or throat swab at home compared to going to a drive-through site; only 4.4% (63/1435) of participants said they would be less likely to participate using self-collected samples. For each specimen collection modality, willingness to collect specimens from children for research was lower than willingness to use on oneself, but the ranked order of modalities was similar. Conclusions: Most participants were willing to participate in a COVID-19 research study that involves laboratory testing; however, there was a strong preference for home specimen collection procedures over drive-through or clinic-based testing. To increase participation and minimize bias, epidemiologic research studies of SARS-CoV-2 infection and immune response should consider home specimen collection methods. %M 32790639 %R 10.2196/19471 %U https://www.jmir.org/2020/9/e19471 %U https://doi.org/10.2196/19471 %U http://www.ncbi.nlm.nih.gov/pubmed/32790639 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 9 %P e21419 %T Public Perceptions and Attitudes Toward COVID-19 Nonpharmaceutical Interventions Across Six Countries: A Topic Modeling Analysis of Twitter Data %A Doogan,Caitlin %A Buntine,Wray %A Linger,Henry %A Brunt,Samantha %+ Department of Data Science and AI, Faculty of Information Technology, Monash University, Wellington Rd, Clayton, 3800, Australia, 61 3 9903 1004, caitlin.doogan@monash.edu %K COVID-19 %K SARS-CoV-2 %K topic modeling %K nonpharmaceutical interventions %K social media %K public health %K machine learning %K social distancing %K lockdown %K face masks %K infodemiology %D 2020 %7 3.9.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32784190 %R 10.2196/21419 %U https://www.jmir.org/2020/9/e21419 %U https://doi.org/10.2196/21419 %U http://www.ncbi.nlm.nih.gov/pubmed/32784190 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e20572 %T Adoption of a Contact Tracing App for Containing COVID-19: A Health Belief Model Approach %A Walrave,Michel %A Waeterloos,Cato %A Ponnet,Koen %+ Research Group MIOS, Department of Communication Studies, Faculty of Social Sciences, University of Antwerp, Sint-Jacobstraat 2, Antwerp, 2000, Belgium, 32 475459785, michel.walrave@uantwerp.be %K COVID-19 %K SARS-CoV-2 %K health belief model %K contact tracing %K proximity tracing %K privacy %D 2020 %7 1.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 32755882 %R 10.2196/20572 %U http://publichealth.jmir.org/2020/3/e20572/ %U https://doi.org/10.2196/20572 %U http://www.ncbi.nlm.nih.gov/pubmed/32755882 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e15409 %T Contributing to Elimination of Cross-Border Malaria Through a Standardized Solution for Case Surveillance, Data Sharing, and Data Interpretation: Development of a Cross-Border Monitoring System %A Saldanha,Raphael %A Mosnier,Émilie %A Barcellos,Christovam %A Carbunar,Aurel %A Charron,Christophe %A Desconnets,Jean-Christophe %A Guarmit,Basma %A Gomes,Margarete Do Socorro Mendonça %A Mandon,Théophile %A Mendes,Anapaula Martins %A Peiter,Paulo César %A Musset,Lise %A Sanna,Alice %A Van Gastel,Benoît %A Roux,Emmanuel %+ Laboratório de Informação em Saúde, Instituto de Comunicação e Informação Científica e Tecnológica em Saúde, Fundação Oswaldo Cruz, Avenida Brasil, 4365, Manguinhos, Rio de Janeiro, 21040-360, Brazil, 55 2138653242, christovam.barcellos@fiocruz.br %K cross-border malaria %K surveillance %K data interoperability %K data visualization %K French Guiana %K Brazil %D 2020 %7 1.9.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Cross-border malaria is a significant obstacle to achieving malaria control and elimination worldwide. Objective: This study aimed to build a cross-border surveillance system that can make comparable and qualified data available to all parties involved in malaria control between French Guiana and Brazil. Methods: Data reconciliation rules based on expert knowledge were defined and applied to the heterogeneous data provided by the existing malaria surveillance systems of both countries. Visualization dashboards were designed to facilitate progressive data exploration, analysis, and interpretation. Dedicated advanced open source and robust software solutions were chosen to facilitate solution sharing and reuse. Results: A database gathering the harmonized data on cross-border malaria epidemiology is updated monthly with new individual malaria cases from both countries. Online dashboards permit a progressive and user-friendly visualization of raw data and epidemiological indicators, in the form of time series, maps, and data quality indexes. The monitoring system was shown to be able to identify changes in time series that are related to control actions, as well as differentiated changes according to space and to population subgroups. Conclusions: This cross-border monitoring tool could help produce new scientific evidence on cross-border malaria dynamics, implementing cross-border cooperation for malaria control and elimination, and can be quickly adapted to other cross-border contexts. %M 32663141 %R 10.2196/15409 %U http://publichealth.jmir.org/2020/3/e15409/ %U https://doi.org/10.2196/15409 %U http://www.ncbi.nlm.nih.gov/pubmed/32663141 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 3 %P e22768 %T Venous Thromboembolism in Hospitalized COVID-19 Patients: Systematic Review %A Birkeland,Kade %A Zimmer,Raymond %A Kimchi,Asher %A Kedan,Ilan %+ Smidt Cedars-Sinai Heart Institute, 8501 Wilshire Blvd Suite 200, Beverly Hills, CA, 90211, United States, 1 3103853496, kedani@cshs.org %K VTE %K COVID-19 %K anticoagulation %K SARS-CoV-2 %K review %K heart %K morbidity %K hospital %K incidence %K treatment %K incidence %D 2020 %7 1.9.2020 %9 Review %J Interact J Med Res %G English %X Background: Coagulopathy associated with COVID-19 infection and venous thromboembolism (VTE) have emerged as significant contributors to morbidity among patients infected with SARS-CoV-2. Objective: We performed a systematic review to estimate VTE incidence in hospitalized patients and to analyze characteristic factors in the VTE cohort. Methods: We searched PubMed and Google Scholar using specified title search terms “SARS-CoV-2” or “COVID-19” and “venous thromboembolism” and “anticoagulation” among others to identify peer-reviewed journal articles published between June 22, 2019, and June 22, 2020. Data were systematically extracted and synthesized using Microsoft Excel for analysis. The main outcome was VTE incidence, and measures included patient characteristics, anticoagulation, and clinical outcomes with assessment for associations. Results: In total, 14 studies were included comprising 1677 patients. Most patients (n=1306, 82.4%) received anticoagulation (either VTE prophylaxis or treatment). VTE incidence was 26.9% (SE 3.1; 95% CI 20.8-33.1) and was correlated with systematic screening (r2=0.34, P=.03) and study duration (r2=–0.33, P=.03). D-dimer was higher for the VTE cohort (5.62 [SD 0.9] vs 1.43 [SD 0.6]; P<.001). Odds of VTE were higher at the intensive care unit (odds ratio [OR] 6.38, 95% CI 3.67-11.11; P<.001) but lower with anticoagulation (OR 0.58, 95% CI 0.36-0.92; P=.02). Conclusions: Despite the utilization of background anticoagulation, VTE incidence was historically high. Future studies are needed to provide additional data to guide optimal VTE prophylaxis and diagnostic strategies. %M 32805702 %R 10.2196/22768 %U http://www.i-jmr.org/2020/3/e22768/ %U https://doi.org/10.2196/22768 %U http://www.ncbi.nlm.nih.gov/pubmed/32805702 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 8 %P e19857 %T Acceptability of App-Based Contact Tracing for COVID-19: Cross-Country Survey Study %A Altmann,Samuel %A Milsom,Luke %A Zillessen,Hannah %A Blasone,Raffaele %A Gerdon,Frederic %A Bach,Ruben %A Kreuter,Frauke %A Nosenzo,Daniele %A Toussaert,Séverine %A Abeler,Johannes %+ University of Oxford, Manor Road, Oxford, OX1 3UQ, United Kingdom, 44 1865 281440, johannes.abeler@economics.ox.ac.uk %K COVID-19 %K contact tracing %K proximity tracing %K app %K digital %K user acceptability %K mHealth %K epidemiology %D 2020 %7 28.8.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X 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. %M 32759102 %R 10.2196/19857 %U http://mhealth.jmir.org/2020/8/e19857/ %U https://doi.org/10.2196/19857 %U http://www.ncbi.nlm.nih.gov/pubmed/32759102 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21613 %T Motivations for Social Distancing and App Use as Complementary Measures to Combat the COVID-19 Pandemic: Quantitative Survey Study %A Kaspar,Kai %+ Department of Psychology, University of Cologne, Richard-Strauss-Str. 2, Cologne, 50931, Germany, 49 221 470 2347, kkaspar@uni-koeln.de %K COVID-19 %K protection motivation theory %K social distancing %K contact tracing app %K data donation app %K social trust %K data security %D 2020 %7 27.8.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32759100 %R 10.2196/21613 %U http://www.jmir.org/2020/8/e21613/ %U https://doi.org/10.2196/21613 %U http://www.ncbi.nlm.nih.gov/pubmed/32759100 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e17667 %T Perceptions and Experiences of Internet-Based Testing for Sexually Transmitted Infections: Systematic Review and Synthesis of Qualitative Research %A Spence,Tommer %A Kander,Inès %A Walsh,Julia %A Griffiths,Frances %A Ross,Jonathan %+ Division of Health Sciences, Warwick Medical School, University of Warwick, Gibbet Hill Road, Coventry, CV4 7AL, United Kingdom, 44 (0)2476 528009, T.Spence@warwick.ac.uk %K sexually transmitted infections %K self-sampling %K screening %K testing %K internet %K digital health %K eHealth %K qualitative research %K thematic synthesis %D 2020 %7 26.8.2020 %9 Review %J J Med Internet Res %G English %X Background: Internet-based testing for sexually transmitted infections (STIs) allows asymptomatic individuals to order a self-sampling kit online and receive their results electronically, reducing the need to attend a clinic unless for treatment. This approach has become increasingly common; however, there is evidence that barriers exist to accessing it, particularly among some high-risk populations. We review the qualitative evidence on this topic, as qualitative research is well-placed to identify the complex influences that relate to accessing testing. Objective: This paper aims to explore perceptions and experiences of internet-based testing for STIs among users and potential users. Methods: Searches were run through 5 electronic databases (CINAHL, EMBASE, MEDLINE, PsycINFO, and Web of Science) to identify peer-reviewed studies published between 2005 and 2018. Search terms were drawn from 4 categories: STIs, testing or screening, digital health, and qualitative methods. Included studies were conducted in high-income countries and explored patient perceptions or experiences of internet-based testing, and data underwent thematic synthesis. Results: A total of 11 studies from the 1735 studies identified in the initial search were included in the review. The synthesis identified that internet-based testing is viewed widely as being acceptable and is preferred over clinic testing by many individuals due to perceived convenience and anonymity. However, a number of studies identified concerns relating to test accuracy and lack of communication with practitioners, particularly when receiving results. There was a lack of consensus on preferred media for results delivery, although convenience and confidentiality were again strong influencing factors. The majority of included studies were limited by the fact that they researched hypothetical services. Conclusions: Internet-based testing providers may benefit from emphasizing this testing’s comparative convenience and privacy compared with face-to-face testing in order to improve uptake, as well as alleviating concerns about the self-sampling process. There is a clear need for further research exploring in depth the perceptions and experiences of people who have accessed internet-based testing and for research on internet-based testing that explicitly gathers the views of populations that are at high risk of STIs. Trial Registration: PROSPERO CRD42019146938; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=146938 %M 32663151 %R 10.2196/17667 %U http://www.jmir.org/2020/8/e17667/ %U https://doi.org/10.2196/17667 %U http://www.ncbi.nlm.nih.gov/pubmed/32663151 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e20794 %T Big Data, Natural Language Processing, and Deep Learning to Detect and Characterize Illicit COVID-19 Product Sales: Infoveillance Study on Twitter and Instagram %A Mackey,Tim Ken %A Li,Jiawei %A Purushothaman,Vidya %A Nali,Matthew %A Shah,Neal %A Bardier,Cortni %A Cai,Mingxiang %A Liang,Bryan %+ Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, School of Medicine, University of California, San Diego, 8950 Villa La Jolla Drive, A124, La Jolla, CA, 92037, United States, 1 951 491 4161, tmackey@ucsd.edu %K COVID-19 %K coronavirus %K infectious disease %K social media %K surveillance %K infoveillance %K infodemiology %K infodemic %K fraud %K cybercrime %D 2020 %7 25.8.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic is perhaps the greatest global health challenge of the last century. Accompanying this pandemic is a parallel “infodemic,” including the online marketing and sale of unapproved, illegal, and counterfeit COVID-19 health products including testing kits, treatments, and other questionable “cures.” Enabling the proliferation of this content is the growing ubiquity of internet-based technologies, including popular social media platforms that now have billions of global users. Objective: This study aims to collect, analyze, identify, and enable reporting of suspected fake, counterfeit, and unapproved COVID-19–related health care products from Twitter and Instagram. Methods: This study is conducted in two phases beginning with the collection of COVID-19–related Twitter and Instagram posts using a combination of web scraping on Instagram and filtering the public streaming Twitter application programming interface for keywords associated with suspect marketing and sale of COVID-19 products. The second phase involved data analysis using natural language processing (NLP) and deep learning to identify potential sellers that were then manually annotated for characteristics of interest. We also visualized illegal selling posts on a customized data dashboard to enable public health intelligence. Results: We collected a total of 6,029,323 tweets and 204,597 Instagram posts filtered for terms associated with suspect marketing and sale of COVID-19 health products from March to April for Twitter and February to May for Instagram. After applying our NLP and deep learning approaches, we identified 1271 tweets and 596 Instagram posts associated with questionable sales of COVID-19–related products. Generally, product introduction came in two waves, with the first consisting of questionable immunity-boosting treatments and a second involving suspect testing kits. We also detected a low volume of pharmaceuticals that have not been approved for COVID-19 treatment. Other major themes detected included products offered in different languages, various claims of product credibility, completely unsubstantiated products, unapproved testing modalities, and different payment and seller contact methods. Conclusions: Results from this study provide initial insight into one front of the “infodemic” fight against COVID-19 by characterizing what types of health products, selling claims, and types of sellers were active on two popular social media platforms at earlier stages of the pandemic. This cybercrime challenge is likely to continue as the pandemic progresses and more people seek access to COVID-19 testing and treatment. This data intelligence can help public health agencies, regulatory authorities, legitimate manufacturers, and technology platforms better remove and prevent this content from harming the public. %M 32750006 %R 10.2196/20794 %U http://publichealth.jmir.org/2020/3/e20794/ %U https://doi.org/10.2196/20794 %U http://www.ncbi.nlm.nih.gov/pubmed/32750006 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20673 %T Global Infodemiology of COVID-19: Analysis of Google Web Searches and Instagram Hashtags %A Rovetta,Alessandro %A Bhagavathula,Akshaya Srikanth %+ Research and Disclosure Division, Mensana srls, Via Moro Aldo 5, Brescia, 25124, Italy, 39 3927112808, rovetta.mresearch@gmail.com %K COVID-19 %K coronavirus %K Google %K Instagram %K infodemiology %K infodemic %K social media %D 2020 %7 25.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Although “infodemiological” methods have been used in research on coronavirus disease (COVID-19), an examination of the extent of infodemic moniker (misinformation) use on the internet remains limited. Objective: The aim of this paper is to investigate internet search behaviors related to COVID-19 and examine the circulation of infodemic monikers through two platforms—Google and Instagram—during the current global pandemic. Methods: We have defined infodemic moniker as a term, query, hashtag, or phrase that generates or feeds fake news, misinterpretations, or discriminatory phenomena. Using Google Trends and Instagram hashtags, we explored internet search activities and behaviors related to the COVID-19 pandemic from February 20, 2020, to May 6, 2020. We investigated the names used to identify the virus, health and risk perception, life during the lockdown, and information related to the adoption of COVID-19 infodemic monikers. We computed the average peak volume with a 95% CI for the monikers. Results: The top six COVID-19–related terms searched in Google were “coronavirus,” “corona,” “COVID,” “virus,” “corona virus,” and “COVID-19.” Countries with a higher number of COVID-19 cases had a higher number of COVID-19 queries on Google. The monikers “coronavirus ozone,” “coronavirus laboratory,” “coronavirus 5G,” “coronavirus conspiracy,” and “coronavirus bill gates” were widely circulated on the internet. Searches on “tips and cures” for COVID-19 spiked in relation to the US president speculating about a “miracle cure” and suggesting an injection of disinfectant to treat the virus. Around two thirds (n=48,700,000, 66.1%) of Instagram users used the hashtags “COVID-19” and “coronavirus” to disperse virus-related information. Conclusions: Globally, there is a growing interest in COVID-19, and numerous infodemic monikers continue to circulate on the internet. Based on our findings, we hope to encourage mass media regulators and health organizers to be vigilant and diminish the use and circulation of these infodemic monikers to decrease the spread of misinformation. %M 32748790 %R 10.2196/20673 %U http://www.jmir.org/2020/8/e20673/ %U https://doi.org/10.2196/20673 %U http://www.ncbi.nlm.nih.gov/pubmed/32748790 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21366 %T Work-Related and Personal Factors Associated With Mental Well-Being During the COVID-19 Response: Survey of Health Care and Other Workers %A Evanoff,Bradley A %A Strickland,Jaime R %A Dale,Ann Marie %A Hayibor,Lisa %A Page,Emily %A Duncan,Jennifer G %A Kannampallil,Thomas %A Gray,Diana L %+ Washington University School of Medicine, 4523 Clayton Avenue, Box 8005, St. Louis, MO, 63110, United States, 1 3144548340, bevanoff@wustl.edu %K COVID-19 %K coronavirus %K pandemic %K mental health %K health care workers %K remote work %K worker well-being %K occupational health %D 2020 %7 25.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The response to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has created an unprecedented disruption in work conditions. This study describes the mental health and well-being of workers both with and without clinical exposure to patients with coronavirus disease (COVID-19). Objective: The aim of this study is to measure the prevalence of stress, anxiety, depression, work exhaustion, burnout, and decreased well-being among faculty and staff at a university and academic medical center during the SARS-CoV-2 pandemic and describe work-related and personal factors associated with their mental health and well-being. Methods: All faculty, staff, and postdoctoral fellows of a university, including its medical school, were invited in April 2020 to complete an online questionnaire measuring stress, anxiety, depression, work exhaustion, burnout, and decreased well-being. We examined associations between these outcomes and factors including work in high-risk clinical settings and family/home stressors. Results: There were 5550 respondents (overall response rate of 34.3%). Overall, 34% of faculty and 14% of staff (n=915) were providing clinical care, while 61% of faculty and 77% of staff were working from home. Among all workers, anxiety (prevalence ratio 1.37, 95% CI 1.09-1.73), depression (prevalence ratio 1.28, 95% CI 1.03-1.59), and high work exhaustion (prevalence ratio 1.24, 95% CI 1.13-1.36) were independently associated with community or clinical exposure to COVID-19. Poor family-supportive behaviors by supervisors were also associated with these outcomes (prevalence ratio 1.40, 95% CI 1.21-1.62; prevalence ratio 1.69, 95% CI 1.48-1.92; and prevalence ratio 1.54, 95% CI 1.44-1.64, respectively). Age <40 years and a greater number of family/home stressors were also associated with these poorer outcomes. Among the subset of clinicians, caring for patients with COVID-19 and working in high-risk clinical settings were additional risk factors. Conclusions: Our findings suggest that the pandemic has had negative effects on the mental health and well-being of both clinical and nonclinical employees. Mitigating exposure to COVID-19 and increasing supervisor support are modifiable risk factors that may protect mental health and well-being for all workers. %M 32763891 %R 10.2196/21366 %U http://www.jmir.org/2020/8/e21366/ %U https://doi.org/10.2196/21366 %U http://www.ncbi.nlm.nih.gov/pubmed/32763891 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 8 %P e20992 %T Nationwide Results of COVID-19 Contact Tracing in South Korea: Individual Participant Data From an Epidemiological Survey %A Lee,Seung Won %A Yuh,Woon Tak %A Yang,Jee Myung %A Cho,Yoon-Sik %A Yoo,In Kyung %A Koh,Hyun Yong %A Marshall,Dominic %A Oh,Donghwan %A Ha,Eun Kyo %A Han,Man Yong %A Yon,Dong Keon %+ Armed Force Medical Command, Republic of Korea Armed Forces, 81 Saemaeul-ro 177, Seongnam, 463-040, Republic of Korea, 82 2 6935 2476, yonkkang@gmail.com %K COVID-19 %K contact tracing %K coronavirus %K South Korea %K survey %K health data %K epidemiology %K transmission %D 2020 %7 25.8.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Evidence regarding the effectiveness of contact tracing of COVID-19 and the related social distancing is limited and inconclusive. Objective: This study aims to investigate the epidemiological characteristics of SARS-CoV-2 transmission in South Korea and evaluate whether a social distancing campaign is effective in mitigating the spread of COVID-19. Methods: We used contract tracing data to investigate the epidemic characteristics of SARS-CoV-2 transmission in South Korea and evaluate whether a social distancing campaign was effective in mitigating the spread of COVID-19. We calculated the mortality rate for COVID-19 by infection type (cluster vs noncluster) and tested whether new confirmed COVID-19 trends changed after a social distancing campaign. Results: There were 2537 patients with confirmed COVID-19 who completed the epidemiologic survey: 1305 (51.4%) cluster cases and 1232 (48.6%) noncluster cases. The mortality rate was significantly higher in cluster cases linked to medical facilities (11/143, 7.70% vs 5/1232, 0.41%; adjusted percentage difference 7.99%; 95% CI 5.83 to 10.14) and long-term care facilities (19/221, 8.60% vs 5/1232, 0.41%; adjusted percentage difference 7.56%; 95% CI 5.66 to 9.47) than in noncluster cases. The change in trends of newly confirmed COVID-19 cases before and after the social distancing campaign was significantly negative in the entire cohort (adjusted trend difference –2.28; 95% CI –3.88 to –0.68) and the cluster infection group (adjusted trend difference –0.96; 95% CI –1.83 to –0.09). Conclusions: In a nationwide contact tracing study in South Korea, COVID-19 linked to medical and long-term care facilities significantly increased the risk of mortality compared to noncluster COVID-19. A social distancing campaign decreased the spread of COVID-19 in South Korea and differentially affected cluster infections of SARS-CoV-2. %M 32784189 %R 10.2196/20992 %U http://medinform.jmir.org/2020/8/e20992/ %U https://doi.org/10.2196/20992 %U http://www.ncbi.nlm.nih.gov/pubmed/32784189 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e20828 %T Real-Time Digital Contact Tracing: Development of a System to Control COVID-19 Outbreaks in Nursing Homes and Long-Term Care Facilities %A Wilmink,Gerald %A Summer,Ilyssa %A Marsyla,David %A Sukhu,Subhashree %A Grote,Jeffrey %A Zobel,Gregory %A Fillit,Howard %A Movva,Satish %+ CarePredict, 324 South University Drive, Plantation, FL, 33324, United States, 1 6153644985, jwilmink@carepredict.com %K COVID-19 %K SARS-CoV-2 %K contact tracing %K nursing homes %K long term care %K care homes %K digital contact tracing %D 2020 %7 25.8.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 32745013 %R 10.2196/20828 %U http://publichealth.jmir.org/2020/3/e20828/ %U https://doi.org/10.2196/20828 %U http://www.ncbi.nlm.nih.gov/pubmed/32745013 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20334 %T Features and Functionalities of Smartphone Apps Related to COVID-19: Systematic Search in App Stores and Content Analysis %A Collado-Borrell,Roberto %A Escudero-Vilaplana,Vicente %A Villanueva-Bueno,Cristina %A Herranz-Alonso,Ana %A Sanjurjo-Saez,Maria %+ Hospital General Universitario Gregorio Marañón, C/del Dr. Esquerdo, 46, Madrid, 28007, Spain, 34 678239017, vicente.escudero@salud.madrid.org %K COVID-19 %K mobile apps %K contact tracing %K monitoring %K telemedicine %K smartphone %D 2020 %7 25.8.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32614777 %R 10.2196/20334 %U https://www.jmir.org/2020/8/e20334 %U https://doi.org/10.2196/20334 %U http://www.ncbi.nlm.nih.gov/pubmed/32614777 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21176 %T Impact of the COVID-19 Epidemic on Lifestyle Behaviors and Their Association With Subjective Well-Being Among the General Population in Mainland China: Cross-Sectional Study %A Hu,Zhao %A Lin,Xuhui %A Chiwanda Kaminga,Atipatsa %A Xu,Huilan %+ Department of Social Medicine and Health Management, Xiangya School of Public Health, Central South University, 238 Shangmayuanling, Changsha, 410078, China, 86 073184135459, xhl6363@sina.com %K COVID-19 %K coronavirus disease %K subjective well-being %K lifestyle behaviors %D 2020 %7 25.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The world is experiencing an unprecedented challenge due to the coronavirus disease (COVID-19) pandemic. However, it is unclear whether people’s lifestyles will change as a result. Objective: The aim of this study is to explore perceived lifestyle changes after the outbreak of COVID-19 and their association with subjective well-being (SWB) among the general population in Mainland China. Methods: An online survey was conducted in May 2020. Lifestyle behaviors including leisure-time physical exercise, leisure-time screen time, and dietary intake were self-reported. SWB was measured using the General Wellbeing Schedule (GWS). Other covariates including sociodemographic factors, self-rated physical health, perceived social support, and loneliness were also assessed by a structured questionnaire. A multivariate ordinal regression method was used to analyze the association between SWB and lifestyle behaviors as well as perceived lifestyle changes. Results: A total of 1033 participants aged between 18 and 60 years were included in this study. The mean GWS score was 71.7 points. About 70% of the respondents reported spending more time looking at screens, whereas about 30% reported an increased frequency of vegetable and fruit intake after the outbreak of COVID-19. Inactive physical exercise (odds ratio [OR] 1.16, 95% CI 1.02-1.48), infrequent vegetable intake (OR 1.45, 95% CI 1.10-1.90), infrequent fruit intake (OR 1.31, 95% CI 1.01-1.70), and often skipping breakfast (OR 1.43, 95% CI 1.08-1.91) were associated with lower SWB after adjusting for sociodemographic factors, self-rated physical health, perceived social support, and loneliness. Moreover, participants who perceived a decrease in the frequency of vegetable, fruit, and breakfast intake were more likely to report lower SWB. Conclusions: The COVID-19 pandemic may have positive and negative impacts on different aspects of lifestyle behaviors. Both unhealthy lifestyle behaviors and negative lifestyle changes were associated with lower SWB. These findings provide scientific evidence that can inform lifestyle guidelines and public mental health interventions during the COVID-19 outbreak. %M 32759103 %R 10.2196/21176 %U http://www.jmir.org/2020/8/e21176/ %U https://doi.org/10.2196/21176 %U http://www.ncbi.nlm.nih.gov/pubmed/32759103 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20259 %T Prognostic Modeling of COVID-19 Using Artificial Intelligence in the United Kingdom: Model Development and Validation %A Abdulaal,Ahmed %A Patel,Aatish %A Charani,Esmita %A Denny,Sarah %A Mughal,Nabeela %A Moore,Luke %+ NIHR Health Protection Research Unit in Healthcare Associated Infections and Antimicrobial Resistance, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2AZ, United Kingdom, 44 783 436 6302, l.moore@imperial.ac.uk %K COVID-19 %K coronavirus %K machine learning %K deep learning %K modeling %K artificial intelligence %K neural network %K prediction %D 2020 %7 25.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The current severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak is a public health emergency and the case fatality rate in the United Kingdom is significant. Although there appear to be several early predictors of outcome, there are no currently validated prognostic models or scoring systems applicable specifically to patients with confirmed SARS-CoV-2. Objective: We aim to create a point-of-admission mortality risk scoring system using an artificial neural network (ANN). Methods: We present an ANN that can provide a patient-specific, point-of-admission mortality risk prediction to inform clinical management decisions at the earliest opportunity. The ANN analyzes a set of patient features including demographics, comorbidities, smoking history, and presenting symptoms and predicts patient-specific mortality risk during the current hospital admission. The model was trained and validated on data extracted from 398 patients admitted to hospital with a positive real-time reverse transcription polymerase chain reaction (RT-PCR) test for SARS-CoV-2. Results: Patient-specific mortality was predicted with 86.25% accuracy, with a sensitivity of 87.50% (95% CI 61.65%-98.45%) and specificity of 85.94% (95% CI 74.98%-93.36%). The positive predictive value was 60.87% (95% CI 45.23%-74.56%), and the negative predictive value was 96.49% (95% CI 88.23%-99.02%). The area under the receiver operating characteristic curve was 90.12%. Conclusions: This analysis demonstrates an adaptive ANN trained on data at a single site, which demonstrates the early utility of deep learning approaches in a rapidly evolving pandemic with no established or validated prognostic scoring systems. %M 32735549 %R 10.2196/20259 %U http://www.jmir.org/2020/8/e20259/ %U https://doi.org/10.2196/20259 %U http://www.ncbi.nlm.nih.gov/pubmed/32735549 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e22033 %T Managing COVID-19 With a Clinical Decision Support Tool in a Community Health Network: Algorithm Development and Validation %A McRae,Michael P %A Dapkins,Isaac P %A Sharif,Iman %A Anderman,Judd %A Fenyo,David %A Sinokrot,Odai %A Kang,Stella K %A Christodoulides,Nicolaos J %A Vurmaz,Deniz %A Simmons,Glennon W %A Alcorn,Timothy M %A Daoura,Marco J %A Gisburne,Stu %A Zar,David %A McDevitt,John T %+ Department of Biomaterials, Bioengineering Institute, New York University College of Dentistry, 433 First Avenue, Room 820, New York, NY, 10010, United States, 1 (212) 998-9204, mcdevitt@nyu.edu %K COVID-19 %K coronavirus %K clinical decision support system %K point of care %K mobile app %K disease severity %K biomarkers %K artificial intelligence %K app %K family health center %D 2020 %7 24.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The coronavirus disease (COVID-19) pandemic has resulted in significant morbidity and mortality; large numbers of patients require intensive care, which is placing strain on health care systems worldwide. There is an urgent need for a COVID-19 disease severity assessment that can assist in patient triage and resource allocation for patients at risk for severe disease. Objective: The goal of this study was to develop, validate, and scale a clinical decision support system and mobile app to assist in COVID-19 severity assessment, management, and care. Methods: Model training data from 701 patients with COVID-19 were collected across practices within the Family Health Centers network at New York University Langone Health. A two-tiered model was developed. Tier 1 uses easily available, nonlaboratory data to help determine whether biomarker-based testing and/or hospitalization is necessary. Tier 2 predicts the probability of mortality using biomarker measurements (C-reactive protein, procalcitonin, D-dimer) and age. Both the Tier 1 and Tier 2 models were validated using two external datasets from hospitals in Wuhan, China, comprising 160 and 375 patients, respectively. Results: All biomarkers were measured at significantly higher levels in patients who died vs those who were not hospitalized or discharged (P<.001). The Tier 1 and Tier 2 internal validations had areas under the curve (AUCs) of 0.79 (95% CI 0.74-0.84) and 0.95 (95% CI 0.92-0.98), respectively. The Tier 1 and Tier 2 external validations had AUCs of 0.79 (95% CI 0.74-0.84) and 0.97 (95% CI 0.95-0.99), respectively. Conclusions: Our results demonstrate the validity of the clinical decision support system and mobile app, which are now ready to assist health care providers in making evidence-based decisions when managing COVID-19 patient care. The deployment of these new capabilities has potential for immediate impact in community clinics and sites, where application of these tools could lead to improvements in patient outcomes and cost containment. %M 32750010 %R 10.2196/22033 %U http://www.jmir.org/2020/8/e22033/ %U https://doi.org/10.2196/22033 %U http://www.ncbi.nlm.nih.gov/pubmed/32750010 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19642 %T Clinical Characteristics and Outcomes of Childbearing-Age Women With COVID-19 in Wuhan: Retrospective, Single-Center Study %A Wei,Lijie %A Gao,Xuan %A Chen,Suhua %A Zeng,Wanjiang %A Wu,Jianli %A Lin,Xingguang %A Zhang,Huiting %A Mwamaka Sharifu,Lali %A Chen,Ling %A Feng,Ling %A Wang,Shaoshuai %+ Department of Obstetrics and Gynecology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, No. 1095, Jiefang Avenue, Wuhan, Hubei 430030, China, 86 83663812, colombo2008@sina.com %K COVID-19 %K SARS-CoV-2 %K childbearing age %K pregnancy %K clinical characteristics %K outcomes %K women %K health information %K epidemiology %K diagnosis %K symptom %D 2020 %7 24.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since December 2019, an outbreak of the coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread rapidly in Wuhan and worldwide. However, previous studies on pregnant patients were limited. Objective: The aim of this study is to evaluate the clinical characteristics and outcomes of pregnant and nonpregnant women with COVID-19. Methods: This study retrospectively collected epidemiological, clinical, laboratory, imaging, management, and outcome data of 43 childbearing-age women patients (including 17 pregnant and 26 nonpregnant patients) who presented with laboratory-confirmed COVID-19 in Tongji Hospital, Wuhan, China from January 19 to March 2, 2020. Clinical outcomes were followed up to March 28, 2020. Results: Of the 43 childbearing-age women in this study, none developed a severe adverse illness or died. The median ages of pregnant and nonpregnant women were 33.0 and 33.5 years, respectively. Pregnant women had a markedly higher proportion of history exposure to hospitals within 2 weeks before onset compared to nonpregnant women (9/17, 53% vs 5/26, 19%, P=.02) and a lower proportion of other family members affected (4/17, 24% vs 19/26, 73%, P=.004). Fever (8/17, 47% vs 18/26, 69%) and cough (9/17, 53% vs 12/26, 46%) were common onsets of symptoms for the two groups. Abdominal pain (n=4, 24%), vaginal bleeding (n=1, 6%), reduced fetal movement (n=1, 6%), and increased fetal movement (n=2, 13%) were observed at onset in the 17 pregnant patients. Higher neutrophil and lower lymphocyte percent were observed in the pregnant group compared to the nonpregnant group (79% vs 56%, P<.001; 15% vs 33%, P<.001, respectively). In both groups, we observed an elevated concentration of high-sensitivity C-reactive protein, erythrocyte sedimentation rate, aminotransferase, and lactate dehydrogenase. Concentrations of alkaline phosphatase and D-dimer in the pregnant group were significantly higher than those of the nonpregnant group (119.0 vs 48.0 U/L, P<.001; 2.1 vs 0.3μg/mL, P<.001, respectively). Both pregnant (4/10, 40%) and nonpregnant (8/15, 53%) women tested positive for influenza A virus. A majority of pregnant and nonpregnant groups received antiviral (13/17, 76% vs 25/26, 96%) and antibiotic (13/17, 76% vs 23/26, 88%) therapy. Additionally, both pregnant (2/11, 18%) and nonpregnant (2/19, 11%) recovered women redetected positive for SARS-CoV-2 after discharge. Conclusions: The epidemiology and clinical and laboratory features of pregnant women with COVID-19 were diverse and atypical, which increased the difficulty of diagnosis. Most pregnant women with COVID-19 were mild and moderate, and rarely developed severe pneumonia or severe adverse outcomes. %M 32750000 %R 10.2196/19642 %U http://www.jmir.org/2020/8/e19642/ %U https://doi.org/10.2196/19642 %U http://www.ncbi.nlm.nih.gov/pubmed/32750000 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19995 %T Chinese Public’s Engagement in Preventive and Intervening Health Behaviors During the Early Breakout of COVID-19: Cross-Sectional Study %A Niu,Zhaomeng %A Wang,Tingting %A Hu,Pengwei %A Mei,Jing %A Tang,Zhihan %+ Hengyang Medical College, University of South China, 28 West Changsheng Road, Hengyang, 421001, China, 86 135 7478 0245, tangzhihan98@163.com %K COVID-19 %K China %K preventive health behaviors %K intervening health behaviors %K psychosocial %K health literacy %K behavior %K prevention %K cross-sectional %D 2020 %7 21.8.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32716897 %R 10.2196/19995 %U http://www.jmir.org/2020/8/e19995/ %U https://doi.org/10.2196/19995 %U http://www.ncbi.nlm.nih.gov/pubmed/32716897 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21257 %T 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 %A Chiu,Nan-Chang %A Chi,Hsin %A Tai,Yu-Lin %A Peng,Chun-Chih %A Tseng,Cheng-Yin %A Chen,Chung-Chu %A Tan,Boon Fatt %A Lin,Chien-Yu %+ Hsinchu MacKay Memorial Hospital, 690 Guanfu Road, East District, Hsinchu, 300, Taiwan, 886 36119595 ext 2582, mmhped.lin@gmail.com %K novel coronavirus %K COVID-19 %K SARS-CoV-2 %K pandemic %K influenza %K pneumonia %K hygiene %K social distancing %K prevention %K incidence %K surveillance %D 2020 %7 20.8.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32750008 %R 10.2196/21257 %U http://www.jmir.org/2020/8/e21257/ %U https://doi.org/10.2196/21257 %U http://www.ncbi.nlm.nih.gov/pubmed/32750008 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19673 %T Diagnostic Value of Imaging Modalities for COVID-19: Scoping Review %A Aljondi,Rowa %A Alghamdi,Salem %+ Department of Applied Radiologic Technology, College of Applied Medical Sciences, University of Jeddah, Al Sharafeyah, Jeddah, 23218, Saudi Arabia, 966 530550559, rowaaljondi@gmail.com %K diagnostic imaging %K radiology %K COVID-19 %K respiratory infection %K pneumonia %K imaging %K CT %K infectious disease %K diagnosis %K review %D 2020 %7 19.8.2020 %9 Review %J J Med Internet Res %G English %X Background: Coronavirus disease (COVID-19) is a serious infectious disease that causes severe respiratory illness. This pandemic represents a serious public health risk. Therefore, early and accurate diagnosis is essential to control disease progression. Radiological examination plays a crucial role in the early identification and management of infected patients. Objective: The aim of this review was to identify the diagnostic value of different imaging modalities used for diagnosis of COVID-19. Methods: A comprehensive literature search was conducted using the PubMed, Scopus, Web of Science, and Google Scholar databases. The keywords diagnostic imaging, radiology, respiratory infection, pneumonia, coronavirus infection and COVID-19 were used to identify radiology articles focusing on the diagnosis of COVID-19 and to determine the diagnostic value of various imaging modalities, including x-ray, computed tomography (CT), ultrasound, and nuclear medicine for identification and management of infected patients. Results: We identified 50 articles in the literature search. Studies that investigated the diagnostic roles and imaging features of patients with COVID-19, using either chest CT, lung ultrasound, chest x-ray, or positron emission topography/computed tomography (PET/CT) scan, were discussed. Of these imaging modalities, chest x-ray and CT scan are the most commonly used for diagnosis and management of COVID-19 patients, with chest CT scan being more accurate and sensitive in identifying COVID-19 at early stages. Only a few studies have investigated the roles of ultrasound and PET/CT scan in diagnosing COVID-19. Conclusions: Chest CT scan remains the most sensitive imaging modality in initial diagnosis and management of suspected and confirmed patients with COVID-19. Other diagnostic imaging modalities could add value in evaluating disease progression and monitoring critically ill patients with COVID-19. %M 32716893 %R 10.2196/19673 %U http://www.jmir.org/2020/8/e19673/ %U https://doi.org/10.2196/19673 %U http://www.ncbi.nlm.nih.gov/pubmed/32716893 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e22590 %T Social Network Analysis of COVID-19 Sentiments: Application of Artificial Intelligence %A Hung,Man %A Lauren,Evelyn %A Hon,Eric S %A Birmingham,Wendy C %A Xu,Julie %A Su,Sharon %A Hon,Shirley D %A Park,Jungweon %A Dang,Peter %A Lipsky,Martin S %+ College of Dental Medicine, Roseman University of Health Sciences, 10894 South River Front Parkway, South Jordan, UT, 84095-3538, United States, 1 801 878 1270, mhung@roseman.edu %K COVID-19 %K coronavirus %K sentiment %K social network %K Twitter %K infodemiology %K infodemic %K pandemic %K crisis %K public health %K business economy %K artificial intelligence %D 2020 %7 18.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The coronavirus disease (COVID-19) pandemic led to substantial public discussion. Understanding these discussions can help institutions, governments, and individuals navigate the pandemic. Objective: The aim of this study is to analyze discussions on Twitter related to COVID-19 and to investigate the sentiments toward COVID-19. Methods: This study applied machine learning methods in the field of artificial intelligence to analyze data collected from Twitter. Using tweets originating exclusively in the United States and written in English during the 1-month period from March 20 to April 19, 2020, the study examined COVID-19–related discussions. Social network and sentiment analyses were also conducted to determine the social network of dominant topics and whether the tweets expressed positive, neutral, or negative sentiments. Geographic analysis of the tweets was also conducted. Results: There were a total of 14,180,603 likes, 863,411 replies, 3,087,812 retweets, and 641,381 mentions in tweets during the study timeframe. Out of 902,138 tweets analyzed, sentiment analysis classified 434,254 (48.2%) tweets as having a positive sentiment, 187,042 (20.7%) as neutral, and 280,842 (31.1%) as negative. The study identified 5 dominant themes among COVID-19–related tweets: health care environment, emotional support, business economy, social change, and psychological stress. Alaska, Wyoming, New Mexico, Pennsylvania, and Florida were the states expressing the most negative sentiment while Vermont, North Dakota, Utah, Colorado, Tennessee, and North Carolina conveyed the most positive sentiment. Conclusions: This study identified 5 prevalent themes of COVID-19 discussion with sentiments ranging from positive to negative. These themes and sentiments can clarify the public’s response to COVID-19 and help officials navigate the pandemic. %M 32750001 %R 10.2196/22590 %U http://www.jmir.org/2020/8/e22590/ %U https://doi.org/10.2196/22590 %U http://www.ncbi.nlm.nih.gov/pubmed/32750001 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21413 %T COVID-19 Mortality Underreporting in Brazil: Analysis of Data From Government Internet Portals %A Veiga e Silva,Lena %A de Andrade Abi Harb,Maria Da Penha %A Teixeira Barbosa dos Santos,Aurea Milene %A de Mattos Teixeira,Carlos André %A Macedo Gomes,Vitor Hugo %A Silva Cardoso,Evelin Helena %A S da Silva,Marcelino %A Vijaykumar,N L %A Venâncio Carvalho,Solon %A Ponce de Leon Ferreira de Carvalho,André %A Lisboa Frances,Carlos Renato %+ Federal University of Pará, R Augusto Corrêa, 01, Guamá, Belém, 66073-040, Brazil, 55 91 3201 7634, lenaveiga@gmail.com %K Brazil %K COVID-19 %K mortality %K underreporting %K respiratory system diseases %K public health %K pandemic %K time series %K forecasting %D 2020 %7 18.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In Brazil, a substantial number of coronavirus disease (COVID-19) cases and deaths have been reported. It has become the second most affected country worldwide, as of June 9, 2020. Official Brazilian government sources present contradictory data on the impact of the disease; thus, it is possible that the actual number of infected individuals and deaths in Brazil is far larger than those officially reported. It is very likely that the actual spread of the disease has been underestimated. Objective: This study investigates the underreporting of cases and deaths related to COVID-19 in the most affected cities in Brazil, based on public data available from official Brazilian government internet portals, to identify the actual impact of the pandemic. Methods: We used data from historical deaths due to respiratory problems and other natural causes from two public portals: DATASUS (Department of Informatics of the Unified Healthcare System) (2010-2018) and the Brazilian Transparency Portal of Civil Registry (2019-2020). These data were used to build time-series models (modular regressions) to predict the expected mortality patterns for 2020. The forecasts were used to estimate the possible number of deaths that were incorrectly registered during the pandemic and posted on government internet portals in the most affected cities in the country. Results: Our model found a significant difference between the real and expected values. The number of deaths due to severe acute respiratory syndrome (SARS) was considerably higher in all cities, with increases between 493% and 5820%. This sudden increase may be associated with errors in reporting. An average underreporting of 40.68% (range 25.9%-62.7%) is estimated for COVID-19–related deaths. Conclusions: The significant rates of underreporting of deaths analyzed in our study demonstrate that officially released numbers are much lower than actual numbers, making it impossible for the authorities to implement a more effective pandemic response. Based on analyses carried out using different fatality rates, it can be inferred that Brazil’s epidemic is worsening, and the actual number of infectees could already be between 1 to 5.4 million. %M 32730219 %R 10.2196/21413 %U http://www.jmir.org/2020/8/e21413/ %U https://doi.org/10.2196/21413 %U http://www.ncbi.nlm.nih.gov/pubmed/32730219 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e21486 %T Use of the HoloLens2 Mixed Reality Headset for Protecting Health Care Workers During the COVID-19 Pandemic: Prospective, Observational Evaluation %A Martin,Guy %A Koizia,Louis %A Kooner,Angad %A Cafferkey,John %A Ross,Clare %A Purkayastha,Sanjay %A Sivananthan,Arun %A Tanna,Anisha %A Pratt,Philip %A Kinross,James %A , %+ Department of Surgery and Cancer, Imperial College London, 10th Floor, QEQM Building, St Mary’s Hospital, London, W2 1NY, United Kingdom, 44 0203 312 6072, guy.martin@imperial.ac.uk %K COVID-19 %K mixed reality %K telemedicine %K protection %K acceptability %K feasibility %K impact %K headset %K virtual reality %K augmented reality %K pilot %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32730222 %R 10.2196/21486 %U http://www.jmir.org/2020/8/e21486/ %U https://doi.org/10.2196/21486 %U http://www.ncbi.nlm.nih.gov/pubmed/32730222 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20914 %T The Infection Rate of COVID-19 in Wuhan, China: Combined Analysis of Population Samples %A Qu,Hui-Qi %A Cheng,Zhangkai Jason %A Duan,Zhifeng %A Tian,Lifeng %A Hakonarson,Hakon %+ Center for Applied Genomics, The Children’s Hospital of Philadelphia, 3615 Civic Center Boulevard, Philadelphia, PA, United States, 1 267 426 0088, Hakonarson@email.chop.edu %K infectious disease %K COVID-19 %K infection rate %K China %K Wuhan %K fatality %K public health %K diagnosis %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The coronavirus disease (COVID-19) pandemic began in Wuhan, China, in December 2019. Wuhan had a much higher mortality rate than the rest of China. However, a large number of asymptomatic infections in Wuhan may have never been diagnosed, contributing to an overestimated mortality rate. Objective: This study aims to obtain an accurate estimate of infections in Wuhan using internet data. Methods: In this study, we performed a combined analysis of the infection rate among evacuated foreign citizens to estimate the infection rate in Wuhan in late January and early February. Results: Based on our analysis, the combined infection rate of the foreign evacuees was 0.013 (95% CI 0.008-0.022). Therefore, we estimate the number of infected people in Wuhan to be 143,000 (range 88,000-242,000), which is significantly higher than previous estimates. Our study indicates that a large number of infections in Wuhan were not diagnosed, which has resulted in an overestimated case fatality rate. Conclusions: Increased awareness of the original infection rate of Wuhan is critical for proper public health measures at all levels, as well as to eliminate panic caused by overestimated mortality rates that may bias health policy actions by the authorities. %M 32707538 %R 10.2196/20914 %U https://www.jmir.org/2020/8/e20914 %U https://doi.org/10.2196/20914 %U http://www.ncbi.nlm.nih.gov/pubmed/32707538 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20773 %T Natural Language Processing for Rapid Response to Emergent Diseases: Case Study of Calcium Channel Blockers and Hypertension in the COVID-19 Pandemic %A Neuraz,Antoine %A Lerner,Ivan %A Digan,William %A Paris,Nicolas %A Tsopra,Rosy %A Rogier,Alice %A Baudoin,David %A Cohen,Kevin Bretonnel %A Burgun,Anita %A Garcelon,Nicolas %A Rance,Bastien %A , %+ Department of Biomedical Informatics, Necker-Enfant Malades Hospital, Assistance Publique – Hôpitaux de Paris (AP-HP), Bat Imagine, Bureau 145, 149 rue de Sèvres, Paris, 75015, France, 33 0624622355, antoine.neuraz@aphp.fr %K medication information %K natural language processing %K electronic health records %K COVID-19 %K public health %K response %K emergent disease %K informatics %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: A novel disease poses special challenges for informatics solutions. Biomedical informatics relies for the most part on structured data, which require a preexisting data or knowledge model; however, novel diseases do not have preexisting knowledge models. In an emergent epidemic, language processing can enable rapid conversion of unstructured text to a novel knowledge model. However, although this idea has often been suggested, no opportunity has arisen to actually test it in real time. The current coronavirus disease (COVID-19) pandemic presents such an opportunity. Objective: The aim of this study was to evaluate the added value of information from clinical text in response to emergent diseases using natural language processing (NLP). Methods: We explored the effects of long-term treatment by calcium channel blockers on the outcomes of COVID-19 infection in patients with high blood pressure during in-patient hospital stays using two sources of information: data available strictly from structured electronic health records (EHRs) and data available through structured EHRs and text mining. Results: In this multicenter study involving 39 hospitals, text mining increased the statistical power sufficiently to change a negative result for an adjusted hazard ratio to a positive one. Compared to the baseline structured data, the number of patients available for inclusion in the study increased by 2.95 times, the amount of available information on medications increased by 7.2 times, and the amount of additional phenotypic information increased by 11.9 times. Conclusions: In our study, use of calcium channel blockers was associated with decreased in-hospital mortality in patients with COVID-19 infection. This finding was obtained by quickly adapting an NLP pipeline to the domain of the novel disease; the adapted pipeline still performed sufficiently to extract useful information. When that information was used to supplement existing structured data, the sample size could be increased sufficiently to see treatment effects that were not previously statistically detectable. %M 32759101 %R 10.2196/20773 %U http://www.jmir.org/2020/8/e20773/ %U https://doi.org/10.2196/20773 %U http://www.ncbi.nlm.nih.gov/pubmed/32759101 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e18855 %T Text Processing for Detection of Fungal Ocular Involvement in Critical Care Patients: Cross-Sectional Study %A Baxter,Sally L %A Klie,Adam R %A Radha Saseendrakumar,Bharanidharan %A Ye,Gordon Y %A Hogarth,Michael %+ Viterbi Family Department of Ophthalmology and Shiley Eye Institute, University of California San Diego, 9415 Campus Point Dr. MC 0946, La Jolla, CA, 92093, United States, 1 858 534 8858, s1baxter@health.ucsd.edu %K fungemia %K fungal endophthalmitis %K fungal ocular involvement %K electronic health records %K diagnosis codes %K regular expressions %K natural language processing %K unstructured data %D 2020 %7 14.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Fungal ocular involvement can develop in patients with fungal bloodstream infections and can be vision-threatening. Ocular involvement has become less common in the current era of improved antifungal therapies. Retrospectively determining the prevalence of fungal ocular involvement is important for informing clinical guidelines, such as the need for routine ophthalmologic consultations. However, manual retrospective record review to detect cases is time-consuming. Objective: This study aimed to determine the prevalence of fungal ocular involvement in a critical care database using both structured and unstructured electronic health record (EHR) data. Methods: We queried microbiology data from 46,467 critical care patients over 12 years (2000-2012) from the Medical Information Mart for Intensive Care III (MIMIC-III) to identify 265 patients with culture-proven fungemia. For each fungemic patient, demographic data, fungal species present in blood culture, and risk factors for fungemia (eg, presence of indwelling catheters, recent major surgery, diabetes, immunosuppressed status) were ascertained. All structured diagnosis codes and free-text narrative notes associated with each patient’s hospitalization were also extracted. Screening for fungal endophthalmitis was performed using two approaches: (1) by querying a wide array of eye- and vision-related diagnosis codes, and (2) by utilizing a custom regular expression pipeline to identify and collate relevant text matches pertaining to fungal ocular involvement. Both approaches were validated using manual record review. The main outcome measure was the documentation of any fungal ocular involvement. Results: In total, 265 patients had culture-proven fungemia, with Candida albicans (n=114, 43%) and Candida glabrata (n=74, 28%) being the most common fungal species in blood culture. The in-hospital mortality rate was 121 (46%). In total, 7 patients were identified as having eye- or vision-related diagnosis codes, none of whom had fungal endophthalmitis based on record review. There were 26,830 free-text narrative notes associated with these 265 patients. A regular expression pipeline based on relevant terms yielded possible matches in 683 notes from 108 patients. Subsequent manual record review again demonstrated that no patients had fungal ocular involvement. Therefore, the prevalence of fungal ocular involvement in this cohort was 0%. Conclusions: MIMIC-III contained no cases of ocular involvement among fungemic patients, consistent with prior studies reporting low rates of ocular involvement in fungemia. This study demonstrates an application of natural language processing to expedite the review of narrative notes. This approach is highly relevant for ophthalmology, where diagnoses are often based on physical examination findings that are documented within clinical notes. %M 32795984 %R 10.2196/18855 %U https://www.jmir.org/2020/8/e18855 %U https://doi.org/10.2196/18855 %U http://www.ncbi.nlm.nih.gov/pubmed/32795984 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20193 %T Hazards of the Cytokine Storm and Cytokine-Targeted Therapy in Patients With COVID-19: Review %A Quirch,Miguel %A Lee,Jeannie %A Rehman,Shabnam %+ Texas Tech University Health Sciences Center, 3601 4th St, Lubbock, TX, 79430, United States, 1 806 743 3543, miguel.quirch@ttuhsc.edu %K coronavirus %K COVID-19 %K convalescent plasma therapy %K cytokine storm %K SARS-CoV-2 %K cytokine %K immunology %K review %K mortality %K inflammation %K therapy %D 2020 %7 13.8.2020 %9 Review %J J Med Internet Res %G English %X Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has challenged medicine and health care on a global scale. Its impact and frightening mortality rate are in large part attributable to the fact that there is a lack of available treatments. It has been shown that in patients who are severely ill, SARS-CoV-2 can lead to an inflammatory response known as cytokine storm, which involves activation and release of inflammatory cytokines in a positive feedback loop of pathogen-triggered inflammation. Currently, cytokine storm is one of the leading causes of morbidity and mortality in SARS-CoV-2, but there is no proven treatment to combat this systemic response. Objective: The aim of this paper is to study the cytokine storm response in SARS-CoV-2 and to explore the early treatment options for patients who are critically ill with the coronavirus disease (COVID-19) in the early stages of the pandemic by reviewing the literature. Methods: A literature review was performed from December 1, 2000, to April 4, 2020, to explore and compare therapies that target cytokine storm among SARS-CoV-2 and prior coronavirus cases. Results: A total of 38 eligible studies including 24 systematic reviews, 5 meta-analyses, 5 experimental model studies, 7 cohort studies, and 4 case reports matched the criteria. Conclusions: The severity of the cytokine storm, measured by elevated levels of interleukin-1B, interferon-γ, interferon-inducible protein 10, and monocyte chemoattractant protein 1, was associated with COVID-19 disease severity. Many treatment options with different targets have been proposed during the early stages of the COVID-19 pandemic, ranging from targeting the virus itself to managing the systemic inflammation caused by the virus and the excessive cytokine response. Among the different agents to manage cytokine storm in patients with COVID-19, there is developing support for convalescent plasma therapy particularly for patients who are critically ill or mechanically ventilated and resistant to antivirals and supportive care. Treatment options that were proposed in the beginning phases of the pandemic were multidimensional, and further research is needed to develop a more established treatment guideline. %M 32707537 %R 10.2196/20193 %U http://www.jmir.org/2020/8/e20193/ %U https://doi.org/10.2196/20193 %U http://www.ncbi.nlm.nih.gov/pubmed/32707537 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20108 %T Characteristics and Outcomes of a Sample of Patients With COVID-19 Identified Through Social Media in Wuhan, China: Observational Study %A Liu,Dong %A Wang,Yuyan %A Wang,Juan %A Liu,Jue %A Yue,Yongjie %A Liu,Wenjun %A Zhang,Fuhai %A Wang,Ziping %+ Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Thoracic Medical Oncology, Peking University Cancer Hospital & Institute, No 52 Fucheng Road, Haidian District, Beijing , China, 86 13301212676, wangzp2007@126.com %K COVID-19 %K risk factors %K web-based data %K outcome %K infectious disease %K clinical characteristic %K mortality %K social media %K prognosis, China %K coronavirus %D 2020 %7 13.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The number of deaths worldwide caused by coronavirus disease (COVID-19) is increasing rapidly. Information about the clinical characteristics of patients with COVID-19 who were not admitted to hospital is limited. Some risk factors of mortality associated with COVID-19 are controversial (eg, smoking). Moreover, the impact of city closure on mortality and admission rates is unknown. Objective: The aim of this study was to explore the risk factors of mortality associated with COVID-19 infection among a sample of patients in Wuhan whose conditions were reported on social media. Methods: We enrolled 599 patients with COVID-19 from 67 hospitals in Wuhan in the study; 117 of the participants (19.5%) were not admitted to hospital. The demographic, epidemiological, clinical, and radiological features of the patients were extracted from their social media posts and coded. Telephone follow-up was conducted 1 month later (between March 15 and 23, 2020) to check the clinical outcomes of the patients and acquire other relevant information. Results: The median age of patients with COVID-19 who died (72 years, IQR 66.5-82.0) was significantly higher than that of patients who recovered (61 years, IQR 53-69, P<.001). We found that lack of admission to hospital (odds ratio [OR] 5.82, 95% CI 3.36-10.1; P<.001), older age (OR 1.08, 95% CI 1.06-1.1; P<.001), diffuse distribution (OR 11.09, 95% CI 0.93-132.9; P=.058), and hypoxemia (odds ratio 2.94, 95% CI 1.32-6.6; P=.009) were associated with increasing odds of death. Smoking was not significantly associated with mortality risk (OR 0.9, 95% CI 0.44-1.85; P=.78). Conclusions: Older age, diffuse distribution, and hypoxemia are factors that can help clinicians identify patients with COVID-19 who have poor prognosis. Our study suggests that aggregated data from social media can also be comprehensive, immediate, and informative in disease prognosis. %M 32716901 %R 10.2196/20108 %U http://www.jmir.org/2020/8/e20108/ %U https://doi.org/10.2196/20108 %U http://www.ncbi.nlm.nih.gov/pubmed/32716901 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e18912 %T 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 %A Woldaregay,Ashenafi Zebene %A Launonen,Ilkka Kalervo %A Albers,David %A Igual,Jorge %A Årsand,Eirik %A Hartvigsen,Gunnar %+ Department of Computer Science, University of Tromsø – The Arctic University of Norway, Hansine Hansens veg 54, Science building Realfagbygget, office A124, Tromsø, Norway, 47 46359333, ashenafi.z.woldaregay@uit.no %K type 1 diabetes %K self-recorded health data %K infection detection %K decision support techniques %K outbreak detection system %K syndromic surveillance %D 2020 %7 12.8.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32784179 %R 10.2196/18912 %U https://www.jmir.org/2020/8/e18912 %U https://doi.org/10.2196/18912 %U http://www.ncbi.nlm.nih.gov/pubmed/32784179 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20634 %T Citizens’ Adherence to COVID-19 Mitigation Recommendations by the Government: A 3-Country Comparative Evaluation Using Web-Based Cross-Sectional Survey Data %A Al-Hasan,Abrar %A Yim,Dobin %A Khuntia,Jiban %+ College of Business Administration, Kuwait University, Information Systems and Operation Management Department, AlShadadiya University City, 13055, Kuwait, 965 51165005, abrar.alhasan@ku.edu.kw %K COVID-19 %K adherence %K social distancing %K government perception %K information sources %K social media %K knowledge %D 2020 %7 11.8.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32716896 %R 10.2196/20634 %U http://www.jmir.org/2020/8/e20634/ %U https://doi.org/10.2196/20634 %U http://www.ncbi.nlm.nih.gov/pubmed/32716896 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19104 %T Approaches Based on Artificial Intelligence and the Internet of Intelligent Things to Prevent the Spread of COVID-19: Scoping Review %A Adly,Aya Sedky %A Adly,Afnan Sedky %A Adly,Mahmoud Sedky %+ Faculty of Oral and Dental Medicine, Cairo University, Cairo University Road, Cairo, , Egypt, 20 1145559778, dr.mahmoud.sedky@gmail.com %K SARS-CoV-2 %K COVID-19 %K novel coronavirus %K artificial intelligence %K internet of things %K telemedicine %K machine learning %K modeling %K simulation %K robotics %D 2020 %7 10.8.2020 %9 Review %J J Med Internet Res %G English %X Background: Artificial intelligence (AI) and the Internet of Intelligent Things (IIoT) are promising technologies to prevent the concerningly rapid spread of coronavirus disease (COVID-19) and to maximize safety during the pandemic. With the exponential increase in the number of COVID-19 patients, it is highly possible that physicians and health care workers will not be able to treat all cases. Thus, computer scientists can contribute to the fight against COVID-19 by introducing more intelligent solutions to achieve rapid control of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes the disease. Objective: The objectives of this review were to analyze the current literature, discuss the applicability of reported ideas for using AI to prevent and control COVID-19, and build a comprehensive view of how current systems may be useful in particular areas. This may be of great help to many health care administrators, computer scientists, and policy makers worldwide. Methods: We conducted an electronic search of articles in the MEDLINE, Google Scholar, Embase, and Web of Knowledge databases to formulate a comprehensive review that summarizes different categories of the most recently reported AI-based approaches to prevent and control the spread of COVID-19. Results: Our search identified the 10 most recent AI approaches that were suggested to provide the best solutions for maximizing safety and preventing the spread of COVID-19. These approaches included detection of suspected cases, large-scale screening, monitoring, interactions with experimental therapies, pneumonia screening, use of the IIoT for data and information gathering and integration, resource allocation, predictions, modeling and simulation, and robotics for medical quarantine. Conclusions: We found few or almost no studies regarding the use of AI to examine COVID-19 interactions with experimental therapies, the use of AI for resource allocation to COVID-19 patients, or the use of AI and the IIoT for COVID-19 data and information gathering/integration. Moreover, the adoption of other approaches, including use of AI for COVID-19 prediction, use of AI for COVID-19 modeling and simulation, and use of AI robotics for medical quarantine, should be further emphasized by researchers because these important approaches lack sufficient numbers of studies. Therefore, we recommend that computer scientists focus on these approaches, which are still not being adequately addressed. %M 32584780 %R 10.2196/19104 %U https://www.jmir.org/2020/8/e19104 %U https://doi.org/10.2196/19104 %U http://www.ncbi.nlm.nih.gov/pubmed/32584780 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e20328 %T Mental Health Disorders and Associated Risk Factors in Quarantined Adults During the COVID-19 Outbreak in China: Cross-Sectional Study %A Guo,Yan %A Cheng,Chao %A Zeng,Yu %A Li,Yiran %A Zhu,Mengting %A Yang,Weixiong %A Xu,He %A Li,Xiaohua %A Leng,Jinhang %A Monroe-Wise,Aliza %A Wu,Shaomin %+ Department of Thoracic Surgery, The First Affiliated Hospital of Sun Yat-sen University, No 58 2nd Zhongshan Road, Guangzhou, 510080, China, 86 87755766, drchengchao@163.com %K COVID-19 %K anxiety or depressive symptoms %K quarantine %K risk and protective factors %D 2020 %7 6.8.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32716899 %R 10.2196/20328 %U http://www.jmir.org/2020/8/e20328/ %U https://doi.org/10.2196/20328 %U http://www.ncbi.nlm.nih.gov/pubmed/32716899 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e20596 %T Mobile Health Apps That Help With COVID-19 Management: Scoping Review %A John Leon Singh,Hanson %A Couch,Danielle %A Yap,Kevin %+ Department of Public Health, School of Psychology and Public Health, La Trobe University, Health Sciences 2 Building, Melbourne, 3086, Australia, 61 3 9479 6068, kevinyap.ehealth@gmail.com %K COVID-19 %K mobile apps %K mHealth %K contact tracing %K symptom monitoring %K information provision %K mobile health %D 2020 %7 6.8.2020 %9 Review %J JMIR Nursing %G English %X Background: Mobile health (mHealth) apps have played an important role in mitigating the coronavirus disease (COVID-19) response. However, there is no resource that provides a holistic picture of the available mHealth apps that have been developed to combat this pandemic. Objective: Our aim is to scope the evidence base on apps that were developed in response to COVID-19. Methods: Following the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines for scoping reviews, literature searches were conducted on Google Search, Google Scholar, and PubMed using the country’s name as keywords and “coronavirus,” “COVID-19,” “nCOV19,” “contact tracing,” “information providing apps,” “symptom tracking,” “mobile apps,” “mobile applications,” “smartphone,” “mobile phone,” and “mHealth.” Countries most affected by COVID-19 and those that first rolled out COVID-19–related apps were included. Results: A total of 46 articles were reviewed from 19 countries, resulting in a total of 29 apps. Among them, 15 (52%) apps were on contact tracing, 7 (24%) apps on quarantine, 7 (24%) on symptom monitoring, and 1 (3%) on information provision. More than half (n=20, 69%) were from governmental sources, only 3 (10%) were from private organizations, and 3 (10%) from universities. There were 6 (21%) apps available on either Android or iOS, and 10 (34%) were available on both platforms. Bluetooth was used in 10 (34%) apps for collecting data, 12 (41%) apps used GPS, and 12 (41%) used other forms of data collection. Conclusions: This review identifies that the majority of COVID-19 apps were for contact tracing and symptom monitoring. However, these apps are effective only if taken up by the community. The sharing of good practices across different countries can enable governments to learn from each other and develop effective strategies to combat and manage this pandemic. %M 32897271 %R 10.2196/20596 %U https://nursing.jmir.org/2020/1/e20596/ %U https://doi.org/10.2196/20596 %U http://www.ncbi.nlm.nih.gov/pubmed/32897271 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e19745 %T Telemedicine in Germany During the COVID-19 Pandemic: Multi-Professional National Survey %A Peine,Arne %A Paffenholz,Pia %A Martin,Lukas %A Dohmen,Sandra %A Marx,Gernot %A Loosen,Sven H %+ Department of Intensive Care and Intermediate Care, University Hospital Rheinisch Westfaelische Technische Hochschule Aachen, Pauwelsstraße 30, Aachen, 52072, Germany, 49 2418038009, apeine@ukaachen.de %K telemedicine %K coronavirus %K COVID-19 %K telehealth %K SARS-CoV-2 %K pandemic %K survey %K medical professional %K availability %K acceptance %K burden %D 2020 %7 5.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In an effort to contain the effects of the coronavirus disease (COVID-19) pandemic, health care systems worldwide implemented telemedical solutions to overcome staffing, technical, and infrastructural limitations. In Germany, a multitude of telemedical systems are already being used, while new approaches are rapidly being developed in response to the crisis. However, the extent of the current implementation within different health care settings, the user’s acceptance and perception, as well as the hindering technical and regulatory obstacles remain unclear. Objective: The aim of this paper is to assess the current status quo of the availability and routine use of telemedical solutions, user acceptance, and the subjectively perceived burdens on telemedical approaches. Furthermore, we seek to assess the perception of public information quality among professional groups and their preferred communication channels. Methods: A national online survey was conducted on 14 consecutive days in March and April 2020, and distributed to doctors, nurses, and other medical professionals in the German language. Results: A total of 2827 medical professionals participated in the study. Doctors accounted for 65.6% (n=1855) of the professionals, 29.5% (n=833) were nursing staff, and 4.9% (n=139) were identified as others such as therapeutic staff. A majority of participants rated the significance of telemedicine within the crisis as high (1065/2730, 39%) or neutral (n=720, 26.4%); however, there were significant differences between doctors and nurses (P=.01) as well as between the stationary sector compared to the ambulatory sector (P<.001). Telemedicine was already in routine use for 19.6% (532/2711) of German health care providers and in partial use for 40.2% (n=1090). Participants working in private practices (239/594, 40.2%) or private clinics (23/59, 39.0%) experienced less regulatory or technical obstacles compared to university hospitals (586/1190, 49.2%). A majority of doctors rated the public information quality on COVID-19 as good (942/1855, 50.8%) or very good (213/1855, 11.5%); nurses rated the quality of public information significantly lower (P<.001). Participant’s age negatively correlated with the perception of telemedicine’s significance (ρ=–0.23; P<.001). Conclusions: Telemedicine has a broad acceptance among German medical professionals. However, to establish telemedical structures within routine care, technical and regulatory burdens must be overcome. %M 32568724 %R 10.2196/19745 %U https://www.jmir.org/2020/8/e19745 %U https://doi.org/10.2196/19745 %U http://www.ncbi.nlm.nih.gov/pubmed/32568724 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 8 %P e15394 %T Applying Machine Learning Models with An Ensemble Approach for Accurate Real-Time Influenza Forecasting in Taiwan: Development and Validation Study %A Cheng,Hao-Yuan %A Wu,Yu-Chun %A Lin,Min-Hau %A Liu,Yu-Lun %A Tsai,Yue-Yang %A Wu,Jo-Hua %A Pan,Ke-Han %A Ke,Chih-Jung %A Chen,Chiu-Mei %A Liu,Ding-Ping %A Lin,I-Feng %A Chuang,Jen-Hsiang %+ Taiwan Centers for Disease Control, 9F, No. 6, Linsen S. Road, Zhong-zheng District, Taipei, 100, Taiwan, 886 2 2395 9825, jhchuang@cdc.gov.tw %K influenza %K Influenza-like illness %K forecasting %K machine learning %K artificial intelligence %K epidemic forecasting %K surveillance %D 2020 %7 5.8.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Changeful seasonal influenza activity in subtropical areas such as Taiwan causes problems in epidemic preparedness. The Taiwan Centers for Disease Control has maintained real-time national influenza surveillance systems since 2004. Except for timely monitoring, epidemic forecasting using the national influenza surveillance data can provide pivotal information for public health response. Objective: We aimed to develop predictive models using machine learning to provide real-time influenza-like illness forecasts. Methods: Using surveillance data of influenza-like illness visits from emergency departments (from the Real-Time Outbreak and Disease Surveillance System), outpatient departments (from the National Health Insurance database), and the records of patients with severe influenza with complications (from the National Notifiable Disease Surveillance System), we developed 4 machine learning models (autoregressive integrated moving average, random forest, support vector regression, and extreme gradient boosting) to produce weekly influenza-like illness predictions for a given week and 3 subsequent weeks. We established a framework of the machine learning models and used an ensemble approach called stacking to integrate these predictions. We trained the models using historical data from 2008-2014. We evaluated their predictive ability during 2015-2017 for each of the 4-week time periods using Pearson correlation, mean absolute percentage error (MAPE), and hit rate of trend prediction. A dashboard website was built to visualize the forecasts, and the results of real-world implementation of this forecasting framework in 2018 were evaluated using the same metrics. Results: All models could accurately predict the timing and magnitudes of the seasonal peaks in the then-current week (nowcast) (ρ=0.802-0.965; MAPE: 5.2%-9.2%; hit rate: 0.577-0.756), 1-week (ρ=0.803-0.918; MAPE: 8.3%-11.8%; hit rate: 0.643-0.747), 2-week (ρ=0.783-0.867; MAPE: 10.1%-15.3%; hit rate: 0.669-0.734), and 3-week forecasts (ρ=0.676-0.801; MAPE: 12.0%-18.9%; hit rate: 0.643-0.786), especially the ensemble model. In real-world implementation in 2018, the forecasting performance was still accurate in nowcasts (ρ=0.875-0.969; MAPE: 5.3%-8.0%; hit rate: 0.582-0.782) and remained satisfactory in 3-week forecasts (ρ=0.721-0.908; MAPE: 7.6%-13.5%; hit rate: 0.596-0.904). Conclusions: This machine learning and ensemble approach can make accurate, real-time influenza-like illness forecasts for a 4-week period, and thus, facilitate decision making. %M 32755888 %R 10.2196/15394 %U https://www.jmir.org/2020/8/e15394 %U https://doi.org/10.2196/15394 %U http://www.ncbi.nlm.nih.gov/pubmed/32755888 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e17658 %T A Comprehensive App That Improves Tuberculosis Treatment Management Through Video-Observed Therapy: Usability Study %A Guo,Xujun %A Yang,Yarui %A Takiff,Howard E %A Zhu,Minmin %A Ma,Jianping %A Zhong,Tao %A Fan,Yuzheng %A Wang,Jian %A Liu,Shengyuan %+ Department of Tuberculosis Control and Prevention, Shenzhen Nanshan Centre for Chronic Disease Control, 7 Huaming Road, Nanshan District, Shenzhen, 518054, China, 86 0755 26407238, liushenglb@126.com %K tuberculosis %K management %K video-observed therapy %K directly observed therapy %K mobile phone %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Treatment of pulmonary tuberculosis (TB) requires at least six months and is compromised by poor adherence. In the directly observed therapy (DOT) scheme recommended by the World Health Organization, the patient is directly observed taking their medications at a health post. An alternative to DOT is video-observed therapy (VOT), in which the patients take videos of themselves taking the medication and the video is uploaded into the app and reviewed by a health care worker. We developed a comprehensive TB management system by using VOT that is installed as an app on the smartphones of both patients and health care workers. It was implemented into the routine TB control program of the Nanshan District of Shenzhen, China. Objective: The aim of this study was to compare the effectiveness of VOT with that of DOT in managing the treatment of patients with pulmonary TB and to evaluate the acceptance of VOT for TB management by patients and health care workers. Methods: Patients beginning treatment between September 2017 and August 2018 were enrolled into the VOT group and their data were compared with the retrospective data of patients who began TB treatment and were managed with routine DOT between January 2016 and August 2017. Sociodemographic characteristics, clinical features, treatment adherence, positive findings of sputum smears, reporting of side effects, time and costs of transportation, and satisfaction were compared between the 2 treatment groups. The attitudes of the health care workers toward the VOT-based system were also analyzed. Results: This study included 158 patients in the retrospective DOT group and 235 patients in the VOT group. The VOT group showed a significantly higher fraction of doses observed (P<.001), less missed observed doses (P<.001), and fewer treatment discontinuations (P<.05) than the DOT group. Over 79.1% (186/235) of the VOT patients had >85% of their doses observed, while only 16.4% (26/158) of the DOT patients had >85% of their doses observed. All patients were cured without recurrences. The VOT management required significantly (P<.001) less median patient time (300 minutes vs 1240 minutes, respectively) and transportation costs (¥53 [US $7.57] vs ¥276 [US $39.43], respectively; P<.001) than DOT. Significantly more patients (191/235, 81.3%) in the VOT group preferred their treatment method compared to those on DOT (37/131, 28.2%) (P<.001), and 92% (61/66) of the health care workers thought that the VOT method was more convenient than DOT for managing patients with TB. Conclusions: Implementation of the VOT-based system into the routine program of TB management was simple and it significantly increased patient adherence to their drug regimens. Our study shows that a comprehensive VOT-based TB management represents a viable and improved evolution of DOT. %M 32735222 %R 10.2196/17658 %U https://mhealth.jmir.org/2020/7/e17658 %U https://doi.org/10.2196/17658 %U http://www.ncbi.nlm.nih.gov/pubmed/32735222 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e16634 %T Explaining Differences in the Acceptability of 99DOTS, a Cell Phone–Based Strategy for Monitoring Adherence to Tuberculosis Medications: Qualitative Study of Patients and Health Care Providers %A Thomas,Beena E %A Kumar,J Vignesh %A Onongaya,Chidiebere %A Bhatt,Spurthi N %A Galivanche,Amith %A Periyasamy,Murugesan %A Chiranjeevi,M %A Khandewale,Amit Subhash %A Ramachandran,Geetha %A Shah,Daksha %A Haberer,Jessica E %A Mayer,Kenneth H %A Subbaraman,Ramnath %+ Department of Public Health and Community Medicine, Tufts University School of Medicine, 136 Harrison Ave, MV237, Boston, MA, 02111, United States, 1 6176360985, ramnath.subbaraman@tufts.edu %K tuberculosis %K medication adherence %K mobile phone %K mHealth %K implementation science %K qualitative research %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: 99DOTS is a cell phone–based strategy for monitoring tuberculosis (TB) medication adherence that has been rolled out to more than 150,000 patients in India’s public health sector. A considerable proportion of patients stop using 99DOTS during therapy. Objective: This study aims to understand reasons for variability in the acceptance and use of 99DOTS by TB patients and health care providers (HCPs). Methods: We conducted qualitative interviews with individuals taking TB therapy in the government program in Chennai and Vellore (HIV-coinfected patients) and Mumbai (HIV-uninfected patients) across intensive and continuation treatment phases. We conducted interviews with HCPs who provide TB care, all of whom were involved in implementing 99DOTS. Interviews were transcribed, coded using a deductive approach, and analyzed with Dedoose 8.0.35 software (SocioCultural Research Consultants, LLC). The findings of the study were interpreted using the unified theory of acceptance and use of technology, which highlights 4 constructs associated with technology acceptance: performance expectancy, effort expectancy, social influences, and facilitating conditions. Results: We conducted 62 interviews with patients with TB, of whom 30 (48%) were HIV coinfected, and 31 interviews with HCPs. Acceptance of 99DOTS by patients was variable. Greater patient acceptance was related to perceptions of improved patient-HCP relationships from increased phone communication, TB pill-taking habit formation due to SMS text messaging reminders, and reduced need to visit health facilities (performance expectancy); improved family involvement in TB care (social influences); and from 99DOTS leading HCPs to engage positively in patients’ care through increased outreach (facilitating conditions). Lower patient acceptance was related to perceptions of reduced face-to-face contact with HCPs (performance expectancy); problems with cell phone access, literacy, cellular signal, or technology fatigue (effort expectancy); high TB- and HIV-related stigma within the family (social influences); and poor counseling in 99DOTS by HCPs or perceptions that HCPs were not acting upon adherence data (facilitating conditions). Acceptance of 99DOTS by HCPs was generally high and related to perceptions that the 99DOTS adherence dashboard and patient-related SMS text messaging alerts improve quality of care, the efficiency of care, and the patient-HCP relationship (performance expectancy); that the dashboard is easy to use (effort expectancy); and that 99DOTS leads to better coordination among HCPs (social influences). However, HCPs described suboptimal facilitating conditions, including inadequate training of HCPs in 99DOTS, unequal changes in workload, and shortages of 99DOTS medication envelopes. Conclusions: In India’s government TB program, 99DOTS had high acceptance by HCPs but variable acceptance by patients. Although some factors contributing to suboptimal patient acceptance are modifiable, other factors such as TB- and HIV-related stigma and poor cell phone accessibility, cellular signal, and literacy are more difficult to address. Screening for these barriers may facilitate targeting of 99DOTS to patients more likely to use this technology. %M 32735220 %R 10.2196/16634 %U http://mhealth.jmir.org/2020/7/e16634/ %U https://doi.org/10.2196/16634 %U http://www.ncbi.nlm.nih.gov/pubmed/32735220 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 7 %P e15965 %T A Predictive Model Based on Machine Learning for the Early Detection of Late-Onset Neonatal Sepsis: Development and Observational Study %A Song,Wongeun %A Jung,Se Young %A Baek,Hyunyoung %A Choi,Chang Won %A Jung,Young Hwa %A Yoo,Sooyoung %+ Healthcare ICT Research Center, Office of eHealth Research and Businesses, Seoul National University Bundang Hospital, 172 Dolma-ro, Bundang-gu, Seongnam-si, 13620, Republic of Korea, 82 32 787 8980, yoosoo0@snubh.org %K prediction %K late-onset neonatal sepsis %K machine learning %D 2020 %7 31.7.2020 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 32735230 %R 10.2196/15965 %U http://medinform.jmir.org/2020/7/e15965/ %U https://doi.org/10.2196/15965 %U http://www.ncbi.nlm.nih.gov/pubmed/32735230 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e22331 %T Notes From the Field: Use of Emergency Medical Service Data to Augment COVID-19 Public Health Surveillance in Montgomery County, Maryland, From March to June 2020 %A Sayers,David R %A Hulse,Scott T %A Webber,Bryant J %A Burns,Timothy A %A Denicoff,Anne L %+ Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD, 20814, United States, 1 2704038911, david.sayers@usuhs.edu %K SARS-CoV-2 %K COVID-19 %K public health %K surveillance %K prediction %K emergency medical service %K EMS %K pulse oximetry %K testing %D 2020 %7 31.7.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Epidemiologic and syndromic surveillance metrics traditionally used by public health departments can be enhanced to better predict hospitalization for coronavirus disease (COVID-19). In Montgomery County, Maryland, measurements of oxygen saturation (SpO2) by pulse oximetry obtained by the emergency medical service (EMS) were added to these traditional metrics to enhance the public health picture for decision makers. During a 78-day period, the rolling 7-day average of the percentage of EMS patients with SpO2 <94% had a stronger correlation with next-day hospital bed occupancy (Spearman ρ=0.58, 95% CI 0.40-0.71) than either the rolling 7-day average of the percentage of positive tests (ρ=0.55, 95% CI: 0.37-0.69) or the rolling 7-day average of the percentage of emergency department visits for COVID-19–like illness (ρ=0.49, 95% CI: 0.30-0.64). Health departments should consider adding EMS data to augment COVID-19 surveillance and thus improve resource allocation. %M 32678799 %R 10.2196/22331 %U http://publichealth.jmir.org/2020/3/e22331/ %U https://doi.org/10.2196/22331 %U http://www.ncbi.nlm.nih.gov/pubmed/32678799 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e20912 %T Multiple Epidemic Wave Model of the COVID-19 Pandemic: Modeling Study %A Kaxiras,Efthimios %A Neofotistos,Georgios %+ Department of Physics, Harvard University, Lyman Lab 339, 17 Oxford Street, Cambridge, MA, 02138, United States, 1 617 495 7977, kaxiras@physics.harvard.edu %K COVID-19 %K multiple waves %K transmission %K intervention measures %K simulations %K modeling %K pandemic response index %K pandemic %K virus %K intervention %D 2020 %7 30.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Intervention measures have been implemented around the world to mitigate the spread of the coronavirus disease (COVID-19) pandemic. Understanding the dynamics of the disease spread and the effectiveness of the interventions is essential in predicting its future evolution. Objective: The aim of this study is to simulate the effect of different social distancing interventions and investigate whether their timing and stringency can lead to multiple waves (subepidemics), which can provide a better fit to the wavy behavior observed in the infected population curve in the majority of countries. Methods: We have designed and run agent-based simulations and a multiple wave model to fit the infected population data for many countries. We have also developed a novel Pandemic Response Index to provide a quantitative and objective way of ranking countries according to their COVID-19 response performance. Results: We have analyzed data from 18 countries based on the multiple wave (subepidemics) hypothesis and present the relevant parameters. Multiple waves have been identified and were found to describe the data better. The effectiveness of intervention measures can be inferred by the peak intensities of the waves. Countries imposing fast and stringent interventions exhibit multiple waves with declining peak intensities. This result strongly corroborated with agent-based simulations outcomes. We also provided an estimate of how much lower the number of infections could have been if early and strict intervention measures had been taken to stop the spread at the first wave, as actually happened for a handful of countries. A novel index, the Pandemic Response Index, was constructed, and based on the model’s results, an index value was assigned to each country, quantifying in an objective manner the country’s response to the pandemic. Conclusions: Our results support the hypothesis that the COVID-19 pandemic can be successfully modeled as a series of epidemic waves (subepidemics) and that it is possible to infer to what extent the imposition of early intervention measures can slow the spread of the disease. %M 32692690 %R 10.2196/20912 %U http://www.jmir.org/2020/7/e20912/ %U https://doi.org/10.2196/20912 %U http://www.ncbi.nlm.nih.gov/pubmed/32692690 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19483 %T Regional Infoveillance of COVID-19 Case Rates: Analysis of Search-Engine Query Patterns %A Cousins,Henry C %A Cousins,Clara C %A Harris,Alon %A Pasquale,Louis R %+ Department of Ophthalmology, Icahn School of Medicine at Mount Sinai, One Gustave L Levy Place, Box 1183, New York, NY, 10029, United States, 1 212 241 6752, louis.pasquale@mssm.edu %K epidemiology %K infoveillance %K COVID-19 %K internet activity %K Google Trends %K infectious disease %K surveillance %K public health %D 2020 %7 30.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Timely allocation of medical resources for coronavirus disease (COVID-19) requires early detection of regional outbreaks. Internet browsing data may predict case outbreaks in local populations that are yet to be confirmed. Objective: We investigated whether search-engine query patterns can help to predict COVID-19 case rates at the state and metropolitan area levels in the United States. Methods: We used regional confirmed case data from the New York Times and Google Trends results from 50 states and 166 county-based designated market areas (DMA). We identified search terms whose activity precedes and correlates with confirmed case rates at the national level. We used univariate regression to construct a composite explanatory variable based on best-fitting search queries offset by temporal lags. We measured the raw and z-transformed Pearson correlation and root-mean-square error (RMSE) of the explanatory variable with out-of-sample case rate data at the state and DMA levels. Results: Predictions were highly correlated with confirmed case rates at the state (mean r=0.69, 95% CI 0.51-0.81; median RMSE 1.27, IQR 1.48) and DMA levels (mean r=0.51, 95% CI 0.39-0.61; median RMSE 4.38, IQR 1.80), using search data available up to 10 days prior to confirmed case rates. They fit case-rate activity in 49 of 50 states and in 103 of 166 DMA at a significance level of .05. Conclusions: Identifiable patterns in search query activity may help to predict emerging regional outbreaks of COVID-19, although they remain vulnerable to stochastic changes in search intensity. %M 32692691 %R 10.2196/19483 %U http://www.jmir.org/2020/7/e19483/ %U https://doi.org/10.2196/19483 %U http://www.ncbi.nlm.nih.gov/pubmed/32692691 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 2 %P e19867 %T Pediatric Mental and Behavioral Health in the Period of Quarantine and Social Distancing With COVID-19 %A Ye,Jiancheng %+ Feinberg School of Medicine, Northwestern University, 633 N Saint Clair St, Chicago, IL, , United States, 1 312 503 3690, jiancheng.ye@u.northwestern.edu %K pediatrics %K mental health %K stay-at-home orders %K health technology %K digital interventions %K social distancing %K COVID-19 %D 2020 %7 28.7.2020 %9 Viewpoint %J JMIR Pediatr Parent %G English %X The coronavirus disease (COVID-19) pandemic has spread rapidly throughout the world and has had a long-term impact. The pandemic has caused great harm to society and caused serious psychological trauma to many people. Children are a vulnerable group in this global public health emergency, as their nervous systems, endocrine systems, and hypothalamic-pituitary-adrenal axes are not well developed. Psychological crises often cause children to produce feelings of abandonment, despair, incapacity, and exhaustion, and even raise the risk of suicide. Children with mental illnesses are especially vulnerable during the quarantine and social distancing period. The inclusion of psychosocial support for children and their families are part of the health responses to disaster and disaster recovery. Based on the biopsychosocial model, some children may have catastrophic thoughts and be prone to experience despair, numbness, flashbacks, and other serious emotional and behavioral reactions. In severe cases, there may be symptoms of psychosis or posttraumatic stress disorder. Timely and appropriate protections are needed to prevent the occurrence of psychological and behavioral problems. The emerging digital applications and health services such as telehealth, social media, mobile health, and remote interactive online education are able to bridge the social distance and support mental and behavioral health for children. Based on the psychological development characteristics of children, this study also illustrates interventions on the psychological impact from the COVID-19 pandemic. Even though the world has been struggling to curb the influences of the pandemic, the quarantine and social distancing policies will have long-term impacts on children. Innovative digital solutions and informatics tools are needed more than ever to mitigate the negative consequences on children. Health care delivery and services should envision and implement innovative paradigms to meet broad well-being needs and child health as the quarantine and social distancing over a longer term becomes a new reality. Future research on children's mental and behavioral health should pay more attention to novel solutions that incorporate cutting edge interactive technologies and digital approaches, leveraging considerable advances in pervasive and ubiquitous computing, human-computer interaction, and health informatics among many others. Digital approaches, health technologies, and informatics are supposed to be designed and implemented to support public health surveillance and critical responses to children’s growth and development. For instance, human-computer interactions, augmented reality, and virtual reality could be incorporated to remote psychological supporting service for children’s health; mobile technologies could be used to monitor children’s mental and behavioral health while protecting their individual privacy; big data and artificial intelligence could be used to support decision making on whether children should go out for physical activities and whether schools should be reopened. Implications to clinical practices, psychological therapeutic practices, and future research directions to address current effort gaps are highlighted in this study. %M 32634105 %R 10.2196/19867 %U http://pediatrics.jmir.org/2020/2/e19867/ %U https://doi.org/10.2196/19867 %U http://www.ncbi.nlm.nih.gov/pubmed/32634105 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e16856 %T Perceptions and Acceptability of Digital Interventions Among Tuberculosis Patients in Cambodia: Qualitative Study of Video-Based Directly Observed Therapy %A Rabinovich,Lila %A Molton,James Steven %A Ooi,Wei Tsang %A Paton,Nicholas Iain %A Batra,Shelly %A Yoong,Joanne %+ Center for Economic and Social Research, University of Southern California, 1090 Vermont Avenue, NW, Washington, DC, 20005, United States, 1 2138210537, lilarabi@usc.edu %K directly observed therapy %K video recording %K telemedicine %K mobile health %K mHealth %K tuberculosis %K low-income settings %K developing countries %K patient acceptance of health care %K patient acceptability %K Cambodia %D 2020 %7 27.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Despite the development of effective drugs for treatment, tuberculosis remains one of the leading causes of death from an infectious disease worldwide. One of the greatest challenges to tuberculosis control is patient adherence to treatment. Recent research has shown that video-based directly observed therapy is a feasible and effective approach to supporting treatment adherence in high-income settings. However, few studies have explored the potential for such a solution in a low- or middle-income country setting. Globally, these countries’ rapidly rising rate of mobile penetration suggests that the potential for translation of these results may be high. Objective: We sought to examine patient perceptions related to the use of mobile health, and specifically video-based directly observed therapy, in a previously unstudied patient demographic: patients with tuberculosis in a low-income country setting (Cambodia). Methods: We conducted a cross-sectional qualitative study in urban and periurban areas in Cambodia, consisting of 6 focus groups with tuberculosis patients who were receiving treatment (standard directly observed therapy) through a nongovernmental organization. Results: Familiarity with mobile technology and apps was widespread in this population, and overall willingness to consider a mobile app for video-based directly observed therapy was high. However, we identified potential challenges. First, patients very much valued their frequent in-person interactions with their health care provider, which may be reduced with the video-based directly observed therapy intervention. Second, there may be technical issues to address, including how to make the app suitable for illiterate participants. Conclusions: While video-based directly observed therapy is a promising technology, even in country settings where mobile penetration is reportedly almost universal, it should be introduced with caution. However, the results were generally promising and yielded important insights that not only will be translated into the further adaptation of key features of video-based directly observed therapy for tuberculosis patients in Cambodia, but also can inform the future design and successful implementation of video-based directly observed therapy interventions in low- and middle-income settings more generally. %M 32716309 %R 10.2196/16856 %U https://www.jmir.org/2020/7/e16856 %U https://doi.org/10.2196/16856 %U http://www.ncbi.nlm.nih.gov/pubmed/32716309 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e17633 %T Causality Analysis of Google Trends and Dengue Incidence in Bandung, Indonesia With Linkage of Digital Data Modeling: Longitudinal Observational Study %A Syamsuddin,Muhammad %A Fakhruddin,Muhammad %A Sahetapy-Engel,Jane Theresa Marlen %A Soewono,Edy %+ Faculty of Mathematics and Natural Sciences, Institut Teknologi Bandung, Jalan Ganesha 10, Bandung, 40132, Indonesia, 62 8122000534, esoewono@math.itb.ac.id %K dengue %K Google Trends %K infodemiology %K infoveillance %K vector error correction model %K Granger causality %D 2020 %7 24.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The popularity of dengue can be inferred from Google Trends that summarizes Google searches of related topics. Both the disease and its Google Trends have a similar source of causation in the dengue virus, leading us to hypothesize that dengue incidence and Google Trends results have a long-run equilibrium. Objective: This research aimed to investigate the properties of this long-run equilibrium in the hope of using the information derived from Google Trends for the early detection of upcoming dengue outbreaks. Methods: This research used the cointegration method to assess a long-run equilibrium between dengue incidence and Google Trends results. The long-run equilibrium was characterized by their linear combination that generated a stationary process. The Dickey-Fuller test was adopted to check the stationarity of the processes. An error correction model (ECM) was then adopted to measure deviations from the long-run equilibrium to examine the short-term and long-term effects. The resulting models were used to determine the Granger causality between the two processes. Additional information about the two processes was obtained by examining the impulse response function and variance decomposition. Results: The Dickey-Fuller test supported an implicit null hypothesis that the dengue incidence and Google Trends results are nonstationary processes (P=.01). A further test showed that the processes were cointegrated (P=.01), indicating that their particular linear combination is a stationary process. These results permitted us to construct ECMs. The model showed the direction of causality of the two processes, indicating that Google Trends results will Granger-cause dengue incidence (not in the reverse order). Conclusions: Various hypothesis testing results in this research concluded that Google Trends results can be used as an initial indicator of upcoming dengue outbreaks. %M 32706682 %R 10.2196/17633 %U http://www.jmir.org/2020/7/e17633/ %U https://doi.org/10.2196/17633 %U http://www.ncbi.nlm.nih.gov/pubmed/32706682 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19904 %T Impact of National Containment Measures on Decelerating the Increase in Daily New Cases of COVID-19 in 54 Countries and 4 Epicenters of the Pandemic: Comparative Observational Study %A Wong,Carlos K H %A Wong,Janet Y H %A Tang,Eric H M %A Au,Chi Ho %A Lau,Kristy T K %A Wai,Abraham K C %+ Emergency Medicine Unit, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Room 514, William MW Mong Block, Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong, , China (Hong Kong), 852 3917 9859, awai@hku.hk %K COVID-19 %K national containment %K lockdown %K curfew %K stay-at-home %K epidemic curve %D 2020 %7 22.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Coronavirus disease (COVID-19) is a worldwide epidemic, and various countries have responded with different containment measures to reduce disease transmission, including stay-at-home orders, curfews, and lockdowns. Comparative studies have not yet been conducted to investigate the impact of these containment measures; these studies are needed to facilitate public health policy-making across countries. Objective: The aim of this study was to describe and evaluate the impact of national containment measures and policies (stay-at-home orders, curfews, and lockdowns) on decelerating the increase in daily new cases of COVID-19 in 54 countries and 4 epicenters of the pandemic in different jurisdictions worldwide. Methods: We reviewed the effective dates of the national containment measures (stay-at-home order, curfew, or lockdown) of 54 countries and 4 epicenters of the COVID-19 pandemic (Wuhan, New York State, Lombardy, and Madrid), and we searched cumulative numbers of confirmed COVID-19 cases and daily new cases provided by health authorities. Data were drawn from an open, crowdsourced, daily-updated COVID-19 data set provided by Our World in Data. We examined the trends in the percent increase in daily new cases from 7 days before to 30 days after the dates on which containment measures went into effect by continent, World Bank income classification, type of containment measures, effective date of containment measures, and number of confirmed cases on the effective date of the containment measures. Results: We included 122,366 patients with confirmed COVID-19 infection from 54 countries and 24,071 patients from 4 epicenters on the effective dates on which stay-at-home orders, curfews, or lockdowns were implemented between January 23 and April 11, 2020. Stay-at-home, curfew, and lockdown measures commonly commenced in countries with approximately 30%, 20%, or 10% increases in daily new cases. All three measures were found to lower the percent increase in daily new cases to <5 within one month. Among the countries studied, 20% had an average percent increase in daily new cases of 30-49 over the seven days prior to the commencement of containment measures; the percent increase in daily new cases in these countries was curbed to 10 and 5 a maximum of 15 days and 23 days after the implementation of containment measures, respectively. Conclusions: Different national containment measures were associated with a decrease in daily new cases of confirmed COVID-19 infection. Stay-at-home orders, curfews, and lockdowns curbed the percent increase in daily new cases to <5 within a month. Resurgence in cases within one month was observed in some South American countries. %M 32658858 %R 10.2196/19904 %U http://www.jmir.org/2020/7/e19904/ %U https://doi.org/10.2196/19904 %U http://www.ncbi.nlm.nih.gov/pubmed/32658858 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e20040 %T Emergency Center Curbside Screening During the COVID-19 Pandemic: Retrospective Cohort Study %A Halalau,Alexandra %A Ditkoff,Jeffrey %A Hamilton,Jessica %A Sharrak,Aryana %A Vanood,Aimen %A Abbas,Amr %A Ziadeh,James %+ Beaumont Health, 3601 W 13 Mile Rd, Royal Oak, MI, 48073, United States, 1 248 551 3481, alexandra.halalau@beaumont.edu %K COVID-19 %K emergency center %K curbside testing %K drive-through testing %K pandemic %K public health %D 2020 %7 21.7.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Coronavirus disease (COVID-19) is a global pandemic that has placed a significant burden on health care systems in the United States. Michigan has been one of the top states affected by COVID-19. Objective: We describe the emergency center curbside testing procedure implemented at Beaumont Hospital, a large hospital in Royal Oak, MI, and aim to evaluate its safety and efficiency. Methods: Anticipating a surge in patients requiring testing, Beaumont Health implemented curbside testing, operated by a multidisciplinary team of health care workers, including physicians, advanced practice providers, residents, nurses, technicians, and registration staff. We report on the following outcomes over a period of 26 days (March 12, 2020, to April 6, 2020): time to medical decision, time spent documenting electronic medical records, overall screening time, and emergency center return evaluations. Results: In total, 2782 patients received curbside services. A nasopharyngeal swab was performed on 1176 patients (41%), out of whom 348 (29.6%) tested positive. The median time for the entire process (from registration to discharge) was 28 minutes (IQR 17-44). The median time to final medical decision was 15 minutes (IQR 8-27). The median time from medical decision to discharge was 9 minutes (IQR 5-16). Only 257 patients (9.2%) returned to the emergency center for an evaluation within 7 or more days, of whom 64 were admitted to the hospital, 11 remained admitted, and 4 expired. Conclusions: Our curbside testing model encourages the incorporation of this model at other high-volume facilities during an infectious disease pandemic. %M 32619184 %R 10.2196/20040 %U http://publichealth.jmir.org/2020/3/e20040/ %U https://doi.org/10.2196/20040 %U http://www.ncbi.nlm.nih.gov/pubmed/32619184 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19982 %T Influence of Mass and Social Media on Psychobehavioral Responses Among Medical Students During the Downward Trend of COVID-19 in Fujian, China: Cross-Sectional Study %A Lin,Yulan %A Hu,Zhijian %A Alias,Haridah %A Wong,Li Ping %+ Department of Epidemiology and Health Statistics, Fujian Provincial Key Laboratory of Environment Factors and Cancer, School of Public Health, Fujian Medical University, 1 Xue Yuan Road, University Town, Fuzhou, 350122, China, 86 (0)591 2286 ext 2573, huzhijian@fjmu.edu.cn %K psychobehavioral %K COVID-19 %K mass media %K social media %K medical students %K China %D 2020 %7 20.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: An extensive amount of information related to the novel coronavirus (COVID-19) pandemic was disseminated by mass and social media in China. To date, there is limited evidence on how this infodemic may influence psychobehavioral responses to the crisis. Objective: The aim of this study is to assess the psychobehavioral responses to the COVID-19 outbreak and examine their associations with mass and social media exposure. Methods: A cross-sectional study among medical and health sciences students from the Fujian Medical University in Fuzhou, China, was conducted between April 6-22, 2020. Results: A total of 2086 completed responses were received. Multivariable analyses demonstrated that four constructs of the Health Belief Model (HBM)—higher perception of susceptibility (odds ratio [OR] 1.44; 95% CI 1.07-1.94), severity (OR 1.32; 95% CI 1.10-1.59), self-efficacy (OR 1.61; 95% CI 1.21-2.15), and perceived control or intention to carry out prevention measures (OR 1.32; 95% CI 1.09-1.59)—were significantly associated with a higher mass media exposure score, whereas only three constructs—higher perception of severity (OR 1.43; 95% CI 1.19-1.72), self-efficacy (OR 1.85; 95% CI 1.38-2.48), and perceived control or intention to carry out prevention measures (OR 1.32; 95% CI 1.08-1.58)—were significantly associated with a higher social media exposure score. Lower emotional consequences and barriers to carry out prevention measures were also significantly associated with greater mass and social media exposure. Our findings on anxiety levels revealed that 38.1% (n=795; 95% CI 36.0-40.2) of respondents reported moderate-to-severe anxiety. A lower anxiety level was significantly associated with higher mass and social media exposure in the univariable analyses; however, the associations were not significant in the multivariable analyses. Conclusions: In essence, both mass and social media are useful means of disseminating health messages and contribute to the betterment of psychobehavioral responses to COVID-19. Our findings stress the importance of the credibility of information shared through mass and social media outlets and viable strategies to counter misinformation during a pandemic. %M 32584779 %R 10.2196/19982 %U https://www.jmir.org/2020/7/e19982 %U https://doi.org/10.2196/19982 %U http://www.ncbi.nlm.nih.gov/pubmed/32584779 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 7 %P e15182 %T Real-World Integration of a Sepsis Deep Learning Technology Into Routine Clinical Care: Implementation Study %A Sendak,Mark P %A Ratliff,William %A Sarro,Dina %A Alderton,Elizabeth %A Futoma,Joseph %A Gao,Michael %A Nichols,Marshall %A Revoir,Mike %A Yashar,Faraz %A Miller,Corinne %A Kester,Kelly %A Sandhu,Sahil %A Corey,Kristin %A Brajer,Nathan %A Tan,Christelle %A Lin,Anthony %A Brown,Tres %A Engelbosch,Susan %A Anstrom,Kevin %A Elish,Madeleine Clare %A Heller,Katherine %A Donohoe,Rebecca %A Theiling,Jason %A Poon,Eric %A Balu,Suresh %A Bedoya,Armando %A O'Brien,Cara %+ Duke Institute for Health Innovation, 200 Morris Street, 3rd Floor, Durham, NC, 27701, United States, 1 919 684 3234, mark.sendak@duke.edu %K machine learning %K translational medicine %K sepsis %K innovation, organizational %K change %K deep learning %D 2020 %7 15.7.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Successful integrations of machine learning into routine clinical care are exceedingly rare, and barriers to its adoption are poorly characterized in the literature. Objective: This study aims to report a quality improvement effort to integrate a deep learning sepsis detection and management platform, Sepsis Watch, into routine clinical care. Methods: In 2016, a multidisciplinary team consisting of statisticians, data scientists, data engineers, and clinicians was assembled by the leadership of an academic health system to radically improve the detection and treatment of sepsis. This report of the quality improvement effort follows the learning health system framework to describe the problem assessment, design, development, implementation, and evaluation plan of Sepsis Watch. Results: Sepsis Watch was successfully integrated into routine clinical care and reshaped how local machine learning projects are executed. Frontline clinical staff were highly engaged in the design and development of the workflow, machine learning model, and application. Novel machine learning methods were developed to detect sepsis early, and implementation of the model required robust infrastructure. Significant investment was required to align stakeholders, develop trusting relationships, define roles and responsibilities, and to train frontline staff, leading to the establishment of 3 partnerships with internal and external research groups to evaluate Sepsis Watch. Conclusions: Machine learning models are commonly developed to enhance clinical decision making, but successful integrations of machine learning into routine clinical care are rare. Although there is no playbook for integrating deep learning into clinical care, learnings from the Sepsis Watch integration can inform efforts to develop machine learning technologies at other health care delivery systems. %M 32673244 %R 10.2196/15182 %U http://medinform.jmir.org/2020/7/e15182/ %U https://doi.org/10.2196/15182 %U http://www.ncbi.nlm.nih.gov/pubmed/32673244 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 7 %P e19866 %T The Role of Health Technology and Informatics in a Global Public Health Emergency: Practices and Implications From the COVID-19 Pandemic %A Ye,Jiancheng %+ Feinberg School of Medicine, Northwestern University, 633 N Saint Clair St, Chicago, IL, United States, 1 312 503 3690, jiancheng.ye@u.northwestern.edu %K health technology %K health information system %K COVID-19 %K artificial intelligence %K telemedicine %K big data %K privacy %D 2020 %7 14.7.2020 %9 Viewpoint %J JMIR Med Inform %G English %X At present, the coronavirus disease (COVID-19) is spreading around the world. It is a critical and important task to take thorough efforts to prevent and control the pandemic. Compared with severe acute respiratory syndrome and Middle East Respiratory Syndrome, COVID-19 spreads more rapidly owing to increased globalization, a longer incubation period, and unobvious symptoms. As the coronavirus has the characteristics of strong transmission and weak lethality, and since the large-scale increase of infected people may overwhelm health care systems, efforts are needed to treat critical patients, track and manage the health status of residents, and isolate suspected patients. The application of emerging health technologies and digital practices in health care, such as artificial intelligence, telemedicine or telehealth, mobile health, big data, 5G, and the Internet of Things, have become powerful “weapons” to fight against the pandemic and provide strong support in pandemic prevention and control. Applications and evaluations of all of these technologies, practices, and health delivery services are highlighted in this study. %M 32568725 %R 10.2196/19866 %U http://medinform.jmir.org/2020/7/e19866/ %U https://doi.org/10.2196/19866 %U http://www.ncbi.nlm.nih.gov/pubmed/32568725 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e10959 %T The Impact of Receiving Pretravel Health Advice on the Prevention of Hajj-Related Illnesses Among Australian Pilgrims: Cohort Study %A Alqahtani,Amani S %A Alsharif,Saeed A %A Garnan,Mohammad A %A Tashani,Mohamed %A BinDhim,Nasser F %A Heywood,Anita E %A Booy,Robert %A Wiley,Kerrie E %A Rashid,Harunor %A , %+ Saudi Food and Drug Authority, 4904 Northern Ring Branch Rd, Riyadh, Saudi Arabia, 966 112038222 ext 3007, amani.shelwa@gmail.com %K Hajj %K health behavior %K mass gathering %K pretravel health advice %K travelers %D 2020 %7 14.7.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Pretravel health advice can play a crucial role in improving both travelers’ awareness about disease risk and compliance with preventive measures. General practitioners (GPs) and the internet have been reported internationally to be the main sources of health advice for travelers to non–mass gathering (MG) destinations. However, few studies have attempted to investigate the sources of health advice among travelers to MGs including the Hajj pilgrimage, and none of these studies further investigated the impact of pretravel advice on pilgrims’ health behaviors. Objective: The objective of this study was to investigate the impact of the source of pretravel health advice (from GPs and specialized Hajj travel agents) on Hajj pilgrims’ awareness of and compliance with health recommendations, and the incidence of Hajj-associated illnesses. Methods: A prospective cohort study (before and during Hajj) was conducted among Australian pilgrims aged ≥18 years in 2015. Results: A total of 421 pilgrims participated prior to Hajj, and 391 (93%) provided follow-up data during Hajj. All participants obtained pretravel health advice from one or more sources, with Hajj travel agents (46%) and general practitioners (GPs; 40%) the most commonly reported sources. In total, 288 (74%) participants reported Hajj-related symptoms, of which 86% (248/288) were respiratory symptoms. Participants who obtained pretravel health advice from travel agents were more likely to be aware of the official Saudi recommendations (adjusted odds ratio [aOR] 2.1, 95% CI 1.2-3.8; P=.01), receive recommended vaccines before travel (aOR 2.4, 95% CI 1.4-3.9; P=.01), use hand sanitizers including soap (aOR 2.5, 95% CI 1.1-6.1; P=.03), and wash their hands after touching an ill person during Hajj (aOR 2.9, 95% CI 1.1-7.1; P=.01), compared to those who sought advice from GPs. However, neither advice from travel agents nor GPs was associated with a lower incidence of Hajj-related illnesses. Conclusions: Advice from travel agents appeared to be accessed by more travelers than that from GPs, and was associated with an increased likelihood of positive travel health behaviors. %M 32673259 %R 10.2196/10959 %U https://publichealth.jmir.org/2020/3/e10959 %U https://doi.org/10.2196/10959 %U http://www.ncbi.nlm.nih.gov/pubmed/32673259 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e19552 %T Implementing mHealth Interventions in a Resource-Constrained Setting: Case Study From Uganda %A Meyer,Amanda J %A Armstrong-Hough,Mari %A Babirye,Diana %A Mark,David %A Turimumahoro,Patricia %A Ayakaka,Irene %A Haberer,Jessica E %A Katamba,Achilles %A Davis,J Lucian %+ Department of Epidemiology of Microbial Diseases, Yale School of Public Health, 60 College Street, New Haven, CT, 06520, United States, 1 203 785 3665, lucian.davis@yale.edu %K mHealth %K implementation %K tuberculosis %K consolidated framework for implementation science %K Uganda %K framework %K intervention %K app %D 2020 %7 13.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Mobile health (mHealth) interventions are becoming more common in low-income countries. Existing research often overlooks implementation challenges associated with the design and technology requirements of mHealth interventions. Objective: We aimed to characterize the challenges that we encountered in the implementation of a complex mHealth intervention in Uganda. Methods: We customized a commercial mobile survey app to facilitate a two-arm household-randomized, controlled trial of home-based tuberculosis (TB) contact investigation. We incorporated digital fingerprinting for patient identification in both study arms and automated SMS messages in the intervention arm only. A local research team systematically documented challenges to implementation in biweekly site visit reports, project management reports, and minutes from biweekly conference calls. We then classified these challenges using the Consolidated Framework for Implementation Research (CFIR). Results: We identified challenges in three principal CFIR domains: (1) intervention characteristics, (2) inner setting, and (3) characteristics of implementers. The adaptability of the app to the local setting was limited by software and hardware requirements. The complexity and logistics of implementing the intervention further hindered its adaptability. Study staff reported that community health workers (CHWs) were enthusiastic regarding the use of technology to enhance TB contact investigation during training and the initial phase of implementation. After experiencing technological failures, their trust in the technology declined along with their use of it. Finally, complex data structures impeded the development and execution of a data management plan that would allow for articulation of goals and provide timely feedback to study staff, CHWs, and participants. Conclusions: mHealth technologies have the potential to make delivery of public health interventions more direct and efficient, but we found that a lack of adaptability, excessive complexity, loss of trust among end users, and a lack of effective feedback systems can undermine implementation, especially in low-resource settings where digital services have not yet proliferated. Implementers should anticipate and strive to avoid these barriers by investing in and adapting to local human and material resources, prioritizing feedback from end users, and optimizing data management and quality assurance procedures. Trial Registration: Pan-African Clinical Trials Registration PACTR201509000877140; https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=877 %M 32673262 %R 10.2196/19552 %U http://mhealth.jmir.org/2020/7/e19552/ %U https://doi.org/10.2196/19552 %U http://www.ncbi.nlm.nih.gov/pubmed/32673262 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e20001 %T Similarities and Differences in COVID-19 Awareness, Concern, and Symptoms by Race and Ethnicity in the United States: Cross-Sectional Survey %A Jones,Jeb %A Sullivan,Patrick S %A Sanchez,Travis H %A Guest,Jodie L %A Hall,Eric W %A Luisi,Nicole %A Zlotorzynska,Maria %A Wilde,Gretchen %A Bradley,Heather %A Siegler,Aaron J %+ Department of Epidemiology, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA, 30322, United States, 1 4047122275, jeb.jones@emory.edu %K COVID-19 %K SARS-CoV-2 %K race %K ethnicity %K awareness %K concern %K symptom %K cross-sectional %K knowledge %K health disparity %K inequality %D 2020 %7 10.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Existing health disparities based on race and ethnicity in the United States are contributing to disparities in morbidity and mortality during the coronavirus disease (COVID-19) pandemic. We conducted an online survey of American adults to assess similarities and differences by race and ethnicity with respect to COVID-19 symptoms, estimates of the extent of the pandemic, knowledge of control measures, and stigma. Objective: The aim of this study was to describe similarities and differences in COVID-19 symptoms, knowledge, and beliefs by race and ethnicity among adults in the United States. Methods: We conducted a cross-sectional survey from March 27, 2020 through April 1, 2020. Participants were recruited on social media platforms and completed the survey on a secure web-based survey platform. We used chi-square tests to compare characteristics related to COVID-19 by race and ethnicity. Statistical tests were corrected using the Holm Bonferroni correction to account for multiple comparisons. Results: A total of 1435 participants completed the survey; 52 (3.6%) were Asian, 158 (11.0%) were non-Hispanic Black, 548 (38.2%) were Hispanic, 587 (40.9%) were non-Hispanic White, and 90 (6.3%) identified as other or multiple races. Only one symptom (sore throat) was found to be different based on race and ethnicity (P=.003); this symptom was less frequently reported by Asian (3/52, 5.8%), non-Hispanic Black (9/158, 5.7%), and other/multiple race (8/90, 8.9%) participants compared to those who were Hispanic (99/548, 18.1%) or non-Hispanic White (95/587, 16.2%). Non-Hispanic White and Asian participants were more likely to estimate that the number of current cases was at least 100,000 (P=.004) and were more likely to answer all 14 COVID-19 knowledge scale questions correctly (Asian participants, 13/52, 25.0%; non-Hispanic White participants, 180/587, 30.7%) compared to Hispanic (108/548, 19.7%) and non-Hispanic Black (25/158, 15.8%) participants. Conclusions: We observed differences with respect to knowledge of appropriate methods to prevent infection by the novel coronavirus that causes COVID-19. Deficits in knowledge of proper control methods may further exacerbate existing race/ethnicity disparities. Additional research is needed to identify trusted sources of information in Hispanic and non-Hispanic Black communities and create effective messaging to disseminate correct COVID-19 prevention and treatment information. %M 32614778 %R 10.2196/20001 %U http://www.jmir.org/2020/7/e20001/ %U https://doi.org/10.2196/20001 %U http://www.ncbi.nlm.nih.gov/pubmed/32614778 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19322 %T Rapid Utilization of Telehealth in a Comprehensive Cancer Center as a Response to COVID-19: Cross-Sectional Analysis %A Lonergan,Peter E %A Washington III,Samuel L %A Branagan,Linda %A Gleason,Nathaniel %A Pruthi,Raj S %A Carroll,Peter R %A Odisho,Anobel Y %+ Department of Urology, Helen Diller Family Comprehensive Cancer Center, University of California, San Francisco, 550 16th Street, San Francisco, CA, 94143, United States, 1 (415) 353 2200, anobel.odisho@ucsf.edu %K health informatics %K telehealth %K video visits %K COVID-19 %K video consultation %K pandemic %K electronic health record %K EHR %D 2020 %7 6.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The emergence of the coronavirus disease (COVID-19) pandemic in March 2020 created unprecedented challenges in the provision of scheduled ambulatory cancer care. As a result, there has been a renewed focus on video-based telehealth consultations as a means to continue ambulatory care. Objective: The aim of this study is to analyze the change in video visit volume at the University of California, San Francisco (UCSF) Comprehensive Cancer Center in response to COVID-19 and compare patient demographics and appointment data from January 1, 2020, and in the 11 weeks after the transition to video visits. Methods: Patient demographics and appointment data (dates, visit types, and departments) were extracted from the electronic health record reporting database. Video visits were performed using a HIPAA (Health Insurance Portability and Accountability Act)-compliant video conferencing platform with a pre-existing workflow. Results: In 17 departments and divisions at the UCSF Cancer Center, 2284 video visits were performed in the 11 weeks before COVID-19 changes were implemented (mean 208, SD 75 per week) and 12,946 video visits were performed in the 11-week post–COVID-19 period (mean 1177, SD 120 per week). The proportion of video visits increased from 7%-18% to 54%-72%, between the pre– and post–COVID-19 periods without any disparity based on race/ethnicity, primary language, or payor. Conclusions: In a remarkably brief period of time, we rapidly scaled the utilization of telehealth in response to COVID-19 and maintained access to complex oncologic care at a time of social distancing. %M 32568721 %R 10.2196/19322 %U https://www.jmir.org/2020/7/e19322 %U https://doi.org/10.2196/19322 %U http://www.ncbi.nlm.nih.gov/pubmed/32568721 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e19902 %T Health Observation App for COVID-19 Symptom Tracking Integrated With Personal Health Records: Proof of Concept and Practical Use Study %A Yamamoto,Keiichi %A Takahashi,Tsubasa %A Urasaki,Miwa %A Nagayasu,Yoichi %A Shimamoto,Tomonari %A Tateyama,Yukiko %A Matsuzaki,Keiichi %A Kobayashi,Daisuke %A Kubo,Satoshi %A Mito,Shigeyuki %A Abe,Tatsuya %A Matsuura,Hideo %A Iwami,Taku %+ Information Technology Center, Wakayama Medical University, 811-1 Kimiidera, Wakayama, 641-8509, Japan, 81 73 441 0901, kyamamo@wakayama-med.ac.jp %K public health informatics %K public health administration %K emerging infectious disease %K preventive medicine %K mobile apps %K contact tracing %D 2020 %7 6.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: As a counter-cluster measure to prevent the spread of the infectious novel coronavirus disease (COVID-19), an efficient system for health observation outside the hospital is urgently required. Personal health records (PHRs) are suitable for the daily management of physical conditions. Importantly, there are no major differences between the items collected by daily health observation via PHR and the observation of items related to COVID-19. Until now, observations related to COVID-19 have been performed exclusively based on disease-specific items. Therefore, we hypothesize that PHRs would be suitable as a symptom-tracking tool for COVID-19. To this end, we integrated health observation items specific to COVID-19 with an existing PHR-based app. Objective: This study is conducted as a proof-of-concept study in a real-world setting to develop a PHR-based COVID-19 symptom-tracking app and to demonstrate the practical use of health observations for COVID-19 using a smartphone or tablet app integrated with PHRs. Methods: We applied the PHR-based health observation app within an active epidemiological investigation conducted by Wakayama City Public Health Center. At the public health center, a list is made of individuals who have been in close contact with known infected cases (health observers). Email addresses are used by the app when a health observer sends data to the public health center. Each health observer downloads the app and installs it on their smartphone. Self-observed health data are entered daily into the app. These data are then sent via the app by email at a designated time. Localized epidemiological officers can visualize the collected data using a spreadsheet macro and, thus, monitor the health condition of all health observers. Results: We used the app as part of an active epidemiological investigation executed at a public health center. During the investigation, 72 close contacts were discovered. Among them, 57 had adopted the use of the health observation app. Before the introduction of the app, all health observers would have been interviewed by telephone, a slow process that took four epidemiological officers more than 2 hours. After the introduction of the app, a single epidemiological officer can carry out health observations. The app was distributed for free beginning in early March, and by mid-May, it had been used by more than 20,280 users and 400 facilities and organizations across Japan. Currently, health observation of COVID-19 is socially recognized and has become one of the requirements for resuming social activities. Conclusions: Health observation by PHRs for the purpose of improving health management can also be effectively applied as a measure against large-scale infectious diseases. Individual habits of improving awareness of personal health and the use of PHRs for daily health management are powerful armaments against the rapid spread of infectious diseases. Ultimately, similar actions may help to prevent the spread of COVID-19. %M 32568728 %R 10.2196/19902 %U https://mhealth.jmir.org/2020/7/e19902 %U https://doi.org/10.2196/19902 %U http://www.ncbi.nlm.nih.gov/pubmed/32568728 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 7 %P e19417 %T Application and Preliminary Outcomes of Remote Diagnosis and Treatment During the COVID-19 Outbreak: Retrospective Cohort Study %A Liu,Luwen %A Gu,Jianqin %A Shao,Fengmin %A Liang,Xinliang %A Yue,Lixia %A Cheng,Qiaomei %A Zhang,Lianzhong %+ Zhengzhou University People's Hospital, Henan Provincial People's Hospital, No. 7 Weiwu Road, Zhengzhou, China, 86 13598896699, llw0624@gs.zzu.edu.cn %K coronavirus disease %K COVID-19 %K remote diagnosis and treatment %K telemedicine %K online outpatient visit %K offline drug delivery %K pandemic management %K China %K Henan Province %D 2020 %7 3.7.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: The coronavirus disease (COVID-19) pandemic, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in the self-quarantine of countless people due to possible infection. This situation makes telemedicine necessary as it can overcome geographical barriers, increase the number of people served, and provide online clinical support for patients. However, the outcomes of telemedicine have not yet been evaluated. Objective: The aim of our study is to describe the epidemiological features and clinical symptoms of patients receiving remote diagnosis and treatment at the online outpatient clinic of our hospital, as well as to analyze the outcomes and advantages of telemedicine, during the COVID-19 pandemic. Methods: Data from patients receiving remote diagnosis and treatment via consultation services for COVID-19 concerns at the online outpatient clinic of Henan Provincial People's Hospital from January 24 to February 17, 2020, were collected. A retrospective analysis was performed on epidemiological features, clinical symptoms, and preliminary outcomes. Results: Online inquiry, consultation, and suggestions were provided for patient concerns related to COVID-19. Our hospital also offered offline noncontact drug delivery services following online ordering and payment. A total of 4589 patients receiving remote diagnosis and treatment were recruited. The daily number of online outpatient visits initially increased and then decreased, reaching its peak on January 28 when the daily number of online outpatient visits totaled 612. Of 4589 patients, 1940 (42.3%) were males and 2649 (57.7%) were females (age range: 78 days to 85 years). Most patients were aged 20-39 years (n=3714, 80.9%) and came from Henan Province (n=3898, 84.9%). The number of patients from other provinces was 691 (15.1%). During the online consultations, patients discussed the following symptoms: fever (n=2383), cough (n=1740), nasal obstruction (n=794), fatigue (n=503), and diarrhea (n=276). A total of 873 orders of noncontact drug delivery following online payment was completed. The daily number of such orders gradually stabilized after the initial, steady increase. For offline drug delivery orders, the median (IQR) was 36 (58). An online satisfaction survey was filled out postconsultation by patients; of the 985 responses received, 98.1% (n=966) of respondents were satisfied with the service they received. Conclusions: Remote diagnosis and treatment offered via online outpatient consultations effectively reduced the burden on hospitals, prevented overcrowding, reduced the risk of cross-infection, and relieved patients' anxiety during the COVID-19 outbreak. This plays an essential role in pandemic management. %M 32568722 %R 10.2196/19417 %U https://mhealth.jmir.org/2020/7/e19417 %U https://doi.org/10.2196/19417 %U http://www.ncbi.nlm.nih.gov/pubmed/32568722 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e18880 %T General Model for COVID-19 Spreading With Consideration of Intercity Migration, Insufficient Testing, and Active Intervention: Modeling Study of Pandemic Progression in Japan and the United States %A Zhan,Choujun %A Tse,Chi Kong %A Lai,Zhikang %A Chen,Xiaoyun %A Mo,Mingshen %+ City University of Hong Kong, Tat Chee Avenue, Kowloon, Hong Kong, 0000, Hong Kong, 852 92701816, cktse@ieee.org %K pandemic spreading %K SEICR model %K COVID-19 %K prediction %K effect of intervention %D 2020 %7 3.7.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) began to spread in mid-December 2019 from Wuhan, China, to most provinces in China and over 200 other countries through an active travel network. Limited by the ability of the country or city to perform tests, the officially reported number of confirmed cases is expected to be much smaller than the true number of infected cases. Objective: This study aims to develop a new susceptible-exposed-infected-confirmed-removed (SEICR) model for predicting the spreading progression of COVID-19 with consideration of intercity travel and the difference between the number of confirmed cases and actual infected cases, and to apply the model to provide a realistic prediction for the United States and Japan under different scenarios of active intervention. Methods: The model introduces a new state variable corresponding to the actual number of infected cases, integrates intercity travel data to track the movement of exposed and infected individuals among cities, and allows different levels of active intervention to be considered so that a realistic prediction of the number of infected individuals can be performed. Moreover, the model generates future progression profiles for different levels of intervention by setting the parameters relative to the values found from the data fitting. Results: By fitting the model with the data of the COVID-19 infection cases and the intercity travel data for Japan (January 15 to March 20, 2020) and the United States (February 20 to March 20, 2020), model parameters were found and then used to predict the pandemic progression in 47 regions of Japan and 50 states (plus a federal district) in the United States. The model revealed that, as of March 19, 2020, the number of infected individuals in Japan and the United States could be 20-fold and 5-fold as many as the number of confirmed cases, respectively. The results showed that, without tightening the implementation of active intervention, Japan and the United States will see about 6.55% and 18.2% of the population eventually infected, respectively, and with a drastic 10-fold elevated active intervention, the number of people eventually infected can be reduced by up to 95% in Japan and 70% in the United States. Conclusions: The new SEICR model has revealed the effectiveness of active intervention for controlling the spread of COVID-19. Stepping up active intervention would be more effective for Japan, and raising the level of public vigilance in maintaining personal hygiene and social distancing is comparatively more important for the United States. %M 32589145 %R 10.2196/18880 %U https://publichealth.jmir.org/2020/3/e18880 %U https://doi.org/10.2196/18880 %U http://www.ncbi.nlm.nih.gov/pubmed/32589145 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 3 %P e19773 %T The Oxford Royal College of General Practitioners Clinical Informatics Digital Hub: Protocol to Develop Extended COVID-19 Surveillance and Trial Platforms %A de Lusignan,Simon %A Jones,Nicholas %A Dorward,Jienchi %A Byford,Rachel %A Liyanage,Harshana %A Briggs,John %A Ferreira,Filipa %A Akinyemi,Oluwafunmi %A Amirthalingam,Gayatri %A Bates,Chris %A Lopez Bernal,Jamie %A Dabrera,Gavin %A Eavis,Alex %A Elliot,Alex J %A Feher,Michael %A Krajenbrink,Else %A Hoang,Uy %A Howsam,Gary %A Leach,Jonathan %A Okusi,Cecilia %A Nicholson,Brian %A Nieri,Philip %A Sherlock,Julian %A Smith,Gillian %A Thomas,Mark %A Thomas,Nicholas %A Tripathy,Manasa %A Victor,William %A Williams,John %A Wood,Ian %A Zambon,Maria %A Parry,John %A O’Hanlon,Shaun %A Joy,Mark %A Butler,Chris %A Marshall,Martin %A Hobbs,FD Richard %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Primary Care Building, Woodstock Road, Oxford, OX26GG, United Kingdom, 44 1865617283, simon.delusignan@phc.ox.ac.uk %K primary health care %K general practice %K medical record systems, computerized %K sentinel surveillance %K public health surveillance %K clinical trials as a topic %K adaptive clinical trials %K severe acute respiratory syndrome coronavirus 2 %K COVID-19 %D 2020 %7 2.7.2020 %9 Protocol %J JMIR Public Health Surveill %G English %X Background: Routinely recorded primary care data have been used for many years by sentinel networks for surveillance. More recently, real world data have been used for a wider range of research projects to support rapid, inexpensive clinical trials. Because the partial national lockdown in the United Kingdom due to the coronavirus disease (COVID-19) pandemic has resulted in decreasing community disease incidence, much larger numbers of general practices are needed to deliver effective COVID-19 surveillance and contribute to in-pandemic clinical trials. Objective: The aim of this protocol is to describe the rapid design and development of the Oxford Royal College of General Practitioners Clinical Informatics Digital Hub (ORCHID) and its first two platforms. The Surveillance Platform will provide extended primary care surveillance, while the Trials Platform is a streamlined clinical trials platform that will be integrated into routine primary care practice. Methods: We will apply the FAIR (Findable, Accessible, Interoperable, and Reusable) metadata principles to a new, integrated digital health hub that will extract routinely collected general practice electronic health data for use in clinical trials and provide enhanced communicable disease surveillance. The hub will be findable through membership in Health Data Research UK and European metadata repositories. Accessibility through an online application system will provide access to study-ready data sets or developed custom data sets. Interoperability will be facilitated by fixed linkage to other key sources such as Hospital Episodes Statistics and the Office of National Statistics using pseudonymized data. All semantic descriptors (ie, ontologies) and code used for analysis will be made available to accelerate analyses. We will also make data available using common data models, starting with the US Food and Drug Administration Sentinel and Observational Medical Outcomes Partnership approaches, to facilitate international studies. The Surveillance Platform will provide access to data for health protection and promotion work as authorized through agreements between Oxford, the Royal College of General Practitioners, and Public Health England. All studies using the Trials Platform will go through appropriate ethical and other regulatory approval processes. Results: The hub will be a bottom-up, professionally led network that will provide benefits for member practices, our health service, and the population served. Data will only be used for SQUIRE (surveillance, quality improvement, research, and education) purposes. We have already received positive responses from practices, and the number of practices in the network has doubled to over 1150 since February 2020. COVID-19 surveillance has resulted in tripling of the number of virology sites to 293 (target 300), which has aided the collection of the largest ever weekly total of surveillance swabs in the United Kingdom as well as over 3000 severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) serology samples. Practices are recruiting to the PRINCIPLE (Platform Randomised trial of INterventions against COVID-19 In older PeopLE) trial, and these participants will be followed up through ORCHID. These initial outputs demonstrate the feasibility of ORCHID to provide an extended national digital health hub. Conclusions: ORCHID will provide equitable and innovative use of big data through a professionally led national primary care network and the application of FAIR principles. The secure data hub will host routinely collected general practice data linked to other key health care repositories for clinical trials and support enhanced in situ surveillance without always requiring large volume data extracts. ORCHID will support rapid data extraction, analysis, and dissemination with the aim of improving future research and development in general practice to positively impact patient care. International Registered Report Identifier (IRRID): DERR1-10.2196/19773 %M 32484782 %R 10.2196/19773 %U https://publichealth.jmir.org/2020/3/e19773 %U https://doi.org/10.2196/19773 %U http://www.ncbi.nlm.nih.gov/pubmed/32484782 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e19514 %T Monitoring and Management of Home-Quarantined Patients With COVID-19 Using a WeChat-Based Telemedicine System: Retrospective Cohort Study %A Xu,Hui %A Huang,Sufang %A Qiu,Chun %A Liu,Shangkun %A Deng,Juan %A Jiao,Bo %A Tan,Xi %A Ai,Ling %A Xiao,Yaru %A Belliato,Mirko %A Yan,Li %+ Department of Emergency Medicine, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, 1095 Jie Fang Avenue, Qiaokou District, Wuhan, 430030, China, 86 13607124420, yanli008@163.com %K telemedicine system %K home quarantine %K quarantine management assessment %K progressive COVID-19 patients %K COVID-19 %D 2020 %7 2.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Most patients with coronavirus disease (COVID-19) who show mild symptoms are sent home by physicians to recover. However, the condition of some of these patients becomes severe or critical as the disease progresses. Objective: The aim of this study was to evaluate a telemedicine model that was developed to address the challenges of treating patients with progressive COVID-19 who are home-quarantined and shortages in the medical workforce. Methods: A telemedicine system was developed to continuously monitor the progression of home-quarantined patients with COVID-19. The system was built based on a popular social media smartphone app called WeChat; the app was used to establish two-way communication between a multidisciplinary team consisting of 7 medical workers and 188 home-quarantined individuals (including 74 confirmed patients with COVID-19). The system helped patients self-assess their conditions and update the multidisciplinary team through a telemedicine form stored on a cloud service, based on which the multidisciplinary team made treatment decisions. We evaluated this telemedicine system via a single-center retrospective study conducted at Tongji Hospital in Wuhan, China, in January 2020. Results: Among 188 individuals using the telemedicine system, 114 (60.6%) were not infected with COVID-19 and were dismissed. Of the 74 confirmed patients with COVID-19, 26 (35%) recovered during the study period and voluntarily stopped using the system. The remaining 48/76 confirmed patients with COVID-19 (63%) used the system until the end of the study, including 6 patients whose conditions progressed to severe or critical. These 6 patients were admitted to hospital and were stabilized (one received extracorporeal membrane oxygenation support for 17 days). All 74 patients with COVID-19 eventually recovered. Through a comparison of the monitored symptoms between hospitalized and nonhospitalized patients, we found prolonged persistence and deterioration of fever, dyspnea, lack of strength, and muscle soreness to be diagnostic of need for hospitalization. Conclusions: By continuously monitoring the changes in several key symptoms, the telemedicine system reduces the risks of delayed hospitalization due to disease progression for patients with COVID-19 quarantined at home. The system uses a set of scales for quarantine management assessment that enables patients to self-assess their conditions. The results are useful for medical staff to identify disease progression and, hence, make appropriate and timely treatment decisions. The system requires few staff to manage a large cohort of patients. In addition, the system can solicit help from recovered but self-quarantined medical workers to alleviate shortages in the medical workforce and free healthy medical workers to fight COVID-19 on the front line. Thus, it optimizes the usage of local medical resources and prevents cross-infections among medical workers and patients. %M 32568727 %R 10.2196/19514 %U https://www.jmir.org/2020/7/e19514 %U https://doi.org/10.2196/19514 %U http://www.ncbi.nlm.nih.gov/pubmed/32568727 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 7 %P e18831 %T Mapping of Health Literacy and Social Panic Via Web Search Data During the COVID-19 Public Health Emergency: Infodemiological Study %A Xu,Chenjie %A Zhang,Xinyu %A Wang,Yaogang %+ School of Public Health, Tianjin Medical University, No 22, Qixiangtai Road, Heping District, Tianjin, 300070, China, 86 13820046130, wangyg@tmu.edu.cn %K COVID-19 %K China %K Baidu %K infodemiology %K web search %K internet %K public health %K emergency %K outbreak %K infectious disease %K pandemic %K health literacy %D 2020 %7 2.7.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Coronavirus disease (COVID-19) is a type of pneumonia caused by a novel coronavirus that was discovered in 2019. As of May 6, 2020, 84,407 cases and 4643 deaths have been confirmed in China. The Chinese population has expressed great concern since the COVID-19 outbreak. Meanwhile, an average of 1 billion people per day are using the Baidu search engine to find COVID-19–related health information. Objective: The aim of this paper is to analyze web search data volumes related to COVID-19 in China. Methods: We conducted an infodemiological study to analyze web search data volumes related to COVID-19. Using Baidu Index data, we assessed the search frequencies of specific search terms in Baidu to describe the impact of COVID-19 on public health, psychology, behaviors, lifestyles, and social policies (from February 11, 2020, to March 17, 2020). Results: The search frequency related to COVID-19 has increased significantly since February 11th. Our heat maps demonstrate that citizens in Wuhan, Hubei Province, express more concern about COVID-19 than citizens from other cities since the outbreak first occurred in Wuhan. Wuhan citizens frequently searched for content related to “medical help,” “protective materials,” and “pandemic progress.” Web searches for “return to work” and “go back to school” have increased eight-fold compared to the previous month. Searches for content related to “closed community and remote office” have continued to rise, and searches for “remote office demand” have risen by 663% from the previous quarter. Employees who have returned to work have mainly engaged in the following web searches: “return to work and prevention measures,” “return to work guarantee policy,” and “time to return to work.” Provinces with large, educated populations (eg, Henan, Hebei, and Shandong) have been focusing on “online education” whereas medium-sized cities have been paying more attention to “online medical care.” Conclusions: Our findings suggest that web search data may reflect changes in health literacy, social panic, and prevention and control policies in response to COVID-19. %M 32540844 %R 10.2196/18831 %U https://www.jmir.org/2020/7/e18831 %U https://doi.org/10.2196/18831 %U http://www.ncbi.nlm.nih.gov/pubmed/32540844 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19636 %T Identification of Symptoms Prognostic of COVID-19 Severity: Multivariate Data Analysis of a Case Series in Henan Province %A Li,Jitian %A Chen,Zhe %A Nie,Yifei %A Ma,Yan %A Guo,Qiaoyun %A Dai,Xiaofeng %+ Wuxi School of Medicine, Jiangnan University, Lihu Avenue 1800, Wuxi, 214122, China, 86 18168870169, 1281423490@qq.com %K prognostic symptoms %K COVID-19 %K severity %K CVD %K Henan Province %D 2020 %7 30.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes coronavirus disease (COVID-19), has been declared a global pandemic. Identifying individuals whose infection can potentially become severe is critical to control the case fatality rate of COVID-19. However, knowledge of symptoms that are prognostic of COVID-19 severity is lacking. Objective: The objective of our study was to identify symptoms prognostic of COVID-19 infection severity. Methods: We analyzed documented symptoms, including fever, cough, fatigue, expectoration, sore throat, chest distress, headache, diarrhea, rhinorrhea, stuffed nose, nausea, vomiting, muscle or joint ache, shortness of breath, and their associations with disease severity using a case series, including 655 confirmed cases from January 23 to February 5, 2020 in Henan Province, China. We also analyzed the influence of individual characteristics, including age, gender, and comorbidities, on symptoms with prognostic value. Results: Fatigue (95% CI 0.141 to 0.334, P<.001), expectoration (95% CI 0.107 to 0.305, P<.001) and stuffed nose (95% CI –0.499 to –0.082, P=.006) were identified as the prognostic symptoms of COVID-19 patients from the multivariate analysis. Fever occurred in 603/655 (92.1%) of the patients but was not associated with disease severity. Fatigue accounted for 184/655 (28.1%) of the patients and was linearly associated with infection severity with statistical significance. Expectoration occurred in 169/655 (25.8%) patients in the cohort and was the sole prognostic factor for patients with cardiovascular complications, including hypertension. Shortness of breath, chest distress, muscle or joint ache, and dry cough, which occurred in 33 (5%), 83 (12.7%), 78 (11.9%), and 276 (42.1%) of the 655 patients, respectively, were significantly enriched among patients classified as severe. Stuffed nose and nausea were associated with favorable disease severity, especially among male patients. More female than male patients were documented as having muscle or joint ache. Headache was most enriched in patents aged 15 to 39 years, followed by those aged 40 to 64 years, with statistical significance. Conclusions: Fatigue and expectoration are signs of severe COVID-19 infection. Shortness of breath, chest distress, muscle or joint ache, and dry cough are prevalent in severe patients. Expectoration is commonly present in older individuals and patients with cardiovascular disorders, including hypertension. Shortness of breath is prognostic of severe infection in male patients. Stuffed nose and nausea are favorable prognostic factors of severe infection, especially among male patients. %M 32544071 %R 10.2196/19636 %U https://www.jmir.org/2020/6/e19636 %U https://doi.org/10.2196/19636 %U http://www.ncbi.nlm.nih.gov/pubmed/32544071 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e21820 %T How to Fight an Infodemic: The Four Pillars of Infodemic Management %A Eysenbach,Gunther %+ JMIR Publications, 130 Queens Quay East, Suite 1100, Toronto, ON, , Canada, 1 416 583 2040, editor@jmir.org %K infodemiology %K infodemic %K COVID-19 %K infoveillance %K pandemic %K epidemics %K emergency management %K public health %D 2020 %7 29.6.2020 %9 Commentary %J J Med Internet Res %G English %X In this issue of the Journal of Medical Internet Research, the World Health Organization (WHO) is presenting a framework for managing the coronavirus disease (COVID-19) infodemic. Infodemiology is now acknowledged by public health organizations and the WHO as an important emerging scientific field and critical area of practice during a pandemic. From the perspective of being the first “infodemiologist” who originally coined the term almost two decades ago, I am positing four pillars of infodemic management: (1) information monitoring (infoveillance); (2) building eHealth Literacy and science literacy capacity; (3) encouraging knowledge refinement and quality improvement processes such as fact checking and peer-review; and (4) accurate and timely knowledge translation, minimizing distorting factors such as political or commercial influences. In the current COVID-19 pandemic, the United Nations has advocated that facts and science should be promoted and that these constitute the antidote to the current infodemic. This is in stark contrast to the realities of infodemic mismanagement and misguided upstream filtering, where social media platforms such as Twitter have advertising policies that sideline science organizations and science publishers, treating peer-reviewed science as “inappropriate content.” %M 32589589 %R 10.2196/21820 %U http://www.jmir.org/2020/6/e21820/ %U https://doi.org/10.2196/21820 %U http://www.ncbi.nlm.nih.gov/pubmed/32589589 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19659 %T Framework for Managing the COVID-19 Infodemic: Methods and Results of an Online, Crowdsourced WHO Technical Consultation %A Tangcharoensathien,Viroj %A Calleja,Neville %A Nguyen,Tim %A Purnat,Tina %A D’Agostino,Marcelo %A Garcia-Saiso,Sebastian %A Landry,Mark %A Rashidian,Arash %A Hamilton,Clayton %A AbdAllah,Abdelhalim %A Ghiga,Ioana %A Hill,Alexandra %A Hougendobler,Daniel %A van Andel,Judith %A Nunn,Mark %A Brooks,Ian %A Sacco,Pier Luigi %A De Domenico,Manlio %A Mai,Philip %A Gruzd,Anatoliy %A Alaphilippe,Alexandre %A Briand,Sylvie %+ Department of Digital Health and Innovation, Science Division, World Health Organization, 20 Avenue Appia, Geneva, 1211, Switzerland, 41 22 791 2476, purnatt@who.int %K COVID-19 %K infodemic %K knowledge translation %K message amplification %K misinformation %K information-seeking behavior %K access to information %K information literacy %K communications media %K internet %K risk communication %K evidence synthesis %D 2020 %7 26.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: An infodemic is an overabundance of information—some accurate and some not—that occurs during an epidemic. In a similar manner to an epidemic, it spreads between humans via digital and physical information systems. It makes it hard for people to find trustworthy sources and reliable guidance when they need it. Objective: A World Health Organization (WHO) technical consultation on responding to the infodemic related to the coronavirus disease (COVID-19) pandemic was held, entirely online, to crowdsource suggested actions for a framework for infodemic management. Methods: A group of policy makers, public health professionals, researchers, students, and other concerned stakeholders was joined by representatives of the media, social media platforms, various private sector organizations, and civil society to suggest and discuss actions for all parts of society, and multiple related professional and scientific disciplines, methods, and technologies. A total of 594 ideas for actions were crowdsourced online during the discussions and consolidated into suggestions for an infodemic management framework. Results: The analysis team distilled the suggestions into a set of 50 proposed actions for a framework for managing infodemics in health emergencies. The consultation revealed six policy implications to consider. First, interventions and messages must be based on science and evidence, and must reach citizens and enable them to make informed decisions on how to protect themselves and their communities in a health emergency. Second, knowledge should be translated into actionable behavior-change messages, presented in ways that are understood by and accessible to all individuals in all parts of all societies. Third, governments should reach out to key communities to ensure their concerns and information needs are understood, tailoring advice and messages to address the audiences they represent. Fourth, to strengthen the analysis and amplification of information impact, strategic partnerships should be formed across all sectors, including but not limited to the social media and technology sectors, academia, and civil society. Fifth, health authorities should ensure that these actions are informed by reliable information that helps them understand the circulating narratives and changes in the flow of information, questions, and misinformation in communities. Sixth, following experiences to date in responding to the COVID-19 infodemic and the lessons from other disease outbreaks, infodemic management approaches should be further developed to support preparedness and response, and to inform risk mitigation, and be enhanced through data science and sociobehavioral and other research. Conclusions: The first version of this framework proposes five action areas in which WHO Member States and actors within society can apply, according to their mandate, an infodemic management approach adapted to national contexts and practices. Responses to the COVID-19 pandemic and the related infodemic require swift, regular, systematic, and coordinated action from multiple sectors of society and government. It remains crucial that we promote trusted information and fight misinformation, thereby helping save lives. %M 32558655 %R 10.2196/19659 %U http://www.jmir.org/2020/6/e19659/ %U https://doi.org/10.2196/19659 %U http://www.ncbi.nlm.nih.gov/pubmed/32558655 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e18419 %T Determining the Impact of a School-Based Health Education Package for Prevention of Intestinal Worm Infections in the Philippines: Protocol for a Cluster Randomized Intervention Trial %A Mationg,Mary Lorraine S %A Williams,Gail M %A Tallo,Veronica L %A Olveda,Remigio M %A Aung,Eindra %A Alday,Portia %A Reñosa,Mark Donald %A Daga,Chona Mae %A Landicho,Jhoys %A Demonteverde,Maria Paz %A Santos,Eunice Dianne %A Bravo,Thea Andrea %A Angly Bieri,Franziska A %A Li,Yuesheng %A Clements,Archie C A %A Steinmann,Peter %A Halton,Kate %A Stewart,Donald E %A McManus,Donald P %A Gray,Darren J %+ Molecular Parasitology Laboratory, Infectious Diseases Division, QIMR Berghofer Medical Research Institute, 300 Herston Rd Herston Queensland, Brisbane, 4006, Australia, 61 7 3362 0401, Don.McManus@qimrberghofer.edu.au %K soil-transmitted helminths %K school-based health educational intervention %K Magic Glasses %K integrated control %K randomized controlled trial %K Philippines %D 2020 %7 25.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Repeated mass drug administration (MDA) of antihelminthics to at-risk populations is still the main strategy for the control of soil-transmitted helminth (STH) infections. However, MDA, as a stand-alone intervention, does not prevent reinfection. Accordingly, complementary measures to prevent STH reinfection, such as health education and improved sanitation, as part of an integrated control approach, are required to augment the effectiveness of MDA for optimal efficiency and sustainability. Objective: The aim of this study is to determine the impact and generalizability of a school-based health education package entitled The Magic Glasses for STH prevention in the Philippines. Methods: We conducted a cluster randomized controlled intervention trial, involving 2020 schoolchildren aged 9-10 years, in 40 schools in Laguna Province, Philippines, to evaluate the impact of the school-based health education package for the prevention of STHs. The trial was conducted over the course of 1 year (June 2016 to July 2017). A total of 20 schools were randomly assigned to the intervention arm, in which The Magic Glasses Philippines health education package was delivered with the standard health education activities endorsed by the Philippines Department of Health (DOH) and the Department of Education (DepEd). The other 20 schools comprised the control arm of the study, where the DOH/DepEd’s standard health education activities were done. At baseline, parasitological assessments and a knowledge, attitude, and practice survey were carried out in all schools. In addition, height, weight, and hemoglobin levels were obtained from each child (after parental consent), and their school attendance and academic performance in English and mathematics were accessed from the school records. The baseline and 2 follow-up surveys were completed using the same study measurements and quality-control assessments. Results: Key results from this cluster randomized intervention trial will shed light on the impact that The Magic Glasses health education package will have against STH infections in schoolchildren in the province of Laguna, located on the Island of Luzon, in the Calabarzon Region of the Philippines. Conclusions: The results of the trial will be used to assess the generalizability of the impact of The Magic Glasses health education package in different epidemiological and cultural settings, providing evidence for translation of this health education package into public health policy and practice in the Asian region and beyond. Trial Registration: Australian New Zealand Clinical Trials Registry number ACTRN12616000508471; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368849 International Registered Report Identifier (IRRID): DERR1-10.2196/18419 %M 32584263 %R 10.2196/18419 %U https://www.researchprotocols.org/2020/6/e18419 %U https://doi.org/10.2196/18419 %U http://www.ncbi.nlm.nih.gov/pubmed/32584263 %0 Journal Article %@ 2561-6722 %I JMIR Publications %V 3 %N 1 %P e20049 %T Digital Approaches to Remote Pediatric Health Care Delivery During the COVID-19 Pandemic: Existing Evidence and a Call for Further Research %A Badawy,Sherif M %A Radovic,Ana %+ Department of Pediatrics, Northwestern University Feinberg School of Medicine, 225 E Chicago Avenue, Box #30, Chicago, IL, 60654, United States, 1 312 227 4000 ext 74836, sbadawy@luriechildrens.org %K coronavirus %K COVID-19 %K SARS-CoV-2 %K pandemic %K outbreak %K public health %K pediatric %K children %K adolescents %K telehealth %K telemedicine %K digital %K interventions %K digital health %K digital medicine %K mobile health %K mHealth %K eHealth %K health care delivery %D 2020 %7 25.6.2020 %9 Viewpoint %J JMIR Pediatr Parent %G English %X The global spread of the coronavirus disease (COVID-19) outbreak poses a public health threat and has affected people worldwide in various unprecedented ways, both personally and professionally. There is no question that the current global COVID-19 crisis, now more than ever, is underscoring the importance of leveraging digital approaches to optimize pediatric health care delivery in the era of this pandemic. In this perspective piece, we highlight some of the available digital approaches that have been and can continue to be used to streamline remote pediatric patient care in the era of the COVID-19 pandemic, including but not limited to telemedicine. JMIR Pediatrics and Parenting is currently publishing a COVID-19 special theme issue in which investigators can share their interim and final research data related to digital approaches to remote pediatric health care delivery in different settings. The COVID-19 pandemic has rapidly transformed health care systems worldwide, with significant variations and innovations in adaptation. There has been rapid expansion of the leveraging and optimization of digital approaches to health care delivery, particularly integrated telemedicine and virtual health. Digital approaches have played and will play major roles as invaluable and reliable resources to overcome restrictions and challenges imposed during the COVID-19 pandemic and to increase access to effective, accessible, and consumer-friendly care for more patients and families. However, a number of challenges remain to be addressed, and further research is needed. Optimizing digital approaches to health care delivery and integrating them into the public health response will be an ongoing process during the current COVID-19 outbreak and during other possible future pandemics. Regulatory changes are essential to support the safe and wide adoption of these approaches. Involving all relevant stakeholders in addressing current and future challenges as well as logistical, technological, and financial barriers will be key for success. Future studies should consider evaluating the following research areas related to telemedicine and other digital approaches: cost-effectiveness and return on investment; impact on quality of care; balance in use and number of visits needed for the management of both acute illness and chronic health conditions; system readiness for further adoption in other settings, such as inpatient services, subspecialist consultations, and rural areas; ongoing user-centered evaluations, with feedback from patients, families, and health care providers; strategies to optimize health equity and address disparities in access to care related to race and ethnicity, socioeconomic status, immigration status, and rural communities; privacy and security concerns for protected health information with Health Insurance Portability and Accountability Act (HIPAA)–secured programs; confidentiality issues for some specific populations, especially adolescents and those in need of mental health services; early detection of exposure to violence and child neglect; and integration of training into undergraduate and graduate medical education and subspecialty fellowships. Addressing these research areas is essential to understanding the benefits, sustainability, safety, and optimization strategies of telemedicine and other digital approaches as key parts of modern health care delivery. These efforts will inform long-term adoption of these approaches with expanded dissemination and implementation efforts. %M 32540841 %R 10.2196/20049 %U http://pediatrics.jmir.org/2020/1/e20049/ %U https://doi.org/10.2196/20049 %U http://www.ncbi.nlm.nih.gov/pubmed/32540841 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19771 %T Leveraging User Experience to Improve Video Consultations in a Cardiology Practice During the COVID-19 Pandemic: Initial Insights %A Vandekerckhove,Pieter %A Vandekerckhove,Yves %A Tavernier,Rene %A De Jaegher,Kelly %A de Mul,Marleen %+ Erasmus School of Health Policy and Management, Erasmus University, Burgemeester Oudlaan 50, Rotterdam, 3000 DR, Netherlands, 31 10 408 8555, vandekerckhove@eshpm.eur.nl %K telemedicine %K design thinking %K cardiology %K patient %K COVID-19 %K user experience %D 2020 %7 25.6.2020 %9 Viewpoint %J J Med Internet Res %G English %X During the coronavirus disease (COVID-19) pandemic, cardiologists have attempted to minimize risks to their patients by using telehealth to provide continuing care. Rapid implementation of video consultations in outpatient clinics for patients with heart disease can be challenging. We employed a design thinking tool called a customer journey to explore challenges and opportunities when using video communication software in the cardiology department of a regional hospital. Interviews were conducted with 5 patients with implanted devices, a nurse, an information technology manager and two cardiologists. Three lessons were identified based on these challenges and opportunities. Attention should be given to the ease of use of the technology, the meeting features, and the establishment of the connection between the cardiologist and the patient. Further, facilitating the role of an assistant (or virtual assistant) with the video consultation software who can manage the telehealth process may improve the success of video consultations. Employing design thinking to implement video consultations in cardiology and to further implement telehealth is crucial to build a resilient health care system that can address urgent needs beyond the COVID-19 pandemic. %M 32519964 %R 10.2196/19771 %U http://www.jmir.org/2020/6/e19771/ %U https://doi.org/10.2196/19771 %U http://www.ncbi.nlm.nih.gov/pubmed/32519964 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19731 %T Suitability and Sufficiency of Telehealth Clinician-Observed, Participant-Collected Samples for SARS-CoV-2 Testing: The iCollect Cohort Pilot Study %A Guest,Jodie L %A Sullivan,Patrick S %A Valentine-Graves,Mariah %A Valencia,Rachel %A Adam,Elizabeth %A Luisi,Nicole %A Nakano,Mariko %A Guarner,Jeannette %A del Rio,Carlos %A Sailey,Charles %A Goedecke,Zoe %A Siegler,Aaron J %A Sanchez,Travis H %+ Rollins School of Public Health, Emory University, 1518 Clifton Rd, Atlanta, GA, 30322, United States, 1 4046802450, Jodie.Guest@emory.edu %K COVID-19 %K testing %K home testing %K telehealth %K pilot study %K diagnostic %K diagnosis %D 2020 %7 25.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The severe acute respiratory coronavirus 2 (SARS-CoV-2) pandemic calls for expanded opportunities for testing, including novel testing strategies such as home-collected specimens. Objective: We aimed to understand whether oropharyngeal swab (OPS), saliva, and dried blood spot (DBS) specimens collected by participants at home and mailed to a laboratory were sufficient for use in diagnostic and serology tests of SARS-CoV-2. Methods: Eligible participants consented online and were mailed a participant-collection kit to support collection of three specimens for SARS-CoV-2 testing: saliva, OPS, and DBS. Participants performed the specimen collection procedures during a telehealth video appointment while clinical observers watched and documented the suitability of the collection. The biological sufficiency of the specimens for detection of SARS-CoV-2 by reverse transcriptase–polymerase chain reaction and serology testing was assessed by laboratorians using visual inspection and quantification of the nucleic acid contents of the samples by ribonuclease P (RNase P) measurements. Results: Of the enrolled participants,153/159 (96.2%) returned their kits, which were included in this analysis. All these participants attended their video appointments. Clinical observers assessed that of the samples collected, 147/153 (96.1%) of the saliva samples, 146/151 (96.7%) of the oropharyngeal samples, and 135/145 (93.1%) of the DBS samples were of sufficient quality for submission for laboratory testing; 100% of the OPS samples and 98% of the saliva samples had cycle threshold values for RNase P <30, indicating that the samples contained sufficient nucleic acid for RNA-PCR testing for SARS-CoV-2. Conclusions: These pilot data indicate that most participant-collected OPS, saliva, and DBS specimens are suitable and sufficient for testing for SARS-CoV-2 RNA and serology. Clinical observers rated the collection of specimens as suitable for testing, and visual and quantitative laboratory assessment indicated that the specimens were biologically sufficient. These data support the utility of participant-collected and mailed-in specimens for SARS-CoV-2 testing. International Registered Report Identifier (IRRID): RR2-10.2196/19054 %M 32479412 %R 10.2196/19731 %U http://publichealth.jmir.org/2020/2/e19731/ %U https://doi.org/10.2196/19731 %U http://www.ncbi.nlm.nih.gov/pubmed/32479412 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19045 %T Telehealth as a Bright Spot of the COVID-19 Pandemic: Recommendations From the Virtual Frontlines ("Frontweb") %A Olayiwola,J Nwando %A Magaña,Candy %A Harmon,Ashley %A Nair,Shalina %A Esposito,Erica %A Harsh,Christine %A Forrest,L Arick %A Wexler,Randy %+ Department of Family Medicine, The Ohio State University Wexner Medical Center, 2231 N High Street, Suite 250, Columbus, OH, 43210, United States, 1 6142932652, nwando.olayiwola@osumc.edu %K telehealth %K telemedicine %K primary care %K COVID-19 %K pandemic %K outbreak %K public health %K infectious disease %D 2020 %7 25.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X The coronavirus disease (COVID-19) pandemic has accelerated the telehealth tipping point in the practice of family medicine and primary care in the United States, making telehealth not just a novel approach to care but also a necessary one for public health safety. Social distancing requirements and stay-at-home orders have shifted patient care from face-to-face consultations in primary care offices to virtual care from clinicians’ homes or offices, moving to a new frontline, which we call the “frontweb.” Our telehealth workgroup employed the Clinical Transformation in Technology implementation framework to accelerate telehealth expansion and to develop a consensus document for clinician recommendations in providing remote virtual care during the pandemic. In a few weeks, telehealth went from under 5% of patient visits to almost 93%, while maintaining high levels of patient satisfaction. In this paper, we share clinician recommendations and guidance gleaned from this transition to the frontweb and offer a systematic approach for ensuring “webside” success. %M 32479413 %R 10.2196/19045 %U http://publichealth.jmir.org/2020/2/e19045/ %U https://doi.org/10.2196/19045 %U http://www.ncbi.nlm.nih.gov/pubmed/32479413 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19691 %T Virtual Management of Patients With Cancer During the COVID-19 Pandemic: Web-Based Questionnaire Study %A Tashkandi,Emad %A Zeeneldin,Ahmed %A AlAbdulwahab,Amal %A Elemam,Omima %A Elsamany,Shereef %A Jastaniah,Wasil %A Abdullah,Shaker %A Alfayez,Mohammad %A Jazieh,Abdul Rahman %A Al-Shamsi,Humaid O %+ Department of Medical Oncology, Oncology Center, King Abdullah Medical City, PO box 715, Makkah, 21955, Saudi Arabia, 966 555290061, Tashkandi.e@kamc.med.sa %K teleoncology %K telemedicine %K eHealth %K cancer %K COVID-19 %K public health %D 2020 %7 24.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: During the coronavirus disease (COVID-19) pandemic, patients with cancer in rural settings and distant geographical areas will be affected the most by curfews. Virtual management (telemedicine) has been shown to reduce health costs and improve access to care. Objective: The aim of this survey is to understand oncologists’ awareness of and views on virtual management, challenges, and preferences, as well as their priorities regarding the prescribing of anticancer treatments during the COVID-19 pandemic. Methods: We created a self-administrated electronic survey about the virtual management of patients with cancer during the COVID-19 pandemic. We evaluated its clinical sensibility and pilot tested the instrument. We surveyed practicing oncologists in Gulf and Arab countries using snowball sampling via emails and social media networks. Reminders were sent 1 and 2 weeks later using SurveyMonkey. Results: We received 222 responses from validated oncologists from April 2-22, 2020. An awareness of virtual clinics, virtual multidisciplinary teams, and virtual prescriptions was reported by 182 (82%), 175 (79%), and 166 (75%) respondents, respectively. Reported challenges associated with virtual management were the lack of physical exam (n=134, 60%), patients’ awareness and access (n=131, 59%), the lack of physical attendance of patients (n=93, 42%), information technology (IT) support (n=82, 37%), and the safety of virtual management (n=78, 35%). Overall, 111 (50%) and 107 (48%) oncologists did not prefer the virtual prescription of chemotherapy and novel immunotherapy, respectively. However, 188 (85%), 165 (74%), and 127 (57%) oncologists preferred the virtual prescription of hormonal therapy, bone modifying agents, and targeted therapy, respectively. In total, 184 (83%), 183 (83%), and 176 (80%) oncologists preferred to continue neoadjuvant, adjuvant, and perioperative treatments, respectively. Overall, 118 (53%) respondents preferred to continue first-line palliative treatment, in contrast to 68 (30%) and 47 (21%) respondents indicating a preference to interrupt second- and third-line palliative treatment, respectively. For administration of virtual prescriptions, all respondents preferred the oral route and 118 (53%) preferred the subcutaneous route. In contrast, 193 (87%) did not prefer the intravenous route for virtual prescriptions. Overall, 102 (46%) oncologists responded that they would “definitely” prefer to manage patients with cancer virtually. Conclusions: Oncologists have a high level of awareness of virtual management. Although their survey responses indicated that second- and third-line palliative treatments should be interrupted, they stated that neoadjuvant, adjuvant, perioperative, and first-line palliative treatments should continue. Our results confirm that oncologists’ views on the priority of anticancer treatments are consistent with the evolving literature during the COVID-19 pandemic. Challenges to virtual management should be addressed to improve the care of patients with cancer. %M 32501807 %R 10.2196/19691 %U http://www.jmir.org/2020/6/e19691/ %U https://doi.org/10.2196/19691 %U http://www.ncbi.nlm.nih.gov/pubmed/32501807 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e20586 %T A Double Triage and Telemedicine Protocol to Optimize Infection Control in an Emergency Department in Taiwan During the COVID-19 Pandemic: Retrospective Feasibility Study %A Lin,Chien-Hao %A Tseng,Wen-Pin %A Wu,Jhong-Lin %A Tay,Joyce %A Cheng,Ming-Tai %A Ong,Hooi-Nee %A Lin,Hao-Yang %A Chen,Yi-Ying %A Wu,Chih-Hsien %A Chen,Jiun-Wei %A Chen,Shey-Ying %A Chan,Chang-Chuan %A Huang,Chien-Hua %A Chen,Shyr-Chyr %+ Department of Emergency Medicine, National Taiwan University Hospital, National Taiwan University College of Medicine, No 7, Zhongshan S Road, Zhongzheng District, Taipei, 100, Taiwan, 886 2 233123456 ext 62831, chhuang5940@ntu.edu.tw %K COVID-19 %K triage %K emergency department %K health care workers %K infection control %K telemedicine %D 2020 %7 23.6.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32544072 %R 10.2196/20586 %U http://www.jmir.org/2020/6/e20586/ %U https://doi.org/10.2196/20586 %U http://www.ncbi.nlm.nih.gov/pubmed/32544072 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 9 %N 6 %P e19292 %T Closing the Psychological Treatment Gap During the COVID-19 Pandemic With a Supportive Text Messaging Program: Protocol for Implementation and Evaluation %A Agyapong,Vincent Israel Opoku %A Hrabok,Marianne %A Vuong,Wesley %A Gusnowski,April %A Shalaby,Reham %A Mrklas,Kelly %A Li,Daniel %A Urichuk,Liana %A Snaterse,Mark %A Surood,Shireen %A Cao,Bo %A Li,Xin-Min %A Greiner,Russ %A Greenshaw,Andrew James %+ Department of Psychiatry, Faculty of Medicine and Dentistry, University of Alberta, 1E1 Walter Mackenzie Health Sciences Centre, 8440 112 St NW, Edmonton, AB, T6G 2B7, Canada, 1 7807144315, agyapong@ualberta.ca %K COVID-19 %K Text4Hope %K mobile phones %K text %K anxiety %K depression %K stress %K pandemic %K e-mental health %D 2020 %7 22.6.2020 %9 Protocol %J JMIR Res Protoc %G English %X Background: Coronavirus disease (COVID-19) has spread globally with far-reaching, significant, and unprecedented impacts on health and everyday life. Threats to mental health, psychological safety, and well-being are now emerging, increasing the impact of this virus on world health. Providing support for these challenges is difficult because of the high number of people requiring support in the context of a need to maintain physical distancing. This protocol describes the use of SMS text messaging (Text4Hope) as a convenient, cost-effective, and accessible population-level mental health intervention. This program is evidence-based, with prior research supporting good outcomes and high user satisfaction. Objective: The project goal is to implement a program of daily supportive SMS text messaging (Text4Hope) to reduce distress related to the COVID-19 crisis, initially among Canadians. The prevalence of stress, anxiety, and depressive symptoms; the demographic correlates of the same; and the outcomes of the Text4Hope intervention in mitigating distress will be evaluated. Methods: Self-administered anonymous online questionnaires will be used to assess stress (Perceived Stress Scale), anxiety (Generalized Anxiety Disorder-7 scale [GAD-7]), and depressive symptoms (Patient Health Questionnaire-9 [PHQ-9]). Data will be collected at baseline (onset of SMS text messaging), the program midpoint (6 weeks), and the program endpoint (12 weeks). Results: Data analysis will include parametric and nonparametric techniques, focusing on primary outcomes (ie, stress, anxiety, and depressive symptoms) and metrics of use, including the number of subscribers and user satisfaction. Given the large size of the data set, machine learning and data mining methods will also be used. Conclusions: This COVID-19 project will provide key information regarding prevalence rates of stress, anxiety, and depressive symptoms during the pandemic; demographic correlates of distress; and outcome data related to this scalable population-level intervention. Information from this study will be valuable for practitioners and useful for informing policy and decision making regarding psychological interventions during the pandemic. International Registered Report Identifier (IRRID): DERR1-10.2196/19292 %M 32501805 %R 10.2196/19292 %U http://www.researchprotocols.org/2020/6/e19292/ %U https://doi.org/10.2196/19292 %U http://www.ncbi.nlm.nih.gov/pubmed/32501805 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19353 %T Modeling COVID-19 Latent Prevalence to Assess a Public Health Intervention at a State and Regional Scale: Retrospective Cohort Study %A Turk,Philip J %A Chou,Shih-Hsiung %A Kowalkowski,Marc A %A Palmer,Pooja P %A Priem,Jennifer S %A Spencer,Melanie D %A Taylor,Yhenneko J %A McWilliams,Andrew D %+ Center for Outcomes Research and Evaluation, Atrium Health, 1300 Scott Ave, Office 124, Charlotte, NC, 28203, United States, 1 304 376 5377, Philip.Turk@atriumhealth.org %K COVID-19 %K public health surveillance %K novel coronavirus 2019 %K pandemic %K forecasting %K SIR model %K detection probability %K latent prevalence %D 2020 %7 19.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Emergence of the coronavirus disease (COVID-19) caught the world off guard and unprepared, initiating a global pandemic. In the absence of evidence, individual communities had to take timely action to reduce the rate of disease spread and avoid overburdening their health care systems. Although a few predictive models have been published to guide these decisions, most have not taken into account spatial differences and have included assumptions that do not match the local realities. Access to reliable information that is adapted to local context is critical for policy makers to make informed decisions during a rapidly evolving pandemic. Objective: The goal of this study was to develop an adapted susceptible-infected-removed (SIR) model to predict the trajectory of the COVID-19 pandemic in North Carolina and the Charlotte Metropolitan Region, and to incorporate the effect of a public health intervention to reduce disease spread while accounting for unique regional features and imperfect detection. Methods: Three SIR models were fit to infection prevalence data from North Carolina and the greater Charlotte Region and then rigorously compared. One of these models (SIR-int) accounted for a stay-at-home intervention and imperfect detection of COVID-19 cases. We computed longitudinal total estimates of the susceptible, infected, and removed compartments of both populations, along with other pandemic characteristics such as the basic reproduction number. Results: Prior to March 26, disease spread was rapid at the pandemic onset with the Charlotte Region doubling time of 2.56 days (95% CI 2.11-3.25) and in North Carolina 2.94 days (95% CI 2.33-4.00). Subsequently, disease spread significantly slowed with doubling times increased in the Charlotte Region to 4.70 days (95% CI 3.77-6.22) and in North Carolina to 4.01 days (95% CI 3.43-4.83). Reflecting spatial differences, this deceleration favored the greater Charlotte Region compared to North Carolina as a whole. A comparison of the efficacy of intervention, defined as 1 – the hazard ratio of infection, gave 0.25 for North Carolina and 0.43 for the Charlotte Region. In addition, early in the pandemic, the initial basic SIR model had good fit to the data; however, as the pandemic and local conditions evolved, the SIR-int model emerged as the model with better fit. Conclusions: Using local data and continuous attention to model adaptation, our findings have enabled policy makers, public health officials, and health systems to proactively plan capacity and evaluate the impact of a public health intervention. Our SIR-int model for estimated latent prevalence was reasonably flexible, highly accurate, and demonstrated efficacy of a stay-at-home order at both the state and regional level. Our results highlight the importance of incorporating local context into pandemic forecast modeling, as well as the need to remain vigilant and informed by the data as we enter into a critical period of the outbreak. %M 32427104 %R 10.2196/19353 %U http://publichealth.jmir.org/2020/2/e19353/ %U https://doi.org/10.2196/19353 %U http://www.ncbi.nlm.nih.gov/pubmed/32427104 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19825 %T Clarification of Misleading Perceptions of COVID-19 Fatality and Testing Rates in Italy: Data Analysis %A Tosi,Davide %A Verde,Alessandro %A Verde,Manuela %+ Department of Theoretical and Applied Science, University of Insubria, Jean Henry Dunant, 3, Varese, 21100, Italy, 39 0332 42138, davide.tosi@uninsubria.it %K COVID-19 %K SARS-CoV-2 %K fatality rate %K swab tests %K Italy %K Lombardy region %D 2020 %7 17.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The fatality rate of coronavirus disease (COVID-19) in Italy is controversial and is greatly affecting discussion on the impact of containment measures that are straining the world’s social and economic fabric, such as instigating large-scale isolation and quarantine, closing borders, imposing limits on public gatherings, and implementing nationwide lockdowns. Objective: The scientific community, citizens, politicians, and mass media are expressing concerns regarding data suggesting that the number of COVID-19–related deaths in Italy is significantly higher than in the rest of the world. Moreover, Italian citizens have misleading perceptions related to the number of swab tests that have actually been performed. Citizens and mass media are denouncing the coverage of COVID-19 swab testing in Italy, claiming that it is not in line with that in other countries worldwide. Methods: In this paper, we attempt to clarify the aspects of COVID-19 fatalities and testing in Italy by performing a set of statistical analyses that highlight the actual numbers in Italy and compare them with official worldwide data. Results: The analysis clearly shows that the Italian COVID-19 fatality and mortality rates are in line with the official world scenario, as are the numbers of COVID-19 tests performed in Italy and in the Lombardy region. Conclusions: This up-to-date analysis may elucidate the evolution of the COVID-19 pandemic in Italy. %M 32490842 %R 10.2196/19825 %U http://www.jmir.org/2020/6/e19825/ %U https://doi.org/10.2196/19825 %U http://www.ncbi.nlm.nih.gov/pubmed/32490842 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19284 %T Digital Health Strategies to Fight COVID-19 Worldwide: Challenges, Recommendations, and a Call for Papers %A Fagherazzi,Guy %A Goetzinger,Catherine %A Rashid,Mohammed Ally %A Aguayo,Gloria A %A Huiart,Laetitia %+ Luxembourg Institute of Health, 1 A-B Rue Thomas Edison, Strassen, 1445, Luxembourg, 352 33669396334, guy.fagherazzi@lih.lu %K coronavirus %K COVID-19 %K digital health %K eHealth %K digital technology %K health care %K surveillance %K communication %K review %K epidemiology %K infodemiology %K public health %D 2020 %7 16.6.2020 %9 Viewpoint %J J Med Internet Res %G English %X The coronavirus disease (COVID-19) pandemic has created an urgent need for coordinated mechanisms to respond to the outbreak across health sectors, and digital health solutions have been identified as promising approaches to address this challenge. This editorial discusses the current situation regarding digital health solutions to fight COVID-19 as well as the challenges and ethical hurdles to broad and long-term implementation of these solutions. To decrease the risk of infection, telemedicine has been used as a successful health care model in both emergency and primary care. Official communication plans should promote facile and diverse channels to inform people about the pandemic and to avoid rumors and reduce threats to public health. Social media platforms such as Twitter and Google Trends analyses are highly beneficial to model pandemic trends as well as to monitor the evolution of patients’ symptoms or public reaction to the pandemic over time. However, acceptability of digital solutions may face challenges due to potential conflicts with users’ cultural, moral, and religious backgrounds. Digital tools can provide collective public health benefits; however, they may be intrusive and can erode individual freedoms or leave vulnerable populations behind. The COVID-19 pandemic has demonstrated the strong potential of various digital health solutions that have been tested during the crisis. More concerted measures should be implemented to ensure that future digital health initiatives will have a greater impact on the epidemic and meet the most strategic needs to ease the life of people who are at the forefront of the crisis. %M 32501804 %R 10.2196/19284 %U http://www.jmir.org/2020/6/e19284/ %U https://doi.org/10.2196/19284 %U http://www.ncbi.nlm.nih.gov/pubmed/32501804 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19782 %T 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 %A Li,Siyue %A Feng,Bo %A Liao,Wang %A Pan,Wenjing %+ School of Journalism and Communication, Renmin University of China, 507, School of Journalism and Communication, 59 Zhongguancun St, Haidian District, Beijing, 100872, China, 86 010 82500855, wenjingpan@ruc.edu.cn %K COVID-19 %K coronavirus %K preventive behaviors %K testing %K online health information %K risk awareness %D 2020 %7 16.6.2020 %9 Original Paper %J J Med Internet Res %G English %X 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. %M 32501801 %R 10.2196/19782 %U http://www.jmir.org/2020/6/e19782/ %U https://doi.org/10.2196/19782 %U http://www.ncbi.nlm.nih.gov/pubmed/32501801 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19981 %T Nature and Diffusion of COVID-19–related Oral Health Information on Chinese Social Media: Analysis of Tweets on Weibo %A Tao,Zhuo-Ying %A Chu,Guang %A McGrath,Colman %A Hua,Fang %A Leung,Yiu Yan %A Yang,Wei-Fa %A Su,Yu-Xiong %+ Division of Oral and Maxillofacial Surgery, Faculty of Dentistry, The University of Hong Kong, 34 Hospital Road, Hong Kong, , China (Hong Kong), 852 28590267, richsu@hku.hk %K COVID-19 %K dentistry %K oral health %K online health %K social media %K tweet %K Weibo %K China %K health information %D 2020 %7 15.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Social media has become increasingly important as a source of information for the public and is widely used for health-related information. The outbreak of the coronavirus disease (COVID-19) has exerted a negative impact on dental practices. Objective: The aim of this study is to analyze the nature and diffusion of COVID-19–related oral health information on the Chinese social media site Weibo. Methods: A total of 15,900 tweets related to oral health and dentistry information from Weibo during the COVID-19 outbreak in China (December 31, 2019, to March 16, 2020) were included in our study. Two researchers coded 1000 of the total tweets in advance, and two main thematic categories with eight subtypes were refined. The included tweets were analyzed over time and geographic region, and coded into eight thematic categories. Additionally, the time distributions of tweets containing information about dental services, needs of dental treatment, and home oral care during the COVID-19 epidemic were further analyzed. Results: People reacted rapidly to the emerging severe acute respiratory syndrome coronavirus 2 threat to dental services, and a large amount of COVID-19–related oral health information was tweeted on Weibo. The time and geographic distribution of tweets shared similarities with epidemiological data of the COVID-19 outbreak in China. Tweets containing home oral care and dental services content were the most frequently exchanged information (n=4803/15,900, 30.20% and n=4478, 28.16%, respectively). Significant differences of public attention were found between various types of bloggers in dental services–related tweets (P<.001), and the tweets from the government and media engaged the most public attention. The distributions of tweets containing information about dental services, needs of dental treatment, and home oral care information dynamically changed with time. Conclusions: Our study overviewed and analyzed social media data on the dental services and oral health information during the COVID-19 epidemic, thus, providing insights for government organizations, media, and dental professionals to better facilitate oral health communication and efficiently shape public concern through social media when routine dental services are unavailable during an unprecedented event. The study of the nature and distribution of social media can serve as a useful adjunct tool to help make public health policies. %M 32501808 %R 10.2196/19981 %U http://www.jmir.org/2020/6/e19981/ %U https://doi.org/10.2196/19981 %U http://www.ncbi.nlm.nih.gov/pubmed/32501808 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 6 %P e18186 %T Artificial Intelligence–Based Multimodal Risk Assessment Model for Surgical Site Infection (AMRAMS): Development and Validation Study %A Chen,Weijia %A Lu,Zhijun %A You,Lijue %A Zhou,Lingling %A Xu,Jie %A Chen,Ken %+ Department of Anesthesiology, Rui Jin Hospital, Luwan Branch, Shanghai Jiao Tong University School of Medicine, South Chongqing Road, No 149, Shanghai, China, 86 021 63864050, nutastray@gmail.com %K surgical site infection %K machine learning %K deep learning %K natural language processing %K artificial intelligence %K risk assessment model %K routinely collected data %K electronic medical record %K neural network %K word embedding %D 2020 %7 15.6.2020 %9 Original Paper %J JMIR Med Inform %G English %X 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. %M 32538798 %R 10.2196/18186 %U http://medinform.jmir.org/2020/6/e18186/ %U https://doi.org/10.2196/18186 %U http://www.ncbi.nlm.nih.gov/pubmed/32538798 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 9 %N 2 %P e16195 %T Public Awareness of Sepsis Compared to Acute Myocardial Infarction and Stroke in Jeddah, Saudi Arabia: Questionnaire Study %A Al-Orainan,Nourah %A EL-Shabasy,Adel Mohamed %A Al-Shanqiti,Khawlah Alamin %A Al-Harbi,Rawan Awad %A Alnashri,Hadeel Rajeh %A Rezqallah,Raghad Ahmed %A Mirghani,Alanoud Abdallah %+ Department of Medicine, King Abdulaziz University, Main Bldg, 2nd Fl., Jeddah, 21589, Saudi Arabia, 966 2 6401000 ext 18131, nalorainan@gmail.com %K sepsis %K public awareness %K survey %D 2020 %7 15.6.2020 %9 Original Paper %J Interact J Med Res %G English %X 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. %M 32538794 %R 10.2196/16195 %U http://www.i-jmr.org/2020/2/e16195/ %U https://doi.org/10.2196/16195 %U http://www.ncbi.nlm.nih.gov/pubmed/32538794 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19934 %T Why African Americans Are a Potential Target for COVID-19 Infection in the United States %A Hamidian Jahromi,Alireza %A Hamidianjahromi,Anahid %+ Department of Plastic Surgery, The University of Tennessee Health Science Center, 910 Madison Avenue, Suite 315, Memphis, TN, 38103, United States, 1 318 518 4600, alirezahamidian@yahoo.com %K coronavirus %K COVID-19 %K African American %K mortality %K race %K virus %K minority %K infectious disease %D 2020 %7 12.6.2020 %9 Viewpoint %J J Med Internet Res %G English %X Since the World Health Organization declared the coronavirus disease (COVID-19) outbreak a pandemic, significant changes have occurred in the United States as the infection spread reached and passed its exponential phase. A stringent analysis of COVID-19 epidemiologic data requires time and would generally be expected to happen with significant delay after the exponential phase of the disease is over and when the focus of the health care system is diverted away from crisis management. Although much has been said about high-risk groups and the vulnerability of the elderly and patients with underlying comorbidities, the impact of race on the susceptibility of ethnic minorities living in indigent communities has not been discussed in detail worldwide and specifically in the United States. There are currently some data on disparities between African American and Caucasian populations for COVID-19 infection and mortality. While health care authorities are reorganizing resources and infrastructure to provide care for symptomatic COVID-19 patients, they should not shy away from protecting the general public as a whole and specifically the most vulnerable members of society, such as the elderly, ethnic minorities, and people with underlying comorbidities. %M 32496205 %R 10.2196/19934 %U http://www.jmir.org/2020/6/e19934/ %U https://doi.org/10.2196/19934 %U http://www.ncbi.nlm.nih.gov/pubmed/32496205 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19938 %T Information Technology–Based Management of Clinically Healthy COVID-19 Patients: Lessons From a Living and Treatment Support Center Operated by Seoul National University Hospital %A Bae,Ye Seul %A Kim,Kyung Hwan %A Choi,Sae Won %A Ko,Taehoon %A Jeong,Chang Wook %A Cho,BeLong %A Kim,Min Sun %A Kang,EunKyo %+ Office of Hospital Information, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea, 82 2 2072 7600, kkh726@snu.ac.kr %K COVID-19 %K clinical informatics %K mobile app %K telemedicine %K hospital information system %K app %K health information technology %D 2020 %7 12.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: South Korea took preemptive action against coronavirus disease (COVID-19) by implementing extensive testing, thorough epidemiological investigation, strict social distancing, and rapid treatment of patients according to disease severity. The Korean government entrusted large-scale hospitals with the operation of living and treatment support centers (LTSCs) for the management for clinically healthy COVID-19 patients. Objective: The aim of this paper is to introduce our experience implementing information and communications technology (ICT)-based remote patient management systems at a COVID-19 LTSC. Methods: We adopted new electronic health record templates, hospital information system (HIS) dashboards, cloud-based medical image sharing, a mobile app, and smart vital sign monitoring devices. Results: Enhancements were made to the HIS to assist in the workflow and care of patients in the LTSC. A dashboard was created for the medical staff to view the vital signs and symptoms of all patients. Patients used a mobile app to consult with their physician or nurse, answer questionnaires, and input self-measured vital signs; the results were uploaded to the hospital information system in real time. Cloud-based image sharing enabled interoperability between medical institutions. Korea’s strategy of aggressive mitigation has “flattened the curve” of the rate of infection. A multidisciplinary approach was integral to develop systems supporting patient care and management at the living and treatment support center as quickly as possible. Conclusions: Faced with a novel infectious disease, we describe the implementation and experience of applying an ICT-based patient management system in the LTSC affiliated with Seoul National University Hospital. ICT-based tools and applications are increasingly important in health care, and we hope that our experience will provide insight into future technology-based infectious disease responses. %M 32490843 %R 10.2196/19938 %U http://www.jmir.org/2020/6/e19938/ %U https://doi.org/10.2196/19938 %U http://www.ncbi.nlm.nih.gov/pubmed/32490843 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 8 %N 2 %P e20173 %T Teaching Adequate Prehospital Use of Personal Protective Equipment During the COVID-19 Pandemic: Development of a Gamified e-Learning Module %A Suppan,Mélanie %A Gartner,Birgit %A Golay,Eric %A Stuby,Loric %A White,Marion %A Cottet,Philippe %A Abbas,Mohamed %A Iten,Anne %A Harbarth,Stephan %A Suppan,Laurent %+ Division of Anesthesiology, Department of Anesthesiology, Clinical Pharmacology, Intensive Care and Emergency Medicine, University of Geneva Hospitals and Faculty of Medicine, Rue Gabrielle-Perret-Gentil 4, Geneva, 1211, Switzerland, 41 223723311, melanie.bochet@hcuge.ch %K personal protective equipment %K electronic learning %K gamification %K prehospital %K COVID-19 %D 2020 %7 12.6.2020 %9 Original Paper %J JMIR Serious Games %G English %X 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. %M 32516115 %R 10.2196/20173 %U http://games.jmir.org/2020/2/e20173/ %U https://doi.org/10.2196/20173 %U http://www.ncbi.nlm.nih.gov/pubmed/32516115 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19855 %T Epidemiological Observations on the Association Between Anosmia and COVID-19 Infection: Analysis of Data From a Self-Assessment Web Application %A Denis,Fabrice %A Galmiche,Simon %A Dinh,Aurélien %A Fontanet,Arnaud %A Scherpereel,Arnaud %A Benezit,Francois %A Lescure,François-Xavier %+ Inter-regional Cancer Institut Jean Bernard, 9, rue Beauverger, Le Mans, 72100, France, 33 243475810, f.denis@cjb72.org %K COVID-19 %K anosmia %K epidemiological surveillance %K self-assessment %K web application %K outbreak %K symptoms %K self-assessment %K surveillance %K epidemiology %D 2020 %7 11.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: We developed a self-assessment and participatory surveillance web application for coronavirus disease (COVID-19), which was launched in France in March 2020. Objective: Our objective was to determine if self-reported symptoms could help monitor the dynamics of the COVID-19 outbreak in France. Methods: Users were asked questions about underlying conditions, sociodemographic status, zip code, and COVID-19 symptoms. Depending on the symptoms reported and the presence of coexisting disorders, users were told to either stay at home, contact a general practitioner (GP), or call an emergency phone number. Data regarding COVID-19–related hospitalizations were retrieved from the Ministry of Health. Results: As of March 29, 2020, the application was opened 4,126,789 times; 3,799,535 electronic questionnaires were filled out; and 2,477,174 users had at least one symptom. In total, 34.8% (n=1,322,361) reported no symptoms. The remaining users were directed to self-monitoring (n=858,878, 22.6%), GP visit or teleconsultation (n=1,033,922, 27.2%), or an emergency phone call (n=584,374, 15.4%). Emergency warning signs were reported by 39.1% of participants with anosmia, a loss of the sense of smell (n=127,586) versus 22.7% of participants without anosmia (n=1,597,289). Anosmia and fever and/or cough were correlated with hospitalizations for COVID-19 (Spearman correlation coefficients=0.87 and 0.82, respectively; P<.001 for both). Conclusions: This study suggests that anosmia may be strongly associated with COVID-19 and its severity. Despite a lack of medical assessment and virological confirmation, self-checking application data could be a relevant tool to monitor outbreak trends. Trial Registration: ClinicalTrials.gov NCT04331171; https://clinicaltrials.gov/ct2/show/NCT04331171 %M 32496206 %R 10.2196/19855 %U http://www.jmir.org/2020/6/e19855/ %U https://doi.org/10.2196/19855 %U http://www.ncbi.nlm.nih.gov/pubmed/32496206 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19509 %T Machine Learning to Detect Self-Reporting of Symptoms, Testing Access, and Recovery Associated With COVID-19 on Twitter: Retrospective Big Data Infoveillance Study %A Mackey,Tim %A Purushothaman,Vidya %A Li,Jiawei %A Shah,Neal %A Nali,Matthew %A Bardier,Cortni %A Liang,Bryan %A Cai,Mingxiang %A Cuomo,Raphael %+ Department of Anesthesiology and Division of Global Public Health and Infectious Diseases, School of Medicine, University of California San Diego, 8950 Villa La Jolla Drive, A124, La Jolla, CA, 92037, United States, 1 9514914161, tmackey@ucsd.edu %K infoveillance %K COVID-19 %K Twitter %K machine learning %K surveillance %D 2020 %7 8.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic is a global health emergency with over 6 million cases worldwide as of the beginning of June 2020. The pandemic is historic in scope and precedent given its emergence in an increasingly digital era. Importantly, there have been concerns about the accuracy of COVID-19 case counts due to issues such as lack of access to testing and difficulty in measuring recoveries. Objective: The aims of this study were to detect and characterize user-generated conversations that could be associated with COVID-19-related symptoms, experiences with access to testing, and mentions of disease recovery using an unsupervised machine learning approach. Methods: Tweets were collected from the Twitter public streaming application programming interface from March 3-20, 2020, filtered for general COVID-19-related keywords and then further filtered for terms that could be related to COVID-19 symptoms as self-reported by users. Tweets were analyzed using an unsupervised machine learning approach called the biterm topic model (BTM), where groups of tweets containing the same word-related themes were separated into topic clusters that included conversations about symptoms, testing, and recovery. Tweets in these clusters were then extracted and manually annotated for content analysis and assessed for their statistical and geographic characteristics. Results: A total of 4,492,954 tweets were collected that contained terms that could be related to COVID-19 symptoms. After using BTM to identify relevant topic clusters and removing duplicate tweets, we identified a total of 3465 (<1%) tweets that included user-generated conversations about experiences that users associated with possible COVID-19 symptoms and other disease experiences. These tweets were grouped into five main categories including first- and secondhand reports of symptoms, symptom reporting concurrent with lack of testing, discussion of recovery, confirmation of negative COVID-19 diagnosis after receiving testing, and users recalling symptoms and questioning whether they might have been previously infected with COVID-19. The co-occurrence of tweets for these themes was statistically significant for users reporting symptoms with a lack of testing and with a discussion of recovery. A total of 63% (n=1112) of the geotagged tweets were located in the United States. Conclusions: This study used unsupervised machine learning for the purposes of characterizing self-reporting of symptoms, experiences with testing, and mentions of recovery related to COVID-19. Many users reported symptoms they thought were related to COVID-19, but they were not able to get tested to confirm their concerns. In the absence of testing availability and confirmation, accurate case estimations for this period of the outbreak may never be known. Future studies should continue to explore the utility of infoveillance approaches to estimate COVID-19 disease severity. %M 32490846 %R 10.2196/19509 %U http://publichealth.jmir.org/2020/2/e19509/ %U https://doi.org/10.2196/19509 %U http://www.ncbi.nlm.nih.gov/pubmed/32490846 %0 Journal Article %@ 2562-7600 %I JMIR Publications %V 3 %N 1 %P e18788 %T Assessing Hand Hygiene and Low-Level Disinfection of Equipment Compliance in an Acute Care Setting: Mixed Methods Approach %A Akram,Hammad %A Andrews-Paul,Alison %A Washburn,Rachel %+ Baylor Scott and White Medical Center-Hillcrest, 100 Hillcrest Medical Blvd, Waco, TX, 76712, United States, 1 2542026221, hammad.akram@bswhealth.org %K compliance %K hand hygiene %K low-level disinfection %K patient safety %K qualitative %K quality improvement %K infection prevention %K infection control %K nursing %K mixed-methods %K HAI %K health care-associated infections %K hand washing %K hand sanitizers %D 2020 %7 5.6.2020 %9 Original Paper %J JMIR Nursing %G English %X 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. %M 34345785 %R 10.2196/18788 %U https://nursing.jmir.org/2020/1/e18788 %U https://doi.org/10.2196/18788 %U http://www.ncbi.nlm.nih.gov/pubmed/34345785 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 6 %P e19455 %T Online Information Exchange and Anxiety Spread in the Early Stage of the Novel Coronavirus (COVID-19) Outbreak in South Korea: Structural Topic Model and Network Analysis %A Jo,Wonkwang %A Lee,Jaeho %A Park,Junli %A Kim,Yeol %+ National Cancer Control Institute, National Cancer Center, 323, Ilsan-ro, Ilsandong-gu, Goyang, 10408, Republic of Korea, 82 31 920 1753, drheat@ncc.re.kr %K coronavirus %K anxiety %K pandemic %K online %K health information exchange %K topic modeling %D 2020 %7 2.6.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In case of a population-wide infectious disease outbreak, such as the novel coronavirus disease (COVID-19), people’s online activities could significantly affect public concerns and health behaviors due to difficulty in accessing credible information from reliable sources, which in turn causes people to seek necessary information on the web. Therefore, measuring and analyzing online health communication and public sentiment is essential for establishing effective and efficient disease control policies, especially in the early stage of an outbreak. Objective: This study aimed to investigate the trends of online health communication, analyze the focus of people’s anxiety in the early stages of COVID-19, and evaluate the appropriateness of online information. Methods: We collected 13,148 questions and 29,040 answers related to COVID-19 from Naver, the most popular Korean web portal (January 20, 2020, to March 2, 2020). Three main methods were used in this study: (1) the structural topic model was used to examine the topics in the online questions; (2) word network analysis was conducted to analyze the focus of people’s anxiety and worry in the questions; and (3) two medical doctors assessed the appropriateness of the answers to the questions, which were primarily related to people’s anxiety. Results: A total of 50 topics and 6 cohesive topic communities were identified from the questions. Among them, topic community 4 (suspecting COVID-19 infection after developing a particular symptom) accounted for the largest portion of the questions. As the number of confirmed patients increased, the proportion of topics belonging to topic community 4 also increased. Additionally, the prolonged situation led to a slight increase in the proportion of topics related to job issues. People’s anxieties and worries were closely related with physical symptoms and self-protection methods. Although relatively appropriate to suspect physical symptoms, a high proportion of answers related to self-protection methods were assessed as misinformation or advertisements. Conclusions: Search activity for online information regarding the COVID-19 outbreak has been active. Many of the online questions were related to people’s anxieties and worries. A considerable portion of corresponding answers had false information or were advertisements. The study results could contribute reference information to various countries that need to monitor public anxiety and provide appropriate information in the early stage of an infectious disease outbreak, including COVID-19. Our research also contributes to developing methods for measuring public opinion and sentiment in an epidemic situation based on natural language data on the internet. %M 32463367 %R 10.2196/19455 %U https://www.jmir.org/2020/6/e19455 %U https://doi.org/10.2196/19455 %U http://www.ncbi.nlm.nih.gov/pubmed/32463367 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19927 %T Primary Health Care Facility Preparedness for Outpatient Service Provision During the COVID-19 Pandemic in India: Cross-Sectional Study %A Garg,Suneela %A Basu,Saurav %A Rustagi,Ruchir %A Borle,Amod %+ Department of Community Medicine, Maulana Azad Medical College, 2 BSZ Marg, New Delhi, 110002, India, 91 8447527452, saurav.basu1983@gmail.com %K primary health care %K COVID-19 %K pandemic %K health systems %K India %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 32452819 %R 10.2196/19927 %U http://publichealth.jmir.org/2020/2/e19927/ %U https://doi.org/10.2196/19927 %U http://www.ncbi.nlm.nih.gov/pubmed/32452819 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19170 %T A Snapshot of SARS-CoV-2 Genome Availability up to April 2020 and its Implications: Data Analysis %A Mavian,Carla %A Marini,Simone %A Prosperi,Mattia %A Salemi,Marco %+ Emerging Pathogens Institute, University of Florida, Mowry Rd 2055, Gainesville, FL, United States, 1 352 273 9567, salemi@pathology.ufl.edu %K covid-19 %K sars-cov-2 %K phylogenetics %K genome %K evolution %K genetics %K pandemic %K infectious disease %K virus %K sequence %K transmission %K tracing %K tracking %D 2020 %7 1.6.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has been growing exponentially, affecting over 4 million people and causing enormous distress to economies and societies worldwide. A plethora of analyses based on viral sequences has already been published both in scientific journals and through non–peer-reviewed channels to investigate the genetic heterogeneity and spatiotemporal dissemination of SARS-CoV-2. However, a systematic investigation of phylogenetic information and sampling bias in the available data is lacking. Although the number of available genome sequences of SARS-CoV-2 is growing daily and the sequences show increasing phylogenetic information, country-specific data still present severe limitations and should be interpreted with caution. Objective: The objective of this study was to determine the quality of the currently available SARS-CoV-2 full genome data in terms of sampling bias as well as phylogenetic and temporal signals to inform and guide the scientific community. Methods: We used maximum likelihood–based methods to assess the presence of sufficient information for robust phylogenetic and phylogeographic studies in several SARS-CoV-2 sequence alignments assembled from GISAID (Global Initiative on Sharing All Influenza Data) data released between March and April 2020. Results: Although the number of high-quality full genomes is growing daily, and sequence data released in April 2020 contain sufficient phylogenetic information to allow reliable inference of phylogenetic relationships, country-specific SARS-CoV-2 data sets still present severe limitations. Conclusions: At the present time, studies assessing within-country spread or transmission clusters should be considered preliminary or hypothesis-generating at best. Hence, current reports should be interpreted with caution, and concerted efforts should continue to increase the number and quality of sequences required for robust tracing of the epidemic. %M 32412415 %R 10.2196/19170 %U http://publichealth.jmir.org/2020/2/e19170/ %U https://doi.org/10.2196/19170 %U http://www.ncbi.nlm.nih.gov/pubmed/32412415 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 5 %P e18627 %T Application of a Mathematical Model in Determining the Spread of the Rabies Virus: Simulation Study %A Huang,Yihao %A Li,Mingtao %+ School of Computer and Information Technology, Shanxi University, 92 Wucheng Road, Taiyuan, 030006, China, 86 15834136789, 297535248@qq.com %K rabies %K computer model %K suppression measures %K basic reproductive number %D 2020 %7 27.5.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: Rabies is an acute infectious disease of the central nervous system caused by the rabies virus. The mortality rate of rabies is almost 100%. For some countries with poor sanitation, the spread of rabies among dogs is very serious. Objective: The objective of this paper was to study the ecological transmission mode of rabies to make theoretical contributions to the suppression of rabies in China. Methods: A mathematical model of the transmission mode of rabies was constructed using relevant data from the literature and officially published figures in China. Using this model, we fitted the data of the number of patients with rabies and predicted the future number of patients with rabies. In addition, we studied the effectiveness of different rabies suppression measures. Results: The results of the study indicated that the number of people infected with rabies will rise in the first stage, and then decrease. The model forecasted that in about 10 years, the number of rabies cases will be controlled within a relatively stable range. According to the prediction results of the model reported in this paper, the number of rabies cases will eventually plateau at approximately 500 people every year. Relatively effective rabies suppression measures include controlling the birth rate of domestic and wild dogs as well as increasing the level of rabies immunity in domestic dogs. Conclusions: The basic reproductive number of rabies in China is still greater than 1. That is, China currently has insufficient measures to control rabies. The research on the transmission mode of rabies and control measures in this paper can provide theoretical support for rabies control in China. %M 32459185 %R 10.2196/18627 %U http://medinform.jmir.org/2020/5/e18627/ %U https://doi.org/10.2196/18627 %U http://www.ncbi.nlm.nih.gov/pubmed/32459185 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e18796 %T Public Engagement and Government Responsiveness in the Communications About COVID-19 During the Early Epidemic Stage in China: Infodemiology Study on Social Media Data %A Liao,Qiuyan %A Yuan,Jiehu %A Dong,Meihong %A Yang,Lin %A Fielding,Richard %A Lam,Wendy Wing Tak %+ School of Public Health, The University of Hong Kong, 2/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Pokfulam, Hong Kong, 852 39179289, qyliao11@hku.hk %K risk communication %K social media %K epidemic %K COVID-19 %K pandemic %K outbreak %K infectious disease %K content analysis %D 2020 %7 26.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Effective risk communication about the outbreak of a newly emerging infectious disease in the early stage is critical for managing public anxiety and promoting behavioral compliance. China has experienced the unprecedented epidemic of the coronavirus disease (COVID-19) in an era when social media has fundamentally transformed information production and consumption patterns. Objective: This study examined public engagement and government responsiveness in the communications about COVID-19 during the early epidemic stage based on an analysis of data from Sina Weibo, a major social media platform in China. Methods: Weibo data relevant to COVID-19 from December 1, 2019, to January 31, 2020, were retrieved. Engagement data (likes, comments, shares, and followers) of posts from government agency accounts were extracted to evaluate public engagement with government posts online. Content analyses were conducted for a random subset of 644 posts from personal accounts of individuals, and 273 posts from 10 relatively more active government agency accounts and the National Health Commission of China to identify major thematic contents in online discussions. Latent class analysis further explored main content patterns, and chi-square for trend examined how proportions of main content patterns changed by time within the study time frame. Results: The public response to COVID-19 seemed to follow the spread of the disease and government actions but was earlier for Weibo than the government. Online users generally had low engagement with posts relevant to COVID-19 from government agency accounts. The common content patterns identified in personal and government posts included sharing epidemic situations; general knowledge of the new disease; and policies, guidelines, and official actions. However, personal posts were more likely to show empathy to affected people (χ21=13.3, P<.001), attribute blame to other individuals or government (χ21=28.9, P<.001), and express worry about the epidemic (χ21=32.1, P<.001), while government posts were more likely to share instrumental support (χ21=32.5, P<.001) and praise people or organizations (χ21=8.7, P=.003). As the epidemic evolved, sharing situation updates (for trend, χ21=19.7, P<.001) and policies, guidelines, and official actions (for trend, χ21=15.3, P<.001) became less frequent in personal posts but remained stable or increased significantly in government posts. Moreover, as the epidemic evolved, showing empathy and attributing blame (for trend, χ21=25.3, P<.001) became more frequent in personal posts, corresponding to a slight increase in sharing instrumental support, praising, and empathizing in government posts (for trend, χ21=9.0, P=.003). Conclusions: The government should closely monitor social media data to improve the timing of communications about an epidemic. As the epidemic evolves, merely sharing situation updates and policies may be insufficient to capture public interest in the messages. The government may adopt a more empathic communication style as more people are affected by the disease to address public concerns. %M 32412414 %R 10.2196/18796 %U http://www.jmir.org/2020/5/e18796/ %U https://doi.org/10.2196/18796 %U http://www.ncbi.nlm.nih.gov/pubmed/32412414 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19501 %T Online National Health Agency Mask Guidance for the Public in Light of COVID-19: Content Analysis %A Laestadius,Linnea %A Wang,Yang %A Ben Taleb,Ziyad %A Kalan,Mohammad Ebrahimi %A Cho,Young %A Manganello,Jennifer %+ Zilber School of Public Health, University of Wisconsin Milwaukee, PO Box 413, Milwaukee, WI, 53201, United States, 1 414 227 4512, llaestad@uwm.edu %K public health policy %K infectious disease %K personal protective equipment %K public health %K COVID-19 %K pandemic %K online health information %K content analysis %D 2020 %7 26.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 32427103 %R 10.2196/19501 %U http://publichealth.jmir.org/2020/2/e19501/ %U https://doi.org/10.2196/19501 %U http://www.ncbi.nlm.nih.gov/pubmed/32427103 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18638 %T Mathematical Modeling of COVID-19 Control and Prevention Based on Immigration Population Data in China: Model Development and Validation %A Huang,Qiangsheng %A Kang,Yu Sunny %+ Ping An Technology (Shenzhen) Co, Ltd, Ping An Wealth Building, 1088 Yuanshen Road, Pudong New District, Shanghai, 200135, China, 86 13761879218, hqsh@live.cn %K COVID-19 %K 2019-ncov %K epidemic control and prevention %K epidemic risk time series model %K incoming immigration population %K new diagnoses per day %D 2020 %7 25.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: At the end of February 2020, the spread of coronavirus disease (COVID-19) in China had drastically slowed and appeared to be under control compared to the peak data in early February of that year. However, the outcomes of COVID-19 control and prevention measures varied between regions (ie, provinces and municipalities) in China; moreover, COVID-19 has become a global pandemic, and the spread of the disease has accelerated in countries outside China. Objective: This study aimed to establish valid models to evaluate the effectiveness of COVID-19 control and prevention among various regions in China. These models also targeted regions with control and prevention problems by issuing immediate warnings. Methods: We built a mathematical model, the Epidemic Risk Time Series Model, and used it to analyze two sets of data, including the daily COVID-19 incidence (ie, newly diagnosed cases) as well as the daily immigration population size. Results: Based on the results of the model evaluation, some regions, such as Shanghai and Zhejiang, were successful in COVID-19 control and prevention, whereas other regions, such as Heilongjiang, yielded poor performance. The evaluation result was highly correlated with the basic reproduction number (R0) value, and the result was evaluated in a timely manner at the beginning of the disease outbreak. Conclusions: The Epidemic Risk Time Series Model was designed to evaluate the effectiveness of COVID-19 control and prevention in different regions in China based on analysis of immigration population data. Compared to other methods, such as R0, this model enabled more prompt issue of early warnings. This model can be generalized and applied to other countries to evaluate their COVID-19 control and prevention. %M 32396132 %R 10.2196/18638 %U http://publichealth.jmir.org/2020/2/e18638/ %U https://doi.org/10.2196/18638 %U http://www.ncbi.nlm.nih.gov/pubmed/32396132 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19434 %T Telehealth Home Support During COVID-19 Confinement for Community-Dwelling Older Adults With Mild Cognitive Impairment or Mild Dementia: Survey Study %A Goodman-Casanova,Jessica Marian %A Dura-Perez,Elena %A Guzman-Parra,Jose %A Cuesta-Vargas,Antonio %A Mayoral-Cleries,Fermin %+ Department of Mental Health, Regional University Hospital of Málaga, Biomedical Research Institute of Malaga (IBIMA), Plaza del Hospital Civil s/n, Málaga, 29009, Spain, 34 660901966, jmariangoodman@gmail.com %K telehealth %K confinement %K coronavirus %K COVID-19 %K well-being %K emergency response %K public health %K mental health %K physical health %K elderly %K older adults %K cognitive impairment %K dementia %D 2020 %7 22.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: The public health emergency of coronavirus disease (COVID-19) is rapidly evolving worldwide; some countries, including Spain, have implemented restrictive measures. Populations that are vulnerable to this outbreak and its physical and mental health effects include community-dwelling older adults with mild cognitive impairment or mild dementia. Telehealth is a potential tool to deliver health care and decrease exposure risk. Objective: The aims of this study were to explore the impact of confinement on the health and well-being of community-dwelling older adults with mild cognitive impairment or mild dementia, to provide television-based and telephone-based health and social support, and to study the effects of a television-based assistive integrated technology, TV-AssistDem (TeleVision-based ASSistive Integrated Service to supporT European adults living with mild DEMentia or mild cognitive impairment). Methods: A telephone-based survey was administered in Spain to 93 participants in the TV-AssistDem clinical trial from March 25 to April 6, 2020. Results: Of the respondents, 60/93 (65%) were women. The mean age was 73.34 (SD 6.07), and 69/93 (74%) lived accompanied. Lockdown measures forced 17/93 respondents (18%) to change their living arrangements. Health status was found to be optimal in 89/93 respondents (96%), with no COVID-19 symptoms. Grocery and pharmacy outings were performed by family members of 68/93 participants (73%); 57 (61%) reported overall well-being, and 65 (70%) maintained their sleep quality. However, participants living alone reported greater negative feelings and more sleeping problems. Regarding leisure activities, 53/93 respondents (57%) took walks, 32 (35%) played memory games, 55 (60%) watched television, and 91 (98%) telephoned relatives. 58/93 (64%) respondents reported accessing moderate or too much COVID-19 information, 89 (97%) received it from television, and 56 (62%) stated that their understanding of the information was extreme. 39/93 (39%) respondents had contacted health and social services, while 29 (31%) requested information regarding these services during the telephone call. There were no significant differences in health and well-being between the intervention and control groups. Respondents with TV-AssistDem performed more memory exercises (24/93, 52% vs 8/93, 17.4%; P<.001) than control respondents. Conclusions: Our findings suggest that during COVID-19 confinement, the physical and mental health and well-being was optimal for the majority of our vulnerable population. However, those living alone reported greater negative psychological effects and sleeping problems. Measures adopted to address the negative experiences of confinement included keeping informed about the situation, accessing health and social services, having a support network that prevents risk of exposure to COVID-19 and guarantees food and medical supplies, a daily routine with maintained sleeping habits and leisure activities, staying physically and mentally active with cognitive stimulation exercises, and ensuring social connectedness using technology. Television sets were preferred technological devices to access COVID-19 information, watch television as a recreational activity, and perform memory exercises as an intellectual activity. Television-based telehealth support using TV-AssistDem demonstrated potential for cognitive stimulation. Trial Registration: ClinicalTrials.gov NCT03653234; https://clinicaltrials.gov/ct2/show/NCT03653234 %M 32401215 %R 10.2196/19434 %U http://www.jmir.org/2020/5/e19434/ %U https://doi.org/10.2196/19434 %U http://www.ncbi.nlm.nih.gov/pubmed/32401215 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 12 %N 2 %P e14973 %T Methicillin-Resistant Staphylococcus aureus Eradication and Decolonization in Children Study (Part 2): Patient- and Parent-Centered Outcomes of Decolonization %A Moore,Courtney M %A Wiehe,Sarah E %A Lynch,Dustin O %A Claxton,Gina EM %A Landman,Matthew P %A Carroll,Aaron E %A Musey,Paul I %+ Department of Emergency Medicine, Indiana University School of Medicine, Department of Emergency Medicine Fifth Third Bank Building | Third Floor, 720 Eskenazi Avenue, Indianapolis, IN, 46202, United States, 1 678 358 9814, pmusey@iu.edu %K patient-centered outcomes %K Staphylococcus aureus %K abscess %K decolonization %K human-centered design %D 2020 %7 20.5.2020 %9 Original Paper %J J Participat Med %G English %X 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 %R 10.2196/14973 %U http://jopm.jmir.org/2020/2/e14973/ %U https://doi.org/10.2196/14973 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 12 %N 2 %P e14974 %T Methicillin-Resistant Staphylococcus aureus Eradication and Decolonization in Children Study (Part 1): Development of a Decolonization Toolkit With Patient and Parent Advisors %A Moore,Courtney M %A Wiehe,Sarah E %A Lynch,Dustin O %A Claxton,Gina EM %A Landman,Matthew P %A Carroll,Aaron E %A Musey,Paul I %+ Department of Emergency Medicine, Indiana University School of Medicine, Department of Emergency Medicine Fifth Third Bank Building, Third Floor, 720 Eskenazi Avenue, Indianapolis, IN, 46202, United States, 1 678 358 9814, pmusey@iu.edu %K Staphylococcus aureus %K MRSA %K abscess %K decolonization %K human-centered design %K communication design %D 2020 %7 20.5.2020 %9 Original Paper %J J Participat Med %G English %X 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 %R 10.2196/14974 %U http://jopm.jmir.org/2020/2/e14974/ %U https://doi.org/10.2196/14974 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19087 %T Mining the Characteristics of COVID-19 Patients in China: Analysis of Social Media Posts %A Huang,Chunmei %A Xu,Xinjie %A Cai,Yuyang %A Ge,Qinmin %A Zeng,Guangwang %A Li,Xiaopan %A Zhang,Weide %A Ji,Chen %A Yang,Ling %+ Department of Geriatrics, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, 1665 Kongjiang Road, Shanghai, China, 86 13651608005, yangling01@xinhuamed.com.cn %K SARS-CoV-2 %K COVID-19 %K coronavirus disease %K social media %K Sina Weibo %K help %D 2020 %7 17.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: In December 2019, pneumonia cases of unknown origin were reported in Wuhan City, Hubei Province, China. Identified as the coronavirus disease (COVID-19), the number of cases grew rapidly by human-to-human transmission in Wuhan. Social media, especially Sina Weibo (a major Chinese microblogging social media site), has become an important platform for the public to obtain information and seek help. Objective: This study aims to analyze the characteristics of suspected or laboratory-confirmed COVID-19 patients who asked for help on Sina Weibo. Methods: We conducted data mining on Sina Weibo and extracted the data of 485 patients who presented with clinical symptoms and imaging descriptions of suspected or laboratory-confirmed cases of COVID-19. In total, 9878 posts seeking help on Sina Weibo from February 3 to 20, 2020 were analyzed. We used a descriptive research methodology to describe the distribution and other epidemiological characteristics of patients with suspected or laboratory-confirmed SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) infection. The distance between patients’ home and the nearest designated hospital was calculated using the geographic information system ArcGIS. Results: All patients included in this study who sought help on Sina Weibo lived in Wuhan, with a median age of 63.0 years (IQR 55.0-71.0). Fever (408/485, 84.12%) was the most common symptom. Ground-glass opacity (237/314, 75.48%) was the most common pattern on chest computed tomography; 39.67% (167/421) of families had suspected and/or laboratory-confirmed family members; 36.58% (154/421) of families had 1 or 2 suspected and/or laboratory-confirmed members; and 70.52% (232/329) of patients needed to rely on their relatives for help. The median time from illness onset to real-time reverse transcription-polymerase chain reaction (RT-PCR) testing was 8 days (IQR 5.0-10.0), and the median time from illness onset to online help was 10 days (IQR 6.0-12.0). Of 481 patients, 32.22% (n=155) lived more than 3 kilometers away from the nearest designated hospital. Conclusions: Our findings show that patients seeking help on Sina Weibo lived in Wuhan and most were elderly. Most patients had fever symptoms, and ground-glass opacities were noted in chest computed tomography. The onset of the disease was characterized by family clustering and most families lived far from the designated hospital. Therefore, we recommend the following: (1) the most stringent centralized medical observation measures should be taken to avoid transmission in family clusters; and (2) social media can help these patients get early attention during Wuhan’s lockdown. These findings can help the government and the health department identify high-risk patients and accelerate emergency responses following public demands for help. %M 32401210 %R 10.2196/19087 %U http://www.jmir.org/2020/5/e19087/ %U https://doi.org/10.2196/19087 %U http://www.ncbi.nlm.nih.gov/pubmed/32401210 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19115 %T Prediction of the COVID-19 Pandemic for the Top 15 Affected Countries: Advanced Autoregressive Integrated Moving Average (ARIMA) Model %A Singh,Ram Kumar %A Rani,Meenu %A Bhagavathula,Akshaya Srikanth %A Sah,Ranjit %A Rodriguez-Morales,Alfonso J %A Kalita,Himangshu %A Nanda,Chintan %A Sharma,Shashi %A Sharma,Yagya Datt %A Rabaan,Ali A %A Rahmani,Jamal %A Kumar,Pavan %+ College of Horticulture and Forestry, Rani Lakshmi Bai Central Agricultural University, NH-75, Near Pahuj Dam, Gwalior Road, Jhansi, 284003, India, 91 9785879797, pawan2607@gmail.com %K SARS-COV2 %K COVID-19 %K coronavirus %K forecast %K prediction %K ARIMA models %D 2020 %7 13.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic has affected more than 200 countries and has infected more than 2,800,000 people as of April 24, 2020. It was first identified in Wuhan City in China in December 2019. Objective: The aim of this study is to identify the top 15 countries with spatial mapping of the confirmed cases. A comparison was done between the identified top 15 countries for confirmed cases, deaths, and recoveries, and an advanced autoregressive integrated moving average (ARIMA) model was used for predicting the COVID-19 disease spread trajectories for the next 2 months. Methods: The comparison of recent cumulative and predicted cases was done for the top 15 countries with confirmed cases, deaths, and recoveries from COVID-19. The spatial map is useful to identify the intensity of COVID-19 infections in the top 15 countries and the continents. The recent reported data for confirmed cases, deaths, and recoveries for the last 3 months was represented and compared between the top 15 infected countries. The advanced ARIMA model was used for predicting future data based on time series data. The ARIMA model provides a weight to past values and error values to correct the model prediction, so it is better than other basic regression and exponential methods. The comparison of recent cumulative and predicted cases was done for the top 15 countries with confirmed cases, deaths, and recoveries from COVID-19. Results: The top 15 countries with a high number of confirmed cases were stratified to include the data in a mathematical model. The identified top 15 countries with cumulative cases, deaths, and recoveries from COVID-19 were compared. The United States, the United Kingdom, Turkey, China, and Russia saw a relatively fast spread of the disease. There was a fast recovery ratio in China, Switzerland, Germany, Iran, and Brazil, and a slow recovery ratio in the United States, the United Kingdom, the Netherlands, Russia, and Italy. There was a high death rate ratio in Italy and the United Kingdom and a lower death rate ratio in Russia, Turkey, China, and the United States. The ARIMA model was used to predict estimated confirmed cases, deaths, and recoveries for the top 15 countries from April 24 to July 7, 2020. Its value is represented with 95%, 80%, and 70% confidence interval values. The validation of the ARIMA model was done using the Akaike information criterion value; its values were about 20, 14, and 16 for cumulative confirmed cases, deaths, and recoveries of COVID-19, respectively, which represents acceptable results. Conclusions: The observed predicted values showed that the confirmed cases, deaths, and recoveries will double in all the observed countries except China, Switzerland, and Germany. It was also observed that the death and recovery rates were rose faster when compared to confirmed cases over the next 2 months. The associated mortality rate will be much higher in the United States, Spain, and Italy followed by France, Germany, and the United Kingdom. The forecast analysis of the COVID-19 dynamics showed a different angle for the whole world, and it looks scarier than imagined, but recovery numbers start looking promising by July 7, 2020. %M 32391801 %R 10.2196/19115 %U http://publichealth.jmir.org/2020/2/e19115/ %U https://doi.org/10.2196/19115 %U http://www.ncbi.nlm.nih.gov/pubmed/32391801 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18821 %T Preparation for Quarantine on the Cruise Ship Diamond Princess in Japan due to COVID-19 %A Yamahata,Yoshihiro %A Shibata,Ayako %+ Obstetrics & Gynecology, Yodogawa Christian Hospital, 1-7-50, Kunijima, Higashiyodogawa-ku, Osaka, 533-0024, Japan, 81 6 6322 2250, sibata700@gmail.com %K SARS-CoV-2 %K COVID-19 %K infectious control %K cruise ship quarantine %K pandemic %K outbreak %K surveillance %K preparation %K infectious disease %K public health %K quarantine %D 2020 %7 11.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X 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. %M 32365046 %R 10.2196/18821 %U http://publichealth.jmir.org/2020/2/e18821/ %U https://doi.org/10.2196/18821 %U http://www.ncbi.nlm.nih.gov/pubmed/32365046 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19161 %T Knowledge and Behaviors Toward COVID-19 Among US Residents During the Early Days of the Pandemic: Cross-Sectional Online Questionnaire %A Clements,John M %+ Master of Public Health Program, Division of Public Health, College of Human Medicine, Michigan State University, 130 E 2nd Street, Suite 202, Flint, MI, 48502, United States, 1 989 708 6338, clemen69@msu.edu %K public health %K surveillance %K COVID-19 %K knowledge %K behavior %K outbreak %K infectious disease %K health information %D 2020 %7 8.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 32369759 %R 10.2196/19161 %U http://publichealth.jmir.org/2020/2/e19161/ %U https://doi.org/10.2196/19161 %U http://www.ncbi.nlm.nih.gov/pubmed/32369759 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19462 %T Considerations for Postacute Rehabilitation for Survivors of COVID-19 %A Sheehy,Lisa Mary %+ Bruyère Research Institute, 43 Bruyère St, Ottawa, ON, K1N5C8, Canada, 1 6135626262 ext 1593, lsheehy@bruyere.org %K covid-19 %K rehabilitation %K subacute care %K inpatient rehabilitation %K public health %K infectious disease %K virus %K patient outcome %K geriatric %K treatment %K recovery %D 2020 %7 8.5.2020 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Coronavirus disease (COVID-19), the infection caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was first reported on December 31, 2019. Because it has only been studied for just over three months, our understanding of this disease is still incomplete, particularly regarding its sequelae and long-term outcomes. Moreover, very little has been written about the rehabilitation needs of patients with COVID-19 after discharge from acute care. The objective of this report is to answer the question “What rehabilitation services do survivors of COVID-19 require?” The question was asked within the context of a subacute hospital delivering geriatric inpatient and outpatient rehabilitation services. Three areas relevant to rehabilitation after COVID-19 were identified. First, details of how patients may present have been summarized, including comorbidities, complications from an intensive care unit stay with or without intubation, and the effects of the virus on multiple body systems, including those pertaining to cardiac, neurological, cognitive, and mental health. Second, I have suggested procedures regarding the design of inpatient rehabilitation units for COVID-19 survivors, staffing issues, and considerations for outpatient rehabilitation. Third, guidelines for rehabilitation (physiotherapy, occupational therapy, speech-language pathology) following COVID-19 have been proposed with respect to recovery of the respiratory system as well as recovery of mobility and function. A thorough assessment and an individualized, progressive treatment plan which focuses on function, disability, and return to participation in society will help each patient to maximize their function and quality of life. Careful consideration of the rehabilitation environment will ensure that all patients recover as completely as possible. %M 32369030 %R 10.2196/19462 %U http://publichealth.jmir.org/2020/2/e19462/ %U https://doi.org/10.2196/19462 %U http://www.ncbi.nlm.nih.gov/pubmed/32369030 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19577 %T Telemedicine During the COVID-19 Pandemic: Experiences From Western China %A Hong,Zhen %A Li,Nian %A Li,Dajiang %A Li,Junhua %A Li,Bing %A Xiong,Weixi %A Lu,Lu %A Li,Weimin %A Zhou,Dong %+ Department of Neurology, West China Hospital, Sichuan University, No. 37 Guoxue Road, Chengdu, 610041, China, 86 28 8542 2893, zhoudong66@yahoo.de %K COVID-19 %K coronavirus disease %K medical education %K pandemics %K teleteaching %K tele-education %K telemedicine %D 2020 %7 8.5.2020 %9 Viewpoint %J J Med Internet Res %G English %X Disasters and pandemics pose unique challenges to health care delivery. As health care resources continue to be stretched due to the increasing burden of the coronavirus disease (COVID-19) pandemic, telemedicine, including tele-education, may be an effective way to rationally allocate medical resources. During the COVID-19 pandemic, a multimodal telemedicine network in Sichuan Province in Western China was activated immediately after the first outbreak in January 2020. The network synergizes a newly established 5G service, a smartphone app, and an existing telemedicine system. Telemedicine was demonstrated to be feasible, acceptable, and effective in Western China, and allowed for significant improvements in health care outcomes. The success of telemedicine here may be a useful reference for other parts of the world. %M 32349962 %R 10.2196/19577 %U http://www.jmir.org/2020/5/e19577/ %U https://doi.org/10.2196/19577 %U http://www.ncbi.nlm.nih.gov/pubmed/32349962 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19368 %T Mathematical Modelling to Assess the Impact of Lockdown on COVID-19 Transmission in India: Model Development and Validation %A Ambikapathy,Bakiya %A Krishnamurthy,Kamalanand %+ Department of Instrumentation Engineering, Madras Institute of Technology Campus, Anna University, Chromepet, Chennai, Tamil Nadu, 600044, India, 91 9884948410, bakiya88@gmail.com %K covid-19 %K coronavirus %K epidemic %K mathematical modelling %K pandemic %K sars %D 2020 %7 7.5.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The World Health Organization has declared the novel coronavirus disease (COVID-19) to be a public health emergency; at present, India is facing a major threat of community spread. We developed a mathematical model for investigating and predicting the effects of lockdown on future COVID-19 cases with a specific focus on India. Objective: The objective of this work was to develop and validate a mathematical model and to assess the impact of various lockdown scenarios on COVID-19 transmission in India. Methods: A model consisting of a framework of ordinary differential equations was developed by incorporating the actual reported cases in 14 countries. After validation, the model was applied to predict COVID-19 transmission in India for different intervention scenarios in terms of lockdown for 4, 14, 21, 42, and 60 days. We also assessed the situations of enhanced exposure due to aggregation of individuals in transit stations and shopping malls before the lockdown. Results: The developed model is efficient in predicting the number of COVID-19 cases compared to the actual reported cases in 14 countries. For India, the model predicted marked reductions in cases for the intervention periods of 14 and 21 days of lockdown and significant reduction for 42 days of lockdown. Such intervention exceeding 42 days does not result in measurable improvement. Finally, for the scenario of “panic shopping” or situations where there is a sudden increase in the factors leading to higher exposure to infection, the model predicted an exponential transmission, resulting in failure of the considered intervention strategy. Conclusions: Implementation of a strict lockdown for a period of at least 21 days is expected to reduce the transmission of COVID-19. However, a further extension of up to 42 days is required to significantly reduce the transmission of COVID-19 in India. Any relaxation in the lockdown may lead to exponential transmission, resulting in a heavy burden on the health care system in the country. %M 32365045 %R 10.2196/19368 %U http://publichealth.jmir.org/2020/2/e19368/ %U https://doi.org/10.2196/19368 %U http://www.ncbi.nlm.nih.gov/pubmed/32365045 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 5 %P e19540 %T Containing COVID-19 Among 627,386 Persons in Contact With the Diamond Princess Cruise Ship Passengers Who Disembarked in Taiwan: Big Data Analytics %A Chen,Chi-Mai %A Jyan,Hong-Wei %A Chien,Shih-Chieh %A Jen,Hsiao-Hsuan %A Hsu,Chen-Yang %A Lee,Po-Chang %A Lee,Chun-Fu %A Yang,Yi-Ting %A Chen,Meng-Yu %A Chen,Li-Sheng %A Chen,Hsiu-Hsi %A Chan,Chang-Chuan %+ Institute of Environmental and Occupational Health Sciences, College of Public Health, National Taiwan University, No.17, Xuzhou Road, Taipei, 100, Taiwan, 886 233668082, ccchan@ntu.edu.tw %K COVID-19 %K mobile geopositioning %K contact tracing %K proximity tracing %K digital contact tracking %K big data %K public health %K precision public health %K surveillance %K virus %D 2020 %7 5.5.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Low infection and case-fatality rates have been thus far observed in Taiwan. One of the reasons for this major success is better use of big data analytics in efficient contact tracing and management and surveillance of those who require quarantine and isolation. Objective: We present here a unique application of big data analytics among Taiwanese people who had contact with more than 3000 passengers that disembarked at Keelung harbor in Taiwan for a 1-day tour on January 31, 2020, 5 days before the outbreak of coronavirus disease (COVID-19) on the Diamond Princess cruise ship on February 5, 2020, after an index case was identified on January 20, 2020. Methods: The smart contact tracing–based mobile sensor data, cross-validated by other big sensor surveillance data, were analyzed by the mobile geopositioning method and rapid analysis to identify 627,386 potential contact-persons. Information on self-monitoring and self-quarantine was provided via SMS, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) tests were offered for symptomatic contacts. National Health Insurance claims big data were linked, to follow-up on the outcome related to COVID-19 among those who were hospitalized due to pneumonia and advised to undergo screening for SARS-CoV-2. Results: As of February 29, a total of 67 contacts who were tested by reverse transcription–polymerase chain reaction were all negative and no confirmed COVID-19 cases were found. Less cases of respiratory syndrome and pneumonia were found after the follow-up of the contact population compared with the general population until March 10, 2020. Conclusions: Big data analytics with smart contact tracing, automated alert messaging for self-restriction, and follow-up of the outcome related to COVID-19 using health insurance data could curtail the resources required for conventional epidemiological contact tracing. %M 32353827 %R 10.2196/19540 %U http://www.jmir.org/2020/5/e19540/ %U https://doi.org/10.2196/19540 %U http://www.ncbi.nlm.nih.gov/pubmed/32353827 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 8 %N 5 %P e14330 %T Use of Machine Learning Techniques for Case-Detection of Varicella Zoster Using Routinely Collected Textual Ambulatory Records: Pilot Observational Study %A Lanera,Corrado %A Berchialla,Paola %A Baldi,Ileana %A Lorenzoni,Giulia %A Tramontan,Lara %A Scamarcia,Antonio %A Cantarutti,Luigi %A Giaquinto,Carlo %A Gregori,Dario %+ Department of Cardiac Thoracic Vascular Sciences and Public Health, University of Padova, Unit of Biostatistics, Epidemiology and Public Health, Via Leonardo Loredan 18, Padova, 35121, Italy, 39 049 827 5384, dario.gregori@unipd.it %K machine learning technique %K text mining %K electronic health report %K varicella zoster %K pediatric infectious disease %D 2020 %7 5.5.2020 %9 Original Paper %J JMIR Med Inform %G English %X Background: The detection of infectious diseases through the analysis of free text on electronic health reports (EHRs) can provide prompt and accurate background information for the implementation of preventative measures, such as advertising and monitoring the effectiveness of vaccination campaigns. Objective: The purpose of this paper is to compare machine learning techniques in their application to EHR analysis for disease detection. Methods: The Pedianet database was used as a data source for a real-world scenario on the identification of cases of varicella. The models’ training and test sets were based on two different Italian regions’ (Veneto and Sicilia) data sets of 7631 patients and 1,230,355 records, and 2347 patients and 569,926 records, respectively, for whom a gold standard of varicella diagnosis was available. Elastic-net regularized generalized linear model (GLMNet), maximum entropy (MAXENT), and LogitBoost (boosting) algorithms were implemented in a supervised environment and 5-fold cross-validated. The document-term matrix generated by the training set involves a dictionary of 1,871,532 tokens. The analysis was conducted on a subset of 29,096 tokens, corresponding to a matrix with no more than a 99% sparsity ratio. Results: The highest predictive values were achieved through boosting (positive predicative value [PPV] 63.1, 95% CI 42.7-83.5 and negative predicative value [NPV] 98.8, 95% CI 98.3-99.3). GLMNet delivered superior predictive capability compared to MAXENT (PPV 24.5% and NPV 98.3% vs PPV 11.0% and NPV 98.0%). MAXENT and GLMNet predictions weakly agree with each other (agreement coefficient 1 [AC1]=0.60, 95% CI 0.58-0.62), as well as with LogitBoost (MAXENT: AC1=0.64, 95% CI 0.63-0.66 and GLMNet: AC1=0.53, 95% CI 0.51-0.55). Conclusions: Boosting has demonstrated promising performance in large-scale EHR-based infectious disease identification. %M 32369038 %R 10.2196/14330 %U https://medinform.jmir.org/2020/5/e14330 %U https://doi.org/10.2196/14330 %U http://www.ncbi.nlm.nih.gov/pubmed/32369038 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18576 %T Surveillance of COVID-19 in the General Population Using an Online Questionnaire: Report From 18,161 Respondents in China %A Luo,Hongxing %A Lie,Yongchan %A Prinzen,Frits W %+ Department of Physiology, Cardiovascular Research Institute Maastricht, Maastricht University, Welsdaal 150 C, Maastricht, 6228JG, Netherlands, 31 685704703, h.luo@maastrichtuniversity.nl %K coronavirus %K surveillance %K syndromic surveillance %K participatory surveillance %K online questionnaire %K Wuhan %K COVID-19 %D 2020 %7 27.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The recent outbreak of the coronavirus disease (COVID-19) has become an international pandemic. So far, little is known about the role of an internet approach in COVID-19 participatory surveillance. Objective: The aim of this study is to investigate whether an online survey can provide population-level information for observing prevalence trends during the early phase of an outbreak and identifying potential risk factors of COVID-19 infection. Methods: A 10-item online questionnaire was developed according to medical guidelines and relevant publications. It was distributed between January 24 and February 17, 2020. The characteristics of respondents and temporal changes of various questionnaire-derived indicators were analyzed. Results: A total of 18,161 questionnaires were returned, including 6.45% (n=1171) from Wuhan City. Geographical distributions of the respondents were consistent with the population per province (R2=0.61, P<.001). History of contact significantly decreased with time, both outside Wuhan City (R2=0.35, P=.002) and outside Hubei Province (R2=0.42, P<.001). The percentage of respondents reporting a fever peaked around February 8 (R2=0.57, P<.001) and increased with a history of contact in the areas outside Wuhan City (risk ratio 1.31, 95% CI 1.13-1.52, P<.001). Male sex, advanced age, and lung diseases were associated with a higher risk of fever in the general population with a history of contact. Conclusions: This study shows the usefulness of an online questionnaire for the surveillance of outbreaks like COVID-19 by providing information about trends of the disease and aiding the identification of potential risk factors. %M 32319956 %R 10.2196/18576 %U http://publichealth.jmir.org/2020/2/e18576/ %U https://doi.org/10.2196/18576 %U http://www.ncbi.nlm.nih.gov/pubmed/32319956 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19218 %T Regulation and Trust: 3-Month Follow-up Study on COVID-19 Mortality in 25 European Countries %A Oksanen,Atte %A Kaakinen,Markus %A Latikka,Rita %A Savolainen,Iina %A Savela,Nina %A Koivula,Aki %+ Tampere University, Kalevantie 5, Faculty of Social Sciences, Tampere, 33014, Finland, 358 503187279, atte.oksanen@tuni.fi %K mortality %K infectious diseases %K sociability %K trust %K prevention %K Europe %D 2020 %7 24.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The outbreak of the coronavirus disease (COVID-19) has dramatically changed societies in 2020. Since the end of February, Europe has been hit particularly hard by COVID-19, but there are major country differences in both the spread of the virus and measures taken to stop the virus. Social psychological factors such as institutional trust could be important in understanding the development of the epidemic. Objective: The aim of this study was to examine country variations of COVID-19 mortality in Europe by analyzing social risk factors explaining the spread of the disease, restrictions and control measures, and institutional trust. Methods: The present study was based on a background analysis of European Social Survey data on 25 European countries (N=47,802). Multilevel mixed effects linear regression models focused on 84 days of the COVID-19 epidemic (January 22 to April 14, 2020) and modelled the daily COVID-19 mortality. Analysis focused on the impact of social relations, restrictions, and institutional trust within each country. Results: The spread of the COVID-19 epidemic has been fast everywhere, but the findings revealed significant differences between countries in COVID-19 mortality. Perceived sociability predicted higher COVID-19 mortality. Major differences between the 25 countries were found in reaction times to the crisis. Late reaction to the crisis predicted later mortality figures. Institutional trust was associated with lower COVID-19 mortality. Conclusions: The analyses demonstrated the importance of societal and social psychological factors in the spread of the COVID-19 epidemic. By considering multiple perspectives, this study showed that country differences in Europe are major, and this will have an impact on how countries will cope with the ongoing crisis in the following months. The results indicated the importance of timely restrictions and cooperation with people. %M 32301734 %R 10.2196/19218 %U http://publichealth.jmir.org/2020/2/e19218/ %U https://doi.org/10.2196/19218 %U http://www.ncbi.nlm.nih.gov/pubmed/32301734 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18700 %T Data Mining and Content Analysis of the Chinese Social Media Platform Weibo During the Early COVID-19 Outbreak: Retrospective Observational Infoveillance Study %A Li,Jiawei %A Xu,Qing %A Cuomo,Raphael %A Purushothaman,Vidya %A Mackey,Tim %+ Department of Anesthesiology and Division of Infectious Diseases and Global Public Health, University of California San Diego School of Medicine, 8950 Villa La Jolla Drive, A124, La Jolla, CA, 92037, United States, 1 9514914161, tmackey@ucsd.edu %K COVID-19 %K coronavirus %K infectious disease %K social media, surveillance %K infoveillance %K infodemiology %D 2020 %7 21.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic, which began in Wuhan, China in December 2019, is rapidly spreading worldwide with over 1.9 million cases as of mid-April 2020. Infoveillance approaches using social media can help characterize disease distribution and public knowledge, attitudes, and behaviors critical to the early stages of an outbreak. Objective: The aim of this study is to conduct a quantitative and qualitative assessment of Chinese social media posts originating in Wuhan City on the Chinese microblogging platform Weibo during the early stages of the COVID-19 outbreak. Methods: Chinese-language messages from Wuhan were collected for 39 days between December 23, 2019, and January 30, 2020, on Weibo. For quantitative analysis, the total daily cases of COVID-19 in Wuhan were obtained from the Chinese National Health Commission, and a linear regression model was used to determine if Weibo COVID-19 posts were predictive of the number of cases reported. Qualitative content analysis and an inductive manual coding approach were used to identify parent classifications of news and user-generated COVID-19 topics. Results: A total of 115,299 Weibo posts were collected during the study time frame consisting of an average of 2956 posts per day (minimum 0, maximum 13,587). Quantitative analysis found a positive correlation between the number of Weibo posts and the number of reported cases from Wuhan, with approximately 10 more COVID-19 cases per 40 social media posts (P<.001). This effect size was also larger than what was observed for the rest of China excluding Hubei Province (where Wuhan is the capital city) and held when comparing the number of Weibo posts to the incidence proportion of cases in Hubei Province. Qualitative analysis of 11,893 posts during the first 21 days of the study period with COVID-19-related posts uncovered four parent classifications including Weibo discussions about the causative agent of the disease, changing epidemiological characteristics of the outbreak, public reaction to outbreak control and response measures, and other topics. Generally, these themes also exhibited public uncertainty and changing knowledge and attitudes about COVID-19, including posts exhibiting both protective and higher-risk behaviors. Conclusions: The results of this study provide initial insight into the origins of the COVID-19 outbreak based on quantitative and qualitative analysis of Chinese social media data at the initial epicenter in Wuhan City. Future studies should continue to explore the utility of social media data to predict COVID-19 disease severity, measure public reaction and behavior, and evaluate effectiveness of outbreak communication. %M 32293582 %R 10.2196/18700 %U http://publichealth.jmir.org/2020/2/e18700/ %U https://doi.org/10.2196/18700 %U http://www.ncbi.nlm.nih.gov/pubmed/32293582 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19145 %T 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 %A Basch,Charles E %A Basch,Corey H %A Hillyer,Grace C %A Jaime,Christie %+ Teachers College, Columbia University, 525 W 120th St, New York, NY, 10027, United States, 1 212 678 3983, ceb35@columbia.edu %K YouTube %K COVID-19 %K social media %K pandemic %K outbreak %K infectious disease %K public health %K prevention %D 2020 %7 21.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 32297593 %R 10.2196/19145 %U http://publichealth.jmir.org/2020/2/e19145/ %U https://doi.org/10.2196/19145 %U http://www.ncbi.nlm.nih.gov/pubmed/32297593 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 4 %P e19359 %T COVID-19 Contact Tracing and Data Protection Can Go Together %A Abeler,Johannes %A Bäcker,Matthias %A Buermeyer,Ulf %A Zillessen,Hannah %+ Department of Economics, University of Oxford, Manor Road, Oxford, United Kingdom, 44 1865281440, johannes.abeler@economics.ox.ac.uk %K COVID-19 %K app %K contact tracing %K proximity tracing %K privacy %K data protection %K Bluetooth %D 2020 %7 20.4.2020 %9 Guest Editorial %J JMIR Mhealth Uhealth %G English %X We discuss the implementation of app-based contact tracing to control the coronavirus disease (COVID-19) pandemic and discuss its data protection and user acceptability aspects. %M 32294052 %R 10.2196/19359 %U http://mhealth.jmir.org/2020/4/e19359/ %U https://doi.org/10.2196/19359 %U http://www.ncbi.nlm.nih.gov/pubmed/32294052 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18941 %T Tracking COVID-19 in Europe: Infodemiology Approach %A Mavragani,Amaryllis %+ Department of Computing Science and Mathematics, Faculty of Natural Sciences, University of Stirling, University Campus, Stirling, FK94LA, United Kingdom, 44 7523782711, amaryllis.mavragani1@stir.ac.uk %K big data %K coronavirus %K COVID-19 %K infodemiology %K infoveillance %K Google Trends %D 2020 %7 20.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Infodemiology (ie, information epidemiology) uses web-based data to inform public health and policy. Infodemiology metrics have been widely and successfully used to assess and forecast epidemics and outbreaks. Objective: In light of the recent coronavirus disease (COVID-19) pandemic that started in Wuhan, China in 2019, online search traffic data from Google are used to track the spread of the new coronavirus disease in Europe. Methods: Time series from Google Trends from January to March 2020 on the Topic (Virus) of “Coronavirus” were retrieved and correlated with official data on COVID-19 cases and deaths worldwide and in the European countries that have been affected the most: Italy (at national and regional level), Spain, France, Germany, and the United Kingdom. Results: Statistically significant correlations are observed between online interest and COVID-19 cases and deaths. Furthermore, a critical point, after which the Pearson correlation coefficient starts declining (even if it is still statistically significant) was identified, indicating that this method is most efficient in regions or countries that have not yet peaked in COVID-19 cases. Conclusions: In the past, infodemiology metrics in general and data from Google Trends in particular have been shown to be useful in tracking and forecasting outbreaks, epidemics, and pandemics as, for example, in the cases of the Middle East respiratory syndrome, Ebola, measles, and Zika. With the COVID-19 pandemic still in the beginning stages, it is essential to explore and combine new methods of disease surveillance to assist with the preparedness of health care systems at the regional level. %M 32250957 %R 10.2196/18941 %U http://publichealth.jmir.org/2020/2/e18941/ %U https://doi.org/10.2196/18941 %U http://www.ncbi.nlm.nih.gov/pubmed/32250957 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e13071 %T Patient Questions and Physician Responses in a Chinese Health Q&A Website: Content Analysis %A Hong,Ziying %A Deng,Zhaohua %A Evans,Richard %A Wu,Haiyan %+ School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, No 13 Hangkong Road, Qiaokou District, Wuhan, 430030, China, 86 19945036079, zh-deng@hust.edu.cn %K health information seeking %K question classification %D 2020 %7 16.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Since the turn of this century, the internet has become an invaluable resource for people seeking health information and answers to health-related queries. Health question and answer websites have grown in popularity in recent years as a means for patients to obtain health information from medical professionals. For patients suffering from chronic illnesses, it is vital that health care providers become better acquainted with patients’ information needs and learn how they express them in text format. Objective: The aims of this study were to: (1) explore whether patients can accurately and adequately express their information needs on health question and answer websites, (2) identify what types of problems are of most concern to those suffering from chronic illnesses, and (3) determine the relationship between question characteristics and the number of answers received. Methods: Questions were collected from a leading Chinese health question and answer website called “All questions will be answered” in January 2018. We focused on questions relating to diabetes and hepatitis, including those that were free and those that were financially rewarded. Content analysis was completed on a total of 7068 (diabetes) and 6685 (hepatitis) textual questions. Correlations between the characteristics of questions (number of words per question, value of reward) and the number of answers received were evaluated using linear regression analysis. Results: The majority of patients are able to accurately express their problem in text format, while some patients may require minor social support. The questions posted were related to three main topics: (1) prevention and examination, (2) diagnosis, and (3) treatment. Patients with diabetes were most concerned with the treatment received, whereas patients with hepatitis focused on the diagnosis results. The number of words per question and the value of the reward were negatively correlated with the number of answers. The number of words per question and the value of the reward were negatively correlated with the number of answers. Conclusions: This study provides valuable insights into the ability of patients suffering from chronic illnesses to make an understandable request on health question and answer websites. Health topics relating to diabetes and hepatitis were classified to address the health information needs of chronically ill patients. Furthermore, identification of the factors affecting the number of answers received per question can help users of these websites to better frame their questions to obtain more valuable answers. %M 32297872 %R 10.2196/13071 %U https://www.jmir.org/2020/4/e13071 %U https://doi.org/10.2196/13071 %U http://www.ncbi.nlm.nih.gov/pubmed/32297872 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18811 %T Interpreting COVID-19 and Virtual Care Trends: Cohort Study %A Khairat,Saif %A Meng,Chenlu %A Xu,Yuxuan %A Edson,Barbara %A Gianforcaro,Robert %+ School or Nursing, University of North Carolina at Chapel Hill, 428 Carrington Hall, NC, NC, 27514, United States, 1 9198435416, saif@unc.edu %K virtual care %K COVID-19 %K trends %K patterns %K pandemic %K outbreak %K infectious disease %K public health %D 2020 %7 15.4.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The coronavirus disease (COVID-19) pandemic is rapidly spreading across the world. As of March 26, 2020, there are more than 500,000 cases and more than 25,000 deaths related to COVID-19, and the numbers are increasing by the hour. Objective: The aim of this study was to explore the trends in confirmed COVID-19 cases in North Carolina, and to understand patterns in virtual visits related to symptoms of COVID-19. Methods: We conducted a cohort study of confirmed COVID-19 cases and patients using an on-demand, statewide virtual urgent care center. We collected data from February 1, 2020, to March 15, 2020. Institutional Review Board exemption was obtained prior to the study. Results: As of March, 18 2020, there were 92 confirmed COVID-19 cases and 733 total virtual visits. Of the total visits, 257 (35.1%) were related to COVID-19-like symptoms. Of the COVID-19-like visits, the number of females was 178 (69.2%). People in the age groups of 30-39 years (n=67, 26.1%) and 40-49 years (n=64, 24.9%) were half of the total patients. Additionally, approximately 96.9% (n=249) of the COVID-like encounters came from within the state of North Carolina. Our study shows that virtual care can provide efficient triaging in the counties with the highest number of COVID-19 cases. We also confirmed that the largest spread of the disease occurs in areas with a high population density as well as in areas with major airports. Conclusions: The use of virtual care presents promising potential in the fight against COVID-19. Virtual care is capable of reducing emergency room visits, conserving health care resources, and avoiding the spread of COVID-19 by treating patients remotely. We call for further adoption of virtual care by health systems across the United States and the world during the COVID-19 pandemic. %M 32252023 %R 10.2196/18811 %U http://publichealth.jmir.org/2020/2/e18811/ %U https://doi.org/10.2196/18811 %U http://www.ncbi.nlm.nih.gov/pubmed/32252023 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e18908 %T Internet Hospitals Help Prevent and Control the Epidemic of COVID-19 in China: Multicenter User Profiling Study %A Gong,Kai %A Xu,Zhong %A Cai,Zhefeng %A Chen,Yuxiu %A Wang,Zhanxiang %+ The Internet Hospital of the First Affiliated Hospital of Xia'men University, 10 Shanggu Road, Siming District, Xia'men City, 361003, China, 86 13063035888, 493834266@qq.com %K internet hospital %K telemedicine %K novel coronavirus disease %K pandemic %K prevention %K control %K coronavirus %K COVID-19 %K public health %K infectious disease %D 2020 %7 14.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: During the spread of the novel coronavirus disease (COVID-19), internet hospitals in China were engaged with epidemic prevention and control, offering epidemic-related online services and medical support to the public. Objective: The aim of this study is to explore the role of internet hospitals during the prevention and control of the COVID-19 outbreak in China. Methods: Online epidemic-related consultations from multicenter internet hospitals in China during the COVID-19 epidemic were collected. The counselees were described and classified into seven type groups. Symptoms were recorded and compared with reported patients with COVID-19. Hypochondriacal suspicion and offline visit motivation were detected within each counselees’ group to evaluate the social panic of the epidemic along with the consequent medical-seeking behaviors. The counselees’ motivation and the doctors’ recommendation for an offline visit were compared. Risk factors affecting the counselees’ tendency of hypochondriacal suspicion and offline visit motivation were explored by logistic regression models. The epidemic prevention and control measures based on internet hospitals were listed, and the corresponding effects were discussed. Results: A total of 4913 consultations were enrolled for analysis with the median age of the counselees at 28 years (IQR 22-33 years). There were 104 (2.12%) healthy counselees, 147 (2.99%) hypochondriacal counselees, 34 (0.69%) exposed counselees, 853 (17.36%) mildly suspicious counselees, 42 (0.85%) moderately suspicious counselees, 3550 (72.26%) highly suspicious counselees, and 183 (3.72%) severely suspicious counselees. A total of 94.20% (n=4628) of counselees had epidemic-related symptoms with a distribution similar to those of COVID-19. The hypochondriacal suspicion (n=2167, 44.11%) was common. The counselees’ motivation and the doctors’ recommendation for offline visits were inconsistent (P<.001) with a Cohen kappa score of 0.039, indicating improper medical-seeking behaviors. Adult counselees (odds ratio [OR]=1.816, P<.001) with epidemiological exposure (OR 7.568, P<.001), shortness of breath (OR 1.440, P=.001), diarrhea (OR 1.272, P=.04), and unrelated symptoms (OR 1.509, P<.001) were more likely to have hypochondriacal suspicion. Counselees with severe illnesses (OR 2.303, P<.001), fever (OR 1.660, P<.001), epidemiological exposure history (OR 1.440, P=.01), and hypochondriacal suspicion (OR 4.826, P<.001) were more likely to attempt an offline visit. Reattending counselees (OR 0.545, P=.002) were less motivated to go to the offline clinic. Conclusions: Internet hospitals can serve different types of epidemic counselees, offer essential medical supports to the public during the COVID-19 outbreak, reduce the social panic, promote social distancing, enhance the public’s ability of self-protection, correct improper medical-seeking behaviors, reduce the chance of nosocomial cross-infection, and facilitate epidemiological screening, thus, playing an important role on preventing and controlling COVID-19. %M 32250962 %R 10.2196/18908 %U http://www.jmir.org/2020/4/e18908/ %U https://doi.org/10.2196/18908 %U http://www.ncbi.nlm.nih.gov/pubmed/32250962 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18668 %T A Mobile Health Platform to Disseminate Validated Institutional Measurements During the COVID-19 Outbreak: Utilization-Focused Evaluation Study %A Zamberg,Ido %A Manzano,Sergio %A Posfay-Barbe,Klara %A Windisch,Olivier %A Agoritsas,Thomas %A Schiffer,Eduardo %+ Division of General Internal Medicine, Department of Medicine, University Hospitals of Geneva, Rue Gabrielle-Perret-Gentil 4, Geneva, 1205, Switzerland, 41 022 372 33 11, idozamberg@gmail.com %K covid-19 %K novel coronavirus %K smartphone %K SARS-COV-2 %K mHealth %K knowledge %K information %K dissemination %K health policy %K infectious disease %K outbreak %K public health %K preparation %D 2020 %7 14.4.2020 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: As part of the response plans for the current outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), authorities are drafting and implementing containment measures across jurisdictions worldwide in the effort to slow down transmission and reduce the infection rate. A solid communication strategy is needed to increase the reach of valid information to health professionals, reduce misinformation, and efficiently implement recommended measures. Objective: The aim of this paper is to describe the utilization of a dedicated mobile health (mHealth) platform to disseminate up-to-date and validated information about SARS-CoV-2 to all medical staff of the Children’s Hospital at the University Hospitals of Geneva. Methods: Three documents containing institutional information concerning screening, local containment procedures, and frequently asked questions and answers for parents were made available to the staff through a mobile app developed in the University of Geneva, Switzerland. Using a third-party statistics tool, we anonymously monitored user activity as well as content utilization patterns since the diagnosis of the first case of SARS-CoV-2 in Switzerland on February 25, 2020. Results: From February 25, 2020, to March 13, 2020 (18 days), information documents on SARS-CoV-2 were viewed 859 times, which accounted for 35.6% of the total content views (total views=332). User activity increased significantly with 50.8 (SD 14.4) users per day in this period as compared to the previous weeks (mean 26.4, SD 9.8; P<.001). In addition, session numbers per day more than doubled during the aforementioned period (P<.001). In a survey, medical staff found the information easy to find within the app. On a 10-point Likert scale, the ability of the app to reassure staff in clinical practice was rated as 7.6 (SD 2.1), time-saving ability was rated as 8.5 (SD 2.1), and the need to look for information from other sources was rated as 5.9 (SD 3.3). Conclusions: The use of an mHealth solution to disseminate novel coronavirus–related information seemed to be an effective and time-saving communication channel within our institution during the SARS-CoV-2 outbreak. Medical staff felt reassured and informed in daily practice. More research should be done on the clinical impact and outcomes of the integration of mHealth solutions as a communication channel of validated information within health institutions. %M 32250958 %R 10.2196/18668 %U http://publichealth.jmir.org/2020/2/e18668/ %U https://doi.org/10.2196/18668 %U http://www.ncbi.nlm.nih.gov/pubmed/32250958 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e19043 %T The Three Steps Needed to End the COVID-19 Pandemic: Bold Public Health Leadership, Rapid Innovations, and Courageous Political Will %A Guest,Jodie L %A del Rio,Carlos %A Sanchez,Travis %+ Rollins School of Public Health at Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 404 727 8403, Travis.Sanchez@emory.edu %K COVID-19 %K coronavirus %K SARS-CoV-2 %D 2020 %7 6.4.2020 %9 Editorial %J JMIR Public Health Surveill %G English %X The world is experiencing the expansive spread of severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) in a global pandemic that is placing strain on health care, economic, and social systems. Commitment to implementing proven public health strategies will require bold public health leadership and courageous acts by politicians. Developing new innovative communication, mitigation, and health care approaches, particularly in the era of social media, is also clearly warranted. We believe that the best public health evidence must inform activities in three priority areas to stop this pandemic: (1) coordinated and consistent stay-at-home orders across multiple jurisdictions, including potential nationwide mandates; (2) rapid scale-up of SARS-CoV-2 testing; and (3) improved health care capacity to respond. This editorial outlines those areas, the rationale behind them, and the call for innovation and engagement of bold public health leadership to empower courageous political action to reduce the number of deaths during this pandemic. %M 32240972 %R 10.2196/19043 %U https://publichealth.jmir.org/2020/2/e19043 %U https://doi.org/10.2196/19043 %U http://www.ncbi.nlm.nih.gov/pubmed/32240972 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 4 %P e18790 %T Use of Rapid Online Surveys to Assess People's Perceptions During Infectious Disease Outbreaks: A Cross-sectional Survey on COVID-19 %A Geldsetzer,Pascal %+ Division of Primary Care and Population Health, Department of Medicine, Stanford University, 1265 Welch Road, Stanford, CA, 94035, United States, 1 6507238596, pgeldsetzer@stanford.edu %K rapid online surveys %K perceptions %K knowledge %K coronavirus %K SARS-CoV-2 %K pandemic %K infectious disease %K outbreak %K survey %K COVID-19 %K public health %D 2020 %7 2.4.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Given the extensive time needed to conduct a nationally representative household survey and the commonly low response rate of phone surveys, rapid online surveys may be a promising method to assess and track knowledge and perceptions among the general public during fast-moving infectious disease outbreaks. Objective: This study aimed to apply rapid online surveying to determine knowledge and perceptions of coronavirus disease 2019 (COVID-19) among the general public in the United States and the United Kingdom. Methods: An online questionnaire was administered to 3000 adults residing in the United States and 3000 adults residing in the United Kingdom who had registered with Prolific Academic to participate in online research. Prolific Academic established strata by age (18-27, 28-37, 38-47, 48-57, or ≥58 years), sex (male or female), and ethnicity (white, black or African American, Asian or Asian Indian, mixed, or “other”), as well as all permutations of these strata. The number of participants who could enroll in each of these strata was calculated to reflect the distribution in the US and UK general population. Enrollment into the survey within each stratum was on a first-come, first-served basis. Participants completed the questionnaire between February 23 and March 2, 2020. Results: A total of 2986 and 2988 adults residing in the United States and the United Kingdom, respectively, completed the questionnaire. Of those, 64.4% (1924/2986) of US participants and 51.5% (1540/2988) of UK participants had a tertiary education degree, 67.5% (2015/2986) of US participants had a total household income between US $20,000 and US $99,999, and 74.4% (2223/2988) of UK participants had a total household income between £15,000 and £74,999. US and UK participants’ median estimate for the probability of a fatal disease course among those infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was 5.0% (IQR 2.0%-15.0%) and 3.0% (IQR 2.0%-10.0%), respectively. Participants generally had good knowledge of the main mode of disease transmission and common symptoms of COVID-19. However, a substantial proportion of participants had misconceptions about how to prevent an infection and the recommended care-seeking behavior. For instance, 37.8% (95% CI 36.1%-39.6%) of US participants and 29.7% (95% CI 28.1%-31.4%) of UK participants thought that wearing a common surgical mask was “highly effective” in protecting them from acquiring COVID-19, and 25.6% (95% CI 24.1%-27.2%) of US participants and 29.6% (95% CI 28.0%-31.3%) of UK participants thought it was prudent to refrain from eating at Chinese restaurants. Around half (53.8%, 95% CI 52.1%-55.6%) of US participants and 39.1% (95% CI 37.4%-40.9%) of UK participants thought that children were at an especially high risk of death when infected with SARS-CoV-2. Conclusions: The distribution of participants by total household income and education followed approximately that of the US and UK general population. The findings from this online survey could guide information campaigns by public health authorities, clinicians, and the media. More broadly, rapid online surveys could be an important tool in tracking the public’s knowledge and misperceptions during rapidly moving infectious disease outbreaks. %M 32240094 %R 10.2196/18790 %U http://www.jmir.org/2020/4/e18790/ %U https://doi.org/10.2196/18790 %U http://www.ncbi.nlm.nih.gov/pubmed/32240094 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 2 %P e18606 %T Emergence of a Novel Coronavirus (COVID-19): Protocol for Extending Surveillance Used by the Royal College of General Practitioners Research and Surveillance Centre and Public Health England %A de Lusignan,Simon %A Lopez Bernal,Jamie %A Zambon,Maria %A Akinyemi,Oluwafunmi %A Amirthalingam,Gayatri %A Andrews,Nick %A Borrow,Ray %A Byford,Rachel %A Charlett,André %A Dabrera,Gavin %A Ellis,Joanna %A Elliot,Alex J %A Feher,Michael %A Ferreira,Filipa %A Krajenbrink,Else %A Leach,Jonathan %A Linley,Ezra %A Liyanage,Harshana %A Okusi,Cecilia %A Ramsay,Mary %A Smith,Gillian %A Sherlock,Julian %A Thomas,Nicholas %A Tripathy,Manasa %A Williams,John %A Howsam,Gary %A Joy,Mark %A Hobbs,Richard %+ Nuffield Department of Primary Care Health Sciences, University of Oxford, Eagle House,Walton Well Road, Oxford, OX2 6ED, United Kingdom, 44 01865289344, simon.delusignan@phc.ox.ac.uk %K general practice %K medical record systems %K computerized %K sentinel surveillance %K coronavirus %K COVID-19 %K SARS-CoV-2 %K surveillance %K infections %K pandemic %K records as topic %K serology %D 2020 %7 2.4.2020 %9 Protocol %J JMIR Public Health Surveill %G English %X Background: The Royal College of General Practitioners (RCGP) Research and Surveillance Centre (RSC) and Public Health England (PHE) have successfully worked together on the surveillance of influenza and other infectious diseases for over 50 years, including three previous pandemics. With the emergence of the international outbreak of the coronavirus infection (COVID-19), a UK national approach to containment has been established to test people suspected of exposure to COVID-19. At the same time and separately, the RCGP RSC’s surveillance has been extended to monitor the temporal and geographical distribution of COVID-19 infection in the community as well as assess the effectiveness of the containment strategy. Objectives: The aims of this study are to surveil COVID-19 in both asymptomatic populations and ambulatory cases with respiratory infections, ascertain both the rate and pattern of COVID-19 spread, and assess the effectiveness of the containment policy. Methods: The RCGP RSC, a network of over 500 general practices in England, extract pseudonymized data weekly. This extended surveillance comprises of five components: (1) Recording in medical records of anyone suspected to have or who has been exposed to COVID-19. Computerized medical records suppliers have within a week of request created new codes to support this. (2) Extension of current virological surveillance and testing people with influenza-like illness or lower respiratory tract infections (LRTI)—with the caveat that people suspected to have or who have been exposed to COVID-19 should be referred to the national containment pathway and not seen in primary care. (3) Serology sample collection across all age groups. This will be an extra blood sample taken from people who are attending their general practice for a scheduled blood test. The 100 general practices currently undertaking annual influenza virology surveillance will be involved in the extended virological and serological surveillance. (4) Collecting convalescent serum samples. (5) Data curation. We have the opportunity to escalate the data extraction to twice weekly if needed. Swabs and sera will be analyzed in PHE reference laboratories. Results: General practice clinical system providers have introduced an emergency new set of clinical codes to support COVID-19 surveillance. Additionally, practices participating in current virology surveillance are now taking samples for COVID-19 surveillance from low-risk patients presenting with LRTIs. Within the first 2 weeks of setup of this surveillance, we have identified 3 cases: 1 through the new coding system, the other 2 through the extended virology sampling. Conclusions: We have rapidly converted the established national RCGP RSC influenza surveillance system into one that can test the effectiveness of the COVID-19 containment policy. The extended surveillance has already seen the use of new codes with 3 cases reported. Rapid sharing of this protocol should enable scientific critique and shared learning. International Registered Report Identifier (IRRID): DERR1-10.2196/18606 %M 32240095 %R 10.2196/18606 %U https://publichealth.jmir.org/2020/2/e18606 %U https://doi.org/10.2196/18606 %U http://www.ncbi.nlm.nih.gov/pubmed/32240095 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e15812 %T Occupational Exposure to Needle Stick Injuries and Hepatitis B Vaccination Coverage Among Clinical Laboratory Staff in Sana’a, Yemen: Cross-Sectional Study %A Al-Abhar,Nabil %A Moghram,Ghuzlan Saeed %A Al-Gunaid,Eshrak Abdulmalek %A Al Serouri,Abdulwahed %A Khader,Yousef %+ Jordan Field Epidemiology Training Program, Jordan Ministry of Health, Pr. Hamzah St, Amman, 11118, Jordan, 962 796802040, yskhader@just.edu.jo %K injury %K hepatitis B %K vaccination %K biosafety %K laboratory staff %K Yemen %D 2020 %7 31.3.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X 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. %M 32229462 %R 10.2196/15812 %U http://publichealth.jmir.org/2020/1/e15812/ %U https://doi.org/10.2196/15812 %U http://www.ncbi.nlm.nih.gov/pubmed/32229462 %0 Journal Article %@ 2152-7202 %I JMIR Publications %V 12 %N 1 %P e18272 %T Influence of Community and Culture in the Ethical Allocation of Scarce Medical Resources in a Pandemic Situation: Deliberative Democracy Study %A Schoch-Spana,Monica %A Brunson,Emily K %A Gwon,Howard %A Regenberg,Alan %A Toner,Eric S %A Daugherty-Biddison,Elizabeth L %+ Department of Anthropology, Texas State University, 601 University Ave, San Marcos, TX, 78666, United States, 1 512 245 8272, ebrunson@txstate.edu %K pandemic %K COVID19 %K influenza %K disaster %K preparedness %K scarce resources %K culture %K ethics %D 2020 %7 30.3.2020 %9 Original Paper %J J Participat Med %G English %X Background: Stark gaps exist between projected health needs in a pandemic situation and the current capacity of health care and medical countermeasure systems. Existing pandemic ethics discussions have advocated to engage the public in scarcity dilemmas and attend the local contexts and cultural perspectives that shape responses to a global health threat. This public engagement study thus considers the role of community and culture in the ethical apportionment of scarce health resources, specifically ventilators, during an influenza pandemic. It builds upon a previous exploration of the values and preferences of Maryland residents regarding how a finite supply of mechanical ventilators ought to be allocated during a severe global outbreak of influenza. An important finding of this earlier research was that local history and place within the state engendered different ways of thinking about scarcity. Objective: Given the intrastate variation in the themes expressed by Maryland participants, the project team sought to examine interstate differences by implementing the same protocol elsewhere to answer the following questions. Does variation in ethical frames of reference exist within different regions of the United States? What practical implications does evidence of sameness and difference possess for pandemic planners and policymakers at local and national levels? Methods: Research using the same deliberative democracy process from the Maryland study was conducted in Central Texas in March 2018 among 30 diverse participants, half of whom identified as Hispanic or Latino. Deliberative democracy provides a moderated process through which community members can learn facts about a public policy matter from experts and explore their own and others’ views. Results: Participants proposed that by evenly distributing supplies of ventilators and applying clear eligibility criteria consistently, health authorities could enable fair allocation of scarce lifesaving equipment. The strong identification, attachment, and obligation of persons toward their nuclear and extended families emerged as a distinctive regional and ethnic core value that has practical implications for the substance, administration, and communication of allocation frameworks. Conclusions: Maryland and Central Texas residents expressed a common, overriding concern about the fairness of allocation decisions. Central Texas deliberants, however, more readily expounded upon family as a central consideration. In Central Texas, family is a principal, culturally inflected lens through which life and death matters are often viewed. Conveners of other pandemic-related public engagement exercises in the United States have advocated the benefits of transparency and inclusivity in developing an ethical allocation framework; this study demonstrates cultural competence as a further advantage. %R 10.2196/18272 %U http://jopm.jmir.org/2020/1/e18272/ %U https://doi.org/10.2196/18272 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e18503 %T The Role of the Global Health Development/Eastern Mediterranean Public Health Network and the Eastern Mediterranean Field Epidemiology Training Programs in Preparedness for COVID-19 %A Al Nsour,Mohannad %A Bashier,Haitham %A Al Serouri,Abulwahed %A Malik,Elfatih %A Khader,Yousef %A Saeed,Khwaja %A Ikram,Aamer %A Abdalla,Abdalla Mohammed %A Belalia,Abdelmounim %A Assarag,Bouchra %A Baig,Mirza Amir %A Almudarra,Sami %A Arqoub,Kamal %A Osman,Shahd %A Abu-Khader,Ilham %A Shalabi,Dana %A Majeed,Yasir %+ Jordan University of Science and Technology, Ar Ramtha 3030, Irbid, 22110, Jordan, 962 796802040, yskhader@just.edu.jo %K COVID-19 %K outbreak %K preparedness %K response %K public health %D 2020 %7 27.3.2020 %9 Editorial %J JMIR Public Health Surveill %G English %X The World Health Organization (WHO) declared the current COVID-19 a public health emergency of international concern on January 30, 2020. Countries in the Eastern Mediterranean Region (EMR) have a high vulnerability and variable capacity to respond to outbreaks. Many of these countries addressed the need for increasing capacity in the areas of surveillance and rapid response to public health threats. Moreover, countries addressed the need for communication strategies that direct the public to actions for self- and community protection. This viewpoint article aims to highlight the contribution of the Global Health Development (GHD)/Eastern Mediterranean Public Health Network (EMPHNET) and the EMR’s Field Epidemiology Training Program (FETPs) to prepare for and respond to the current COVID-19 threat. GHD/EMPHNET has the scientific expertise to contribute to elevating the level of country alert and preparedness in the EMR and to provide technical support through health promotion, training and training materials, guidelines, coordination, and communication. The FETPs are currently actively participating in surveillance and screening at the ports of entry, development of communication materials and guidelines, and sharing information to health professionals and the public. However, some countries remain ill-equipped, have poor diagnostic capacity, and are in need of further capacity development in response to public health threats. It is essential that GHD/EMPHNET and FETPs continue building the capacity to respond to COVID-19 and intensify support for preparedness and response to public health emergencies. %M 32217506 %R 10.2196/18503 %U http://publichealth.jmir.org/2020/1/e18503/ %U https://doi.org/10.2196/18503 %U http://www.ncbi.nlm.nih.gov/pubmed/32217506 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 6 %N 1 %P e14627 %T Media Reports as a Source for Monitoring Impact of Influenza on Hospital Care: Qualitative Content Analysis %A Reukers,Daphne F M %A Marbus,Sierk D %A Smit,Hella %A Schneeberger,Peter %A Donker,Gé %A van der Hoek,Wim %A van Gageldonk-Lafeber,Arianne B %+ Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Postbus 1, 3720 BA, Bilthoven, , Netherlands, 31 302743419, daphne.reukers@rivm.nl %K influenza %K severe acute respiratory infections %K SARI %K surveillance %K media reports %K news articles %K hospital care %D 2020 %7 4.3.2020 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Netherlands, like most European countries, has a robust influenza surveillance system in primary care. However, there is a lack of real-time nationally representative data on hospital admissions for complications of influenza. Anecdotal information about hospital capacity problems during influenza epidemics can, therefore, not be substantiated. Objective: The aim of this study was to assess whether media reports could provide relevant information for estimating the impact of influenza on hospital capacity, in the absence of hospital surveillance data. Methods: Dutch news articles on influenza in hospitals during the influenza season (week 40 of 2017 until week 20 of 2018) were searched in a Web-based media monitoring program (Coosto). Trends in the number of weekly articles were compared with trends in 5 different influenza surveillance systems. A content analysis was performed on a selection of news articles, and information on the hospital, department, problem, and preventive or response measures was collected. Results: The trend in weekly news articles correlated significantly with the trends in all 5 surveillance systems, including severe acute respiratory infections (SARI) surveillance. However, the peak in all 5 surveillance systems preceded the peak in news articles. Content analysis showed hospitals (N=69) had major capacity problems (46/69, 67%), resulting in admission stops (9/46, 20%), postponement of nonurgent surgical procedures (29/46, 63%), or both (8/46, 17%). Only few hospitals reported the use of point-of-care testing (5/69, 7%) or a separate influenza ward (3/69, 4%) to accelerate clinical management, but most resorted to ad hoc crisis management (34/69, 49%). Conclusions: Media reports showed that the 2017/2018 influenza epidemic caused serious problems in hospitals throughout the country. However, because of the time lag in media reporting, it is not a suitable alternative for near real-time SARI surveillance. A robust SARI surveillance program is important to inform decision making. %M 32130197 %R 10.2196/14627 %U http://publichealth.jmir.org/2020/1/e14627/ %U https://doi.org/10.2196/14627 %U http://www.ncbi.nlm.nih.gov/pubmed/32130197 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 8 %N 3 %P e15998 %T Leveraging Providers’ Preferences to Customize Instructional Content in Information and Communications Technology–Based Training Interventions: Retrospective Analysis of a Mobile Phone–Based Intervention in India %A Tyagi,Hanu %A Sabharwal,Manisha %A Dixit,Nishi %A Pal,Arnab %A Deo,Sarang %+ Carlson School of Management, University of Minnesota, 321 19th Ave S, Minneapolis, MN, 55455, United States, 1 7637427688, tyagi035@umn.edu %K public health %K mobile health %K health care providers %K health care workers %K instructional technology %K information technology %K infectious diseases %K provider training %K learning preferences %D 2020 %7 3.3.2020 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Many public health programs and interventions across the world increasingly rely on using information and communications technology (ICT) tools to train and sensitize health professionals. However, the effects of such programs on provider knowledge, practice, and patient health outcomes have been inconsistent. One of the reasons for the varied effectiveness of these programs is the low and varying levels of provider engagement, which, in turn, could be because of the form and mode of content used. Tailoring instructional content could improve engagement, but it is expensive and logistically demanding to do so with traditional training Objective: This study aimed to discover preferences among providers on the form (articles or videos), mode (featuring peers or experts), and length (short or long) of the instructional content; to quantify the extent to which differences in these preferences can explain variation in provider engagement with ICT-based training interventions; and to compare the power of content preferences to explain provider engagement against that of demographic variables. Methods: We used data from a mobile phone–based intervention focused on improving tuberculosis diagnostic practices among 24,949 private providers from 5 specialties and 1734 cities over 1 year. Engagement time was used as the primary outcome to assess provider engagement. K-means clustering was used to segment providers based on the proportion of engagement time spent on content formats, modes, and lengths to discover their content preferences. The identified clusters were used to predict engagement time using a linear regression model. Subsequently, we compared the accuracy of the cluster-based prediction model with one based on demographic variables of providers (eg, specialty and geographic location). Results: The average engagement time across all providers was 7.5 min (median 0, IQR 0-1.58). A total of 69.75% (17,401/24,949) of providers did not consume any content. The average engagement time for providers with nonzero engagement time was 24.8 min (median 4.9, IQR 2.2-10.1). We identified 4 clusters of providers with distinct preferences for form, mode, and length of content. These clusters explained a substantially higher proportion of the variation in engagement time compared with demographic variables (32.9% vs 1.0%) and yielded a more accurate prediction for the engagement time (root mean square error: 4.29 vs 5.21 and mean absolute error: 3.30 vs 4.26). Conclusions: Providers participating in a mobile phone–based digital campaign have inherent preferences for instructional content. Targeting providers based on individual content preferences could result in higher provider engagement as compared to targeting providers based on demographic variables. %M 32130191 %R 10.2196/15998 %U https://mhealth.jmir.org/2020/3/e15998 %U https://doi.org/10.2196/15998 %U http://www.ncbi.nlm.nih.gov/pubmed/32130191 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e16427 %T Effectiveness and Parental Acceptability of Social Networking Interventions for Promoting Seasonal Influenza Vaccination Among Young Children: Randomized Controlled Trial %A Liao,Qiuyan %A Fielding,Richard %A Cheung,Yee Tak Derek %A Lian,Jinxiao %A Yuan,Jiehu %A Lam,Wendy Wing Tak %+ University of Hong Kong, 7 Sassoon Road, Pokfulam, Hong Kong, China (Hong Kong), 852 3917 9289, qyliao11@hku.hk %K influenza vaccination %K social media %K intervention %K children %D 2020 %7 28.2.2020 %9 Original Paper %J J Med Internet Res %G English %X Background: Seasonal influenza vaccination (SIV) coverage among young children remains low worldwide. Mobile social networking apps such as WhatsApp Messenger are promising tools for health interventions. Objective: This was a preliminary study to test the effectiveness and parental acceptability of a social networking intervention that sends weekly vaccination reminders and encourages exchange of SIV-related views and experiences among mothers via WhatsApp discussion groups for promoting childhood SIV. The second objective was to examine the effect of introducing time pressure on mothers’ decision making for childhood SIV for vaccination decision making. This was done using countdowns of the recommended vaccination timing. Methods: Mothers of child(ren) aged 6 to 72 months were randomly allocated to control or to one of two social networking intervention groups receiving vaccination reminders with (SNI+TP) or without (SNI–TP) a time pressure component via WhatsApp discussion groups at a ratio of 5:2:2. All participants first completed a baseline assessment. Both the SNI–TP and SNI+TP groups subsequently received weekly vaccination reminders from October to December 2017 and participated in WhatsApp discussions about SIV moderated by a health professional. All participants completed a follow-up assessment from April to May 2018. Results: A total of 84.9% (174/205), 71% (57/80), and 75% (60/80) who were allocated to the control, SNI–TP, and SNI+TP groups, respectively, completed the outcome assessment. The social networking intervention significantly promoted mothers’ self-efficacy for taking children for SIV (SNI–TP: odds ratio [OR] 2.69 [1.07-6.79]; SNI+TP: OR 2.50 [1.13-5.55]), but did not result in significantly improved children’s SIV uptake. Moreover, after adjusting for mothers’ working status, introducing additional time pressure reduced the overall SIV uptake in children of working mothers (OR 0.27 [0.10-0.77]) but significantly increased the SIV uptake among children of mothers without a full-time job (OR 6.53 [1.87-22.82]). Most participants’ WhatsApp posts were about sharing experience or views (226/434, 52.1%) of which 44.7% (101/226) were categorized as negative, such as their concerns over vaccine safety, side effects and effectiveness. Although participants shared predominantly negative experience or views about SIV at the beginning of the discussion, the moderator was able to encourage the discussion of more positive experience or views and more knowledge and information. Most intervention group participants indicated willingness to receive the same interventions (110/117, 94.0%) and recommend the interventions to other mothers (102/117, 87.2%) in future Conclusions: Online information support can effectively promote mothers’ self-efficacy for taking children for SIV but alone it may not sufficient to address maternal concerns over SIV to achieve a positive vaccination decision. However, the active involvement of health professionals in online discussions can shape positive discussions about vaccination. Time pressure on decision making interacts with maternal work status, facilitating vaccination uptake among mothers who may have more free time, but having the opposite effect among busier working mothers. Trial Registration: Hong Kong University Clinical Trials Registry HKUCTR-2250; https://tinyurl.com/vejv276 %M 32130136 %R 10.2196/16427 %U http://www.jmir.org/2020/2/e16427/ %U https://doi.org/10.2196/16427 %U http://www.ncbi.nlm.nih.gov/pubmed/32130136 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 22 %N 2 %P e15727 %T Use of Digital Technology to Enhance Tuberculosis Control: Scoping Review %A Lee,Yejin %A Raviglione,Mario C %A Flahault,Antoine %+ Institute of Global Health, Faculty of Medicine, University of Geneva, 9 Chemin des Mines, Geneva, 1202, Switzerland, 41 765383087, Ye-Jin.Lee@etu.unige.ch %K tuberculosis %K mHealth %K eHealth %K medical informatics %D 2020 %7 13.2.2020 %9 Review %J J Med Internet Res %G English %X Background: Tuberculosis (TB) is the leading cause of death from a single infectious agent, with around 1.5 million deaths reported in 2018, and is a major contributor to suffering worldwide, with an estimated 10 million new cases every year. In the context of the World Health Organization’s End TB strategy and the quest for digital innovations, there is a need to understand what is happening around the world regarding research into the use of digital technology for better TB care and control. Objective: The purpose of this scoping review was to summarize the state of research on the use of digital technology to enhance TB care and control. This study provides an overview of publications covering this subject and answers 3 main questions: (1) to what extent has the issue been addressed in the scientific literature between January 2016 and March 2019, (2) which countries have been investing in research in this field, and (3) what digital technologies were used? Methods: A Web-based search was conducted on PubMed and Web of Science. Studies that describe the use of digital technology with specific reference to keywords such as TB, digital health, eHealth, and mHealth were included. Data from selected studies were synthesized into 4 functions using narrative and graphical methods. Such digital health interventions were categorized based on 2 classifications, one by function and the other by targeted user. Results: A total of 145 relevant studies were identified out of the 1005 published between January 2016 and March 2019. Overall, 72.4% (105/145) of the research focused on patient care and 20.7% (30/145) on surveillance and monitoring. Other programmatic functions 4.8% (7/145) and electronic learning 2.1% (3/145) were less frequently studied. Most digital health technologies used for patient care included primarily diagnostic 59.4% (63/106) and treatment adherence tools 40.6% (43/106). On the basis of the second type of classification, 107 studies targeted health care providers (107/145, 73.8%), 20 studies targeted clients (20/145, 13.8%), 17 dealt with data services (17/145, 11.7%), and 1 study was on the health system or resource management. The first authors’ affiliations were mainly from 3 countries: the United States (30/145 studies, 20.7%), China (20/145 studies, 13.8%), and India (17/145 studies, 11.7%). The researchers from the United States conducted their research both domestically and abroad, whereas researchers from China and India conducted all studies domestically. Conclusions: The majority of research conducted between January 2016 and March 2019 on digital interventions for TB focused on diagnostic tools and treatment adherence technologies, such as video-observed therapy and SMS. Only a few studies addressed interventions for data services and health system or resource management. %M 32053111 %R 10.2196/15727 %U https://www.jmir.org/2020/2/e15727 %U https://doi.org/10.2196/15727 %U http://www.ncbi.nlm.nih.gov/pubmed/32053111 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 4 %N 1 %P e16424 %T An Integrated mHealth App for Dengue Reporting and Mapping, Health Communication, and Behavior Modification: Development and Assessment of Mozzify %A Herbuela,Von Ralph Dane Marquez %A Karita,Tomonori %A Francisco,Micanaldo Ernesto %A Watanabe,Kozo %+ Graduate School of Science and Engineering, Ehime University, Bunkyo-cho 3, Matsuyama, Japan, 81 89-927-9847, watanabe_kozo@cee.ehime-u.ac.jp %K dengue fever %K mHealth %K real-time surveillance %K health communication %K behavior modification %D 2020 %7 8.1.2020 %9 Original Paper %J JMIR Form Res %G English %X Background: For the last 10 years, mobile phones have provided the global health community with innovative and cost-effective strategies to address the challenges in the prevention and management of dengue fever. Objective: The aim is to introduce and describe the design and development process of Mozzify, an integrated mobile health (mHealth) app that features real-time dengue fever case reporting and mapping system, health communication (real-time worldwide news and chat forum/timeline, within-app educational videos, links to local and international health agency websites, interactive signs and symptoms checker, and a hospital directions system), and behavior modification (reminders alert program on the preventive practices against dengue fever). We also aim to assess Mozzify in terms of engagement and information-sharing abilities, functionality, aesthetics, subjective quality, and perceived impact. Methods: The main goals of the Mozzify app were to increase awareness, improve knowledge, and change attitudes about dengue fever, health care-seeking behavior, and intention-to-change behavior on preventive practices for dengue fever among users. It was assessed using the Mobile Application Rating Scale (MARS) among 50 purposively sampled individuals: public health experts (n=5), environment and health-related researchers (n=23), and nonclinical (end users) participants (n=22). Results: High acceptability and excellent satisfaction ratings (mean scores ≥4.0 out of 5) based on the MARS subscales indicate that the app has excellent user design, functionality, usability, engagement, and information among public health experts, environment and health-related researchers, and end users. The app’s subjective quality (recommending the app to other people and the app’s overall star rating), and specific quality (increase awareness, improve knowledge, and change attitudes about dengue fever; health care-seeking behavior; and intention-to-change behavior on preventive practices for dengue fever) also obtained excellent satisfaction ratings from the participants. Some issues and suggestions were raised during the focus group and individual discussions regarding the availability of the app for Android devices, language options limitations, provision of predictive surveillance, and inclusion of other mosquito-borne diseases. Conclusions: Mozzify may be a promising integrated strategic health intervention system for dengue fever case reporting and mapping; increase awareness, improve knowledge, and change attitude about dengue fever; and disseminating and sharing information on dengue fever among the general population and health experts. It also can be an effective aid in the successful translation of knowledge on preventive measures against dengue fever to practice. %M 31913128 %R 10.2196/16424 %U https://formative.jmir.org/2020/1/e16424 %U https://doi.org/10.2196/16424 %U http://www.ncbi.nlm.nih.gov/pubmed/31913128 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e12016 %T Enhanced Safety Surveillance of Influenza Vaccines in General Practice, Winter 2015-16: Feasibility Study %A de Lusignan,Simon %A Correa,Ana %A Dos Santos,Gaël %A Meyer,Nadia %A Haguinet,François %A Webb,Rebecca %A McGee,Christopher %A Byford,Rachel %A Yonova,Ivelina %A Pathirannehelage,Sameera %A Ferreira,Filipa Matos %A Jones,Simon %+ University of Surrey, Department of Clinical and Experimental Medicine, University of Surrey, Guildford, United Kingdom, 44 01483 68 ext 3089, s.lusignan@surrey.ac.uk %K vaccines %K safety management %K medical records systems, computerized %K drug-related side effects and adverse reactions %K influenza, human %K influenza vaccines %K general practice %K England %D 2019 %7 14.11.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The European Medicines Agency (EMA) requires vaccine manufacturers to conduct enhanced real-time surveillance of seasonal influenza vaccination. The EMA has specified a list of adverse events of interest to be monitored. The EMA sets out 3 different ways to conduct such surveillance: (1) active surveillance, (2) enhanced passive surveillance, or (3) electronic health record data mining (EHR-DM). English general practice (GP) is a suitable setting to implement enhanced passive surveillance and EHR-DM. Objective: This study aimed to test the feasibility of conducting enhanced passive surveillance in GP using the yellow card scheme (adverse events of interest reporting cards) to determine if it has any advantages over EHR-DM alone. Methods: A total of 9 GPs in England participated, of which 3 tested the feasibility of enhanced passive surveillance and the other 6 EHR-DM alone. The 3 that tested EPS provided patients with yellow (adverse events) cards for patients to report any adverse events. Data were extracted from all 9 GPs’ EHRs between weeks 35 and 49 (08/24/2015 to 12/06/2015), the main period of influenza vaccination. We conducted weekly analysis and end-of-study analyses. Results: Our GPs were largely distributed across England with a registered population of 81,040. In the week 49 report, 15,863/81,040 people (19.57% of the registered practice population) were vaccinated. In the EPS practices, staff managed to hand out the cards to 61.25% (4150/6776) of the vaccinees, and of these cards, 1.98% (82/4150) were returned to the GP offices. Adverse events of interests were reported by 113 /7223 people (1.56%) in the enhanced passive surveillance practices, compared with 322/8640 people (3.73%) in the EHR-DM practices. Conclusions: Overall, we demonstrated that GPs EHR-DM was an appropriate method of enhanced surveillance. However, the use of yellow cards, in enhanced passive surveillance practices, did not enhance the collection of adverse events of interests as demonstrated in this study. Their return rate was poor, data entry from them was not straightforward, and there were issues with data reconciliation. We concluded that customized cards prespecifying the EMA’s adverse events of interests, combined with EHR-DM, were needed to maximize data collection. International Registered Report Identifier (IRRID): RR2-10.1136/bmjopen-2016-015469 %M 31724955 %R 10.2196/12016 %U http://publichealth.jmir.org/2019/4/e12016/ %U https://doi.org/10.2196/12016 %U http://www.ncbi.nlm.nih.gov/pubmed/31724955 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 11 %P e14186 %T Feasibility of Point-of-Care Testing for Influenza Within a National Primary Care Sentinel Surveillance Network in England: Protocol for a Mixed Methods Study %A de Lusignan,Simon %A Hoang,Uy %A Liyanage,Harshana %A Yonova,Ivelina %A Ferreira,Filipa %A Diez-Domingo,Javier %A Clark,Tristan %+ Department of Clinical and Experimental Medicine, University of Surrey, Leggett Building, Daphne Jackson Road, Guildford, GU2 7WG, United Kingdom, 44 1483 684802, simon.delusignan@phc.ox.ac.uk %K diagnosis %K influenza, human %K point-of-care systems %K general practice %D 2019 %7 11.11.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Point-of-care testing (POCT) for influenza promises to provide real-time information to influence clinical decision making and improve patient outcomes. Public Health England has published a toolkit to assist implementation of these tests in the UK National Health Service. Objective: A feasibility study will be undertaken to assess the implementation of influenza POCT in primary care as part of a sentinel surveillance network. Methods: We will conduct a mixed methods study to compare the sampling rates in practices using POCT and current virology swabbing practices not using POCT, and to understand the issues and barriers to implementation of influenza POCT in primary care workflows. The study will take place between March and May 2019. It will be nested in general practices that are part of the English national sentinel surveillance network run by the Royal College of General Practitioners Research and Surveillance Centre. The primary outcome is the number of valid influenza swabs taken and tested by the practices involved in the study using the new POCT. Results: A total of 6 practices were recruited, and data collection commenced on March 11, 2019. Moreover, 312 swab samples had been collected at the time of submission of the protocol, which was 32.5% (312/960) of the expected sample size. In addition, 68 samples were positive for influenza, which was 20.1% (68/338) of the expected sample size. Conclusions: To the best of our knowledge, this is the first time an evaluation study has been undertaken on POCT for influenza in general practice in the United Kingdom. This proposed study promises to shed light on the feasibility of implementation of POCT in primary care and on the views of practitioners about the use of influenza POCT in primary care, including its impact on primary care workflows. International Registered Report Identifier (IRRID): DERR1-10.2196/14186 %M 31710303 %R 10.2196/14186 %U http://www.researchprotocols.org/2019/11/e14186/ %U https://doi.org/10.2196/14186 %U http://www.ncbi.nlm.nih.gov/pubmed/31710303 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14664 %T A Collaborative Initiative to Strengthen Sustainable Public Health Capacity for Polio Eradication and Routine Immunization Activities in the Eastern Mediterranean Region %A Al Gunaid,Magid %A Lami,Faris %A Jarour,Najwa %+ Polio and Immunization Team, Global Health Development/Eastern Mediterranean Public Health Network, Shemeisani, Abdallah Ben Abbas Street, Building No 42, Amman, , Jordan, 962 65519962 ext 409, mgunaid@globalhealthdev.org %K GHD/EMPHNET %K Global Polio Eradication Initiative %K acute flaccid paralysis %K vaccine-preventable disease %K VPD %K surveillance %K Eastern Mediterranean region %K EMR %K Global Vaccine Action Plan %K demand creation %K microplans %K polio transition %D 2019 %7 29.10.2019 %9 Viewpoint %J JMIR Public Health Surveill %G English %X The many challenges in the Eastern Mediterranean region put the involved countries at risk of polio transmission and affect their ability to meet progress targets in eliminating vaccine-preventable diseases. The Global Health Development (GHD) and Eastern Mediterranean Public Health Network (EMPHNET) are working together on the project “Strengthening sustainable public health capacity in the Eastern Mediterranean region for polio eradication and routine immunization activities” with an overall goal of improving routine immunization, eradicating poliovirus, and controlling/eliminating or eradicating other vaccine-preventable diseases in the Eastern Mediterranean region. The aim of this manuscript is to describe the project and the achievements of GHD/EMPHNET over the last 3 years (2016-2018) to build effective surveillance and immunization systems in the Eastern Mediterranean region through the development of a sustainable and competent public health system to eradicate polio and control/eliminate vaccine-preventable diseases. This project assists the targeted Eastern Mediterranean region countries to build effective surveillance and immunization systems in an effort to expand their capacities to eradicate polio and control/eliminate other vaccine-preventable diseases. The project is streamlined with the Global Polio Eradication Initiative, the Centers for Disease Control and Prevention’s Strategic Framework for Global Immunization 2016-2020, and the Polio Eradication and Endgame Strategic Plan 2013-2018. The project also supports the Global Health Security Agenda by focusing on efforts to accelerate progress toward a world safe and secure from infectious disease threats. Project activities were designed to respond to countries’ needs and assist them in building their institutional and workforce capacity to effectively plan, implement, and evaluate activities to eradicate polio and strengthen routine immunization activities. The project activities covered a set of areas including surveillance of acute flaccid paralysis and other vaccine-preventable diseases, family and community engagement, workforce capacity building, improvement of data quality, management and use of information systems, use of polio assets to control/eliminate other vaccine-preventable diseases, support of countries to develop national strategies, piloting of innovative initiatives, program evaluation and accountability, and immunization strengthening. The project adopts the Global Polio Eradication Initiative strategies for assisting countries to strengthen routine immunization services, maintain highly sensitive acute flaccid paralysis surveillance, and sustain polio eradication functions. %M 31663863 %R 10.2196/14664 %U http://publichealth.jmir.org/2019/4/e14664/ %U https://doi.org/10.2196/14664 %U http://www.ncbi.nlm.nih.gov/pubmed/31663863 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 10 %P e14276 %T The Fever Coach Mobile App for Participatory Influenza Surveillance in Children: Usability Study %A Kim,Myeongchan %A Yune,Sehyo %A Chang,Seyun %A Jung,Yuseob %A Sa,Soon Ok %A Han,Hyun Wook %+ Department of Biomedical Informatics, Graduate School of Medicine, CHA University, Pangyo-ro 335, Bundang-gu, Seongnam-si, Gyeonggi-do, 13488, Republic of Korea, 82 31 881 7109, stepano7@gmail.com %K data collection %K detecting epidemics %K mobile app %K health care app %K influenza epidemics %K influenza in children %D 2019 %7 17.10.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Effective surveillance of influenza requires a broad network of health care providers actively reporting cases of influenza-like illnesses and positive laboratory results. Not only is this traditional surveillance system costly to establish and maintain but there is also a time lag between a change in influenza activity and its detection. A new surveillance system that is both reliable and timely will help public health officials to effectively control an epidemic and mitigate the burden of the disease. Objective: This study aimed to evaluate the use of parent-reported data of febrile illnesses in children submitted through the Fever Coach app in real-time surveillance of influenza activities. Methods: Fever Coach is a mobile app designed to help parents and caregivers manage fever in young children, currently mainly serviced in South Korea. The app analyzes data entered by a caregiver and provides tailored information for care of the child based on the child’s age, sex, body weight, body temperature, and accompanying symptoms. Using the data submitted to the app during the 2016-2017 influenza season, we built a regression model that monitors influenza incidence for the 2017-2018 season and validated the model by comparing the predictions with the public influenza surveillance data from the Korea Centers for Disease Control and Prevention (KCDC). Results: During the 2-year study period, 70,203 diagnosis data, including 7702 influenza reports, were submitted. There was a significant correlation between the influenza activity predicted by Fever Coach and that reported by KCDC (Spearman ρ=0.878; P<.001). Using this model, the influenza epidemic in the 2017-2018 season was detected 10 days before the epidemic alert announced by KCDC. Conclusions: The Fever Coach app successfully collected data from 7.73% (207,699/2,686,580) of the target population by providing care instruction for febrile children. These data were used to develop a model that accurately estimated influenza activity measured by the central government agency using reports from sentinel facilities in the national surveillance network. %M 31625946 %R 10.2196/14276 %U https://mhealth.jmir.org/2019/10/e14276 %U https://doi.org/10.2196/14276 %U http://www.ncbi.nlm.nih.gov/pubmed/31625946 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14348 %T Preventing Emerging and Re-emerging Infections in the Eastern Mediterranean Region: Gaps, Challenges, and Priorities %A Araj,Rawan %A Alqasrawi,Sultan %A Samy,Sahar %A Alwahdanee,Ghaya %A Wadi,Jamal %A Mofleh,Jawad %A Alsanouri,Tarek %+ Global Health Development/Eastern Mediterranean Public Health Network, Abdallah Ben Abbas St, Building No 42, Amman, 91116, Jordan, 962 778284521, raraj@globalhealthdev.org %K emerging %K infectious %K diseases %K Eastern Mediterranean %D 2019 %7 9.10.2019 %9 Viewpoint %J JMIR Public Health Surveill %G English %X Background: The Eastern Mediterranean Public Health Network, supported by the Biosecurity Engagement Program, contributed significantly to strengthening the preparedness and response to the emerging and re-emerging infections in the region. Objective: This study aimed to determine the gaps, challenges, and priorities for preventing the emerging and re-emerging infections, with a focus on biosafety and biosecurity in four countries of the region, namely, Egypt, Iraq, Jordan, and Morocco. Methods: A total of two different methods were used to determine the gaps and priorities for preventing the emerging and re-emerging infections. The first method was a rapid assessment for the preparedness and response to the emerging and re-emerging infections in four countries of the region, with a focus on biosafety and biosecurity. The second method was a face-to-face round table meeting of the participating teams for two days, where the teams from all countries presented their countries’ profiles, findings, priorities, and gaps based on the countries’ assessments. Results: The assessment and meeting resulted in several priorities and recommendations for each of the countries in the areas of legislation and coordination, biosafety and biosecurity, surveillance and human resources, case management and response, infection control and prevention, and risk communication and laboratory capacity. Conclusions: Many recommendations were relatively consistent throughout, including improving communication or building collaborations to improve the overall health of the country. %M 31599734 %R 10.2196/14348 %U https://publichealth.jmir.org/2019/4/e14348 %U https://doi.org/10.2196/14348 %U http://www.ncbi.nlm.nih.gov/pubmed/31599734 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14252 %T Evaluation of the Yield of Histopathology in the Diagnosis of Lymph Node Tuberculosis in Morocco, 2017: Cross-Sectional Study %A Bennani,Kenza %A Khattabi,Asmae %A Akrim,Mohammed %A Mahtar,Mohamed %A Benmansour,Najib %A Essakalli Hossyni,Leila %A Karkouri,Mehdi %A Cherradi,Nadia %A El Messaoudi,My Driss %A Lahlou,Ouafae %A Cherkaoui,Imad %A Khader,Yousef %A Maaroufi,Abderrahmane %A Ottmani,Salah-Eddine %+ Direction of Epidemiology and Diseases Control, Ministry of Health, 71 Avenue Ibn Sina Agdal-Rabat Morocco, Rabat, 10080, Morocco, 212 661390920, kenzabennani20@gmail.com %K lymph node tuberculosis %K yield %K histopathology %K positive predictive value %K Morocco %D 2019 %7 9.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The frequency of occurrence of extrapulmonary tuberculosis (EPTB) has been increasing globally over the last two decades. In Morocco, EPTB cases account for 46% of the patients reported with a new episode of tuberculosis (TB). Lymph node TB (LNTB) is the most common form of EPTB. In line with the guidelines of the National TB Program, the diagnosis is mainly based on clinical evidence, including histopathology. Objective: This study aimed to evaluate the yield of histopathology testing in the diagnosis of LNTB. Methods: This cross-sectional, prospective study was conducted among patients with cervical lymph node who were enrolled in the study from November 2016 to May 2017 in three regions of Morocco. We compared the outcomes of histopathological testing with those of bacteriology. Sensitivity (Se), specificity (Sp), positive predictive value (PPV), and negative predictive value (NPV) of histopathology testing were calculated. Culture and Xpert tests were used as the gold standard Laboratoty Testing. Results: A total of 262 patients were enrolled in this study. The Se, Sp, PPV, and NPV of histopathology testing were 95.6% (129/135), 64.6% (82/127), 74.1% (129/174), and 93.2% (82/88), respectively, in the presence of granuloma with or without caseous necrosis and were 84.4% (114/135), 74.8% (95/127), 78.1% (114/146), and 81.9% (95/116), respectively, in the presence of granuloma with caseous necrosis. The granuloma with caseous necrosis was associated with increased PPV and Sp of histopathology testing (P<.05). Conclusions: The presence of the granuloma with caseous necrosis in the histopathological examination had significantly improved the yield of histopathology testing for the diagnosis of LNTB. The findings recommend to maintain histopathology testing in establishing the LNTB diagnosis and to explore other techniques to improve it. %M 31599732 %R 10.2196/14252 %U https://publichealth.jmir.org/2019/4/e14252 %U https://doi.org/10.2196/14252 %U http://www.ncbi.nlm.nih.gov/pubmed/31599732 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e10920 %T Syndromic Surveillance of Communicable Diseases in Mobile Clinics During the Arbaeenia Mass Gathering in Wassit Governorate, Iraq, in 2014: Cross-Sectional Study %A Lami,Faris %A Asi,Wejdan %A Khistawi,Adnan %A Jawad,Iman %+ Department of Community and Family Medicine, College of Medicine, University of Baghdad, Bab Al Muadham, Rusafa, Baghdad, 00964, Iraq, 964 7901402692, farislami@yahoo.com %K Arbaeenia %K mass gathering %K syndromic surveillance %K communicable diseases %K Iraq %D 2019 %7 7.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Arbaeenia is the largest religious mass gathering organized annually in Karbala city, Iraq, and is attended by 8-14 million people. Outbreaks of communicable diseases are a significant risk due to overcrowding and potential food and water contamination. Syndromic surveillance is often used for rapid detection and response to disease outbreaks. Objective: This study was conducted to identify the main communicable diseases syndromes among pilgrims during the Arbaeenia mass gathering in Wassit governorate, Iraq, in 2014. Methods: This cross-sectional study was conducted in the 40 mobile clinics established within Wassit governorates along the road to Karbala during the Arbaeenia mass gathering. Six communicable disease syndromes were selected: acute watery diarrhea, bloody diarrhea, fever and cough, vomiting with or without diarrhea, fever and bleeding tendency, and fever and rash. A simple questionnaire was used to directly gather basic demographics and the syndromic diagnosis from the attendees. Results: A total of 87,865 patients attended the clinics during the 10-day period, with an average of 219 patients/clinic/day. Approximately 5% (3999) of the attendees had communicable diseases syndromes: of these, 1693 (42%) had fever and cough, 1144 (29%) had acute diarrhea, 1062 (27%) presented with vomiting with/without diarrhea, and 100 (2%) had bloody diarrhea. The distribution of the syndromes did not vary by age or gender. Stool specimen cultures for Vibrio cholerae performed for 120 patients with acute diarrhea were all negative. Conclusions: Syndromic surveillance was useful in determining the main communicable diseases encountered during the mass gathering. Expansion of this surveillance to other governorates and the use of mobile technology can help in timely detection and response to communicable disease outbreaks. %M 31593544 %R 10.2196/10920 %U https://publichealth.jmir.org/2019/4/e10920 %U https://doi.org/10.2196/10920 %U http://www.ncbi.nlm.nih.gov/pubmed/31593544 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 10 %P e13557 %T Children Immunization App (CImA) Among Syrian Refugees in Zaatari Camp, Jordan: Protocol for a Cluster Randomized Controlled Pilot Trial Intervention Study %A Khader,Yousef S %A Laflamme,Lucie %A Schmid,Daniela %A El-Halabi,Soha %A Abu Khdair,Mohammad %A Sengoelge,Mathilde %A Atkins,Salla %A Tahtamouni,Manal %A Derrough,Tarik %A El-Khatib,Ziad %+ Department of Public Health Sciences, Karolinska Institutet, Stockholm,, Sweden, 46 6643461861, ziad.khatib@gmail.com %K mHealth %K refugees %K vaccines %K Jordan %K Syria %D 2019 %7 7.10.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: There are up to 19.4 million children who are still unvaccinated and face unnecessary deaths, especially among refugees. However, growing access to smartphones, among refugees, can be a leading factor to improve vaccination rates. Objective: This study aims to determine whether a smartphone app can improve the vaccination uptake among refugees and determine the app’s effectiveness in improving the documentation of vaccination records. Methods: We developed and planned to test an app through a cluster randomized trial that will be carried out at the Zaatari refugee camp in Jordan. The study will be open to all parents who carry Android smartphones, have at least one child, and agree to participate in the study. The parents will be recruited to the study by trained volunteers at the vaccination sites around the Zaatari camp. Inclusion criteria will be the following: having at least one child of 0 to 5 years, being a local resident of the camp, and having an Android smartphone. Results: The intervention includes an app that will allow storing Jordanian vaccination records, per child, on the parents’ smartphones in Arabic and English (in an interchangeable fashion). Every record will have a set of automated reminders before the appointment of each child. The app will summarize immunization records in form of due, taken, or overdue appointments, labeled in orange, green, and red, respectively. Baseline will include the collection of our primary and secondary outcomes that are needed for the pre and postdata measurements. This includes social demographic data, any previous vaccination history, and electronic health literacy. Participants, in both study arms, will be monitored for their follow-up visits to the clinic for vaccination doses. For the study outcome measures, we will measure any differences in the uptake of vaccinations. The secondary outcome is to analyze the effect of the children immunization app on visits for follow-up doses. Conclusions: Owing to the limited evidence of effective interventions for childhood vaccination among refugees, research in this area is greatly needed. The project will have a significant impact on the health of refugees and the public health system. In Jordan and the Middle East, the vaccination level is low. Given the influx of refugees from the area, it is crucial to ensure a high vaccination level among the children. International Registered Report Identifier (IRRID): PRR1-10.2196/13557 %M 31593549 %R 10.2196/13557 %U https://www.researchprotocols.org/2019/10/e13557 %U https://doi.org/10.2196/13557 %U http://www.ncbi.nlm.nih.gov/pubmed/31593549 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e14510 %T Real-Time Surveillance of Infectious Diseases and Other Health Conditions During Iraq’s Arbaeenia Mass Gathering: Cross-Sectional Study %A Lami,Faris %A Hameed,Inam %A Jewad,Abdul Wahhab %A Khader,Yousef %A Amiri,Mirwais %+ Department of Community and Family Medicine, College of Medicine, University of Baghdad, Bab Al Muadham, Resafa, Baghdad, 00964, Iraq, 964 7901402692, farislami@gmail.com %K mass gathering %K Arbaeenia %K surveillance %K Iraq %D 2019 %7 4.10.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The most common religious mass gatherings in the Middle East are the Hajj at Mecca in Saudi Arabia, which occurs annually, and the Arbaeenia in Karbala. The importance of developing public health surveillance systems for mass gatherings has been previously emphasized in other reports. Objective: This study aimed to describe the common illnesses and health conditions affecting people during the Arbaeenia mass gathering in Iraq in 2016. Methods: A total of 60 data collectors took part in the field data collection over a period of 11 days, from November 12, 2016 to November 22, 2016. Data were collected from 20 health outlets along the major route from Najaf to Karbala (10 health facilities in each governorate). Two digital forms, the Health Facility Survey and the Case Survey, were used for data collection. Results: A total of 41,689 patients (33.3% female and 66.7% male) visited the 20 health care facilities over a period of 11 days from November 12, 2016 to November 22, 2016. More than three quarters of patients (77.5%; n=32,309) were between 20-59 years of age, more than half of patients were mainly from Iraq (56.5%; n=23,554), and about 38.9% (n=16,217) were from Iran. Patients in this study visited these health care facilities and presented with one or more conditions. Of a total 41,689 patients, 58.5% (n=24,398) had acute or infectious conditions and symptoms, 33.1% (n=13,799) had chronic conditions, 23.9% (n=9974) had traumas or injuries, 28.2% (n=11,762) had joint pain related to walking long distances, and 0.3% (n=133) had chronic dermatologic conditions. Conclusions: The Arbaeenia mass gathering in 2016 exerted a high burden on the Iraqi health care system. Therefore, efforts must be made both before and during the event to ensure preparedness, proper management, and control of different conditions. %M 31588905 %R 10.2196/14510 %U https://publichealth.jmir.org/2019/4/e14510 %U https://doi.org/10.2196/14510 %U http://www.ncbi.nlm.nih.gov/pubmed/31588905 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 4 %P e13403 %T Differences in Regional Patterns of Influenza Activity Across Surveillance Systems in the United States: Comparative Evaluation %A Baltrusaitis,Kristin %A Vespignani,Alessandro %A Rosenfeld,Roni %A Gray,Josh %A Raymond,Dorrie %A Santillana,Mauricio %+ Computational Health Informatics Program, Boston Children’s Hospital, 1 Autumn St, Boston, MA, 02215, United States, 1 617 599 5460, msantill@fas.harvard.edu %K digital disease surveillance %K influenza %K surveillance %K participatory syndromic surveillance %K disease modeling %D 2019 %7 14.9.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Centers for Disease Control and Prevention (CDC) tracks influenza-like illness (ILI) using information on patient visits to health care providers through the Outpatient Influenza-like Illness Surveillance Network (ILINet). As participation in this system is voluntary, the composition, coverage, and consistency of health care reports vary from state to state, leading to different measures of ILI activity between regions. The degree to which these measures reflect actual differences in influenza activity or systematic differences in the methods used to collect and aggregate the data is unclear. Objective: The objective of our study was to qualitatively and quantitatively compare national and region-specific ILI activity in the United States across 4 surveillance data sources—CDC ILINet, Flu Near You (FNY), athenahealth, and HealthTweets.org—to determine whether these data sources, commonly used as input in influenza modeling efforts, show geographical patterns that are similar to those observed in CDC ILINet’s data. We also compared the yearly percentage of FNY participants who sought health care for ILI symptoms across geographical areas. Methods: We compared the national and regional 2018-2019 ILI activity baselines, calculated using noninfluenza weeks from previous years, for each surveillance data source. We also compared measures of ILI activity across geographical areas during 3 influenza seasons, 2015-2016, 2016-2017, and 2017-2018. Geographical differences in weekly ILI activity within each data source were also assessed using relative mean differences and time series heatmaps. National and regional age-adjusted health care–seeking percentages were calculated for each influenza season by dividing the number of FNY participants who sought medical care for ILI symptoms by the total number of ILI reports within an influenza season. Pearson correlations were used to assess the association between the health care–seeking percentages and baselines for each surveillance data source. Results: We observed consistent differences in ILI activity across geographical areas for CDC ILINet and athenahealth data. ILI activity for FNY displayed little variation across geographical areas, whereas differences in ILI activity for HealthTweets.org were associated with the total number of tweets within a geographical area. The percentage of FNY participants who sought health care for ILI symptoms differed slightly across geographical areas, and these percentages were positively correlated with CDC ILINet and athenahealth baselines. Conclusions: Our findings suggest that differences in ILI activity across geographical areas as reported by a given surveillance system may not accurately reflect true differences in the prevalence of ILI. Instead, these differences may reflect systematic collection and aggregation biases that are particular to each system and consistent across influenza seasons. These findings are potentially relevant in the real-time analysis of the influenza season and in the definition of unbiased forecast models. %M 31579019 %R 10.2196/13403 %U https://publichealth.jmir.org/2019/4/e13403 %U https://doi.org/10.2196/13403 %U http://www.ncbi.nlm.nih.gov/pubmed/31579019 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 3 %P e14227 %T Outbreak Investigation of a Multipathogen Foodborne Disease in a Training Institute in Rabat, Morocco: Case-Control Study %A Moumni Abdou,Houda %A Dahbi,Ilham %A Akrim,Mohammed %A Meski,Fatima Zahra %A Khader,Yousef %A Lakranbi,Mohammed %A Ezzine,Hind %A Khattabi,Asmae %+ Field Epidemiology Training Program, Ecole Nationale de Santé Publique, Ministry of Health, 335 Ave Mohammed V, Rabat, Morocco, 212 661079082, houdamoumnni@gmail.com %K disease outbreaks %K foodborne diseases %K Staphylococcus %K Escherichia coli %D 2019 %7 25.09.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: On June 18, 2017, the public health service was alerted about 43 students in the training institute in Rabat who were admitted to the emergency room for acute gastroenteritis following the uptake of a meal a day before. Objective: This study aimed to investigate the foodborne disease outbreak by confirming the outbreak, identifying the source of contamination, and recommending control measures. Methods: We conducted a case-control study. Cases and controls were selected in a ratio of 1:1. We defined a case as any member of the training institute who attended the Ramadan buffet in the institute’s restaurant and who had presented, in the weekend of June 16 to 20, 2017, symptoms of diarrhea or vomiting with at least one of the following signs: abdominal pain, fever, headache, nausea, and dizziness. A control was defined as anyone who attended the Ramadan buffet in the institute’s restaurant but had not presented any symptoms from June 16 to 20, 2017. We conducted a bivariate and multivariable analysis. Stools of ill students were collected, and a food specimen was collected for bacterial testing. Results: A total of 50 cases and 50 controls were selected. Among the cases, males were predominant (43/50, 86%); the median age was 21 years. A total of 47 cases sought medical care. There were no hospitalizations and no deaths. The episode was short with an estimated average incubation period of 9 hours. The epidemic curve oriented toward a common source of contamination. Among food items, briwates were strongly associated with the illness with an odd ratio of 14.23 (95% CI 5.04-40.04; P<.001). Laboratory testing of briwates showed presence of Escherichia coli O157 and Staphylococcus aureus. Conclusions: This foodborne disease outbreak was likely caused by briwates that was contaminated with S aureus and E coli. We recommended strengthening hygiene measures. Food handling techniques should be taught as part of continuous professional development for food handlers. %M 31573941 %R 10.2196/14227 %U https://publichealth.jmir.org/2019/3/e14227 %U https://doi.org/10.2196/14227 %U http://www.ncbi.nlm.nih.gov/pubmed/31573941 %0 Journal Article %@ 2561-326X %I JMIR Publications %V 3 %N 3 %P e11555 %T Developing a Digital Solution for Dengue Through Epihack: Qualitative Evaluation Study of a Five-Day Health Hackathon in Sri Lanka %A Panchapakesan,Chitra %A Sheldenkar,Anita %A Wimalaratne,Prasad %A Wijayamuni,Ruwan %A Lwin,May Oo %+ Wee Kim Wee School of Communication and Information, Nanyang Technological University, 31 Nanyang Link, Singapore,, Singapore, 65 9446 6036, chitra002@e.ntu.edu.sg %K Epihack %K civic engagement %K dengue %K digital epidemiology %K participatory surveillance %K participatory epidemiology %K participatory design %K workshop %D 2019 %7 29.08.2019 %9 Original Paper %J JMIR Form Res %G English %X Background: Dengue is a mosquito-borne viral disease that has increasingly affected Sri Lanka in recent years. To address this issue, dengue surveillance through increasingly prevalent digital surveillance applications has been suggested for use by health authorities and the general public. Epihack Sri Lanka was a 5-day hackathon event organized to develop a digital dengue surveillance tool. Objective: The goal of the research was to examine the effectiveness of a collaborative hackathon that brought together information technology (IT) and health experts from around the globe to develop a solution to the dengue pandemic in Sri Lanka. Methods: Ethnographic observation and qualitative informal interviews were conducted with 58 attendees from 11 countries over the 5-day Epihack to identify the main factors that influence a collaborative hackathon. Interviews were transcribed and coded based on grounded theory. Results: Three major themes were identified during the Epihack Sri Lanka event: engagement, communication, and current disease environment. Unlike other hackathons, Epihack had no winners or prizes and was collaborative rather than competitive, which worked well in formulating a variety of ideas and bringing together volunteers with a sense of civic duty to improve public health. Having health and IT experts work together concurrently was received positively and considered highly beneficial to the development of the product. Participants were overall very satisfied with the event, although they thought it could have been longer. Communication issues and cultural differences were observed but continued to decrease as the event progressed. This was found to be extremely important to the efficiency of the event, which highlighted the benefit of team-bonding exercises. Bringing expert knowledge and examples of systems from around the world benefited the creation of new ideas. However, developing a system that can adapt and cater to the local disease environment is important in successfully developing the concepts. Conclusions: Epihack Sri Lanka was successful in bringing together health and IT experts to develop a digital solution for dengue surveillance. The collaborative format achieved a variety of fruitful ideas and may lead to more hackathons working in this way in the future. Good communication, participant engagement, and stakeholder interest with adaptation of ideas to complement the current environment are vital to achieve the goals of the event. %M 31469074 %R 10.2196/11555 %U http://formative.jmir.org/2019/3/e11555/ %U https://doi.org/10.2196/11555 %U http://www.ncbi.nlm.nih.gov/pubmed/31469074 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 3 %P e11780 %T Flucast: A Real-Time Tool to Predict Severity of an Influenza Season %A Moa,Aye %A Muscatello,David %A Chughtai,Abrar %A Chen,Xin %A MacIntyre,C Raina %+ Biosecurity Program, The Kirby Institute, University of New South Wales, Gate 9, High Street, Sydney, NSW 2052, Australia, 61 02 93850938, a.moa@unsw.edu.au %K prediction tool %K influenza %K risk assessment %D 2019 %7 23.07.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Influenza causes serious illness requiring annual health system surge capacity, yet annual seasonal variation makes it difficult to forecast and plan for the severity of an upcoming season. Research shows that hospital and health system stakeholders indicate a preference for forecasting tools that are easy to use and understand to assist with surge capacity planning for influenza. Objective: This study aimed to develop a simple risk prediction tool, Flucast, to predict the severity of an emerging influenza season. Methods: Study data were obtained from the National Notifiable Diseases Surveillance System and Australian Influenza Surveillance Reports from the Department of Health, Australia. We tested Flucast using retrospective seasonal data for 11 Australian influenza seasons. We compared five different models using parameters known early in the season that may be associated with the severity of the season. To calibrate the tool, the resulting estimates of seasonal severity were validated against independent reports of influenza-attributable morbidity and mortality. The model with the highest predictive accuracy against retrospective seasonal activity was chosen as a best-fit model to develop the Flucast tool. The tool was prospectively tested against the 2018 and the emerging 2019 influenza season. Results: The Flucast tool predicted the severity of all retrospectively studied years correctly for influenza seasonal activity in Australia. With the use of real-time data, the tool provided a reasonable early prediction of a low to moderate season for the 2018 and severe seasonal activity for the upcoming 2019 season. The tool meets stakeholder preferences for simplicity and ease of use to assist with surge capacity planning. Conclusions: The Flucast tool may be useful to inform future health system influenza preparedness planning, surge capacity, and intervention programs in real time, and can be adapted for different settings and geographic locations. %M 31339102 %R 10.2196/11780 %U http://publichealth.jmir.org/2019/3/e11780/ %U https://doi.org/10.2196/11780 %U http://www.ncbi.nlm.nih.gov/pubmed/31339102 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e12383 %T Preliminary Flu Outbreak Prediction Using Twitter Posts Classification and Linear Regression With Historical Centers for Disease Control and Prevention Reports: Prediction Framework Study %A Alessa,Ali %A Faezipour,Miad %+ Department of Computer Science and Engineering, University of Bridgeport, 221 University Avenue, Bridgeport, CT, 06604, United States, 1 203 576 4702, mfaezipo@bridgeport.edu %K FastText %K influenza %K machine learning %K social networking site %K text classification %D 2019 %7 23.6.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social networking sites (SNSs) such as Twitter are widely used by diverse demographic populations. The amount of data within SNSs has created an efficient resource for real-time analysis. Thus, data from SNSs can be used effectively to track disease outbreaks and provide necessary warnings. Current SNS-based flu detection and prediction frameworks apply conventional machine learning approaches that require lengthy training and testing, which is not the optimal solution for new outbreaks with new signs and symptoms. Objective: The objective of this study was to propose an efficient and accurate framework that uses data from SNSs to track disease outbreaks and provide early warnings, even for newest outbreaks, accurately. Methods: We presented a framework of outbreak prediction that included 3 main modules: text classification, mapping, and linear regression for weekly flu rate predictions. The text classification module used the features of sentiment analysis and predefined keyword occurrences. Various classifiers, including FastText (FT) and 6 conventional machine learning algorithms, were evaluated to identify the most efficient and accurate one for the proposed framework. The text classifiers were trained and tested using a prelabeled dataset of flu-related and unrelated Twitter postings. The selected text classifier was then used to classify over 8,400,000 tweet documents. The flu-related documents were then mapped on a weekly basis using a mapping module. Finally, the mapped results were passed together with historical Centers for Disease Control and Prevention (CDC) data to a linear regression module for weekly flu rate predictions. Results: The evaluation of flu tweet classification showed that FT, together with the extracted features, achieved accurate results with an F-measure value of 89.9% in addition to its efficiency. Therefore, FT was chosen to be the classification module to work together with the other modules in the proposed framework, including a regression-based estimator, for flu trend predictions. The estimator was evaluated using several regression models. Regression results show that the linear regression–based estimator achieved the highest accuracy results using the measure of Pearson correlation. Thus, the linear regression model was used for the module of weekly flu rate estimation. The prediction results were compared with the available recent data from CDC as the ground truth and showed a strong correlation of 96.29% . Conclusions: The results demonstrated the efficiency and the accuracy of the proposed framework that can be used even for new outbreaks with new signs and symptoms. The classification results demonstrated that the FT-based framework improves the accuracy and the efficiency of flu disease surveillance systems that use unstructured data such as data from SNSs. %R 10.2196/12383 %U http://publichealth.jmir.org/2019/2/e12383/ %U https://doi.org/10.2196/12383 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e13359 %T Prevalence of Schistosoma Haematobium Measured by a Mobile Health System in an Unexplored Endemic Region in the Subprefecture of Torrock, Chad %A Lalaye,Didier %A de Bruijn,Mirjam E %A de Jong,Tom PVM %+ Julius Global Health Center, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584CX, Netherlands, 31 887555555, lalaye84@gmail.com %K Schistosoma haematobium %K prevalence %K Chad %K neglected tropical diseases %K mobile health %D 2019 %7 18.06.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Schistosoma haematobium is a parasitic digenetic trematode responsible for schistosomiasis (also known as bilharzia). The disease is caused by penetration of the skin by the parasite, spread by intermediate host molluscs in stagnant waters, and can be treated by administration of praziquantel. Schistosomiasis is considered to be an important but neglected tropical disease. Objective: The aim of this pilot study was to investigate the prevalence of schistosomiasis in the subprefecture of Torrock, an endemic area in Chad where no earlier investigation had been conducted and no distribution system for pharmacotherapy has ever existed. Methods: This study examined 1875 children aged 1 to 14 years over a period of 1 year. After centrifugation, urine examination was performed by a direct microscopic investigation for eggs. The investigation was conducted with a mobile health (mHealth) approach, using short message service (SMS) for communication among parents, local health workers, a pharmacist, and a medical doctor. An initial awareness campaign requested parents to have their children examined for schistosomiasis. Urine was then collected at home by the parents following the SMS request. Urine results that proved positive were sent to a medical doctor by SMS, who in turn ordered a pharmacist by SMS to distribute praziquantel to the infected children. Results: Direct microscopic examination of urine found 467 positive cases (24.9% of the total sample). Of all male and female samples, 341 (34%) and 127 (14.4%) samples were positive, respectively. The infection rate was equally distributed over age groups. The newly developed mHealth system had a limited level of participation (8%) from an estimated total of 25,000 children in the target group. Conclusions: The prevalence of schistosomiasis in children in the subprefecture of Torrock is moderately high. Efforts will be required to enhance the awareness of parents and to reach a larger percentage of the population. Systematic governmental measures should be put in place as soon as possible to increase awareness in the area and to diagnose and treat cases of schistosomiasis. %M 31215519 %R 10.2196/13359 %U http://publichealth.jmir.org/2019/2/e13359/ %U https://doi.org/10.2196/13359 %U http://www.ncbi.nlm.nih.gov/pubmed/31215519 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 6 %P e12843 %T Rapid Analysis of Diagnostic and Antimicrobial Patterns in R (RadaR): Interactive Open-Source Software App for Infection Management and Antimicrobial Stewardship %A Luz,Christian Friedemann %A Berends,Matthijs S %A Dik,Jan-Willem H %A Lokate,Mariëtte %A Pulcini,Céline %A Glasner,Corinna %A Sinha,Bhanu %+ Department of Medical Microbiology and Infection Prevention, University Medical Center Groningen, University of Groningen, Hanzeplein 1, Groningen, 9713 GZ, Netherlands, 31 50 361 3480, c.f.luz@umcg.nl %K antimicrobial stewardship %K software %K hospital records %K data visualization %K infection, medical informatics applications %D 2019 %7 24.5.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Analyzing process and outcome measures for all patients diagnosed with an infection in a hospital, including those suspected of having an infection, requires not only processing of large datasets but also accounting for numerous patient parameters and guidelines. Substantial technical expertise is required to conduct such rapid, reproducible, and adaptable analyses; however, such analyses can yield valuable insights for infection management and antimicrobial stewardship (AMS) teams. Objective: The aim of this study was to present the design, development, and testing of RadaR (Rapid analysis of diagnostic and antimicrobial patterns in R), a software app for infection management, and to ascertain whether RadaR can facilitate user-friendly, intuitive, and interactive analyses of large datasets in the absence of prior in-depth software or programming knowledge. Methods: RadaR was built in the open-source programming language R, using Shiny, an additional package to implement Web-app frameworks in R. It was developed in the context of a 1339-bed academic tertiary referral hospital to handle data of more than 180,000 admissions. Results: RadaR enabled visualization of analytical graphs and statistical summaries in a rapid and interactive manner. It allowed users to filter patient groups by 17 different criteria and investigate antimicrobial use, microbiological diagnostic use and results including antimicrobial resistance, and outcome in length of stay. Furthermore, with RadaR, results can be stratified and grouped to compare defined patient groups on the basis of individual patient features. Conclusions: AMS teams can use RadaR to identify areas within their institutions that might benefit from increased support and targeted interventions. It can be used for the assessment of diagnostic and therapeutic procedures and for visualizing and communicating analyses. RadaR demonstrated the feasibility of developing software tools for use in infection management and for AMS teams in an open-source approach, thus making it free to use and adaptable to different settings. %M 31199325 %R 10.2196/12843 %U https://www.jmir.org/2019/6/e12843/ %U https://doi.org/10.2196/12843 %U http://www.ncbi.nlm.nih.gov/pubmed/31199325 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e11036 %T Identifying Key Topics Bearing Negative Sentiment on Twitter: Insights Concerning the 2015-2016 Zika Epidemic %A Mamidi,Ravali %A Miller,Michele %A Banerjee,Tanvi %A Romine,William %A Sheth,Amit %+ Department of Biological Sciences, Wright State University, 3640 Colonel Glenn Hwy., Dayton, OH, 45435, United States, 1 5742613969, millerme91@gmail.com %K social media %K machine learning %K natural language processing %K epidemiology %K Zika %K infodemiology %K infoveillance %K twitter %K sentiment analysis %D 2019 %7 04.06.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: To understand the public sentiment regarding the Zika virus, social media can be leveraged to understand how positive, negative, and neutral sentiments are expressed in society. Specifically, understanding the characteristics of negative sentiment could help inform federal disease control agencies’ efforts to disseminate relevant information to the public about Zika-related issues. Objective: The purpose of this study was to analyze the public sentiment concerning Zika using posts on Twitter and determine the qualitative characteristics of positive, negative, and neutral sentiments expressed. Methods: Machine learning techniques and algorithms were used to analyze the sentiment of tweets concerning Zika. A supervised machine learning classifier was built to classify tweets into 3 sentiment categories: positive, neutral, and negative. Tweets in each category were then examined using a topic-modeling approach to determine the main topics for each category, with focus on the negative category. Results: A total of 5303 tweets were manually annotated and used to train multiple classifiers. These performed moderately well (F1 score=0.48-0.68) with text-based feature extraction. All 48,734 tweets were then categorized into the sentiment categories. Overall, 10 topics for each sentiment category were identified using topic modeling, with a focus on the negative sentiment category. Conclusions: Our study demonstrates how sentiment expressed within discussions of epidemics on Twitter can be discovered. This allows public health officials to understand public sentiment regarding an epidemic and enables them to address specific elements of negative sentiment in real time. Our negative sentiment classifier was able to identify tweets concerning Zika with 3 broad themes: neural defects,Zika abnormalities, and reports and findings. These broad themes were based on domain expertise and from topics discussed in journals such as Morbidity and Mortality Weekly Report and Vaccine. As the majority of topics in the negative sentiment category concerned symptoms, officials should focus on spreading information about prevention and treatment research. %M 31165711 %R 10.2196/11036 %U http://publichealth.jmir.org/2019/2/e11036/ %U https://doi.org/10.2196/11036 %U http://www.ncbi.nlm.nih.gov/pubmed/31165711 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e14216 %T Tools for the Diagnosis of Herpes Simplex Virus 1/2: Systematic Review of Studies Published Between 2012 and 2018 %A Arshad,Zeeshaan %A Alturkistani,Abrar %A Brindley,David %A Lam,Ching %A Foley,Kimberley %A Meinert,Edward %+ Healthcare Translation Research Group, Department of Paediatrics, University of Oxford, Level 2, Children's Hospital, John Radcliffe Hospital, Oxford, OX3 9DU, United Kingdom, 44 7824446808, edward.meinert@paediatrics.ox.ac.uk %K diagnostic techniques and procedures %K herpes simplex %K diagnosis %D 2019 %7 23.05.2019 %9 Review %J JMIR Public Health Surveill %G English %X Background: Herpes simplex virus (HSV)-1 and HSV-2 are common infections affecting the global population, with HSV-1 estimated to affect 67% of the global population. HSV can have rare but severe manifestations, such as encephalitis and neonatal herpes, necessitating the use of reliable and accurate diagnostic tools for the detection of the viruses. Currently used HSV diagnostic tools require highly specialized skills and availability of a laboratory setting but may lack sensitivity. The numerous recently developed HSV diagnostic tools need to be identified and compared in a systematic way to make the best decision about which diagnostic tool to use. The diagnosis of HSV is essential for prompt treatment with antivirals. To select the best test for a patient, knowledge of the performance and limitations of each test is critical. Objective: This systematic review has summarized recent studies evaluating HSV-1 and HSV-2 diagnostic tools. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, selection criteria, data extraction, and data analysis were determined before the commencement of the study. Studies assessing the specificity/sensitivity of HSV-1 or HSV-2 diagnostic tools published between 2012 and 2018 were included. Quality assessment of included studies was performed using the quality assessment of diagnostic accuracy studies (QUADAS-2) tool. Results: Searches of the PubMed database yielded 264 studies; 11 studies included 11 molecular assays, and 8 studies included 19 different serological assays for the detection of HSV-1, HSV-2, or both. A greater proportion of molecular assay–based tools are being developed by commercial entities. Studies that tested molecular assays mostly focused on cutaneous and mucosal HSV infections (n=13); 2 studies focused on ocular disease, whereas only 1 study focused on the central nervous system manifestations. The Simplexa HSV 1 & 2 Direct is currently the only Food and Drug Administration–approved device for use on cerebrospinal fluid. No tools focused on prenatal screening. We also present performance metrics of tests for benchmarking of future technology. Most of the included studies had a high risk of bias rating in half of the QUADAS-2 tool risk of bias domains. Conclusions: The use of serologic tests to diagnose genital lesions is inappropriate because positive results may be due to chronic infection, whereas negative results may overlook recent infection. The incidence of acute infections is rising. As these infections present the greatest risk to fetuses, work needs to be done to prevent vertical transfer. Prenatal screening for primary infection and subsequent medical intervention will assist in lowering the rate of neonatal herpes. In conclusion, HSV diagnosis is moving away from culture-based methods to serology-based or polymerase chain reaction–based methods. Sensitive, rapid, and efficient HSV diagnostic tools should be adopted for the prevention of acute infections and neonatal herpes. %M 31124465 %R 10.2196/14216 %U http://publichealth.jmir.org/2019/2/e14216/ %U https://doi.org/10.2196/14216 %U http://www.ncbi.nlm.nih.gov/pubmed/31124465 %0 Journal Article %@ 1929-073X %I JMIR Publications %V 8 %N 2 %P e12664 %T EasyDetectDisease: An Android App for Early Symptom Detection and Prevention of Childhood Infectious Diseases %A Ponum,Mahvish %A Hasan,Osman %A Khan,Saadia %+ School of Electrical Engineering and Computer Science, National University of Sciences and Technology, Islamabad, Pakistan, Islamabad, 440000, Pakistan, 92 3067826262, mponum.msit15seecs@seecs.edu.pk %K infectious diseases %K mHealth %K causes of death %D 2019 %7 14.05.2019 %9 Original Paper %J Interact J Med Res %G English %X Background: Infectious diseases often lead to death among children under 5 years in many underdeveloped and developing countries. One of the main reasons behind this is an unawareness of disease symptoms among mothers and child caregivers. To overcome this, we propose the EasyDetectDisease mobile health app to educate mothers about the early symptoms of pediatric diseases and to provide them with practical advice for preventing the spread of such diseases in children under 5 years. The EasyDetectDisease app includes detailed knowledge of infectious diseases, including the corresponding symptoms, causes, incubation period, preventive measures, nutritional guidelines such as breastfeeding, video tutorials of child patients, and video guidelines by pediatric health experts to promote child health. It also provides information on the diagnosis of the infectious diseases based on symptoms. Objective: The objective of this study was to evaluate the usability (eg, ease of use, easy detection of disease, functionality, and navigation of interfaces) of the EasyDetectDisease app among mothers of children under 5 years of age. Methods: Two health sessions, held in Pakistan, were used to evaluate the usability of EasyDetectDisease by 30 mothers of children under 5 years. The app was evaluated based on various quantitative and qualitative measures. Results: The participating mothers confirmed that they were able to diagnose diseases accurately and that after following the instructions provided, their children recovered rapidly without any nutritional deficiency. All participating mothers showed an interest in using the EasyDetectDisease app if made available by governmental public health agencies, and they suggested its inclusion in all mobile phones as a built-in health app in the future. Conclusions: EasyDetectDisease was modified into a user-friendly app based on feedback collected during the usability sessions. All participants found it acceptable and easy to use, especially illiterate mothers. The EasyDetectDisease app proved to be a useful tool for child health care at home and for the treatment of infectious diseases and is expected to reduce the mortality rate of children under 5 years of age. %M 31094329 %R 10.2196/12664 %U http://www.i-jmr.org/2019/2/e12664/ %U https://doi.org/10.2196/12664 %U http://www.ncbi.nlm.nih.gov/pubmed/31094329 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 5 %P e13090 %T Identifying Protective Health Behaviors on Twitter: Observational Study of Travel Advisories and Zika Virus %A Daughton,Ashlynn R %A Paul,Michael J %+ Information Science, University of Colorado, Boulder, Technology Learning Center, 1045 18th Street, UCB 315, Boulder, CO, 80309, United States, 1 303 735 7581, adaughton@lanl.gov %K social media %K travel %K behavior %K communicable diseases %K zika virus %K public health %K epidemiology %K information science %K travel-related illness %D 2019 %7 13.05.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: An estimated 3.9 billion individuals live in a location endemic for common mosquito-borne diseases. The emergence of Zika virus in South America in 2015 marked the largest known Zika outbreak and caused hundreds of thousands of infections. Internet data have shown promise in identifying human behaviors relevant for tracking and understanding other diseases. Objective: Using Twitter posts regarding the 2015-16 Zika virus outbreak, we sought to identify and describe considerations and self-disclosures of a specific behavior change relevant to the spread of disease—travel cancellation. If this type of behavior is identifiable in Twitter, this approach may provide an additional source of data for disease modeling. Methods: We combined keyword filtering and machine learning classification to identify first-person reactions to Zika in 29,386 English-language tweets in the context of travel, including considerations and reports of travel cancellation. We further explored demographic, network, and linguistic characteristics of users who change their behavior compared with control groups. Results: We found differences in the demographics, social networks, and linguistic patterns of 1567 individuals identified as changing or considering changing travel behavior in response to Zika as compared with a control sample of Twitter users. We found significant differences between geographic areas in the United States, significantly more discussion by women than men, and some evidence of differences in levels of exposure to Zika-related information. Conclusions: Our findings have implications for informing the ways in which public health organizations communicate with the public on social media, and the findings contribute to our understanding of the ways in which the public perceives and acts on risks of emerging infectious diseases. %M 31094347 %R 10.2196/13090 %U https://www.jmir.org/2019/5/e13090/ %U https://doi.org/10.2196/13090 %U http://www.ncbi.nlm.nih.gov/pubmed/31094347 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e10842 %T Text-Based Illness Monitoring for Detection of Novel Influenza A Virus Infections During an Influenza A (H3N2)v Virus Outbreak in Michigan, 2016: Surveillance and Survey %A Stewart,Rebekah J %A Rossow,John %A Eckel,Seth %A Bidol,Sally %A Ballew,Grant %A Signs,Kimberly %A Conover,Julie Thelen %A Burns,Erin %A Bresee,Joseph S %A Fry,Alicia M %A Olsen,Sonja J %A Biggerstaff,Matthew %+ Influenza Division, National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, 1600 Clifton Road NE, MS E-10, Atlanta, GA, 30333, United States, 1 404 718 4580, yxp5@cdc.gov %K influenza %K surveillance %K novel %K agricultural %K fairs %K texting %D 2019 %7 26.04.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Rapid reporting of human infections with novel influenza A viruses accelerates detection of viruses with pandemic potential and implementation of an effective public health response. After detection of human infections with influenza A (H3N2) variant (H3N2v) viruses associated with agricultural fairs during August 2016, the Michigan Department of Health and Human Services worked with the US Centers for Disease Control and Prevention (CDC) to identify infections with variant influenza viruses using a text-based illness monitoring system. Objective: To enhance detection of influenza infections using text-based monitoring and evaluate the feasibility and acceptability of the system for use in future outbreaks of novel influenza viruses. Methods: During an outbreak of H3N2v virus infections among agricultural fair attendees, we deployed a text-illness monitoring (TIM) system to conduct active illness surveillance among households of youth who exhibited swine at fairs. We selected all fairs with suspected H3N2v virus infections. For fairs without suspected infections, we selected only those fairs that met predefined criteria. Eligible respondents were identified and recruited through email outreach and/or on-site meetings at fairs. During the fairs and for 10 days after selected fairs, enrolled households received daily, automated text-messages inquiring about illness; reports of illness were investigated by local health departments. To understand the feasibility and acceptability of the system, we monitored enrollment and trends in participation and distributed a Web-based survey to households of exhibitors from five fairs. Results: Among an estimated 500 households with a member who exhibited swine at one of nine selected fairs, representatives of 87 (17.4%) households were enrolled, representing 392 household members. Among fairs that were ongoing when the TIM system was deployed, the number of respondents peaked at 54 on the third day of the fair and then steadily declined throughout the rest of the monitoring period; 19 out of 87 household representatives (22%) responded through the end of the 10-day monitoring period. We detected 2 H3N2v virus infections using the TIM system, which represents 17% (2/12) of all H3N2v virus infections detected during this outbreak in Michigan. Of the 70 survey respondents, 16 (23%) had participated in the TIM system. A total of 73% (11/15) participated because it was recommended by fair coordinators and 80% (12/15) said they would participate again. Conclusions: Using a text-message system, we monitored for illness among a large number of individuals and households and detected H3N2v virus infections through active surveillance. Text-based illness monitoring systems are useful for detecting novel influenza virus infections when active monitoring is necessary. Participant retention and testing of persons reporting illness are critical elements for system improvement. %M 31025948 %R 10.2196/10842 %U http://publichealth.jmir.org/2019/2/e10842/ %U https://doi.org/10.2196/10842 %U http://www.ncbi.nlm.nih.gov/pubmed/31025948 %0 Journal Article %@ 2291-9279 %I JMIR Publications %V 7 %N 2 %P e8540 %T FightHPV: Design and Evaluation of a Mobile Game to Raise Awareness About Human Papillomavirus and Nudge People to Take Action Against Cervical Cancer %A Ruiz-López,Tomás %A Sen,Sagar %A Jakobsen,Elisabeth %A Tropé,Ameli %A Castle,Philip E %A Hansen,Bo Terning %A Nygård,Mari %+ HPV Research Group, Department of Research, Cancer Registry of Norway, Ullernchausseen 64, 0379 Oslo, Norway, Oslo,, Norway, 47 95181886, mari.nygard@kreftregisteret.no %K papillomavirus vaccines %K educational technology %K uterine cervical neoplasms %K papillomavirus infections %K primary prevention %K secondary prevention %K early detection of cancer %K mobile applications %K health education %K learning %D 2019 %7 08.04.2019 %9 Original Paper %J JMIR Serious Games %G English %X Background: Human papillomavirus (HPV) is the most common sexually transmitted infection globally. High-risk HPV types can cause cervical cancer, other anogenital cancer, and oropharyngeal cancer; low-risk HPV types can cause genital warts. Cervical cancer is highly preventable through HPV vaccination and screening; however, a lack of awareness and knowledge of HPV and these preventive strategies represents an important barrier to reducing the burden of the disease. The rapid development and widespread use of mobile technologies in the last few years present an opportunity to overcome this lack of knowledge and create new, effective, and modern health communication strategies. Objective: This study aimed to describe the development of a mobile app called FightHPV, a game-based learning tool that educates mobile technology users about HPV, the disease risks associated with HPV infection, and existing preventive methods. Methods: The first version of FightHPV was improved in a design-development-evaluation loop, which incorporated feedback from a beta testing study of 40 participants, a first focus group of 6 participants aged between 40 and 50 years and a second focus group of 23 participants aged between 16 and 18 years. Gameplay data from the beta testing study were collected using Google Analytics (Google), whereas feedback from focus groups was evaluated qualitatively. Of the 29 focus group participants, 26 returned self-administered questionnaires. HPV knowledge before and after playing the game was evaluated in the 22 participants from the second focus group who returned a questionnaire. Results: FightHPV communicates concepts about HPV, associated diseases and their prevention by representing relationships among 14 characters in 6 episodes of 10 levels each, with each level being represented by a puzzle. Main concepts were reinforced with text explanations. Beta testing revealed that many players either failed or had to retry several times before succeeding at the more difficult levels in the game. It also revealed that players gave up at around level 47 of 60, which prompted the redesign of FightHPV to increase accessibility to all episodes. Focus group discussions led to several improvements in the user experience and dissemination of health information in the game, such as making all episodes available from the beginning of the game and rewriting the information in a more appealing way. Among the 26 focus group participants who returned a questionnaire, all stated that FightHPV is an appealing educational tool, 69% (18/26) reported that they liked the game, and 81% (21/26) stated that the game was challenging. We observed an increase in HPV knowledge after playing the game (P=.001). Conclusions: FightHPV was easy to access, use, and it increased awareness about HPV infection, its consequences, and preventive measures. FightHPV can be used to educate people to take action against HPV and cervical cancer. %M 30958271 %R 10.2196/games.8540 %U https://games.jmir.org/2019/2/e8540/ %U https://doi.org/10.2196/games.8540 %U http://www.ncbi.nlm.nih.gov/pubmed/30958271 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 5 %N 2 %P e12214 %T Improved Real-Time Influenza Surveillance: Using Internet Search Data in Eight Latin American Countries %A Clemente,Leonardo %A Lu,Fred %A Santillana,Mauricio %+ Computational Health Informatics Program, Boston Children's Hospital, 1 Autumn St, Boston, MA, 02215, United States, 1 617 919 1795, msantill@g.harvard.edu %K google flu trends %K influenza monitoring %K real-time disease surveillance %K digital epidemiology %K influenza, human %K developing countries %K machine learning %D 2019 %7 04.04.2019 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Novel influenza surveillance systems that leverage Internet-based real-time data sources including Internet search frequencies, social-network information, and crowd-sourced flu surveillance tools have shown improved accuracy over the past few years in data-rich countries like the United States. These systems not only track flu activity accurately, but they also report flu estimates a week or more ahead of the publication of reports produced by healthcare-based systems, such as those implemented and managed by the Centers for Disease Control and Prevention. Previous work has shown that the predictive capabilities of novel flu surveillance systems, like Google Flu Trends (GFT), in developing countries in Latin America have not yet delivered acceptable flu estimates. Objective: The aim of this study was to show that recent methodological improvements on the use of Internet search engine information to track diseases can lead to improved retrospective flu estimates in multiple countries in Latin America. Methods: A machine learning-based methodology that uses flu-related Internet search activity and historical information to monitor flu activity, named ARGO (AutoRegression with Google search), was extended to generate flu predictions for 8 Latin American countries (Argentina, Bolivia, Brazil, Chile, Mexico, Paraguay, Peru, and Uruguay) for the time period: January 2012 to December of 2016. These retrospective (out-of-sample) Influenza activity predictions were compared with historically observed flu suspected cases in each country, as reported by Flunet, an influenza surveillance database maintained by the World Health Organization. For a baseline comparison, retrospective (out-of-sample) flu estimates were produced for the same time period using autoregressive models that only leverage historical flu activity information. Results: Our results show that ARGO-like models’ predictive power outperform autoregressive models in 6 out of 8 countries in the 2012-2016 time period. Moreover, ARGO significantly improves on historical flu estimates produced by the now discontinued GFT for the time period of 2012-2015, where GFT information is publicly available. Conclusions: We demonstrate here that a self-correcting machine learning method, leveraging Internet-based disease-related search activity and historical flu trends, has the potential to produce reliable and timely flu estimates in multiple Latin American countries. This methodology may prove helpful to local public health officials who design and implement interventions aimed at mitigating the effects of influenza outbreaks. Our methodology generally outperforms both the now-discontinued tool GFT, and autoregressive methodologies that exploit only historical flu activity to produce future disease estimates. %M 30946017 %R 10.2196/12214 %U https://publichealth.jmir.org/2019/2/e12214/ %U https://doi.org/10.2196/12214 %U http://www.ncbi.nlm.nih.gov/pubmed/30946017 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 7 %N 4 %P e11687 %T Mobile Health for Tuberculosis Management in South India: Is Video-Based Directly Observed Treatment an Acceptable Alternative? %A Kumar,Anil A %A De Costa,Ayesha %A Das,Arundathi %A Srinivasa,GA %A D'Souza,George %A Rodrigues,Rashmi %+ Department of Community Health, St John's Medical College, St John's National Academy of Health Sciences, Koramangala 4th Block, Bangalore, 560034, India, 91 9845389538, rashmijr@gmail.com %K medical informatics %K tuberculosis %K mHealth %K adherence %K mobile phone %K reminder %K SMS %K voice call %K DOT %K vDOT %K video DOT %D 2019 %7 03.04.2019 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: With the availability of low-cost mobile devices and the ease of internet access, mobile health (mHealth) is digitally revolutionizing the health sector even in resource-constrained settings. It is however necessary to assess end-user perceptions before deploying potential interventions. Objective: This study aimed to assess the mobile phone usage patterns and the acceptability of mobile phone support during care and treatment in patients with tuberculosis (TB) in South India. Methods: This exploratory study was conducted at an urban private tertiary care teaching hospital and nearby public primary-level health care facilities in Bangalore, South India. We recruited 185 patients with TB through consecutive sampling. Subsequent to written informed consent, participants responded to an interviewer-administered pretested questionnaire. The questionnaire included questions on demographics, phone usage patterns, and the benefits of using of mobile phone technology to improve health outcomes and treatment adherence. Frequency, mean, median, and SD or interquartile range were used to describe the data. Bivariate associations were assessed between demographics, clinical details, phone usage, and mHealth communication preferences using the chi-square test and odds ratios. Associations with a P value ≤.20 were included in a logistic regression model. A P value of <.05 was considered significant. Results: Of the 185 participants, 151 (81.6%) used a mobile phone, and half of them owned a smartphone. The primary use of the mobile phone was to communicate over voice calls (147/151, 97.4%). The short message service (SMS) text messaging feature was used by only 66/151 (43.7%) mobile phone users. A total of 87 of the 151 mobile phone users (57.6%) knew how to use the camera. Only 41/151 (27.2%) mobile phone users had used their mobile phones to communicate with their health care providers. Although receiving medication reminders via mobile phones was acceptable to all participants, 2 participants considered repeated reminders as an intrusion of their privacy. A majority of the participants (137/185, 74.1%) preferred health communications via voice calls. Of the total participants, 123/185 (66.5%) requested reminders to be sent only at specific times during the day, 22/185 (11.9%) suggested reminders should synchronize with their prescribed medication schedule, whereas 40/185 (21.6%) did not have any time preferences. English literacy was associated with a preference for SMS in comparison with voice calls. Most participants (142/185, 76.8%) preferred video-based directly observed treatment when compared with in-person directly observed treatment. Conclusions: Although mobile phones for supporting health and treatment adherence were acceptable to patients with TB, mHealth interventions should consider language, mode of communication, and preferred timing for communication to improve uptake. %M 30942696 %R 10.2196/11687 %U http://mhealth.jmir.org/2019/4/e11687/ %U https://doi.org/10.2196/11687 %U http://www.ncbi.nlm.nih.gov/pubmed/30942696 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 3 %P e13699 %T Author Contribution Correction: An Integrated Influenza Surveillance Framework Based on National Influenza-Like Illness Incidence and Multiple Hospital Electronic Medical Records for Early Prediction of Influenza Epidemics: Design and Evaluation %A Yang,Cheng-Yi %A Chen,Ray-Jade %A Chou,Wan-Lin %A Lee,Yuarn-Jang %A Lo,Yu-Sheng %+ Graduate Institute of Biomedical Informatics, Taipei Medical University, 250 Wuxing Street, Taipei, 11031, Taiwan, 886 939588576, Loyusen@tmu.edu.tw %D 2019 %7 12.03.2019 %9 Corrigenda and Addenda %J J Med Internet Res %G English %X %M 30860974 %R 10.2196/13699 %U http://www.jmir.org/2019/3/e13699/ %U https://doi.org/10.2196/13699 %U http://www.ncbi.nlm.nih.gov/pubmed/30860974 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 21 %N 2 %P e12341 %T An Integrated Influenza Surveillance Framework Based on National Influenza-Like Illness Incidence and Multiple Hospital Electronic Medical Records for Early Prediction of Influenza Epidemics: Design and Evaluation %A Yang,Cheng-Yi %A Chen,Ray-Jade %A Chou,Wan-Lin %A Lee,Yuarn-Jang %A Lo,Yu-Sheng %+ Graduate Institute of Biomedical Informatics, Taipei Medical University, 250 Wuxing Street, Taipei, 11031, Taiwan, 886 939588576, Loyusen@tmu.edu.tw %K influenza %K epidemics %K influenza surveillance %K electronic disease surveillance %K electronic medical records %K electronic health records %K public health %D 2019 %7 01.02.2019 %9 Original Paper %J J Med Internet Res %G English %X Background: Influenza is a leading cause of death worldwide and contributes to heavy economic losses to individuals and communities. Therefore, the early prediction of and interventions against influenza epidemics are crucial to reduce mortality and morbidity because of this disease. Similar to other countries, the Taiwan Centers for Disease Control and Prevention (TWCDC) has implemented influenza surveillance and reporting systems, which primarily rely on influenza-like illness (ILI) data reported by health care providers, for the early prediction of influenza epidemics. However, these surveillance and reporting systems show at least a 2-week delay in prediction, indicating the need for improvement. Objective: We aimed to integrate the TWCDC ILI data with electronic medical records (EMRs) of multiple hospitals in Taiwan. Our ultimate goal was to develop a national influenza trend prediction and reporting tool more accurate and efficient than the current influenza surveillance and reporting systems. Methods: First, the influenza expertise team at Taipei Medical University Health Care System (TMUHcS) identified surveillance variables relevant to the prediction of influenza epidemics. Second, we developed a framework for integrating the EMRs of multiple hospitals with the ILI data from the TWCDC website to proactively provide results of influenza epidemic monitoring to hospital infection control practitioners. Third, using the TWCDC ILI data as the gold standard for influenza reporting, we calculated Pearson correlation coefficients to measure the strength of the linear relationship between TMUHcS EMRs and regional and national TWCDC ILI data for 2 weekly time series datasets. Finally, we used the Moving Epidemic Method analyses to evaluate each surveillance variable for its predictive power for influenza epidemics. Results: Using this framework, we collected the EMRs and TWCDC ILI data of the past 3 influenza seasons (October 2014 to September 2017). On the basis of the EMRs of multiple hospitals, 3 surveillance variables, TMUHcS-ILI, TMUHcS-rapid influenza laboratory tests with positive results (RITP), and TMUHcS-influenza medication use (IMU), which reflected patients with ILI, those with positive results from rapid influenza diagnostic tests, and those treated with antiviral drugs, respectively, showed strong correlations with the TWCDC regional and national ILI data (r=.86-.98). The 2 surveillance variables—TMUHcS-RITP and TMUHcS-IMU—showed predictive power for influenza epidemics 3 to 4 weeks before the increase noted in the TWCDC ILI reports. Conclusions: Our framework periodically integrated and compared surveillance data from multiple hospitals and the TWCDC website to maintain a certain prediction quality and proactively provide monitored results. Our results can be extended to other infectious diseases, mitigating the time and effort required for data collection and analysis. Furthermore, this approach may be developed as a cost-effective electronic surveillance tool for the early and accurate prediction of epidemics of influenza and other infectious diseases in densely populated regions and nations. %M 30707099 %R 10.2196/12341 %U http://www.jmir.org/2019/2/e12341/ %U https://doi.org/10.2196/12341 %U http://www.ncbi.nlm.nih.gov/pubmed/30707099 %0 Journal Article %@ 1929-0748 %I JMIR Publications %V 8 %N 1 %P e11333 %T Estimating Vaccine Effectiveness Against Hospitalized Influenza During Pregnancy: Multicountry Protocol for a Retrospective Cohort Study %A Naleway,Allison L %A Ball,Sarah %A Kwong,Jeffrey C %A Wyant,Brandy E %A Katz,Mark A %A Regan,Annette K %A Russell,Margaret L %A Klein,Nicola P %A Chung,Hannah %A Simmonds,Kimberley A %A Azziz-Baumgartner,Eduardo %A Feldman,Becca S %A Levy,Avram %A Fell,Deshayne B %A Drews,Steven J %A Garg,Shikha %A Effler,Paul %A Barda,Noam %A Irving,Stephanie A %A Shifflett,Patricia %A Jackson,Michael L %A Thompson,Mark G %+ Kaiser Permanente Northwest, Center for Health Research, 3800 North Interstate Avenue, Portland, OR, 97005, United States, 1 503 335 6352, allison.naleway@kpchr.org %K influenza %K pregnancy %K hospitalization %K epidemiology %K vaccines %D 2019 %7 21.01.2019 %9 Protocol %J JMIR Res Protoc %G English %X Background: Although pregnant women are believed to have elevated risks of severe influenza infection and are targeted for influenza vaccination, no study to date has examined influenza vaccine effectiveness (IVE) against laboratory-confirmed influenza-associated hospitalizations during pregnancy, primarily because this outcome poses many methodological challenges. Objective: The Pregnancy Influenza Vaccine Effectiveness Network (PREVENT) was formed in 2016 as an international collaboration with the Centers for Disease Control and Prevention; Abt Associates; and study sites in Australia, Canada, Israel, and the United States. The primary goal of this collaboration is to estimate IVE in preventing acute respiratory or febrile illness (ARFI) hospitalizations associated with laboratory-confirmed influenza virus infection during pregnancy. Secondary aims include (1) describing the incidence, clinical course, and severity of influenza-associated ARFI hospitalization during pregnancy; (2) comparing the characteristics of ARFI-hospitalized pregnant women who were tested for influenza with those who were not tested; (3) describing influenza vaccination coverage in pregnant women; and (4) comparing birth outcomes among women with laboratory-confirmed influenza-associated hospitalization versus other noninfluenza ARFI hospitalizations. Methods: For an initial assessment of IVE, sites identified a retrospective cohort of pregnant women aged from 18 to 50 years whose pregnancies overlapped with local influenza seasons from 2010 to 2016. Pregnancies were defined as those that ended in a live birth or stillbirth of at least 20 weeks gestation. The analytic sample for the primary IVE analysis was restricted to pregnant women who were hospitalized for ARFI during site-specific influenza seasons and clinically tested for influenza virus infection using real-time reverse transcription polymerase chain reaction. Results: We identified approximately 2 million women whose pregnancies overlapped with influenza seasons; 550,344 had at least one hospitalization during this time. After restricting to women who were hospitalized for ARFI and tested for influenza, the IVE analytic sample included 1005 women. Conclusions: In addition to addressing the primary question about the effectiveness of influenza vaccination, PREVENT data will address other important knowledge gaps including understanding the incidence, clinical course, and severity of influenza-related hospitalizations during pregnancy. The data infrastructure and international partnerships created for these analyses may be useful and informative for future influenza studies. International Registered Report Identifier (IRRID): DERR1-10.2196/11333 %M 30664495 %R 10.2196/11333 %U http://www.researchprotocols.org/2019/1/e11333/ %U https://doi.org/10.2196/11333 %U http://www.ncbi.nlm.nih.gov/pubmed/30664495 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 4 %P e11361 %T Real Time Influenza Monitoring Using Hospital Big Data in Combination with Machine Learning Methods: Comparison Study %A Poirier,Canelle %A Lavenu,Audrey %A Bertaud,Valérie %A Campillo-Gimenez,Boris %A Chazard,Emmanuel %A Cuggia,Marc %A Bouzillé,Guillaume %+ Laboratoire Traitement du Signal et de l'Image, Université de Rennes 1, 2 rue Henri Le Guilloux, Rennes, 35033, France, 33 667857225, canelle.poirier@outlook.fr %K electronic health records %K big data %K infodemiology %K infoveillance %K influenza %K machine learning %K Sentinelles network %D 2018 %7 21.12.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Traditional surveillance systems produce estimates of influenza-like illness (ILI) incidence rates, but with 1- to 3-week delay. Accurate real-time monitoring systems for influenza outbreaks could be useful for making public health decisions. Several studies have investigated the possibility of using internet users’ activity data and different statistical models to predict influenza epidemics in near real time. However, very few studies have investigated hospital big data. Objective: Here, we compared internet and electronic health records (EHRs) data and different statistical models to identify the best approach (data type and statistical model) for ILI estimates in real time. Methods: We used Google data for internet data and the clinical data warehouse eHOP, which included all EHRs from Rennes University Hospital (France), for hospital data. We compared 3 statistical models—random forest, elastic net, and support vector machine (SVM). Results: For national ILI incidence rate, the best correlation was 0.98 and the mean squared error (MSE) was 866 obtained with hospital data and the SVM model. For the Brittany region, the best correlation was 0.923 and MSE was 2364 obtained with hospital data and the SVM model. Conclusions: We found that EHR data together with historical epidemiological information (French Sentinelles network) allowed for accurately predicting ILI incidence rates for the entire France as well as for the Brittany region and outperformed the internet data whatever was the statistical model used. Moreover, the performance of the two statistical models, elastic net and SVM, was comparable. %M 30578212 %R 10.2196/11361 %U http://publichealth.jmir.org/2018/4/e11361/ %U https://doi.org/10.2196/11361 %U http://www.ncbi.nlm.nih.gov/pubmed/30578212 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 4 %P e10827 %T Dynamics of Health Agency Response and Public Engagement in Public Health Emergency: A Case Study of CDC Tweeting Patterns During the 2016 Zika Epidemic %A Chen,Shi %A Xu,Qian %A Buchenberger,John %A Bagavathi,Arunkumar %A Fair,Gabriel %A Shaikh,Samira %A Krishnan,Siddharth %+ Department of Public Health Sciences, University of North Carolina at Charlotte, 9021 University City Boulevard, Charlotte, NC, 28223, United States, 1 8148800738, schen56@uncc.edu %K Centers for Disease Control and Prevention %K public engagement %K Twitter %K time series analysis %K Zika epidemic %K social media %K twitter %K infodemiology %K infoveillance %D 2018 %7 22.11.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Social media have been increasingly adopted by health agencies to disseminate information, interact with the public, and understand public opinion. Among them, the Centers for Disease Control and Prevention (CDC) is one of the first US government health agencies to adopt social media during health emergencies and crisis. It had been active on Twitter during the 2016 Zika epidemic that caused 5168 domestic noncongenital cases in the United States. Objective: The aim of this study was to quantify the temporal variabilities in CDC’s tweeting activities throughout the Zika epidemic, public engagement defined as retweeting and replying, and Zika case counts. It then compares the patterns of these 3 datasets to identify possible discrepancy among domestic Zika case counts, CDC’s response on Twitter, and public engagement in this topic. Methods: All of the CDC-initiated tweets published in 2016 with corresponding retweets and replies were collected from 67 CDC–associated Twitter accounts. Both univariate and multivariate time series analyses were performed in each quarter of 2016 for domestic Zika case counts, CDC tweeting activities, and public engagement in the CDC-initiated tweets. Results: CDC sent out >84.0% (5130/6104) of its Zika tweets in the first quarter of 2016 when Zika case counts were low in the 50 US states and territories (only 560/5168, 10.8% cases and 662/38,885, 1.70% cases, respectively). While Zika case counts increased dramatically in the second and third quarters, CDC efforts on Twitter substantially decreased. The time series of public engagement in the CDC-initiated tweets generally differed among quarters and from that of original CDC tweets based on autoregressive integrated moving average model results. Both original CDC tweets and public engagement had the highest mutual information with Zika case counts in the second quarter. Furthermore, public engagement in the original CDC tweets was substantially correlated with and preceded actual Zika case counts. Conclusions: Considerable discrepancies existed among CDC’s original tweets regarding Zika, public engagement in these tweets, and actual Zika epidemic. The patterns of these discrepancies also varied between different quarters in 2016. CDC was much more active in the early warning of Zika, especially in the first quarter of 2016. Public engagement in CDC’s original tweets served as a more prominent predictor of actual Zika epidemic than the number of CDC’s original tweets later in the year. %M 30467106 %R 10.2196/10827 %U http://publichealth.jmir.org/2018/4/e10827/ %U https://doi.org/10.2196/10827 %U http://www.ncbi.nlm.nih.gov/pubmed/30467106 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 11 %P e10239 %T Text Messages Sent to Household Tuberculosis Contacts in Kampala, Uganda: Process Evaluation %A Meyer,Amanda J %A Babirye,Diana %A Armstrong-Hough,Mari %A Mark,David %A Ayakaka,Irene %A Katamba,Achilles %A Haberer,Jessica E %A Davis,J Lucian %+ Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Yale University, 60 College Street, PO Box 208034, New Haven, CT, 06520, United States, 1 203 785 3665, lucian.davis@yale.edu %K Africa %K fidelity %K implementation %K intervention %K short message service %K tuberculosis %D 2018 %7 20.11.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Previous studies have reported the inconsistent effectiveness of text messaging (short message service, SMS) for improving health outcomes, but few have examined to what degree the quality, or “fidelity,” of implementation may explain study results. Objective: The aim of this study was to determine the fidelity of a one-time text messaging (SMS) intervention to promote the uptake of tuberculosis evaluation services among household contacts of index patients with tuberculosis. Methods: From February to June 2017, we nested a process evaluation of text message (SMS) delivery within the intervention arm of a randomized controlled trial of tuberculosis contact investigation in Kampala, Uganda. Because mobile service providers in Uganda do not provide delivery confirmations, we asked household tuberculosis contacts to confirm the receipt of a one-time tuberculosis-related text message (SMS) by sending a text message (SMS) reply through a toll-free “short code.” Two weeks later, a research officer followed up by telephone to confirm the receipt of the one-time text message (SMS) and administer a survey. We considered participants lost to follow-up after 3 unsuccessful call attempts on 3 separate days over a 1-week period. Results: Of 206 consecutive household contacts, 119 had a text message (SMS) initiated from the server. While 33% (39/119) were children aged 5-14 years, including 20% (24/119) girls and 13% (15/119) boys, 18 % (21/119) were adolescents or young adults, including 12% (14/119) young women and 6% (7/119) young men. 50% (59/119) were adults, including 26% (31/119) women and 24% (28/119) men. Of 107 (90%) participants for whom we could ascertain text message (SMS) receipt status, 67% (72/107) confirmed text message (SMS) receipt, including 22% (24/107) by reply text message (SMS) and 45% (48/107) during the follow-up telephone survey. No significant clinical or demographic differences were observed between those who did and did not report receiving the text message (SMS). Furthermore, 52% (56/107) reported ever reading the SMS. The cumulative likelihood of a text message (SMS) reaching its target and being read and retained by a participant was 19%. Conclusions: The fidelity of a one-time text message (SMS) intervention to increase the uptake of household tuberculosis contact investigation and linkage to care was extremely low, a fact only discoverable through detailed process evaluation. This study suggests the need for systematic process monitoring and reporting of implementation fidelity in both research studies and programmatic interventions using mobile communications to improve health. %M 30459147 %R 10.2196/10239 %U http://mhealth.jmir.org/2018/11/e10239/ %U https://doi.org/10.2196/10239 %U http://www.ncbi.nlm.nih.gov/pubmed/30459147 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 11 %P e287 %T Using Video Technology to Increase Treatment Completion for Patients With Latent Tuberculosis Infection on 3-Month Isoniazid and Rifapentine: An Implementation Study %A Lam,Chee Kin %A McGinnis Pilote,Kara %A Haque,Ashraful %A Burzynski,Joseph %A Chuck,Christine %A Macaraig,Michelle %+ Bureau of Tuberculosis Control, New York City Department of Health and Mental Hygiene, 42-09 28th Street, CN72b, WS 24-017, Long Island City, NY, 11101, United States, 1 718 310 2538, clam4@health.nyc.gov %K computer-assisted therapy %K directly observed therapy %K mobile phone %K telemedicine %K videoconferencing %D 2018 %7 20.11.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Since January 2013, the New York City (NYC) Health Department Tuberculosis (TB) Program has offered persons diagnosed with latent TB infection (LTBI) the 3-month, once-weekly isoniazid and rifapentine (3HP) treatment regimen. Patients on this treatment are monitored in-person under directly observed therapy (DOT). To address patient and provider barriers to in-person DOT, we piloted the use of a videoconferencing software app to remotely conduct synchronous DOT (video directly observed therapy; VDOT) for patients on 3HP. Objective: The objective of our study was to evaluate the implementation of VDOT for patients on 3HP and to assess whether treatment completion for these patients increased when they were monitored using VDOT compared with that using the standard in-person DOT. Methods: Between February and October 2015, patients diagnosed with LTBI at any of the four NYC Health Department TB clinics who met eligibility criteria for treatment with 3HP under VDOT (V3HP) were followed until 16 weeks after treatment initiation, with treatment completion defined as ingestion of 11 doses within 16 weeks. Treatment completion of patients on V3HP was compared with that of patients on 3HP under clinic-based, in-person DOT who were part of a prior study in 2013. Furthermore, outcomes of video sessions with V3HP patients were collected and analyzed. Results: During the study period, 70% (50/71) of eligible patients were placed on V3HP. Treatment completion among V3HP patients was 88% (44/50) compared with 64.9% (196/302) among 3HP patients on clinic DOT (P<.001). A total of 360 video sessions were conducted for V3HP patients with a median of 8 (range: 1-11) sessions per patient and a median time of 4 (range: 1-59) minutes per session. Adherence issues (eg, >15 minutes late) during video sessions occurred 104 times. No major side effects were reported by V3HP patients. Conclusions: The NYC TB program observed higher treatment completion with VDOT than that previously seen with clinic DOT among patients on 3HP. Expanding the use of VDOT may improve treatment completion and corresponding outcomes for patients with LTBI. %M 30459146 %R 10.2196/jmir.9825 %U https://www.jmir.org/2018/11/e287/ %U https://doi.org/10.2196/jmir.9825 %U http://www.ncbi.nlm.nih.gov/pubmed/30459146 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 11 %P e11541 %T Feasibility, Acceptability, and Adoption of Digital Fingerprinting During Contact Investigation for Tuberculosis in Kampala, Uganda: A Parallel-Convergent Mixed-Methods Analysis %A White,Elizabeth B %A Meyer,Amanda J %A Ggita,Joseph M %A Babirye,Diana %A Mark,David %A Ayakaka,Irene %A Haberer,Jessica E %A Katamba,Achilles %A Armstrong-Hough,Mari %A Davis,John Lucian %+ Department of Epidemiology of Microbial Diseases, Yale School of Public Health, Laboratory of Epidemiology and Public Health, 60 College Street, New Haven, CT, 06510, United States, 1 (203) 785 2867, lucian.davis@yale.edu %K biometrics %K mHealth %K mobile phone %K tuberculosis %D 2018 %7 15.11.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: In resource-constrained settings, challenges with unique patient identification may limit continuity of care, monitoring and evaluation, and data integrity. Biometrics offers an appealing but understudied potential solution. Objective: The objective of this mixed-methods study was to understand the feasibility, acceptability, and adoption of digital fingerprinting for patient identification in a study of household tuberculosis contact investigation in Kampala, Uganda. Methods: Digital fingerprinting was performed using multispectral fingerprint scanners. We tested associations between demographic, clinical, and temporal characteristics and failure to capture a digital fingerprint. We used generalized estimating equations and a robust covariance estimator to account for clustering. In addition, we evaluated the clustering of outcomes by household and community health workers (CHWs) by calculating intraclass correlation coefficients (ICCs). To understand the determinants of intended and actual use of fingerprinting technology, we conducted 15 in-depth interviews with CHWs and applied a widely used conceptual framework, the Technology Acceptance Model 2 (TAM2). Results: Digital fingerprints were captured for 75.5% (694/919) of participants, with extensive clustering by household (ICC=.99) arising from software (108/179, 60.3%) and hardware (65/179, 36.3%) failures. Clinical and demographic characteristics were not markedly associated with fingerprint capture. CHWs successfully fingerprinted all contacts in 70.1% (213/304) of households, with modest clustering of outcomes by CHWs (ICC=.18). The proportion of households in which all members were successfully fingerprinted declined over time (ρ=.30, P<.001). In interviews, CHWs reported that fingerprinting failures lowered their perceptions of the quality of the technology, threatened their social image as competent health workers, and made the technology more difficult to use. Conclusions: We found that digital fingerprinting was feasible and acceptable for individual identification, but problems implementing the hardware and software lead to a high failure rate. Although CHWs found fingerprinting to be acceptable in principle, their intention to use the technology was tempered by perceptions that it was inconsistent and of questionable value. TAM2 provided a valuable framework for understanding the motivations behind CHWs’ intentions to use the technology. We emphasize the need for routine process evaluation of biometrics and other digital technologies in resource-constrained settings to assess implementation effectiveness and guide improvement of delivery. %M 30442637 %R 10.2196/11541 %U http://www.jmir.org/2018/11/e11541/ %U https://doi.org/10.2196/11541 %U http://www.ncbi.nlm.nih.gov/pubmed/30442637 %0 Journal Article %@ 2369-3762 %I JMIR Publications %V 4 %N 2 %P e10347 %T Use of Grading of Recommendations, Assessment, Development, and Evaluation to Combat Fake News: A Case Study of Influenza Vaccination in Pregnancy %A Zafar,Sidra %A Habboush,Yacob %A Beidas,Sary %+ Department of Internal Medicine, Orange Park Medical Center, 2001 Kingsley Avenue, Orange Park, Jacksonville, FL, 32073, United States, 1 904 639 8500, sary.beidas@hcahealthcare.com %K GRADE %K influenza %K vaccination %K spontaneous abortion %K miscarriage %D 2018 %7 07.11.2018 %9 Review %J JMIR Med Educ %G English %X Background: The Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework is a validated evaluation tool used to assess the quality of scientific publications. It helps in enhancing clinicians’ decision-making process and supports production of informed healthy policy. Objective: The purpose of this report was two-fold. First, we reviewed the interpretation of observational studies. The second purpose was to share or provide an example using the GRADE criteria. Methods: To illustrate the use of the GRADE framework to assess publications, we selected a study evaluating the risk of spontaneous abortion (SAB) after influenza vaccine administration. Results: Since 2004, the Centers for Disease Control and Prevention and the Advisory Committee on Immunization Practice have recommended influenza vaccination of pregnant women. Previous studies have not found an association between influenza vaccination and SAB. However, in a recent case-control study by Donahue et al, a correlation with SAB in women who received the H1N1 influenza vaccine was identified. For women who received H1N1–containing vaccine in the previous and current influenza season, the adjusted odds ratio (aOR) for SAB was 7.7 (95% CI, 2.2-27.3), while the aOR for women not vaccinated in the previous season but vaccinated in the current season was 1.3 (95% CI, 0.7-2.7). Conclusions: Our goal is to enable the readers to critique published literature using appropriate evaluation tools such as GRADE. %M 30404772 %R 10.2196/10347 %U http://mededu.jmir.org/2018/2/e10347/ %U https://doi.org/10.2196/10347 %U http://www.ncbi.nlm.nih.gov/pubmed/30404772 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 4 %P e68 %T Assessing the Concepts and Designs of 58 Mobile Apps for the Management of the 2014-2015 West Africa Ebola Outbreak: Systematic Review %A Tom-Aba,Daniel %A Nguku,Patrick Mboya %A Arinze,Chinedu Chukwujekwu %A Krause,Gerard %+ Department of Epidemiology, Helmholtz Centre for Infection Research (HZI), Inhoffen Strasse 7, Braunschweig, 38124, Germany, 49 01739136081, daniel.tom-aba@helmholtz-hzi.de %K case management %K contact tracing %K Ebola virus disease %K eHealth %K mHealth %K systematic review %K West Africa %D 2018 %7 29.10.2018 %9 Review %J JMIR Public Health Surveill %G English %X Background: The use of mobile phone information technology (IT) in the health sector has received much attention especially during the 2014-2015 Ebola virus disease (EVD) outbreak. mHealth can be attributed to a major improvement in EVD control, but there lacks an overview of what kinds of tools were available and used based on the functionalities they offer. Objective: We aimed to conduct a systematic review of mHealth tools in the context of the recent EVD outbreak to identify the most promising approaches and guide further mHealth developments for infectious disease control. Methods: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we searched for all reports on mHealth tools developed in the context of the 2014-2015 EVD outbreak published between January 1, 2014 and December 31, 2015 on Google Scholar, MEDLINE, CAB Abstracts (Global Health), POPLINE, and Web of Science in any language using the search strategy: (“outbreak” OR “epidemic”) AND (“mobile phone” OR “smartphone” OR “smart phone” OR “mobile phone” OR “tablet” OR “mHealth”) AND (“Ebola” OR ”EVD” OR “VHF” OR “Ebola virus disease” OR “viral hemorrhagic fever”) AND (“2014” OR “2015”). The relevant publications were selected by 2 independent reviewers who applied a standardized data extraction form on the tools’ functionalities. Results: We identified 1220 publications through the search strategy, of which 6.31% (77/1220) were original publications reporting on 58 specific mHealth tools in the context of the EVD outbreak. Of these, 62% (34/55) offered functionalities for surveillance, 22% (10/45) for case management, 18% (7/38) for contact tracing, and 6% (3/51) for laboratory data management. Only 3 tools, namely Community Care, Sense Ebola Followup, and Surveillance and Outbreak Response Management and Analysis System supported all four of these functionalities. Conclusions: Among the 58 identified tools related to EVD management in 2014 and 2015, only 3 appeared to contain all 4 key functionalities relevant for the response to EVD outbreaks and may be most promising for further development. %M 30373727 %R 10.2196/publichealth.9015 %U http://publichealth.jmir.org/2018/4/e68/ %U https://doi.org/10.2196/publichealth.9015 %U http://www.ncbi.nlm.nih.gov/pubmed/30373727 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 3 %P e65 %T Twitter-Based Influenza Detection After Flu Peak via Tweets With Indirect Information: Text Mining Study %A Wakamiya,Shoko %A Kawai,Yukiko %A Aramaki,Eiji %+ Nara Institute of Science and Technology, 8916-5 Takayama-cho, Ikoma, 630 0192, Japan, 81 743 72 6053, socialcomputing-office@is.naist.jp %K influenza surveillance %K location mention %K Twitter %K social network %K spatial analysis %K internet %K microblog %K infodemiology %K infoveillance %D 2018 %7 25.9.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The recent rise in popularity and scale of social networking services (SNSs) has resulted in an increasing need for SNS-based information extraction systems. A popular application of SNS data is health surveillance for predicting an outbreak of epidemics by detecting diseases from text messages posted on SNS platforms. Such applications share the following logic: they incorporate SNS users as social sensors. These social sensor–based approaches also share a common problem: SNS-based surveillance are much more reliable if sufficient numbers of users are active, and small or inactive populations produce inconsistent results. Objective: This study proposes a novel approach to estimate the trend of patient numbers using indirect information covering both urban areas and rural areas within the posts. Methods: We presented a TRAP model by embedding both direct information and indirect information. A collection of tweets spanning 3 years (7 million influenza-related tweets in Japanese) was used to evaluate the model. Both direct information and indirect information that mention other places were used. As indirect information is less reliable (too noisy or too old) than direct information, the indirect information data were not used directly and were considered as inhibiting direct information. For example, when indirect information appeared often, it was considered as signifying that everyone already had a known disease, leading to a small amount of direct information. Results: The estimation performance of our approach was evaluated using the correlation coefficient between the number of influenza cases as the gold standard values and the estimated values by the proposed models. The results revealed that the baseline model (BASELINE+NLP) shows .36 and that the proposed model (TRAP+NLP) improved the accuracy (.70, +.34 points). Conclusions: The proposed approach by which the indirect information inhibits direct information exhibited improved estimation performance not only in rural cities but also in urban cities, which demonstrated the effectiveness of the proposed method consisting of a TRAP model and natural language processing (NLP) classification. %M 30274968 %R 10.2196/publichealth.8627 %U http://publichealth.jmir.org/2018/3/e65/ %U https://doi.org/10.2196/publichealth.8627 %U http://www.ncbi.nlm.nih.gov/pubmed/30274968 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 8 %P e10886 %T Cloud Computing for Infectious Disease Surveillance and Control: Development and Evaluation of a Hospital Automated Laboratory Reporting System %A Wang,Mei-Hua %A Chen,Han-Kun %A Hsu,Min-Huei %A Wang,Hui-Chi %A Yeh,Yu-Ting %+ Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, 250 Wuxing Street, Taipei,, Taiwan, 886 22490088 ext 8901, yuting@tmu.edu.tw %K laboratory autoreporting system %K HALR %K electronic medical records %D 2018 %7 08.08.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Outbreaks of several serious infectious diseases have occurred in recent years. In response, to mitigate public health risks, countries worldwide have dedicated efforts to establish an information system for effective disease monitoring, risk assessment, and early warning management for international disease outbreaks. A cloud computing framework can effectively provide the required hardware resources and information access and exchange to conveniently connect information related to infectious diseases and develop a cross-system surveillance and control system for infectious diseases. Objective: The objective of our study was to develop a Hospital Automated Laboratory Reporting (HALR) system based on such a framework and evaluate its effectiveness. Methods: We collected data for 6 months and analyzed the cases reported within this period by the HALR and the Web-based Notifiable Disease Reporting (WebNDR) systems. Furthermore, system evaluation indicators were gathered, including those evaluating sensitivity and specificity. Results: The HALR system reported 15 pathogens and 5174 cases, and the WebNDR system reported 34 cases. In a comparison of the two systems, sensitivity was 100% and specificity varied according to the reported pathogens. In particular, the specificity for Streptococcus pneumoniae, Mycobacterium tuberculosis complex, and hepatitis C virus were 99.8%, 96.6%, and 97.4%, respectively. However, the specificity for influenza virus and hepatitis B virus were only 79.9% and 47.1%, respectively. After the reported data were integrated with patients’ diagnostic results in their electronic medical records (EMRs), the specificity for influenza virus and hepatitis B virus increased to 89.2% and 99.1%, respectively. Conclusions: The HALR system can provide early reporting of specified pathogens according to test results, allowing for early detection of outbreaks and providing trends in infectious disease data. The results of this study show that the sensitivity and specificity of early disease detection can be increased by integrating the reported data in the HALR system with the cases’ clinical information (eg, diagnostic results) in EMRs, thereby enhancing the control and prevention of infectious diseases. %M 30089608 %R 10.2196/10886 %U http://www.jmir.org/2018/8/e10886/ %U https://doi.org/10.2196/10886 %U http://www.ncbi.nlm.nih.gov/pubmed/30089608 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e10218 %T A Surveillance Infrastructure for Malaria Analytics: Provisioning Data Access and Preservation of Interoperability %A Al Manir,Mohammad Sadnan %A Brenas,Jon Haël %A Baker,Christopher JO %A Shaban-Nejad,Arash %+ Oak Ridge National Laboratory Center for for Biomedical Informatics, Department of Pediatrics, The University of Tennessee Health Science Center, 50 N Dunlap Street, R492, Memphis, TN, 38103, United States, 1 901 287 5836, ashabann@uthsc.edu %K malaria surveillance %K global health %K interoperability %K change management %K Web services %K population health intelligence %D 2018 %7 15.06.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: According to the World Health Organization, malaria surveillance is weakest in countries and regions with the highest malaria burden. A core obstacle is that the data required to perform malaria surveillance are fragmented in multiple data silos distributed across geographic regions. Furthermore, consistent integrated malaria data sources are few, and a low degree of interoperability exists between them. As a result, it is difficult to identify disease trends and to plan for effective interventions. Objective: We propose the Semantics, Interoperability, and Evolution for Malaria Analytics (SIEMA) platform for use in malaria surveillance based on semantic data federation. Using this approach, it is possible to access distributed data, extend and preserve interoperability between multiple dynamic distributed malaria sources, and facilitate detection of system changes that can interrupt mission-critical global surveillance activities. Methods: We used Semantic Automated Discovery and Integration (SADI) Semantic Web Services to enable data access and improve interoperability, and the graphical user interface-enabled semantic query engine HYDRA to implement the target queries typical of malaria programs. We implemented a custom algorithm to detect changes to community-developed terminologies, data sources, and services that are core to SIEMA. This algorithm reports to a dashboard. Valet SADI is used to mitigate the impact of changes by rebuilding affected services. Results: We developed a prototype surveillance and change management platform from a combination of third-party tools, community-developed terminologies, and custom algorithms. We illustrated a methodology and core infrastructure to facilitate interoperable access to distributed data sources using SADI Semantic Web services. This degree of access makes it possible to implement complex queries needed by our user community with minimal technical skill. We implemented a dashboard that reports on terminology changes that can render the services inactive, jeopardizing system interoperability. Using this information, end users can control and reactively rebuild services to preserve interoperability and minimize service downtime. Conclusions: We introduce a framework suitable for use in malaria surveillance that supports the creation of flexible surveillance queries across distributed data resources. The platform provides interoperable access to target data sources, is domain agnostic, and with updates to core terminological resources is readily transferable to other surveillance activities. A dashboard enables users to review changes to the infrastructure and invoke system updates. The platform significantly extends the range of functionalities offered by malaria information systems, beyond the state-of-the-art. %M 29907554 %R 10.2196/10218 %U http://publichealth.jmir.org/2018/2/e10218/ %U https://doi.org/10.2196/10218 %U http://www.ncbi.nlm.nih.gov/pubmed/29907554 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 2 %P e36 %T Validation of a Natural Language Processing Algorithm for Detecting Infectious Disease Symptoms in Primary Care Electronic Medical Records in Singapore %A Hardjojo,Antony %A Gunachandran,Arunan %A Pang,Long %A Abdullah,Mohammed Ridzwan Bin %A Wah,Win %A Chong,Joash Wen Chen %A Goh,Ee Hui %A Teo,Sok Huang %A Lim,Gilbert %A Lee,Mong Li %A Hsu,Wynne %A Lee,Vernon %A Chen,Mark I-Cheng %A Wong,Franco %A Phang,Jonathan Siung King %+ Saw Swee Hock School of Public Health, National University Health System, National University of Singapore, MD1, #10-01, 12 Science Drive 2, Singapore, 117549, Singapore, 65 65165781, mark_chen@nuhs.edu.sg %K natural language processing %K communicable diseases %K epidemiology %K surveillance %K syndromic surveillance %K electronic health records %D 2018 %7 11.6.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Free-text clinical records provide a source of information that complements traditional disease surveillance. To electronically harness these records, they need to be transformed into codified fields by natural language processing algorithms. Objective: The aim of this study was to develop, train, and validate Clinical History Extractor for Syndromic Surveillance (CHESS), an natural language processing algorithm to extract clinical information from free-text primary care records. Methods: CHESS is a keyword-based natural language processing algorithm to extract 48 signs and symptoms suggesting respiratory infections, gastrointestinal infections, constitutional, as well as other signs and symptoms potentially associated with infectious diseases. The algorithm also captured the assertion status (affirmed, negated, or suspected) and symptom duration. Electronic medical records from the National Healthcare Group Polyclinics, a major public sector primary care provider in Singapore, were randomly extracted and manually reviewed by 2 human reviewers, with a third reviewer as the adjudicator. The algorithm was evaluated based on 1680 notes against the human-coded result as the reference standard, with half of the data used for training and the other half for validation. Results: The symptoms most commonly present within the 1680 clinical records at the episode level were those typically present in respiratory infections such as cough (744/7703, 9.66%), sore throat (591/7703, 7.67%), rhinorrhea (552/7703, 7.17%), and fever (928/7703, 12.04%). At the episode level, CHESS had an overall performance of 96.7% precision and 97.6% recall on the training dataset and 96.0% precision and 93.1% recall on the validation dataset. Symptoms suggesting respiratory and gastrointestinal infections were all detected with more than 90% precision and recall. CHESS correctly assigned the assertion status in 97.3%, 97.9%, and 89.8% of affirmed, negated, and suspected signs and symptoms, respectively (97.6% overall accuracy). Symptom episode duration was correctly identified in 81.2% of records with known duration status. Conclusions: We have developed an natural language processing algorithm dubbed CHESS that achieves good performance in extracting signs and symptoms from primary care free-text clinical records. In addition to the presence of symptoms, our algorithm can also accurately distinguish affirmed, negated, and suspected assertion statuses and extract symptom durations. %M 29907560 %R 10.2196/medinform.8204 %U http://medinform.jmir.org/2018/2/e36/ %U https://doi.org/10.2196/medinform.8204 %U http://www.ncbi.nlm.nih.gov/pubmed/29907560 %0 Journal Article %@ 2291-5222 %I JMIR Publications %V 6 %N 6 %P e136 %T A New Influenza-Tracking Smartphone App (Flu-Report) Based on a Self-Administered Questionnaire: Cross-Sectional Study %A Fujibayashi,Kazutoshi %A Takahashi,Hiromizu %A Tanei,Mika %A Uehara,Yuki %A Yokokawa,Hirohide %A Naito,Toshio %+ Department of General Medicine, School of Medicine, Juntendo University, 3-1-3, Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan, 81 3 5802 1190, kfujiba@juntendo.ac.jp %K influenza %K epidemiology %K pandemics %K internet %K participatory surveillance %K participatory epidemiology %D 2018 %7 06.06.2018 %9 Original Paper %J JMIR Mhealth Uhealth %G English %X Background: Influenza infections can spread rapidly, and influenza outbreaks are a major public health concern worldwide. Early detection of signs of an influenza pandemic is important to prevent global outbreaks. Development of information and communications technologies for influenza surveillance, including participatory surveillance systems involving lay users, has recently increased. Many of these systems can estimate influenza activity faster than the conventional influenza surveillance systems. Unfortunately, few of these influenza-tracking systems are available in Japan. Objective: This study aimed to evaluate the flu-tracking ability of Flu-Report, a new influenza-tracking mobile phone app that uses a self-administered questionnaire for the early detection of influenza activity. Methods: Flu-Report was used to collect influenza-related information (ie, dates on which influenza infections were diagnosed) from November 2016 to March 2017. Participants were adult volunteers from throughout Japan, who also provided information about their cohabiting family members. The utility of Flu-Report was evaluated by comparison with the conventional influenza surveillance information and basic information from an existing large-scale influenza-tracking system (an automatic surveillance system based on electronic records of prescription drug purchases). Results: Information was obtained through Flu-Report for approximately 10,094 volunteers. In total, 2134 participants were aged <20 years, 6958 were aged 20-59 years, and 1002 were aged ≥60 years. Between November 2016 and March 2017, 347 participants reported they had influenza or an influenza-like illness in the 2016 season. Flu-Report-derived influenza infection time series data displayed a good correlation with basic information obtained from the existing influenza surveillance system (rho, ρ=.65, P=.001). However, the influenza morbidity ratio for our participants was approximately 25% of the mean influenza morbidity ratio for the Japanese population. The Flu-Report influenza morbidity ratio was 5.06% (108/2134) among those aged <20 years, 3.16% (220/6958) among those aged 20-59 years, and 0.59% (6/1002) among those aged ≥60 years. In contrast, influenza morbidity ratios for Japanese individuals aged <20 years, 20-59 years, and ≥60 years were recently estimated at 31.97% to 37.90%, 8.16% to 9.07%, and 2.71% to 4.39%, respectively. Conclusions: Flu-Report supports easy access to near real-time information about influenza activity via the accumulation of self-administered questionnaires. However, Flu-Report users may be influenced by selection bias, which is a common issue associated with surveillance using information and communications technologies. Despite this, Flu-Report has the potential to provide basic data that could help detect influenza outbreaks. %R 10.2196/mhealth.9834 %U http://mhealth.jmir.org/2018/6/e136/ %U https://doi.org/10.2196/mhealth.9834 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 2 %P e40 %T Estimating the Risk of Influenza-Like Illness Transmission Through Social Contacts: Web-Based Participatory Cohort Study %A Chan,Ta-Chien %A Hu,Tsuey-Hwa %A Hwang,Jing-Shiang %+ Institute of Statistical Science, Academia Sinica, 128 Academia Road, Section 2, Taipei City, 115, Taiwan, 886 2 2783 5611, hwang@sinica.edu.tw %K flu transmission %K social networks %K contact diary %K diet %K exercise %K sleep quality %D 2018 %7 09.04.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Epidemiological studies on influenza have focused mostly on enhancing vaccination coverage or promoting personal hygiene behavior. Few studies have investigated potential effects of personal health behaviors and social contacts on the risk of getting influenza-like illness (ILI). Objective: Taking advantage of an online participatory cohort, this study aimed to estimate the increased risk of getting ILI after contact with infected persons and examine how personal health behaviors, weather, and air pollution affect the probability of getting ILI. Methods: A Web-based platform was designed for participants to record daily health behaviors and social contacts during the influenza season of October 1, 2015 to March 31, 2016, in Taiwan. Data on sleep, diet, physical activity, self-reported ILI, and contact with infected persons were retrieved from the diaries. Measurements of weather and air pollutants were used for calculating environmental exposure levels for the participants. We fitted a mixed-effects logistic regression model to the daily measurements of the diary keepers to estimate the effects of these variables on the risk of getting ILI. Results: During the influenza season, 160 participants provided 14,317 health diaries and recorded 124,222 face-to-face contacts. The model estimated odds ratio of getting ILI was 1.87 (95% CI 1.40-2.50) when a person had contact with others having ILI in the previous 3 days. Longer duration of physical exercise and eating more fruits, beans, and dairy products were associated with lower risk of getting ILI. However, staying up late was linked to an elevated risk of getting ILI. Higher variation of ambient temperature and worse air quality were associated with increased risk of developing ILI. Conclusions: Developing a healthier lifestyle, avoiding contact with persons having ILI symptoms, and staying alert with respect to temperature changes and air quality can reduce the risk of getting ILI. %M 29631987 %R 10.2196/publichealth.8874 %U http://publichealth.jmir.org/2018/2/e40/ %U https://doi.org/10.2196/publichealth.8874 %U http://www.ncbi.nlm.nih.gov/pubmed/29631987 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 4 %N 1 %P e10640 %T Surveillance and Molecular Epidemiology of Avian Influenza H9N2 Viruses Circulating in Pakistan %A Farooq Tahir,Muhammad %D 2018 %7 29.03.2018 %9 Abstract %J iproc %G English %X Background: Avian influenza H9N2 is highly endemic in commercial and backyard poultry in Pakistan. Its widespread circulation and high mutation rates provide a possibility of novel reassorted viruses hence posing a serious public health threat. Objective: This study was aimed to isolate and evaluate the AI H9N2 viruses circulating in poultry as well as aquatic birds in Pakistan between 2014 and 2017. Methods: Specimens were collected from morbid or dead birds suspected for AI H9N2 on the basis of clinical signs or post-mortem lesions brought to five poultry diagnostic laboratories in Punjab. The samples were subjected for virus isolation. The isolates then were confirmed for H and N type using PCR. Six isolates were subjected to phylogenetic analysis of Haemagglutinin gene. The results were compared with isolate reported previously from Pakistan and other regional countries for homology. Results: 129,622 samples from 7481 poultry flocks were processed, 5.3% (399/7481) were positive for AIV H9N2. Sequence analysis showed that it had homology of 84-93% with different regional strains. Changes were seen at 24 different sites and at cleavage site at K148R and I151R in comparison to previous Pakistani isolates. Six possible glycosylation sites were observed. Neighbor joining phylogenetic tree confirmed its 93.4% homology with the isolate of Iran. The isolates were the same clade as other regional isolates and have common ancestors. Conclusions: The prevailing H9N2 viruses in Pakistan have certain markers and elements in the HA gene that may improve its avian to human transmission. Continuous surveillance of influenza A viruses is necessary to monitor their antigenic determinants. Protocols for the AI surveillance have officially been notified by Department of Livestock & Dairy Development Department, Punjab as a result of these findings. %R 10.2196/10640 %U http://www.iproc.org/2018/1/e10640/ %U https://doi.org/10.2196/10640 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 4 %N 1 %P e10619 %T Evaluation of Lab-based Influenza Surveillance System in Pakistan, 2017 %A Noreen,Nadia %D 2018 %7 29.03.2018 %9 Abstract %J iproc %G English %X Background: Globally 5-10% of adults and 20-30% of the children are affected by influenza annually. Annual epidemics results in 3-5 million cases and 500,000 deaths. Influenza is a common illness in Pakistan however absence of a robust surveillance system makes assessment of burden of disease an issue. Objective: The study was conducted to identify key strengths and weaknesses of the system and to make recommendations based on findings. Methods: An evaluative descriptive study was conducted from April to July 2017. The Lab-based Influenza Surveillance System was conducted at the national level. Assessment of qualitative and quantitative system attributes was done utilizing the CDC’s Updated Guidelines for Evaluating Public Health Surveillance Systems, 2001. Desk review of literature, departmental documents and reports were also conducted. The stakeholders were identified and interviewed using a semi-structured questionnaire. Results: The system was found to be simple and easy to operate but less flexible to integrate with other diseases. Data quality was good as 80% of observed forms were completely filled. Timeliness was good as the data takes 24-48 hours from sample collection to report submission to the central level. Acceptability is good as private and public-sector hospitals and labs are involved. Sensitivity calculated was 62% and Predictive Value Positive (PVP) was 37.2%. The representativeness of Lab based influenza surveillance system is poor as it is a sentinel surveillance with specific reporting sites strategically placed. Data from all sentinel sites is analyzed at national reference lab where it is summarized to use for planning and management purposes. Conclusions: The system is meeting its objectives. Sustainability and stability of the system needs to be improved by allocation of public funds. Extension of the coverage of the system will result in improved representativeness. Regular capacity building of the staff at reporting site will ensure continued quality of reporting. %R 10.2196/10619 %U http://www.iproc.org/2018/1/e10619/ %U https://doi.org/10.2196/10619 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 4 %N 1 %P e10599 %T Severe Acute Respiratory Infections with Influenza and Non-Influenza Respiratory Viruses: Yemen, 2011-2016 %A Al Amad,Mohammed %D 2018 %7 29.03.2018 %9 Abstract %J iproc %G English %X Background: Sentinel surveillance for severe acute respiratory infections (SARI) is an important tool to monitor influenza circulation and burden of other respiratory pathogens. In Yemen, two sites established at Sana'a and Aden city. Pharyngeal samples are tested for influenza and non- influenza by the Real-Time-PCR assay in NAMRU 3. Objective: Describe severity of SARI as indicated by admission to intensive care unit (ICU) and fatality as well as associated influenza and non-influenza viruses among patients in the two sites to provide recommendations for improving SARI surveillance. Methods: Data from 2012-2016 of SARI patients who admitted in the two sites based on WHO case definition was obtained from Ministry of Health, It analyzed by Epi info 7 and P<0.05 was the cut point for significance. Results: 2,211 patients were admitted in the two sites, 32% in 2013, 62% from Aden, 63% < two years, 20% had chronic diseases and 35% admitted to ICU. Overall SARI fatality was 8% which was significantly higher in Aden than Sana'a (10% vs. 5%, P<0.001), among patients with chronic disease (14% vs. 6.5% P<0.001) and admitted to ICU (10% vs. 7%, P=0.04). Samples of 82% (1,811) patients were tested where influenza viruses (75% Type A) were detected in 5% (89) more in Sana'a than Aden (6% vs. 4%, P=0.04) compared to 36% (655) of non-influenza viruses that included 43% (279) Respiratory Syncytial Virus and 17% (109) Adenovirus. The fatality of confirmed influenza was 9 % compared to 8% for non-influenza viruses. Conclusions: Our findings showed that children < 2 years are more affected by SARI. Both influenza and non-influenza viruses lead to mortality and necessitate prompt diagnosis and treatment. Expanding SARI surveillance to involve more hospitals at different governorate is recommended to give more comprehensive picture regarding SARI. %R 10.2196/10599 %U http://www.iproc.org/2018/1/e10599/ %U https://doi.org/10.2196/10599 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 4 %N 1 %P e10600 %T Defining Influenza Baseline and Threshold Values Using Surveillance Data - Egypt, Season 2016-17 %A AbdElGawad,Basma %A Refaey,S %A Abu El Sood,H %A El Shourbagy,S %A Mohsen,A %A Fahim,M %D 2018 %7 29.03.2018 %9 Abstract %J iproc %G English %X Background: Influenza infection represents a substantial public health problem resulting in global burden of mortality and morbidity. Influenza thresholds indicate level of disease activity that would signal the start or end of a season and provide an alert to an unusually severe or atypical season so, adjust preventive and control measures. Objective: To establish baseline and threshold values for 2016/17 season. Methods: Using Acute Respiratory Illness (ARI) surveillance data from 2013 to 2017, two parameters were assessed to monitor influenza activity: percentage of ARI samples positive for influenza and composite parameter (percentage of samples tested positive *ARI rate). Three threshold levels (baseline, alert and epidemic) were established by calculation of average of each week in all preceding seasons, 40% Upper Confidence Limit (UCL) and 90% UCL of each week respectively, then a four-week running average used to smooth the curve. Each parameter was compared against corresponding threshold and transmission intensity was categorized as low, moderate and high. Results: For season 2016/2017, both parameters showed two waves of activity crossing baseline threshold. First started at week 35 to 45 with dominance of Flu A/H3 activity (293(89) % of 329 positive samples, remain was Flu B) that exceeds epidemic threshold. The other, started week 12 to 14 with dominance of Flu B activity (136(99) % of 138 positive samples, remain was Flu A/H3). Percentage positive parameter signaled other weeks away from the defined season. Conclusions: Public health actions were taken in response to the observed increase flu A/H3 activity, to trim the impact and serious consequences of the disease. Continuous calculation of baseline and threshold levels can assess not only seasonal influenza but also potential pandemic influenza, contributing to the country’s pandemic preparedness and have important implications especially for resource-limited countries. %R 10.2196/10600 %U http://www.iproc.org/2018/1/e10600/ %U https://doi.org/10.2196/10600 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e32 %T Does Eating Chicken Feet With Pickled Peppers Cause Avian Influenza? Observational Case Study on Chinese Social Media During the Avian Influenza A (H7N9) Outbreak %A Chen,Bin %A Shao,Jian %A Liu,Kui %A Cai,Gaofeng %A Jiang,Zhenggang %A Huang,Yuru %A Gu,Hua %A Jiang,Jianmin %+ Zhejiang Provincial Center for Disease Control and Prevention, No. 3399, Binsheng Rd, Binjiang District, Hangzhou, 310051, China, 86 87115183, jmjiang@cdc.zj.cn %K social media %K misinformation %K infodemiology %K avian influenza A %K disease outbreak %D 2018 %7 29.03.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: A hot topic on the relationship between a popular avian-origin food and avian influenza occurred on social media during the outbreak of the emerging avian influenza A (H7N9). The misinformation generated from this topic had caused great confusion and public concern. Objective: Our goals were to analyze the trend and contents of the relevant posts during the outbreak. We also aimed to understand the characteristics of the misinformation and to provide suggestions to reduce public misconception on social media during the emerging disease outbreak. Methods: The original microblog posts were collected from China’s Sina Weibo and Tencent Weibo using a combination of keywords between April 1, 2013 and June 2, 2013. We analyzed the weekly and daily trend of the relevant posts. Content analyses were applied to categorize the posts into 4 types with unified sorting criteria. The posts’ characteristics and geographic locations were also analyzed in each category. We conducted further analysis on the top 5 most popular misleading posts. Results: A total of 1680 original microblog posts on the topic were retrieved and 341 (20.30%) of these posts were categorized as misleading messages. The number of relevant posts had not increased much during the first 2 weeks but rose to a high level in the next 2 weeks after the sudden increase in number of reported cases at the beginning of week 3. The posts under “misleading messages” occurred and increased from the beginning of week 3, but their daily posting number decreased when the daily number of posts under “refuting messages” outnumbered them. The microbloggers of the misleading posts had the lowest mean rank of followers and previous posts, but their posts had a highest mean rank of posts. The proportion of “misleading messages” in places with no reported cases was significantly higher than that in the epidemic areas (23.6% vs 13.8%). The popular misleading posts appeared to be short and consisted of personal narratives, which were easily disseminated on social media. Conclusions: Our findings suggested the importance of responding to common questions and misconceptions on social media platforms from the beginning of disease outbreaks. Authorities need to release clear and reliable information related to the popular topics early on. The microbloggers posting correct information should be empowered and their posts could be promoted to clarify false information. Equal importance should be attached to clarify misinformation in both the outbreak and nonoutbreak areas. %M 29599109 %R 10.2196/publichealth.8198 %U http://publichealth.jmir.org/2018/1/e32/ %U https://doi.org/10.2196/publichealth.8198 %U http://www.ncbi.nlm.nih.gov/pubmed/29599109 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 20 %N 3 %P e71 %T Self-Swabbing for Virological Confirmation of Influenza-Like Illness Among an Internet-Based Cohort in the UK During the 2014-2015 Flu Season: Pilot Study %A Wenham,Clare %A Gray,Eleanor R %A Keane,Candice E %A Donati,Matthew %A Paolotti,Daniela %A Pebody,Richard %A Fragaszy,Ellen %A McKendry,Rachel A %A Edmunds,W John %+ Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, Keppel Street, London, WC1E 7HT, United Kingdom, 44 207 955 ext 6592, c.wenham@lse.ac.uk %K influenza %K influenza-like illness %K surveillance %K online %K cohort study %K virological confirmation %D 2018 %7 01.03.2018 %9 Original Paper %J J Med Internet Res %G English %X Background: Routine influenza surveillance, based on laboratory confirmation of viral infection, often fails to estimate the true burden of influenza-like illness (ILI) in the community because those with ILI often manage their own symptoms without visiting a health professional. Internet-based surveillance can complement this traditional surveillance by measuring symptoms and health behavior of a population with minimal time delay. Flusurvey, the UK’s largest crowd-sourced platform for surveillance of influenza, collects routine data on more than 6000 voluntary participants and offers real-time estimates of ILI circulation. However, one criticism of this method of surveillance is that it is only able to assess ILI, rather than virologically confirmed influenza. Objective: We designed a pilot study to see if it was feasible to ask individuals from the Flusurvey platform to perform a self-swabbing task and to assess whether they were able to collect samples with a suitable viral content to detect an influenza virus in the laboratory. Methods: Virological swabbing kits were sent to pilot study participants, who then monitored their ILI symptoms over the influenza season (2014-2015) through the Flusurvey platform. If they reported ILI, they were asked to undertake self-swabbing and return the swabs to a Public Health England laboratory for multiplex respiratory virus polymerase chain reaction testing. Results: A total of 700 swab kits were distributed at the start of the study; from these, 66 participants met the definition for ILI and were asked to return samples. In all, 51 samples were received in the laboratory, 18 of which tested positive for a viral cause of ILI (35%). Conclusions: This demonstrated proof of concept that it is possible to apply self-swabbing for virological laboratory testing to an online cohort study. This pilot does not have significant numbers to validate whether Flusurvey surveillance accurately reflects influenza infection in the community, but highlights that the methodology is feasible. Self-swabbing could be expanded to larger online surveillance activities, such as during the initial stages of a pandemic, to understand community transmission or to better assess interseasonal activity. %M 29496658 %R 10.2196/jmir.9084 %U http://www.jmir.org/2018/3/e71/ %U https://doi.org/10.2196/jmir.9084 %U http://www.ncbi.nlm.nih.gov/pubmed/29496658 %0 Journal Article %@ 2291-9694 %I JMIR Publications %V 6 %N 1 %P e12 %T Potential Application of Digitally Linked Tuberculosis Diagnostics for Real-Time Surveillance of Drug-Resistant Tuberculosis Transmission: Validation and Analysis of Test Results %A Ng,Kamela Charmaine %A Meehan,Conor Joseph %A Torrea,Gabriela %A Goeminne,Léonie %A Diels,Maren %A Rigouts,Leen %A de Jong,Bouke Catherine %A André,Emmanuel %+ Mycobacteriology Unit, Department of Biomedical Sciences, Institute of Tropical Medicine, Nationalestraat 155, Antwerp, 2000, Belgium, 32 (0) 33455345, kng@itg.be %K tuberculosis %K drug resistance %K rifampicin-resistant tuberculosis %K rapid diagnostic tests %K Xpert MTB/RIF %K Genotype MTBDRplus v2.0 %K Genoscholar NTM + MDRTB II %K RDT probe reactions %K rpoB mutations %K validation and analysis %K real-time detection %D 2018 %7 27.02.2018 %9 Original Paper %J JMIR Med Inform %G English %X Background: Tuberculosis (TB) is the highest-mortality infectious disease in the world and the main cause of death related to antimicrobial resistance, yet its surveillance is still paper-based. Rifampicin-resistant TB (RR-TB) is an urgent public health crisis. The World Health Organization has, since 2010, endorsed a series of rapid diagnostic tests (RDTs) that enable rapid detection of drug-resistant strains and produce large volumes of data. In parallel, most high-burden countries have adopted connectivity solutions that allow linking of diagnostics, real-time capture, and shared repository of these test results. However, these connected diagnostics and readily available test results are not used to their full capacity, as we have yet to capitalize on fully understanding the relationship between test results and specific rpoB mutations to elucidate its potential application to real-time surveillance. Objective: We aimed to validate and analyze RDT data in detail, and propose the potential use of connected diagnostics and associated test results for real-time evaluation of RR-TB transmission. Methods: We selected 107 RR-TB strains harboring 34 unique rpoB mutations, including 30 within the rifampicin resistance–determining region (RRDR), from the Belgian Coordinated Collections of Microorganisms, Antwerp, Belgium. We subjected these strains to Xpert MTB/RIF, GenoType MTBDRplus v2.0, and Genoscholar NTM + MDRTB II, the results of which were validated against the strains’ available rpoB gene sequences. We determined the reproducibility of the results, analyzed and visualized the probe reactions, and proposed these for potential use in evaluating transmission. Results: The RDT probe reactions detected most RRDR mutations tested, although we found a few critical discrepancies between observed results and manufacturers’ claims. Based on published frequencies of probe reactions and RRDR mutations, we found specific probe reactions with high potential use in transmission studies: Xpert MTB/RIF probes A, Bdelayed, C, and Edelayed; Genotype MTBDRplus v2.0 WT2, WT5, and WT6; and Genoscholar NTM + MDRTB II S1 and S3. Inspection of probe reactions of disputed mutations may potentially resolve discordance between genotypic and phenotypic test results. Conclusions: We propose a novel approach for potential real-time detection of RR-TB transmission through fully using digitally linked TB diagnostics and shared repository of test results. To our knowledge, this is the first pragmatic and scalable work in response to the consensus of world-renowned TB experts in 2016 on the potential of diagnostic connectivity to accelerate efforts to eliminate TB. This is evidenced by the ability of our proposed approach to facilitate comparison of probe reactions between different RDTs used in the same setting. Integrating this proposed approach as a plug-in module to a connectivity platform will increase usefulness of connected TB diagnostics for RR-TB outbreak detection through real-time investigation of suspected RR-TB transmission cases based on epidemiologic linking. %M 29487047 %R 10.2196/medinform.9309 %U http://medinform.jmir.org/2018/1/e12/ %U https://doi.org/10.2196/medinform.9309 %U http://www.ncbi.nlm.nih.gov/pubmed/29487047 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e16 %T Associations of Topics of Discussion on Twitter With Survey Measures of Attitudes, Knowledge, and Behaviors Related to Zika: Probabilistic Study in the United States %A Farhadloo,Mohsen %A Winneg,Kenneth %A Chan,Man-Pui Sally %A Hall Jamieson,Kathleen %A Albarracin,Dolores %+ University of Illinois at Urbana-Champaign, 603 E Daniel St, Champaign, IL,, United States, 1 209 761 5350, mfarhad@illinois.edu %K Zika %K Twitter %K topic modeling %K public policy %K public health %D 2018 %7 09.02.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Recent outbreaks of Zika virus around the world led to increased discussions about this issue on social media platforms such as Twitter. These discussions may provide useful information about attitudes, knowledge, and behaviors of the population regarding issues that are important for public policy. Objective: We sought to identify the associations of the topics of discussions on Twitter and survey measures of Zika-related attitudes, knowledge, and behaviors, not solely based upon the volume of such discussions but by analyzing the content of conversations using probabilistic techniques. Methods: Using probabilistic topic modeling with US county and week as the unit of analysis, we analyzed the content of Twitter online communications to identify topics related to the reported attitudes, knowledge, and behaviors captured in a national representative survey (N=33,193) of the US adult population over 33 weeks. Results: Our analyses revealed topics related to “congress funding for Zika,” “microcephaly,” “Zika-related travel discussions,” “insect repellent,” “blood transfusion technology,” and “Zika in Miami” were associated with our survey measures of attitudes, knowledge, and behaviors observed over the period of the study. Conclusions: Our results demonstrated that it is possible to uncover topics of discussions from Twitter communications that are associated with the Zika-related attitudes, knowledge, and behaviors of populations over time. Social media data can be used as a complementary source of information alongside traditional data sources to gauge the patterns of attitudes, knowledge, and behaviors in a population. %M 29426815 %R 10.2196/publichealth.8186 %U http://publichealth.jmir.org/2018/1/e16/ %U https://doi.org/10.2196/publichealth.8186 %U http://www.ncbi.nlm.nih.gov/pubmed/29426815 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e7 %T Internet Exposure Associated With Canadian Parents’ Perception of Risk on Childhood Immunization: Cross-Sectional Study %A Tustin,Jordan Lee %A Crowcroft,Natasha Sarah %A Gesink,Dionne %A Johnson,Ian %A Keelan,Jennifer %+ School of Occupational and Public Health, Ryerson University, 350 Victoria St, Toronto, ON, M5B 2K3, Canada, 1 979 5000 ext 3021, jtustin@ryerson.ca %K Canadian parents %K vaccination %K immunization %K Internet %K vaccine safety %D 2018 %7 19.01.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: There is a large presence of provaccination and antivaccination content on the Internet. The Internet has been identified as an important source for parents to seek and share vaccine information. There are concerns that parental fears or hesitancy on childhood immunizations are increasing due to the popularity of social media and exposure to online antivaccination sentiment. No other studies have investigated the association between seeking vaccine information online and Canadian parents’ perception of risk on childhood immunization. Objective: We aimed to investigate the potential association between seeking vaccine information on the Internet and Canadian parents’ perception of risk on childhood immunization in order to quantify the perceived association and increase our understanding on the impact of the Internet to help guide public health interventions. Methods: We analyzed this association in two population samples: a self-selecting Web-based sample of Canadian parents recruited through Facebook (n=966) and a population-based sample of parents recruited by random digit dialing (RDD; n=951). The outcome was parental perception of vaccine safety on a seven-point ordinal scale from “not safe” to “extremely safe.” An ordinal regression model was used to investigate if Internet information seeking on childhood vaccination predicted parental perception of vaccine safety. Results: After adjusting for income level, Internet reliability, age of parent, and region, the odds of perceiving vaccines as less safe rather than more safe were 1.6 times higher (95% CI 1.3-2.1) for parents who used the Internet to search for vaccination information compared to parents who did not search the Internet in the Web-based sample, and 2.0 times higher (95% CI 1.6-2.5) in the population-based RDD sample. Conclusions: The results suggest the Internet is significantly associated with Canadian parents’ negative perception of vaccine risk. Governmental and scientific sectors should consider the development and implementation of Web-based vaccine interventions to promote confidence in immunization. %M 29351896 %R 10.2196/publichealth.8921 %U http://publichealth.jmir.org/2018/1/e7/ %U https://doi.org/10.2196/publichealth.8921 %U http://www.ncbi.nlm.nih.gov/pubmed/29351896 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 4 %N 1 %P e4 %T Accurate Influenza Monitoring and Forecasting Using Novel Internet Data Streams: A Case Study in the Boston Metropolis %A Lu,Fred Sun %A Hou,Suqin %A Baltrusaitis,Kristin %A Shah,Manan %A Leskovec,Jure %A Sosic,Rok %A Hawkins,Jared %A Brownstein,John %A Conidi,Giuseppe %A Gunn,Julia %A Gray,Josh %A Zink,Anna %A Santillana,Mauricio %+ Computational Health Informatics Program, Boston Children’s Hospital, 1 Autumn St, Boston, MA, 02215, United States, 1 617 919 1795, msantill@fas.harvard.edu %K epidemiology %K public health %K machine learning %K regression analysis %K influenza, human %K communicable diseases %K statistics %K patient generated data %D 2018 %7 09.01.2018 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Influenza outbreaks pose major challenges to public health around the world, leading to thousands of deaths a year in the United States alone. Accurate systems that track influenza activity at the city level are necessary to provide actionable information that can be used for clinical, hospital, and community outbreak preparation. Objective: Although Internet-based real-time data sources such as Google searches and tweets have been successfully used to produce influenza activity estimates ahead of traditional health care–based systems at national and state levels, influenza tracking and forecasting at finer spatial resolutions, such as the city level, remain an open question. Our study aimed to present a precise, near real-time methodology capable of producing influenza estimates ahead of those collected and published by the Boston Public Health Commission (BPHC) for the Boston metropolitan area. This approach has great potential to be extended to other cities with access to similar data sources. Methods: We first tested the ability of Google searches, Twitter posts, electronic health records, and a crowd-sourced influenza reporting system to detect influenza activity in the Boston metropolis separately. We then adapted a multivariate dynamic regression method named ARGO (autoregression with general online information), designed for tracking influenza at the national level, and showed that it effectively uses the above data sources to monitor and forecast influenza at the city level 1 week ahead of the current date. Finally, we presented an ensemble-based approach capable of combining information from models based on multiple data sources to more robustly nowcast as well as forecast influenza activity in the Boston metropolitan area. The performances of our models were evaluated in an out-of-sample fashion over 4 influenza seasons within 2012-2016, as well as a holdout validation period from 2016 to 2017. Results: Our ensemble-based methods incorporating information from diverse models based on multiple data sources, including ARGO, produced the most robust and accurate results. The observed Pearson correlations between our out-of-sample flu activity estimates and those historically reported by the BPHC were 0.98 in nowcasting influenza and 0.94 in forecasting influenza 1 week ahead of the current date. Conclusions: We show that information from Internet-based data sources, when combined using an informed, robust methodology, can be effectively used as early indicators of influenza activity at fine geographic resolutions. %M 29317382 %R 10.2196/publichealth.8950 %U http://publichealth.jmir.org/2018/1/e4/ %U https://doi.org/10.2196/publichealth.8950 %U http://www.ncbi.nlm.nih.gov/pubmed/29317382 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 12 %P e416 %T Estimating the Population Impact of a New Pediatric Influenza Vaccination Program in England Using Social Media Content %A Wagner,Moritz %A Lampos,Vasileios %A Yom-Tov,Elad %A Pebody,Richard %A Cox,Ingemar J %+ Public Health England, 61 Colindale Ave, London, NW9 5EQ, United Kingdom, 44 7539078912, moritz.wagner.16@ucl.ac.uk %K health intervention %K influenza %K vaccination %K social media %K Twitter %D 2017 %7 21.12.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: The rollout of a new childhood live attenuated influenza vaccine program was launched in England in 2013, which consisted of a national campaign for all 2 and 3 year olds and several pilot locations offering the vaccine to primary school-age children (4-11 years of age) during the influenza season. The 2014/2015 influenza season saw the national program extended to include additional pilot regions, some of which offered the vaccine to secondary school children (11-13 years of age) as well. Objective: We utilized social media content to obtain a complementary assessment of the population impact of the programs that were launched in England during the 2013/2014 and 2014/2015 flu seasons. The overall community-wide impact on transmission in pilot areas was estimated for the different age groups that were targeted for vaccination. Methods: A previously developed statistical framework was applied, which consisted of a nonlinear regression model that was trained to infer influenza-like illness (ILI) rates from Twitter posts originating in pilot (school-age vaccinated) and control (unvaccinated) areas. The control areas were then used to estimate ILI rates in pilot areas, had the intervention not taken place. These predictions were compared with their corresponding Twitter-based ILI estimates. Results: Results suggest a reduction in ILI rates of 14% (1-25%) and 17% (2-30%) across all ages in only the primary school-age vaccine pilot areas during the 2013/2014 and 2014/2015 influenza seasons, respectively. No significant impact was observed in areas where two age cohorts of secondary school children were vaccinated. Conclusions: These findings corroborate independent assessments from traditional surveillance data, thereby supporting the ongoing rollout of the program to primary school-age children and providing evidence of the value of social media content as an additional syndromic surveillance tool. %M 29269339 %R 10.2196/jmir.8184 %U http://www.jmir.org/2017/12/e416/ %U https://doi.org/10.2196/jmir.8184 %U http://www.ncbi.nlm.nih.gov/pubmed/29269339 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e90 %T Syndromic Surveillance Models Using Web Data: The Case of Influenza in Greece and Italy Using Google Trends %A Samaras,Loukas %A García-Barriocanal,Elena %A Sicilia,Miguel-Angel %+ Computer Science Department, University of Alcalá, Polytechnic Building, Ctra. Barcelona Km. 33.6, Alcalá de Henares (Madrid), 28871, Spain, 34 6974706531, lsamaras@ath.forthnet.gr %K Google Trends %K influenza %K Web, syndromic surveillance %K statistical correlation %K forecast %K ARIMA %D 2017 %7 20.11.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: An extended discussion and research has been performed in recent years using data collected through search queries submitted via the Internet. It has been shown that the overall activity on the Internet is related to the number of cases of an infectious disease outbreak. Objective: The aim of the study was to define a similar correlation between data from Google Trends and data collected by the official authorities of Greece and Europe by examining the development and the spread of seasonal influenza in Greece and Italy. Methods: We used multiple regressions of the terms submitted in the Google search engine related to influenza for the period from 2011 to 2012 in Greece and Italy (sample data for 104 weeks for each country). We then used the autoregressive integrated moving average statistical model to determine the correlation between the Google search data and the real influenza cases confirmed by the aforementioned authorities. Two methods were used: (1) a flu score was created for the case of Greece and (2) comparison of data from a neighboring country of Greece, which is Italy. Results: The results showed that there is a significant correlation that can help the prediction of the spread and the peak of the seasonal influenza using data from Google searches. The correlation for Greece for 2011 and 2012 was .909 and .831, respectively, and correlation for Italy for 2011 and 2012 was .979 and .933, respectively. The prediction of the peak was quite precise, providing a forecast before it arrives to population. Conclusions: We can create an Internet surveillance system based on Google searches to track influenza in Greece and Italy. %M 29158208 %R 10.2196/publichealth.8015 %U http://publichealth.jmir.org/2017/4/e90/ %U https://doi.org/10.2196/publichealth.8015 %U http://www.ncbi.nlm.nih.gov/pubmed/29158208 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e89 %T Check and Report Ebola (CARE) Hotline: The User Perspective of an Innovative Tool for Postarrival Monitoring of Ebola in the United States %A McCarthy,Ilana Olin %A Wojno,Abbey E %A Joseph,Heather A %A Teesdale,Scott %+ Centers for Disease Control and Prevention, Division of Global Migration and Quarantine, 1600 Clifton Road, Mail Stop E-07, Atlanta, GA, 30333, United States, +1 4046616153, yyr6@cdc.gov %K Ebola %K postarrival monitoring %K interactive voice recognition %D 2017 %7 14.11.2017 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: The response to the 2014-2016 Ebola epidemic included an unprecedented effort from federal, state, and local public health authorities to monitor the health of travelers entering the United States from countries with Ebola outbreaks. The Check and Report Ebola (CARE) Hotline, a novel approach to monitoring, was designed to enable travelers to report their health status daily to an interactive voice recognition (IVR) system. The system was tested with 70 Centers for Disease Control and Prevention (CDC) federal employees returning from deployments in outbreak countries. Objective: The objective of this study was to describe the development of the CARE Hotline as a tool for postarrival monitoring and examine the usage characteristics and user experience of the tool during a public health emergency. Methods: Data were obtained from two sources. First, the CARE Hotline system produced a call log which summarized the usage characteristics of all 70 users’ daily health reports. Second, we surveyed federal employees (n=70) who used the CARE Hotline to engage in monitoring. A total of 21 (21/70, 30%) respondents were included in the survey analytic sample. Results: While the CARE Hotline was used for monitoring, 70 users completed a total of 1313 calls. We found that 94.06% (1235/1313) of calls were successful, and the average call time significantly decreased from the beginning of the monitoring period to the end by 32 seconds (Z score=−6.52, P<.001). CARE Hotline call log data were confirmed by user feedback; survey results indicated that users became more familiar with the system and found the system easier to use, from the beginning to the end of their monitoring period. The majority of the users were highly satisfied (90%, 19/21) with the system, indicating ease of use and convenience as primary reasons, and would recommend it for future monitoring efforts (90%, 19/21). Conclusions: The CARE Hotline garnered high user satisfaction, required minimal reporting time from users, and was an easily learned tool for monitoring. This phone-based technology can be modified for future public health emergencies. %M 29138130 %R 10.2196/publichealth.7817 %U http://publichealth.jmir.org/2017/4/e89/ %U https://doi.org/10.2196/publichealth.7817 %U http://www.ncbi.nlm.nih.gov/pubmed/29138130 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e87 %T Will Participatory Syndromic Surveillance Work in Latin America? Piloting a Mobile Approach to Crowdsource Influenza-Like Illness Data in Guatemala %A Prieto,José Tomás %A Jara,Jorge H %A Alvis,Juan Pablo %A Furlan,Luis R %A Murray,Christian Travis %A Garcia,Judith %A Benghozi,Pierre-Jean %A Kaydos-Daniels,Susan Cornelia %+ Center for Health Studies, Universidad del Valle de Guatemala, 18 Av. 11-95, Zona 15, Vista Hermosa III, Guatemala City, 01015, Guatemala, +1 4044216455, josetomasprieto@gmail.com %K crowdsourcing %K human flu %K influenza %K grippe %K mHealth %K texting %K mobile apps %K short message service %K text message %K developing countries %D 2017 %7 14.11.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In many Latin American countries, official influenza reports are neither timely nor complete, and surveillance of influenza-like illness (ILI) remains thin in consistency and precision. Public participation with mobile technology may offer new ways of identifying nonmedically attended cases and reduce reporting delays, but no published studies to date have assessed the viability of ILI surveillance with mobile tools in Latin America. We implemented and assessed an ILI-tailored mobile health (mHealth) participatory reporting system. Objective: The objectives of this study were to evaluate the quality and characteristics of electronically collected data, the user acceptability of the symptom reporting platform, and the costs of running the system and of identifying ILI cases, and to use the collected data to characterize cases of reported ILI. Methods: We recruited the heads of 189 households comprising 584 persons during randomly selected home visits in Guatemala. From August 2016 to March 2017, participants used text messages or an app to report symptoms of ILI at home, the ages of the ILI cases, if medical attention was sought, and if medicines were bought in pharmacies. We sent weekly reminders to participants and compensated those who sent reports with phone credit. We assessed the simplicity, flexibility, acceptability, stability, timeliness, and data quality of the system. Results: Nearly half of the participants (47.1%, 89/189) sent one or more reports. We received 468 reports, 83.5% (391/468) via text message and 16.4% (77/468) via app. Nine-tenths of the reports (93.6%, 438/468) were received within 48 hours of the transmission of reminders. Over a quarter of the reports (26.5%, 124/468) indicated that at least someone at home had ILI symptoms. We identified 202 ILI cases and collected age information from almost three-fifths (58.4%, 118/202): 20 were aged between 0 and 5 years, 95 were aged between 6 and 64 years, and three were aged 65 years or older. Medications were purchased from pharmacies, without medical consultation, in 33.1% (41/124) of reported cases. Medical attention was sought in 27.4% (34/124) of reported cases. The cost of identifying an ILI case was US $6.00. We found a positive correlation (Pearson correlation coefficient=.8) between reported ILI and official surveillance data for noninfluenza viruses from weeks 41 (2016) to 13 (2017). Conclusions: Our system has the potential to serve as a practical complement to respiratory virus surveillance in Guatemala. Its strongest attributes are simplicity, flexibility, and timeliness. The biggest challenge was low enrollment caused by people’s fear of victimization and lack of phone credit. Authorities in Central America could test similar methods to improve the timeliness, and extend the breadth, of disease surveillance. It may allow them to rapidly detect localized or unusual circulation of acute respiratory illness and trigger appropriate public health actions. %M 29138128 %R 10.2196/publichealth.8610 %U http://publichealth.jmir.org/2017/4/e87/ %U https://doi.org/10.2196/publichealth.8610 %U http://www.ncbi.nlm.nih.gov/pubmed/29138128 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 11 %P e370 %T Subregional Nowcasts of Seasonal Influenza Using Search Trends %A Kandula,Sasikiran %A Hsu,Daniel %A Shaman,Jeffrey %+ Department of Environmental Health Sciences, Columbia University, ARB Building, 11th Floor, 722 West 168th Street, New York, NY, 10032, United States, 1 2123053590, sk3542@cumc.columbia.edu %K human influenza %K classification and regression trees %K nowcasts %K infodemiology %K infoveillance %K surveillance %D 2017 %7 06.11.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Limiting the adverse effects of seasonal influenza outbreaks at state or city level requires close monitoring of localized outbreaks and reliable forecasts of their progression. Whereas forecasting models for influenza or influenza-like illness (ILI) are becoming increasingly available, their applicability to localized outbreaks is limited by the nonavailability of real-time observations of the current outbreak state at local scales. Surveillance data collected by various health departments are widely accepted as the reference standard for estimating the state of outbreaks, and in the absence of surveillance data, nowcast proxies built using Web-based activities such as search engine queries, tweets, and access of health-related webpages can be useful. Nowcast estimates of state and municipal ILI were previously published by Google Flu Trends (GFT); however, validations of these estimates were seldom reported. Objective: The aim of this study was to develop and validate models to nowcast ILI at subregional geographic scales. Methods: We built nowcast models based on autoregressive (autoregressive integrated moving average; ARIMA) and supervised regression methods (Random forests) at the US state level using regional weighted ILI and Web-based search activity derived from Google's Extended Trends application programming interface. We validated the performance of these methods using actual surveillance data for the 50 states across six seasons. We also built state-level nowcast models using state-level estimates of ILI and compared the accuracy of these estimates with the estimates of the regional models extrapolated to the state level and with the nowcast estimates published by GFT. Results: Models built using regional ILI extrapolated to state level had a median correlation of 0.84 (interquartile range: 0.74-0.91) and a median root mean square error (RMSE) of 1.01 (IQR: 0.74-1.50), with noticeable variability across seasons and by state population size. Model forms that hypothesize the availability of timely state-level surveillance data show significantly lower errors of 0.83 (0.55-0.23). Compared with GFT, the latter model forms have lower errors but also lower correlation. Conclusions: These results suggest that the proposed methods may be an alternative to the discontinued GFT and that further improvements in the quality of subregional nowcasts may require increased access to more finely resolved surveillance data. %M 29109069 %R 10.2196/jmir.7486 %U http://www.jmir.org/2017/11/e370/ %U https://doi.org/10.2196/jmir.7486 %U http://www.ncbi.nlm.nih.gov/pubmed/29109069 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e83 %T Combining Participatory Influenza Surveillance with Modeling and Forecasting: Three Alternative Approaches %A Brownstein,John S %A Chu,Shuyu %A Marathe,Achla %A Marathe,Madhav V %A Nguyen,Andre T %A Paolotti,Daniela %A Perra,Nicola %A Perrotta,Daniela %A Santillana,Mauricio %A Swarup,Samarth %A Tizzoni,Michele %A Vespignani,Alessandro %A Vullikanti,Anil Kumar S %A Wilson,Mandy L %A Zhang,Qian %+ Network Dynamics and Simulation Science Laboratory, Biocomplexity Institute, Virginia Tech, 1015 Life Science Circle, Blacksburg, VA,, United States, 1 540 231 9210, amarathe@vt.edu %K forecasting %K disease surveillance %K crowdsourcing %K nonresponse bias %D 2017 %7 01.11.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Influenza outbreaks affect millions of people every year and its surveillance is usually carried out in developed countries through a network of sentinel doctors who report the weekly number of Influenza-like Illness cases observed among the visited patients. Monitoring and forecasting the evolution of these outbreaks supports decision makers in designing effective interventions and allocating resources to mitigate their impact. Objective: Describe the existing participatory surveillance approaches that have been used for modeling and forecasting of the seasonal influenza epidemic, and how they can help strengthen real-time epidemic science and provide a more rigorous understanding of epidemic conditions. Methods: We describe three different participatory surveillance systems, WISDM (Widely Internet Sourced Distributed Monitoring), Influenzanet and Flu Near You (FNY), and show how modeling and simulation can be or has been combined with participatory disease surveillance to: i) measure the non-response bias in a participatory surveillance sample using WISDM; and ii) nowcast and forecast influenza activity in different parts of the world (using Influenzanet and Flu Near You). Results: WISDM-based results measure the participatory and sample bias for three epidemic metrics i.e. attack rate, peak infection rate, and time-to-peak, and find the participatory bias to be the largest component of the total bias. The Influenzanet platform shows that digital participatory surveillance data combined with a realistic data-driven epidemiological model can provide both short-term and long-term forecasts of epidemic intensities, and the ground truth data lie within the 95 percent confidence intervals for most weeks. The statistical accuracy of the ensemble forecasts increase as the season progresses. The Flu Near You platform shows that participatory surveillance data provide accurate short-term flu activity forecasts and influenza activity predictions. The correlation of the HealthMap Flu Trends estimates with the observed CDC ILI rates is 0.99 for 2013-2015. Additional data sources lead to an error reduction of about 40% when compared to the estimates of the model that only incorporates CDC historical information. Conclusions: While the advantages of participatory surveillance, compared to traditional surveillance, include its timeliness, lower costs, and broader reach, it is limited by a lack of control over the characteristics of the population sample. Modeling and simulation can help overcome this limitation as well as provide real-time and long-term forecasting of influenza activity in data-poor parts of the world. %M 29092812 %R 10.2196/publichealth.7344 %U http://publichealth.jmir.org/2017/4/e83/ %U https://doi.org/10.2196/publichealth.7344 %U http://www.ncbi.nlm.nih.gov/pubmed/29092812 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e81 %T Knowledge, Attitudes, and Practices Regarding Zika: Paper- and Internet-Based Survey in Zhejiang, China %A Huang,Yu %A Xu,Shuiyang %A Wang,Lei %A Zhao,Yushui %A Liu,He %A Yao,Dingming %A Xu,Yue %A Lv,Qiaohong %A Hao,Gang %A Xu,Yan %A Wu,Qingqing %+ Department of Health Education, Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou,, China, 86 057187115239, qqwu@cdc.zj.cn %K Zika virus disease %K knowledge, attitudes, and practice %K Internet-based survey %K paper-based survey %D 2017 %7 30.10.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: As public access to the Internet increases, many health workers prefer to carry out health education online, reducing the use of traditional community-based health education methods. Since March 2016, four Zika cases have been confirmed in Zhejiang, China. Rapid assessment of people’s knowledge, attitudes, and practices (KAP) regarding Zika is crucial to its prevention and control. Web-based surveys to assess public KAP may be a growing trend; however, we had little experience with this method. Objectives: The aim of this study was to explore KAP regarding Zika in residents of Zhejiang using both traditional paper- and innovative Internet-based investigations. Methods: A questionnaire was designed by Zhejiang Provincial Center for Disease Control and Prevention. A paper-based version of the survey was used in a cross-sectional community study following multistage cluster random sampling, and an Internet-based survey was promoted through a local health education site. Data were interpreted via univariate and multivariate analyses. Results: A total of 447 community residents participated in the paper-based survey, with a response rate of 89.4% (447/500), and 621 eligible Internet users participated in the Internet-based survey, with a response rate of 36.92% (621/1682). Age, education level, and occupation differed significantly between participants in the paper- and Internet-based surveys. Participants completing the Internet-based survey were much younger (χ22=144.7, P<.001) and had a higher level of education (χ22=423.5, P<.001) than those completing the paper-based survey. Among participants completing the paper-based survey, there were more farmers, housewives, and unemployed people (χ23=413.7, P<.001). Overall, 83.52% of participants (892/1068) knew the transmission route for Zika, 76.12% (813/1068) knew that pregnant women were at high risk of severe complications, 66.39% (709/1068) knew that contracting Zika during pregnancy could lead to newborn babies with microcephaly, and 98.88% (1056/1068) knew places where mosquitos could usually be found. After controlling for sociodemographic variables, participants completing the Internet-based survey were more likely to know the transmission route of Zika (odds ratio [OR]=5.0, 95% CI 3.0-8.0), the association between pregnant women with Zika and newborn babies with microcephaly (OR 2.1, 95% CI 1.4-3.0), and that pregnant women were at high risk for Zika (OR 5.5, 95% CI 3.5-8.4) than those completing the paper-based survey. They were less likely to worry about contracting Zika (OR 0.6, 95% CI 0.4-0.9) and more likely to actively seek information about Zika than participants completing the paper-based survey (OR 3.3, 95% CI 2.0-5.6). Conclusions: Participants completing the Internet-based survey had a higher level of basic knowledge and more positive attitudes and behaviors than participants completing the paper-based survey. In addition to providing Web-based health information, the government should ensure sufficient access to health information for the elderly and less educated people in the community to improve health equity. %M 29084711 %R 10.2196/publichealth.7663 %U http://publichealth.jmir.org/2017/4/e81/ %U https://doi.org/10.2196/publichealth.7663 %U http://www.ncbi.nlm.nih.gov/pubmed/29084711 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 4 %P e67 %T A Smart Card-Based Electronic School Absenteeism System for Influenza-Like Illness Surveillance in Hong Kong: Design, Implementation, and Feasibility Assessment %A Ip,Dennis KM %A Lau,Eric HY %A So,Hau Chi %A Xiao,Jingyi %A Lam,Chi Kin %A Fang,Vicky J %A Tam,Yat Hung %A Leung,Gabriel M %A Cowling,Benjamin J %+ WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 1/F, Patrick Manson Building (North Wing), 7 Sassoon Road, Hong Kong,, China (Hong Kong), 852 39176712, dkmip@hku.hk %K influenza %K public health surveillance %K school health %K absenteeism %K smart cards %D 2017 %7 06.10.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: School-aged children have the highest incidence of respiratory virus infections each year, and transmission of respiratory viruses such as influenza virus can be a major concern in school settings. School absenteeism data have been employed as a component of influenza surveillance systems in some locations. Data timeliness and system acceptance remain as key determinants affecting the usefulness of a prospective surveillance system. Objective: The aim of this study was to assess the feasibility of implementing an electronic school absenteeism surveillance system using smart card–based technology for influenza-like illness (ILI) surveillance among a representative network of local primary and secondary schools in Hong Kong. Methods: We designed and implemented a surveillance system according to the Protocol for a Standardized information infrastructure for Pandemic and Emerging infectious disease Response (PROSPER). We employed an existing smart card–based education and school administration platform for data capture, customized the user interface, and used additional back end systems built for other downstream surveillance steps. We invited local schools to participate and collected absenteeism data by the implemented system. We compared temporal trend of the absenteeism data with data from existing community sentinel and laboratory surveillance data. Results: We designed and implemented an ILI surveillance system utilizing smart card–based attendance tracking approach for data capture. We implemented the surveillance system in a total of 107 schools (including 66 primary schools and 41 secondary schools), covering a total of 75,052 children. The system successfully captured information on absences for 2 consecutive academic years (2012-2013 and 2013-2014). The absenteeism data we collected from the system reflected ILI activity in the community, with an upsurge in disease activity detected up to 1 to 2 weeks preceding other existing surveillance systems. Conclusions: We designed and implemented a novel smart card technology–based school absenteeism surveillance system. Our study demonstrated the feasibility of building a large-scale surveillance system riding on a routinely adopted data collection approach and the use of simple system enhancement to minimize workload implication and enhance system acceptability. Data from this system have potential value in supplementing existing sentinel influenza surveillance for situational awareness of influenza activity in the community. %M 28986338 %R 10.2196/publichealth.6810 %U http://publichealth.jmir.org/2017/4/e67/ %U https://doi.org/10.2196/publichealth.6810 %U http://www.ncbi.nlm.nih.gov/pubmed/28986338 %0 Journal Article %@ 2369-6893 %I JMIR Publications %V 3 %N 1 %P e56 %T Detecting Influenza Epidemics Using Self-reported Data Through Mobile App (FeverCoach) %A Kim,Myeongchan %A Yune,Sehyo %A Han,Hyun Wook %+ Department of Biomedical Informatics, School of Medicine, Ajou University, 206, World cup-ro, Suwon,, Republic Of Korea, 82 1062920812, james.hw.han@gmail.com %K children %K epidemics %K health care %K human influenza %K Mobile health (mHealth) %D 2017 %7 22.9.2017 %9 Abstract %J iproc %G English %X Background: Timely forecast of influenza activity is critical for a public health system to prepare for an influenza epidemic and mitigate its burden. Currently, influenza surveillance relies on traditional data sources such as reports from health care providers, which lag behind real-time by several days to weeks. In an effort to reduce the time lag, internet search information, voluntary web-based records, and electronic health records have been suggested as the alternative data sources for influenza surveillance. However, low specificity, low rate of report, or privacy concerns limits the use of such data. Objective: FeverCoach mobile application provides tailored information to help caregivers manage a febrile child. Using the self-reported diagnosis data submitted to the app, we developed a new algorithm that accurately predicted the influenza trend in South Korea. Methods: Users of FeverCoach agreed to the use of de-identified data for research purposes. The app shows information about use of antipyretics and adjuvant way to relieve fever when users enter the child’s age, sex, body temperature, and the duration of fever. Users can choose from the list of 21 candidate diseases including Influenza after a physician office visit. Additional information about the disease was provided following submission of the diagnosis. Public influenza-like illness (ILI) data was obtained from the Korea Centers for Disease Control and Prevention (KCDC) website. The data was collected from September 2016 to March 2017. Ordinary least squares linear regression was used to build a model using the data from the app to predict the influenza trend. To perform linear regression, we calculate logit(Pcdc) and logit(Papp) where logit(p) is natural log of p/(1-p), Pcdc is (ILI visit counts)/(total patient visit counts) and Papp is (Influenza report on FeverCoach)/(total diagnosis report on FeverCoach). Results: We collected 13,014 self-reported diagnoses. Of all users, 81% of the children were under 5 years of age. The animated visualization of spatiotemporal diagnosis report is available online at https://www.youtube.com/watch?v=-8kDXz43gO8. Ordinary least square regression showed significant association between logit(Pcdc) and logit(Papp) (R2=0.860, P<.001). Using this regression model, we could detect an influenza epidemic 5 days before the 2016-2017 season’s influenza epidemic alert by KCDC. Conclusions: We found that it is possible to predict influenza epidemics earlier than KCDC with a relatively small amoount data. Collection of specific and accurate data was made possible by targeting a well-defined population. %R 10.2196/iproc.8686 %U http://www.iproc.org/2017/1/e56/ %U https://doi.org/10.2196/iproc.8686 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 3 %P e66 %T Influenzanet: Citizens Among 10 Countries Collaborating to Monitor Influenza in Europe %A Koppeschaar,Carl E %A Colizza,Vittoria %A Guerrisi,Caroline %A Turbelin,Clément %A Duggan,Jim %A Edmunds,W John %A Kjelsø,Charlotte %A Mexia,Ricardo %A Moreno,Yamir %A Meloni,Sandro %A Paolotti,Daniela %A Perrotta,Daniela %A van Straten,Edward %A Franco,Ana O %+ De Grote Griepmeting, Science in Action BV, Postbus 1786, Amsterdam, 1000 BT, Netherlands, 31 620621593, carlkop@xs4all.nl %K influenza %K surveillance %K Internet %K vaccination %K Europe %D 2017 %7 19.09.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The wide availability of the Internet and the growth of digital communication technologies have become an important tool for epidemiological studies and health surveillance. Influenzanet is a participatory surveillance system monitoring the incidence of influenza-like illness (ILI) in Europe since 2003. It is based on data provided by volunteers who self-report their symptoms via the Internet throughout the influenza season and currently involves 10 countries. Objective: In this paper, we describe the Influenzanet system and provide an overview of results from several analyses that have been performed with the collected data, which include participant representativeness analyses, data validation (comparing ILI incidence rates between Influenzanet and sentinel medical practice networks), identification of ILI risk factors, and influenza vaccine effectiveness (VE) studies previously published. Additionally, we present new VE analyses for the Netherlands, stratified by age and chronic illness and offer suggestions for further work and considerations on the continuity and sustainability of the participatory system. Methods: Influenzanet comprises country-specific websites where residents can register to become volunteers to support influenza surveillance and have access to influenza-related information. Participants are recruited through different communication channels. Following registration, volunteers submit an intake questionnaire with their postal code and sociodemographic and medical characteristics, after which they are invited to report their symptoms via a weekly electronic newsletter reminder. Several thousands of participants have been engaged yearly in Influenzanet, with over 36,000 volunteers in the 2015-16 season alone. Results: In summary, for some traits and in some countries (eg, influenza vaccination rates in the Netherlands), Influenzanet participants were representative of the general population. However, for other traits, they were not (eg, participants underrepresent the youngest and oldest age groups in 7 countries). The incidence of ILI in Influenzanet was found to be closely correlated although quantitatively higher than that obtained by the sentinel medical practice networks. Various risk factors for acquiring an ILI infection were identified. The VE studies performed with Influenzanet data suggest that this surveillance system could develop into a complementary tool to measure the effectiveness of the influenza vaccine, eventually in real time. Conclusions: Results from these analyses illustrate that Influenzanet has developed into a fast and flexible monitoring system that can complement the traditional influenza surveillance performed by sentinel medical practices. The uniformity of Influenzanet allows for direct comparison of ILI rates between countries. It also has the important advantage of yielding individual data, which can be used to identify risk factors. The way in which the Influenzanet system is constructed allows the collection of data that could be extended beyond those of ILI cases to monitor pandemic influenza and other common or emerging diseases. %M 28928112 %R 10.2196/publichealth.7429 %U http://publichealth.jmir.org/2017/3/e66/ %U https://doi.org/10.2196/publichealth.7429 %U http://www.ncbi.nlm.nih.gov/pubmed/28928112 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 9 %P e315 %T Enhancing Seasonal Influenza Surveillance: Topic Analysis of Widely Used Medicinal Drugs Using Twitter Data %A Kagashe,Ireneus %A Yan,Zhijun %A Suheryani,Imran %+ School of Management and Economics, Beijing Institute of Technology, Main Building, No. 5 South Zhongguancun Street, Haidian, Beijing, 100081, China, 86 10 68912845, yanzhijun@bit.edu.cn %K machine learning %K Twitter messaging %K social media %K disease outbreaks %K influenza %K public health surveillance %K natural language processing %K influenza vaccines %D 2017 %7 12.09.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Uptake of medicinal drugs (preventive or treatment) is among the approaches used to control disease outbreaks, and therefore, it is of vital importance to be aware of the counts or frequencies of most commonly used drugs and trending topics about these drugs from consumers for successful implementation of control measures. Traditional survey methods would have accomplished this study, but they are too costly in terms of resources needed, and they are subject to social desirability bias for topics discovery. Hence, there is a need to use alternative efficient means such as Twitter data and machine learning (ML) techniques. Objective: Using Twitter data, the aim of the study was to (1) provide a methodological extension for efficiently extracting widely consumed drugs during seasonal influenza and (2) extract topics from the tweets of these drugs and to infer how the insights provided by these topics can enhance seasonal influenza surveillance. Methods: From tweets collected during the 2012-13 flu season, we first identified tweets with mentions of drugs and then constructed an ML classifier using dependency words as features. The classifier was used to extract tweets that evidenced consumption of drugs, out of which we identified the mostly consumed drugs. Finally, we extracted trending topics from each of these widely used drugs’ tweets using latent Dirichlet allocation (LDA). Results: Our proposed classifier obtained an F1 score of 0.82, which significantly outperformed the two benchmark classifiers (ie, P<.001 with the lexicon-based and P=.048 with the 1-gram term frequency [TF]). The classifier extracted 40,428 tweets that evidenced consumption of drugs out of 50,828 tweets with mentions of drugs. The most widely consumed drugs were influenza virus vaccines that had around 76.95% (31,111/40,428) share of the total; other notable drugs were Theraflu, DayQuil, NyQuil, vitamins, acetaminophen, and oseltamivir. The topics of each of these drugs exhibited common themes or experiences from people who have consumed these drugs. Among these were the enabling and deterrent factors to influenza drugs uptake, which are keys to mitigating the severity of seasonal influenza outbreaks. Conclusions: The study results showed the feasibility of using tweets of widely consumed drugs to enhance seasonal influenza surveillance in lieu of the traditional or conventional surveillance approaches. Public health officials and other stakeholders can benefit from the findings of this study, especially in enhancing strategies for mitigating the severity of seasonal influenza outbreaks. The proposed methods can be extended to the outbreaks of other diseases. %M 28899847 %R 10.2196/jmir.7393 %U http://www.jmir.org/2017/9/e315/ %U https://doi.org/10.2196/jmir.7393 %U http://www.ncbi.nlm.nih.gov/pubmed/28899847 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 3 %N 3 %P e57 %T Evaluation of Sampling Recommendations From the Influenza Virologic Surveillance Right Size Roadmap for Idaho %A Rosenthal,Mariana %A Anderson,Katey %A Tengelsen,Leslie %A Carter,Kris %A Hahn,Christine %A Ball,Christopher %+ Centers for Disease Control and Prevention, Idaho Department of Health and Welfare, 450 W. State Street, 4th Floor, Boise, ID, 83720, United States, 1 619 808 3992, mariana.rosenthal@doh.wa.gov %K influenza %K sample size %K public health surveillance %D 2017 %7 24.08.2017 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The Right Size Roadmap was developed by the Association of Public Health Laboratories and the Centers for Disease Control and Prevention to improve influenza virologic surveillance efficiency. Guidelines were provided to state health departments regarding representativeness and statistical estimates of specimen numbers needed for seasonal influenza situational awareness, rare or novel influenza virus detection, and rare or novel influenza virus investigation. Objective: The aim of this study was to compare Roadmap sampling recommendations with Idaho’s influenza virologic surveillance to determine implementation feasibility. Methods: We calculated the proportion of medically attended influenza-like illness (MA-ILI) from Idaho’s influenza-like illness surveillance among outpatients during October 2008 to May 2014, applied data to Roadmap-provided sample size calculators, and compared calculations with actual numbers of specimens tested for influenza by the Idaho Bureau of Laboratories (IBL). We assessed representativeness among patients’ tested specimens to census estimates by age, sex, and health district residence. Results: Among outpatients surveilled, Idaho’s mean annual proportion of MA-ILI was 2.30% (20,834/905,818) during a 5-year period. Thus, according to Roadmap recommendations, Idaho needs to collect 128 specimens from MA-ILI patients/week for situational awareness, 1496 influenza-positive specimens/week for detection of a rare or novel influenza virus at 0.2% prevalence, and after detection, 478 specimens/week to confirm true prevalence is ≤2% of influenza-positive samples. The mean number of respiratory specimens Idaho tested for influenza/week, excluding the 2009-2010 influenza season, ranged from 6 to 24. Various influenza virus types and subtypes were collected and specimen submission sources were representative in terms of geographic distribution, patient age range and sex, and disease severity. Conclusions: Insufficient numbers of respiratory specimens are submitted to IBL for influenza laboratory testing. Increased specimen submission would facilitate meeting Roadmap sample size recommendations. %M 28838883 %R 10.2196/publichealth.6648 %U http://publichealth.jmir.org/2017/3/e57/ %U https://doi.org/10.2196/publichealth.6648 %U http://www.ncbi.nlm.nih.gov/pubmed/28838883 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 19 %N 6 %P e211 %T Integrated Detection and Prediction of Influenza Activity for Real-Time Surveillance: Algorithm Design %A Spreco,Armin %A Eriksson,Olle %A Dahlström,Örjan %A Cowling,Benjamin John %A Timpka,Toomas %+ Faculty of Health Sciences, Department of Medical and Health Sciences, Linköping University, IMH:s kansli, Sandbäcksgatan 7, Linköping, 581 83, Sweden, 46 737543032, armin.spreco@liu.se %K human influenza %K algorithms %K epidemiological surveillance %K public health surveillance %K evaluation research %K epidemiological methods %D 2017 %7 15.06.2017 %9 Original Paper %J J Med Internet Res %G English %X Background: Influenza is a viral respiratory disease capable of causing epidemics that represent a threat to communities worldwide. The rapidly growing availability of electronic “big data” from diagnostic and prediagnostic sources in health care and public health settings permits advance of a new generation of methods for local detection and prediction of winter influenza seasons and influenza pandemics. Objective: The aim of this study was to present a method for integrated detection and prediction of influenza virus activity in local settings using electronically available surveillance data and to evaluate its performance by retrospective application on authentic data from a Swedish county. Methods: An integrated detection and prediction method was formally defined based on a design rationale for influenza detection and prediction methods adapted for local surveillance. The novel method was retrospectively applied on data from the winter influenza season 2008-09 in a Swedish county (population 445,000). Outcome data represented individuals who met a clinical case definition for influenza (based on International Classification of Diseases version 10 [ICD-10] codes) from an electronic health data repository. Information from calls to a telenursing service in the county was used as syndromic data source. Results: The novel integrated detection and prediction method is based on nonmechanistic statistical models and is designed for integration in local health information systems. The method is divided into separate modules for detection and prediction of local influenza virus activity. The function of the detection module is to alert for an upcoming period of increased load of influenza cases on local health care (using influenza-diagnosis data), whereas the function of the prediction module is to predict the timing of the activity peak (using syndromic data) and its intensity (using influenza-diagnosis data). For detection modeling, exponential regression was used based on the assumption that the beginning of a winter influenza season has an exponential growth of infected individuals. For prediction modeling, linear regression was applied on 7-day periods at the time in order to find the peak timing, whereas a derivate of a normal distribution density function was used to find the peak intensity. We found that the integrated detection and prediction method detected the 2008-09 winter influenza season on its starting day (optimal timeliness 0 days), whereas the predicted peak was estimated to occur 7 days ahead of the factual peak and the predicted peak intensity was estimated to be 26% lower than the factual intensity (6.3 compared with 8.5 influenza-diagnosis cases/100,000). Conclusions: Our detection and prediction method is one of the first integrated methods specifically designed for local application on influenza data electronically available for surveillance. The performance of the method in a retrospective study indicates that further prospective evaluations of the methods are justified. %M 28619700 %R 10.2196/jmir.7101 %U http://www.jmir.org/2017/6/e211/ %U https://doi.org/10.2196/jmir.7101 %U http://www.ncbi.nlm.nih.gov/pubmed/28619700 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 2 %P e161 %T Evaluating Google, Twitter, and Wikipedia as Tools for Influenza Surveillance Using Bayesian Change Point Analysis: A Comparative Analysis %A Sharpe,J Danielle %A Hopkins,Richard S %A Cook,Robert L %A Striley,Catherine W %+ Rollins School of Public Health, Department of Epidemiology, Emory University, 1518 Clifton Road NE, Atlanta, GA, 30322, United States, 1 912 399 2811, danielle.sharpe@emory.edu %K Internet %K social media %K Bayes theorem %K public health surveillance %K influenza, human %D 2016 %7 20.10.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: Traditional influenza surveillance relies on influenza-like illness (ILI) syndrome that is reported by health care providers. It primarily captures individuals who seek medical care and misses those who do not. Recently, Web-based data sources have been studied for application to public health surveillance, as there is a growing number of people who search, post, and tweet about their illnesses before seeking medical care. Existing research has shown some promise of using data from Google, Twitter, and Wikipedia to complement traditional surveillance for ILI. However, past studies have evaluated these Web-based sources individually or dually without comparing all 3 of them, and it would be beneficial to know which of the Web-based sources performs best in order to be considered to complement traditional methods. Objective: The objective of this study is to comparatively analyze Google, Twitter, and Wikipedia by examining which best corresponds with Centers for Disease Control and Prevention (CDC) ILI data. It was hypothesized that Wikipedia will best correspond with CDC ILI data as previous research found it to be least influenced by high media coverage in comparison with Google and Twitter. Methods: Publicly available, deidentified data were collected from the CDC, Google Flu Trends, HealthTweets, and Wikipedia for the 2012-2015 influenza seasons. Bayesian change point analysis was used to detect seasonal changes, or change points, in each of the data sources. Change points in Google, Twitter, and Wikipedia that occurred during the exact week, 1 preceding week, or 1 week after the CDC’s change points were compared with the CDC data as the gold standard. All analyses were conducted using the R package “bcp” version 4.0.0 in RStudio version 0.99.484 (RStudio Inc). In addition, sensitivity and positive predictive values (PPV) were calculated for Google, Twitter, and Wikipedia. Results: During the 2012-2015 influenza seasons, a high sensitivity of 92% was found for Google, whereas the PPV for Google was 85%. A low sensitivity of 50% was calculated for Twitter; a low PPV of 43% was found for Twitter also. Wikipedia had the lowest sensitivity of 33% and lowest PPV of 40%. Conclusions: Of the 3 Web-based sources, Google had the best combination of sensitivity and PPV in detecting Bayesian change points in influenza-related data streams. Findings demonstrated that change points in Google, Twitter, and Wikipedia data occasionally aligned well with change points captured in CDC ILI data, yet these sources did not detect all changes in CDC data and should be further studied and developed. %M 27765731 %R 10.2196/publichealth.5901 %U http://publichealth.jmir.org/2016/2/e161/ %U https://doi.org/10.2196/publichealth.5901 %U http://www.ncbi.nlm.nih.gov/pubmed/27765731 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 7 %P e177 %T Estimating Influenza Outbreaks Using Both Search Engine Query Data and Social Media Data in South Korea %A Woo,Hyekyung %A Cho,Youngtae %A Shim,Eunyoung %A Lee,Jong-Koo %A Lee,Chang-Gun %A Kim,Seong Hwan %+ Department of Health Science and Service, School of Public Health, Seoul National University, 1 Kwanakro, Kwanakgu, Seoul, 151-172, Republic Of Korea, 82 10 7135 4610, youngtae@snu.ac.kr %K influenza %K surveillance %K population surveillance %K infodemiology %K infoveillance %K Internet search %K query %K social media %K big data %K forecasting %K epidemiology %K early response %D 2016 %7 04.07.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: As suggested as early as in 2006, logs of queries submitted to search engines seeking information could be a source for detection of emerging influenza epidemics if changes in the volume of search queries are monitored (infodemiology). However, selecting queries that are most likely to be associated with influenza epidemics is a particular challenge when it comes to generating better predictions. Objective: In this study, we describe a methodological extension for detecting influenza outbreaks using search query data; we provide a new approach for query selection through the exploration of contextual information gleaned from social media data. Additionally, we evaluate whether it is possible to use these queries for monitoring and predicting influenza epidemics in South Korea. Methods: Our study was based on freely available weekly influenza incidence data and query data originating from the search engine on the Korean website Daum between April 3, 2011 and April 5, 2014. To select queries related to influenza epidemics, several approaches were applied: (1) exploring influenza-related words in social media data, (2) identifying the chief concerns related to influenza, and (3) using Web query recommendations. Optimal feature selection by least absolute shrinkage and selection operator (Lasso) and support vector machine for regression (SVR) were used to construct a model predicting influenza epidemics. Results: In total, 146 queries related to influenza were generated through our initial query selection approach. A considerable proportion of optimal features for final models were derived from queries with reference to the social media data. The SVR model performed well: the prediction values were highly correlated with the recent observed influenza-like illness (r=.956; P<.001) and virological incidence rate (r=.963; P<.001). Conclusions: These results demonstrate the feasibility of using search queries to enhance influenza surveillance in South Korea. In addition, an approach for query selection using social media data seems ideal for supporting influenza surveillance based on search query data. %M 27377323 %R 10.2196/jmir.4955 %U http://www.jmir.org/2016/7/e177/ %U https://doi.org/10.2196/jmir.4955 %U http://www.ncbi.nlm.nih.gov/pubmed/27377323 %0 Journal Article %@ 1438-8871 %I JMIR Publications %V 18 %N 6 %P e175 %T Google Flu Trends Spatial Variability Validated Against Emergency Department Influenza-Related Visits %A Klembczyk,Joseph Jeffrey %A Jalalpour,Mehdi %A Levin,Scott %A Washington,Raynard E %A Pines,Jesse M %A Rothman,Richard E %A Dugas,Andrea Freyer %+ Johns Hopkins University, School of Medicine, 128 S Belvedere Dr, Hampstead, NC, 28443, United States, 1 518 573 2045, jjklem@gmail.com %K influenza %K surveillance %K emergency department %K google flu trends %K infoveillance %D 2016 %7 28.06.2016 %9 Original Paper %J J Med Internet Res %G English %X Background: Influenza is a deadly and costly public health problem. Variations in its seasonal patterns cause dangerous surges in emergency department (ED) patient volume. Google Flu Trends (GFT) can provide faster influenza surveillance information than traditional CDC methods, potentially leading to improved public health preparedness. GFT has been found to correlate well with reported influenza and to improve influenza prediction models. However, previous validation studies have focused on isolated clinical locations. Objective: The purpose of the study was to measure GFT surveillance effectiveness by correlating GFT with influenza-related ED visits in 19 US cities across seven influenza seasons, and to explore which city characteristics lead to better or worse GFT effectiveness. Methods: Using Healthcare Cost and Utilization Project data, we collected weekly counts of ED visits for all patients with diagnosis (International Statistical Classification of Diseases 9) codes for influenza-related visits from 2005-2011 in 19 different US cities. We measured the correlation between weekly volume of GFT searches and influenza-related ED visits (ie, GFT ED surveillance effectiveness) per city. We evaluated the relationship between 15 publically available city indicators (11 sociodemographic, two health care utilization, and two climate) and GFT surveillance effectiveness using univariate linear regression. Results: Correlation between city-level GFT and influenza-related ED visits had a median of .84, ranging from .67 to .93 across 19 cities. Temporal variability was observed, with median correlation ranging from .78 in 2009 to .94 in 2005. City indicators significantly associated (P<.10) with improved GFT surveillance include higher proportion of female population, higher proportion with Medicare coverage, higher ED visits per capita, and lower socioeconomic status. Conclusions: GFT is strongly correlated with ED influenza-related visits at the city level, but unexplained variation over geographic location and time limits its utility as standalone surveillance. GFT is likely most useful as an early signal used in conjunction with other more comprehensive surveillance techniques. City indicators associated with improved GFT surveillance provide some insight into the variability of GFT effectiveness. For example, populations with lower socioeconomic status may have a greater tendency to initially turn to the Internet for health questions, thus leading to increased GFT effectiveness. GFT has the potential to provide valuable information to ED providers for patient care and to administrators for ED surge preparedness. %M 27354313 %R 10.2196/jmir.5585 %U http://www.jmir.org/2016/6/e175/ %U https://doi.org/10.2196/jmir.5585 %U http://www.ncbi.nlm.nih.gov/pubmed/27354313 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 1 %P e20 %T Effectiveness of Implementation of Electronic Malaria Information System as the National Malaria Surveillance System in Thailand %A Ma,Shaojin %A Lawpoolsri,Saranath %A Soonthornworasiri,Ngamphol %A Khamsiriwatchara,Amnat %A Jandee,Kasemsak %A Taweeseneepitch,Komchaluch %A Pawarana,Rungrawee %A Jaiklaew,Sukanya %A Kijsanayotin,Boonchai %A Kaewkungwal,Jaranit %+ Department of Tropical Hygiene (Biomedical and Health Informatics), Faculty of Tropical Medicine, Mahidol University, 420/6 Ratchawithi Road, Ratchathewi, Bangkok, 10400, Thailand, 66 23549181, jaranit.kae@mahidol.ac.th %K surveillance system %K epidemiology %K mixed-methods %K evaluation %K malaria %K eMIS %K data quality %K public health informatics %K Thailand %D 2016 %7 06.05.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: In moving toward malaria elimination, one strategy is to implement an active surveillance system for effective case management. Thailand has developed and implemented the electronic Malaria Information System (eMIS) capturing individualized electronic records of suspected or confirmed malaria cases. Objective: The main purpose of this study was to determine how well the eMIS improves the quality of Thailand’s malaria surveillance system. In particular, the focus of the study was to evaluate the effectiveness of the eMIS in terms of the system users’ perception and the system outcomes (ie, quality of data) regarding the management of malaria patients. Methods: A mixed-methods technique was used with the framework based on system effectiveness attributes: data quality, timeliness, simplicity, acceptability, flexibility, stability, and usefulness. Three methods were utilized: data records review, survey of system users, and in-depth interviews with key stakeholders. From the two highest endemic provinces, paper forms matching electronic records of 4455 noninfected and 784 malaria-infected cases were reviewed. Web-based anonymous questionnaires were distributed to all 129 eMIS data entry staff throughout Thailand, and semistructured interviews were conducted with 12 management-level officers. Results: The eMIS is well accepted by system users at both management and operational levels. The data quality has enabled malaria personnel to perform more effective prevention and control activities. There is evidence of practices resulting in inconsistencies and logical errors in data reporting. Critical data elements were mostly completed, except for a few related to certain dates and area classifications. Timeliness in reporting a case to the system was acceptable with a delay of 3-4 days. The evaluation of quantitative and qualitative data confirmed that the eMIS has high levels of simplicity, acceptability, stability, and flexibility. Conclusions: Overall, the system implemented has achieved its objective. The results of the study suggested that the eMIS helps improve the quality of Thailand’s malaria surveillance system. As the national malaria surveillance system, the eMIS’s functionalities have provided the malaria staff working at the point of care with close-to-real-time case management data quality, covering case detection, case investigation, drug compliance, and follow-up visits. Such features has led to an improvement in the quality of the malaria control program; the government officials now have quicker access to both individual and aggregated data to promptly react to possible outbreak. The eMIS thus plays one of the key roles in moving toward the national goal of malaria elimination by the next decade. %M 27227156 %R 10.2196/publichealth.5347 %U http://publichealth.jmir.org/2016/1/e20/ %U https://doi.org/10.2196/publichealth.5347 %U http://www.ncbi.nlm.nih.gov/pubmed/27227156 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 5 %N 2 %P e56 %T Improving Rates of Influenza Vaccination Through Electronic Health Record Portal Messages, Interactive Voice Recognition Calls and Patient-Enabled Electronic Health Record Updates: Protocol for a Randomized Controlled Trial %A Cutrona,Sarah L %A Sreedhara,Meera %A Goff,Sarah L %A Fisher,Lloyd D %A Preusse,Peggy %A Jackson,Madeline %A Sundaresan,Devi %A Garber,Lawrence D %A Mazor,Kathleen M %+ University of Massachusetts School of Medicine, Division of General Medicine/Primary Care, 55 Lake Street, Worcester, MA, 01605, United States, 1 5088563085, Sarah.Cutrona@umassmemorial.org %K electronic health records %K influenza vaccines %K clinical decision support %K Internet %K Telephone %K Electronic Mail %K Health Records, Personal %K Medical Informatics Applications %D 2016 %7 06.05.2016 %9 Protocol %J JMIR Res Protoc %G English %X Background: Clinical decision support (CDS), including computerized reminders for providers and patients, can improve health outcomes. CDS promoting influenza vaccination, delivered directly to patients via an electronic health record (EHR) patient portal and interactive voice recognition (IVR) calls, offers an innovative approach to improving patient care. Objective: To test the effectiveness of an EHR patient portal and IVR outreach to improve rates of influenza vaccination in a large multispecialty group practice in central Massachusetts. Methods: We describe a nonblinded, randomized controlled trial of EHR patient portal messages and IVR calls designed to promote influenza vaccination. In our preparatory phase, we conducted qualitative interviews with patients, providers, and staff to inform development of EHR portal messages with embedded questionnaires and IVR call scripts. We also provided practice-wide education on influenza vaccines to all physicians and staff members, including information on existing vaccine-specific EHR CDS. Outreach will target adult patients who remain unvaccinated for more than 2 months after the start of the influenza season. Using computer-generated randomization and a factorial design, we will assign 20,000 patients who are active users of electronic patient portals to one of the 4 study arms: (1) receipt of a portal message promoting influenza vaccines and offering online appointment scheduling; (2) receipt of an IVR call with similar content but without appointment facilitation; (3) both (1) and (2); or (4) neither (1) nor (2) (usual care). We will randomize patients without electronic portals (10,000 patients) to (1) receipt of IVR call or (2) usual care. Both portal messages and IVR calls promote influenza vaccine completion. Our primary outcome is percentage of eligible patients with influenza vaccines administered at our group practice during the 2014-15 influenza season. Both outreach methods also solicit patient self-report on influenza vaccinations completed outside the clinic or on barriers to influenza vaccination. Self-reported data from both outreach modes will be uploaded into the EHR to increase accuracy of existing provider-directed EHR CDS (vaccine alerts). Results: With our proposed sample size and using a factorial design, power calculations using baseline vaccination rate estimates indicated that 4286 participants per arm would give 80% power to detect a 3% improvement in influenza vaccination rates between groups (α=.05; 2-sided). Intention-to-treat unadjusted chi-square analyses will be performed to assess the impact of portal messages, either alone or in combination with the IVR call, on influenza vaccination rates. The project was funded in January 2014. Patient enrollment for the project described here completed in December 2014. Data analysis is currently under way and first results are expected to be submitted for publication in 2016. Conclusions: If successful, this study’s intervention may be adapted by other large health care organizations to increase vaccination rates among their eligible patients. ClinicalTrial: ClinicalTrials.gov NCT02266277; https://clinicaltrials.gov/ct2/show/NCT02266277 (Archived by WebCite at http://www.webcitation.org/6fbLviHLH). %M 27153752 %R 10.2196/resprot.5478 %U http://www.researchprotocols.org/2016/2/e56/ %U https://doi.org/10.2196/resprot.5478 %U http://www.ncbi.nlm.nih.gov/pubmed/27153752 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 2 %N 1 %P e1 %T The Measles Vaccination Narrative in Twitter: A Quantitative Analysis %A Radzikowski,Jacek %A Stefanidis,Anthony %A Jacobsen,Kathryn H %A Croitoru,Arie %A Crooks,Andrew %A Delamater,Paul L %+ Center for Geospatial Intelligence, Department of Geography and Geoinformation Science, George Mason University, 4400 University Drive, MS 6C3, Fairfax, VA, 22030, United States, 1 (703)9931212, astefani@gmu.edu %K social media %K health narrative %K geographic characteristics %K data analysis %K health informatics %K GIS (geographic information systems) %D 2016 %7 04.01.2016 %9 Original Paper %J JMIR Public Health Surveill %G English %X Background: The emergence of social media is providing an alternative avenue for information exchange and opinion formation on health-related issues. Collective discourse in such media leads to the formation of a complex narrative, conveying public views and perceptions. Objective: This paper presents a study of Twitter narrative regarding vaccination in the aftermath of the 2015 measles outbreak, both in terms of its cyber and physical characteristics. We aimed to contribute to the analysis of the data, as well as presenting a quantitative interdisciplinary approach to analyze such open-source data in the context of health narratives. Methods: We collected 669,136 tweets referring to vaccination from February 1 to March 9, 2015. These tweets were analyzed to identify key terms, connections among such terms, retweet patterns, the structure of the narrative, and connections to the geographical space. Results: The data analysis captures the anatomy of the themes and relations that make up the discussion about vaccination in Twitter. The results highlight the higher impact of stories contributed by news organizations compared to direct tweets by health organizations in communicating health-related information. They also capture the structure of the antivaccination narrative and its terms of reference. Analysis also revealed the relationship between community engagement in Twitter and state policies regarding child vaccination. Residents of Vermont and Oregon, the two states with the highest rates of non-medical exemption from school-entry vaccines nationwide, are leading the social media discussion in terms of participation. Conclusions: The interdisciplinary study of health-related debates in social media across the cyber-physical debate nexus leads to a greater understanding of public concerns, views, and responses to health-related issues. Further coalescing such capabilities shows promise towards advancing health communication, thus supporting the design of more effective strategies that take into account the complex and evolving public views of health issues. %M 27227144 %R 10.2196/publichealth.5059 %U http://publichealth.jmir.org/2016/1/e1/ %U https://doi.org/10.2196/publichealth.5059 %U http://www.ncbi.nlm.nih.gov/pubmed/27227144 %0 Journal Article %@ 1929-0748 %I JMIR Publications Inc. %V 4 %N 2 %P e74 %T Household Transmission of Zoonotic Influenza Viruses in a Cohort of Egyptian Poultry Growers %A El Rifay,Amira S %A Elabd,Mona A %A Abu Zeid,Dina %A Gomaa,Mokhtar R %A Tang,Li %A McKenzie,Pamela P %A Webby,Richard J %A Ali,Mohamed A %A Kayali,Ghazi %+ St Jude Children's Research Hospital, 262 Danny Thomas Place, Memphis, TN, 38105, United States, 1 9015953400, ghazi.kayali@stjude.org %K influenza %K avian %K epidemiology %K cohort %D 2015 %7 22.06.2015 %9 Original Paper %J JMIR Res Protoc %G English %X Background: The highly pathogenic avian influenza H5N1 viruses and the low pathogenic H9N2 viruses are enzootic in Egyptian poultry. Several cases of human infection with H5N1 were reported in Egypt. We previously determined that the seroprevalence of H5N1 antibodies in Egyptians exposed to poultry is 2.1% (15/708), suggesting that mild or subclinical infections with this virus occur. We aim to measure the incidence of avian influenza infection in Egyptians exposed to poultry, study risk factors of infection, study the resulting immune response, study household transmission rates, and characterize the viruses causing infections. Objective: The objective of the study is to design a 7-year, prospective, household-based cohort investigation to determine incidence and household transmission of avian influenza viruses in humans exposed to poultry. Methods: At baseline, we will collect sera to measure antibodies against influenza A. Field nurses will visit enrolled subjects at least weekly to check for influenza-like illness symptoms and verify influenza infection by a point of care rapid test. From subjects with influenza infection and their household contacts, we will collect nasal swabs, throat swabs, and nasal washes to characterize the antigenic and genetic makeup of influenza viruses infecting humans. The nurse will also obtain 2x 3-ml blood samples, one for serology, and another for isolating peripheral blood mononuclear cells. Results: Results from this cohort will enhance our understanding of the transmission of avian influenza viruses to humans in a country where such viruses are enzootic. Conclusions: This may enhance public health efforts aimed at reducing this burden. %M 26099368 %R 10.2196/resprot.4331 %U http://www.researchprotocols.org/2015/2/e74/ %U https://doi.org/10.2196/resprot.4331 %U http://www.ncbi.nlm.nih.gov/pubmed/26099368 %0 Journal Article %@ 2369-2960 %I JMIR Publications %V 1 %N 1 %P e5 %T Using Social Media to Perform Local Influenza Surveillance in an Inner-City Hospital: A Retrospective Observational Study %A Broniatowski,David Andre %A Dredze,Mark %A Paul,Michael J %A Dugas,Andrea %+ Department of Engineering Management and Systems Engineering, The George Washington University, Science and Engineering Hall, 800 22nd Street NW, #2700, Washington, DC, 20052, United States, 1 2029943751, broniatowski@gwu.edu %K Web mining %K social computing %K time series analysis %D 2015 %7 29.05.2015 %9 Short Paper %J JMIR Public Health Surveill %G English %X Background: Public health officials and policy makers in the United States expend significant resources at the national, state, county, and city levels to measure the rate of influenza infection. These individuals rely on influenza infection rate information to make important decisions during the course of an influenza season driving vaccination campaigns, clinical guidelines, and medical staffing. Web and social media data sources have emerged as attractive alternatives to supplement existing practices. While traditional surveillance methods take 1-2 weeks, and significant labor, to produce an infection estimate in each locale, web and social media data are available in near real-time for a broad range of locations. Objective: The objective of this study was to analyze the efficacy of flu surveillance from combining data from the websites Google Flu Trends and HealthTweets at the local level. We considered both emergency department influenza-like illness cases and laboratory-confirmed influenza cases for a single hospital in the City of Baltimore. Methods: This was a retrospective observational study comparing estimates of influenza activity of Google Flu Trends and Twitter to actual counts of individuals with laboratory-confirmed influenza, and counts of individuals presenting to the emergency department with influenza-like illness cases. Data were collected from November 20, 2011 through March 16, 2014. Each parameter was evaluated on the municipal, regional, and national scale. We examined the utility of social media data for tracking actual influenza infection at the municipal, state, and national levels. Specifically, we compared the efficacy of Twitter and Google Flu Trends data. Results: We found that municipal-level Twitter data was more effective than regional and national data when tracking actual influenza infection rates in a Baltimore inner-city hospital. When combined, national-level Twitter and Google Flu Trends data outperformed each data source individually. In addition, influenza-like illness data at all levels of geographic granularity were best predicted by national Google Flu Trends data. Conclusions: In order to overcome sensitivity to transient events, such as the news cycle, the best-fitting Google Flu Trends model relies on a 4-week moving average, suggesting that it may also be sacrificing sensitivity to transient fluctuations in influenza infection to achieve predictive power. Implications for influenza forecasting are discussed in this report. %M 27014744 %R 10.2196/publichealth.4472 %U http://publichealth.jmir.org/2015/1/e5/ %U https://doi.org/10.2196/publichealth.4472 %U http://www.ncbi.nlm.nih.gov/pubmed/27014744 %0 Journal Article %@ 2291-5222 %I JMIR Publications Inc. %V 3 %N 1 %P e15 %T Knowledge, Attitudes, and Practices Regarding Avian Influenza A (H7N9) Among Mobile Phone Users: A Survey in Zhejiang Province, China %A Gu,Hua %A Jiang,Zhenggang %A Chen,Bin %A Zhang,Jueman (Mandy) %A Wang,Zhengting %A Wang,Xinyi %A Cai,Jian %A Chen,Yongdi %A Zheng,Dawei %A Jiang,Jianmin %+ Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Road, Binjiang District, Hangzhou, 310051, China, 86 57187115009, jmjiang@cdc.zj.cn %K influenza A virus, subtype H7N9 %K knowledge %K attitude %K surveillance %D 2015 %7 04.02.2015 %9 Original Paper %J JMIR mHealth uHealth %G English %X Background: Understanding people’s knowledge, attitudes, and practices (KAP) regarding a new infectious disease is crucial to the prevention and control of it. Human infection with avian influenza A (H7N9) was first identified on March 31, 2013 in China. Out of the total number of 134 cases confirmed from March to September 2013 in China, Zhejiang Province saw the greatest number (46 cases). Objective: This study employed a mobile Internet survey to assess KAP regarding H7N9 among mobile phone users in Zhejiang Province. This study intended to examine KAP by region and the association between sociodemographic variables and KAP. Methods: An anonymous questionnaire was designed by Zhejiang Provincial Center for Disease Control and Prevention (CDC). A cross-sectional survey was executed through a mobile Internet application platform of China Unicom in 5 regions in Zhejiang Province. Stratified and clustered sampling methods were applied and mobile phone users were invited to participate in the study voluntarily. Results: A total of 9582 eligible mobile phone users participated in the survey with a response rate of 1.92% (9582/5,000,000). A total of 9105 valid responses (95.02%) were included for statistical analysis. Generally, more than three-quarters of the participants had some basic knowledge of H7N9 and held the attitude recommended by the Zhejiang CDC toward eating cooked poultry (77.55%, 7061/9105) and visiting a hospital at the occurrence of symptoms (78.51%, 7148/9105). Approximately half of the participants worried about contracting H7N9, and took preventive practices recommended by the Zhejiang CDC. But only 14.29% (1301/9105) of participants kept eating cooked poultry as usual. Although worry about H7N9 infection did not differ by region, Hangzhou saw the largest proportion of participants with knowledge of H7N9, which was probably because Hangzhou had the greatest number of H7N9 cases. KAP varied by some sociodemographic variables. Female participants were more likely to know about symptoms of H7N9 (OR 1.32, 95% CI 1.08-1.61), to worry about contracting it (OR 1.15, 95% CI 1.04-1.27), and to report their lives being influenced by it (OR 1.27, 95% CI 1.15-1.41). They were also more likely to take the recommended precautions. Male participants and younger participants were less likely to comply with advocated protective practices. Conclusions: The results suggest that health education should be customized depending on sociodemographic variables to achieve more effective behavioral outcomes. %M 25653213 %R 10.2196/mhealth.3394 %U http://mhealth.jmir.org/2015/1/e15/ %U https://doi.org/10.2196/mhealth.3394 %U http://www.ncbi.nlm.nih.gov/pubmed/25653213 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 12 %P e289 %T Cumulative Query Method for Influenza Surveillance Using Search Engine Data %A Seo,Dong-Woo %A Jo,Min-Woo %A Sohn,Chang Hwan %A Shin,Soo-Yong %A Lee,JaeHo %A Yu,Maengsoo %A Kim,Won Young %A Lim,Kyoung Soo %A Lee,Sang-Il %+ Asan Medical Center, Department of Preventive Medicine, University of Ulsan, College of Medicine, 88, Olympic-Ro 43-Gil, Songpa-gu, Seoul, 138-769, Republic Of Korea, 82 2 3010 3350, leiseo@hanmail.net %K syndromic surveillance system %K influenza %K influenza-like illness %K Google Flu Trends %K Internet search %K query %D 2014 %7 16.12.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Internet search queries have become an important data source in syndromic surveillance system. However, there is currently no syndromic surveillance system using Internet search query data in South Korea. Objectives: The objective of this study was to examine correlations between our cumulative query method and national influenza surveillance data. Methods: Our study was based on the local search engine, Daum (approximately 25% market share), and influenza-like illness (ILI) data from the Korea Centers for Disease Control and Prevention. A quota sampling survey was conducted with 200 participants to obtain popular queries. We divided the study period into two sets: Set 1 (the 2009/10 epidemiological year for development set 1 and 2010/11 for validation set 1) and Set 2 (2010/11 for development Set 2 and 2011/12 for validation Set 2). Pearson’s correlation coefficients were calculated between the Daum data and the ILI data for the development set. We selected the combined queries for which the correlation coefficients were .7 or higher and listed them in descending order. Then, we created a cumulative query method n representing the number of cumulative combined queries in descending order of the correlation coefficient. Results: In validation set 1, 13 cumulative query methods were applied, and 8 had higher correlation coefficients (min=.916, max=.943) than that of the highest single combined query. Further, 11 of 13 cumulative query methods had an r value of ≥.7, but 4 of 13 combined queries had an r value of ≥.7. In validation set 2, 8 of 15 cumulative query methods showed higher correlation coefficients (min=.975, max=.987) than that of the highest single combined query. All 15 cumulative query methods had an r value of ≥.7, but 6 of 15 combined queries had an r value of ≥.7. Conclusions: Cumulative query method showed relatively higher correlation with national influenza surveillance data than combined queries in the development and validation set. %M 25517353 %R 10.2196/jmir.3680 %U http://www.jmir.org/2014/12/e289/ %U https://doi.org/10.2196/jmir.3680 %U http://www.ncbi.nlm.nih.gov/pubmed/25517353 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 11 %P e250 %T The Reliability of Tweets as a Supplementary Method of Seasonal Influenza Surveillance %A Aslam,Anoshé A %A Tsou,Ming-Hsiang %A Spitzberg,Brian H %A An,Li %A Gawron,J Mark %A Gupta,Dipak K %A Peddecord,K Michael %A Nagel,Anna C %A Allen,Christopher %A Yang,Jiue-An %A Lindsay,Suzanne %+ Department of Geography, San Diego State University, Storm Hall 313C, 5500 Campanile Drive, San Diego, CA, 92115, United States, 1 619 594 0205, mtsou@mail.sdsu.edu %K Twitter %K tweets %K infoveillance %K infodemiology %K syndromic surveillance %K influenza %K Internet %D 2014 %7 14.11.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Existing influenza surveillance in the United States is focused on the collection of data from sentinel physicians and hospitals; however, the compilation and distribution of reports are usually delayed by up to 2 weeks. With the popularity of social media growing, the Internet is a source for syndromic surveillance due to the availability of large amounts of data. In this study, tweets, or posts of 140 characters or less, from the website Twitter were collected and analyzed for their potential as surveillance for seasonal influenza. Objective: There were three aims: (1) to improve the correlation of tweets to sentinel-provided influenza-like illness (ILI) rates by city through filtering and a machine-learning classifier, (2) to observe correlations of tweets for emergency department ILI rates by city, and (3) to explore correlations for tweets to laboratory-confirmed influenza cases in San Diego. Methods: Tweets containing the keyword “flu” were collected within a 17-mile radius from 11 US cities selected for population and availability of ILI data. At the end of the collection period, 159,802 tweets were used for correlation analyses with sentinel-provided ILI and emergency department ILI rates as reported by the corresponding city or county health department. Two separate methods were used to observe correlations between tweets and ILI rates: filtering the tweets by type (non-retweets, retweets, tweets with a URL, tweets without a URL), and the use of a machine-learning classifier that determined whether a tweet was “valid”, or from a user who was likely ill with the flu. Results: Correlations varied by city but general trends were observed. Non-retweets and tweets without a URL had higher and more significant (P<.05) correlations than retweets and tweets with a URL. Correlations of tweets to emergency department ILI rates were higher than the correlations observed for sentinel-provided ILI for most of the cities. The machine-learning classifier yielded the highest correlations for many of the cities when using the sentinel-provided or emergency department ILI as well as the number of laboratory-confirmed influenza cases in San Diego. High correlation values (r=.93) with significance at P<.001 were observed for laboratory-confirmed influenza cases for most categories and tweets determined to be valid by the classifier. Conclusions: Compared to tweet analyses in the previous influenza season, this study demonstrated increased accuracy in using Twitter as a supplementary surveillance tool for influenza as better filtering and classification methods yielded higher correlations for the 2013-2014 influenza season than those found for tweets in the previous influenza season, where emergency department ILI rates were better correlated to tweets than sentinel-provided ILI rates. Further investigations in the field would require expansion with regard to the location that the tweets are collected from, as well as the availability of more ILI data. %M 25406040 %R 10.2196/jmir.3532 %U http://www.jmir.org/2014/11/e250/ %U https://doi.org/10.2196/jmir.3532 %U http://www.ncbi.nlm.nih.gov/pubmed/25406040 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 10 %P e236 %T A Case Study of the New York City 2012-2013 Influenza Season With Daily Geocoded Twitter Data From Temporal and Spatiotemporal Perspectives %A Nagar,Ruchit %A Yuan,Qingyu %A Freifeld,Clark C %A Santillana,Mauricio %A Nojima,Aaron %A Chunara,Rumi %A Brownstein,John S %+ Children's Hospital Informatics Program, Boston Children's Hospital, 1 Autumn Street, Boston, MA, , United States, 1 2817258062, ruchit.nagar@yale.edu %K influenza %K Twitter %K New York City %K spatiotemporal %K Google Flu Trends %K infodemiology %K mHealth %K social media, natural language processing %K medical informatics %D 2014 %7 20.10.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Twitter has shown some usefulness in predicting influenza cases on a weekly basis in multiple countries and on different geographic scales. Recently, Broniatowski and colleagues suggested Twitter’s relevance at the city-level for New York City. Here, we look to dive deeper into the case of New York City by analyzing daily Twitter data from temporal and spatiotemporal perspectives. Also, through manual coding of all tweets, we look to gain qualitative insights that can help direct future automated searches. Objective: The intent of the study was first to validate the temporal predictive strength of daily Twitter data for influenza-like illness emergency department (ILI-ED) visits during the New York City 2012-2013 influenza season against other available and established datasets (Google search query, or GSQ), and second, to examine the spatial distribution and the spread of geocoded tweets as proxies for potential cases. Methods: From the Twitter Streaming API, 2972 tweets were collected in the New York City region matching the keywords “flu”, “influenza”, “gripe”, and “high fever”. The tweets were categorized according to the scheme developed by Lamb et al. A new fourth category was added as an evaluator guess for the probability of the subject(s) being sick to account for strength of confidence in the validity of the statement. Temporal correlations were made for tweets against daily ILI-ED visits and daily GSQ volume. The best models were used for linear regression for forecasting ILI visits. A weighted, retrospective Poisson model with SaTScan software (n=1484), and vector map were used for spatiotemporal analysis. Results: Infection-related tweets (R=.763) correlated better than GSQ time series (R=.683) for the same keywords and had a lower mean average percent error (8.4 vs 11.8) for ILI-ED visit prediction in January, the most volatile month of flu. SaTScan identified primary outbreak cluster of high-probability infection tweets with a 2.74 relative risk ratio compared to medium-probability infection tweets at P=.001 in Northern Brooklyn, in a radius that includes Barclay’s Center and the Atlantic Avenue Terminal. Conclusions: While others have looked at weekly regional tweets, this study is the first to stress test Twitter for daily city-level data for New York City. Extraction of personal testimonies of infection-related tweets suggests Twitter’s strength both qualitatively and quantitatively for ILI-ED prediction compared to alternative daily datasets mixed with awareness-based data such as GSQ. Additionally, granular Twitter data provide important spatiotemporal insights. A tweet vector-map may be useful for visualization of city-level spread when local gold standard data are otherwise unavailable. %M 25331122 %R 10.2196/jmir.3416 %U http://www.jmir.org/2014/10/e236/ %U https://doi.org/10.2196/jmir.3416 %U http://www.ncbi.nlm.nih.gov/pubmed/25331122 %0 Journal Article %@ 1438-8871 %I JMIR Publications Inc. %V 16 %N 9 %P e221 %T An Internet-Based Epidemiological Investigation of the Outbreak of H7N9 Avian Influenza A in China Since Early 2013 %A Mao,Chen %A Wu,Xin-Yin %A Fu,Xiao-Hong %A Di,Meng-Yang %A Yu,Yuan-Yuan %A Yuan,Jin-Qiu %A Yang,Zu-Yao %A Tang,Jin-Ling %+ School of Public Health and Primary Care, The Chinese University of Hong Kong, Hong Kong, 4/F, School of Public Health and Primary Care, Prince of Wales Hospital, Shatin, New Territories, Hong Kong, , China (Hong Kong), 852 22528779, jltang@cuhk.edu.hk %K influenza A virus, H7N9 subtype %K Internet %K big data %K disease outbreaks %K epidemiology %D 2014 %7 25.09.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: In early 2013, a new type of avian influenza, H7N9, emerged in China. It quickly became an issue of great public concern and a widely discussed topic on the Internet. A considerable volume of relevant information was made publicly available on the Internet through various sources. Objective: This study aimed to describe the outbreak of H7N9 in China based on data openly available on the Internet and to validate our investigation by comparing our findings with a well-conducted conventional field epidemiologic study. Methods: We searched publicly accessible Internet data on the H7N9 outbreak primarily from government and major mass media websites in China up to February 10, 2014. Two researchers independently extracted, compared, and confirmed the information of each confirmed H7N9 case using a self-designed data extraction form. We summarized the epidemiological and clinical characteristics of confirmed H7N9 cases and compared them with those from the field study. Results: According to our data updated until February 10, 2014, 334 confirmed H7N9 cases were identified. The median age was 58 years and 67.0% (219/327) were males. Cases were reported in 15 regions in China. Five family clusters were found. Of the 16.8% (56/334) of the cases with relevant data, 69.6% (39/56) reported a history of exposure to animals. Of the 1751 persons with a close contact with a confirmed case, 0.6% (11/1751) of them developed respiratory symptoms during the 7-day surveillance period. In the 97.9% (327/334) of the cases with relevant data, 21.7% (71/327) died, 20.8% (68/327) were discharged from a hospital, and 57.5% (188/327) were of uncertain status. We compared our findings before February 10, 2014 and those before December 1, 2013 with those from the conventional field study, which had the latter cutoff date of ours in data collection. Our study showed most epidemiological and clinical characteristics were similar to those in the field study, except for case fatality (71/327, 21.7% for our data before February 10; 45/138, 32.6% for our data before December 1; 47/139, 33.8% for the field study), time from illness onset to first medical care (4 days, 3 days, and 1 day), and time from illness onset to death (16.5 days, 17 days, and 21 days). Conclusions: Findings from our Internet-based investigation were similar to those from the conventional field study in most epidemiological and clinical aspects of the outbreak. Importantly, publicly available Internet data are open to any interested researchers and can thus greatly facilitate the investigation and control of such outbreaks. With improved efforts for Internet data provision, Internet-based investigation has a great potential to become a quick, economical, novel approach to investigating sudden issues of great public concern that involve a relatively small number of cases like this H7N9 outbreak. %M 25257217 %R 10.2196/jmir.3763 %U http://www.jmir.org/2014/9/e221/ %U https://doi.org/10.2196/jmir.3763 %U http://www.ncbi.nlm.nih.gov/pubmed/25257217 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 4 %P e116 %T Performance of eHealth Data Sources in Local Influenza Surveillance: A 5-Year Open Cohort Study %A Timpka,Toomas %A Spreco,Armin %A Dahlström,Örjan %A Eriksson,Olle %A Gursky,Elin %A Ekberg,Joakim %A Blomqvist,Eva %A Strömgren,Magnus %A Karlsson,David %A Eriksson,Henrik %A Nyce,James %A Hinkula,Jorma %A Holm,Einar %+ Department of Medical and Health Sciences, Linköping University, Linköping University Hospital Campus, Linköping, SE58183, Sweden, 46 101030000, toomas.timpka@liu.se %K influenza %K infectious disease surveillance %K Internet %K eHealth %K Google Flu Trends %K telenursing call centers %K website usage %K open cohort design %K public health %D 2014 %7 28.04.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: There is abundant global interest in using syndromic data from population-wide health information systems—referred to as eHealth resources—to improve infectious disease surveillance. Recently, the necessity for these systems to achieve two potentially conflicting requirements has been emphasized. First, they must be evidence-based; second, they must be adjusted for the diversity of populations, lifestyles, and environments. Objective: The primary objective was to examine correlations between data from Google Flu Trends (GFT), computer-supported telenursing centers, health service websites, and influenza case rates during seasonal and pandemic influenza outbreaks. The secondary objective was to investigate associations between eHealth data, media coverage, and the interaction between circulating influenza strain(s) and the age-related population immunity. Methods: An open cohort design was used for a five-year study in a Swedish county (population 427,000). Syndromic eHealth data were collected from GFT, telenursing call centers, and local health service website visits at page level. Data on mass media coverage of influenza was collected from the major regional newspaper. The performance of eHealth data in surveillance was measured by correlation effect size and time lag to clinically diagnosed influenza cases. Results: Local media coverage data and influenza case rates showed correlations with large effect sizes only for the influenza A (A) pH1N1 outbreak in 2009 (r=.74, 95% CI .42-.90; P<.001) and the severe seasonal A H3N2 outbreak in 2011-2012 (r=.79, 95% CI .42-.93; P=.001), with media coverage preceding case rates with one week. Correlations between GFT and influenza case data showed large effect sizes for all outbreaks, the largest being the seasonal A H3N2 outbreak in 2008-2009 (r=.96, 95% CI .88-.99; P<.001). The preceding time lag decreased from two weeks during the first outbreaks to one week from the 2009 A pH1N1 pandemic. Telenursing data and influenza case data showed correlations with large effect sizes for all outbreaks after the seasonal B and A H1 outbreak in 2007-2008, with a time lag decreasing from two weeks for the seasonal A H3N2 outbreak in 2008-2009 (r=.95, 95% CI .82-.98; P<.001) to none for the A p H1N1 outbreak in 2009 (r=.84, 95% CI .62-.94; P<.001). Large effect sizes were also observed between website visits and influenza case data. Conclusions: Correlations between the eHealth data and influenza case rates in a Swedish county showed large effect sizes throughout a five-year period, while the time lag between signals in eHealth data and influenza rates changed. Further research is needed on analytic methods for adjusting eHealth surveillance systems to shifts in media coverage and to variations in age-group related immunity between virus strains. The results can be used to inform the development of alert-generating eHealth surveillance systems that can be subject for prospective evaluations in routine public health practice. %M 24776527 %R 10.2196/jmir.3099 %U http://www.jmir.org/2014/4/e116/ %U https://doi.org/10.2196/jmir.3099 %U http://www.ncbi.nlm.nih.gov/pubmed/24776527 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 3 %P e78 %T Determinants of Follow-Up Participation in the Internet-Based European Influenza Surveillance Platform Influenzanet %A Bajardi,Paolo %A Vespignani,Alessandro %A Funk,Sebastian %A Eames,Ken TD %A Edmunds,W John %A Turbelin,Clément %A Debin,Marion %A Colizza,Vittoria %A Smallenburg,Ronald %A Koppeschaar,Carl E %A Franco,Ana O %A Faustino,Vitor %A Carnahan,Annasara %A Rehn,Moa %A Paolotti,Daniela %+ Institute for Scientific Interchange Foundation, via Alassio 11/c, Torino, , Italy, 39 011 6603090, daniela.paolotti@isi.it %K participatory surveillance %K Internet %K influenza %D 2014 %7 10.03.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: “Influenzanet” is a network of Internet-based platforms aimed at collecting real-time data for influenza surveillance in several European countries. More than 30,000 European volunteers participate every year in the study, representing one of the largest existing Internet-based multicenter cohorts. Each week during the influenza season, participants are asked to report their symptoms (if any) along with a set of additional questions. Objective: Focusing on the first influenza season of 2011-12, when the Influenzanet system was completely harmonized within a common framework in Sweden, the United Kingdom, the Netherlands, Belgium, France, Italy, and Portugal, we investigated the propensity of users to regularly come back to the platform to provide information about their health status. Our purpose was to investigate demographic and behavioral factors associated with participation in follow-up. Methods: By means of a multilevel analysis, we evaluated the association between regular participation during the season and sociodemographic and behavioral characteristics as measured by a background questionnaire completed by participants on registration. Results: We found that lower participation in follow-up was associated with lower educational status (odds ratio [OR] 0.80, 95% CI 0.75-0.85), smoking (OR 0.64, 95% CI 0.59-0.70), younger age (OR ranging from 0.30, 95% CI 0.26-0.33 to 0.70, 95% CI 0.64-0.77), not being vaccinated against seasonal influenza (OR 0.77, 95% CI 0.72-0.84), and living in a household with children (OR 0.69, 95% CI 0.65-0.74). Most of these results hold when single countries are analyzed separately. Conclusions: Given the opportunistic enrollment of self-selected volunteers in the Influenzanet study, we have investigated how sociodemographic and behavioral characteristics may be associated with follow-up participation in the Influenzanet cohort. The study described in this paper shows that, overall, the most important determinants of participation are related to education and lifestyle: smoking, lower education level, younger age, people living with children, and people who have not been vaccinated against seasonal influenza tend to have a lower participation in follow-up. Despite the cross-country variation, the main findings are similar in the different national cohorts, and indeed the results are found to be valid also when performing a single-country analysis. Differences between countries do not seem to play a crucial role in determining the factors associated with participation in follow-up. %M 24613818 %R 10.2196/jmir.3010 %U http://www.jmir.org/2014/3/e78/ %U https://doi.org/10.2196/jmir.3010 %U http://www.ncbi.nlm.nih.gov/pubmed/24613818 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 16 %N 1 %P e20 %T Importance of Internet Surveillance in Public Health Emergency Control and Prevention: Evidence From a Digital Epidemiologic Study During Avian Influenza A H7N9 Outbreaks %A Gu,Hua %A Chen,Bin %A Zhu,Honghong %A Jiang,Tao %A Wang,Xinyi %A Chen,Lei %A Jiang,Zhenggang %A Zheng,Dawei %A Jiang,Jianmin %+ Zhejiang Provincial Center for Disease Control and Prevention, 3399 Binsheng Rd, Binjiang District, Hangzhou, 310051, China, 86 571 87115009, jmjiang@cdc.zj.cn %K influenza A virus, H7N9 subtype %K Internet %K surveillance %K disease outbreak %D 2014 %7 17.01.2014 %9 Original Paper %J J Med Internet Res %G English %X Background: Outbreaks of human infection with a new avian influenza A H7N9 virus occurred in China in the spring of 2013. Control and prevention of a new human infectious disease outbreak can be strongly affected by public reaction and social impact through the Internet and social media. Objective: This study aimed to investigate the potential roles of Internet surveillance in control and prevention of the human H7N9 outbreaks. Methods: Official data for the human H7N9 outbreaks were collected via the China National Health and Family Planning Committee website from March 31 to April 24, 2013. We obtained daily posted and forwarded number of blogs for the keyword “H7N9” from Sina microblog website and a daily Baidu Attention Index (BAI) from Baidu website, which reflected public attention to the outbreak. Rumors identified and confirmed by the authorities were collected from Baidu search engine. Results: Both daily posted and forwarded number and BAI for keyword H7N9 increased quickly during the first 3 days of the outbreaks and remained at a high level for 5 days. The total daily posted and forwarded number for H7N9 on Sina microblog peaked at 850,000 on April 3, from zero blogs before March 31, increasing to 97,726 on April 1 and to 370,607 on April 2, and remaining above 500,000 from April 5-8 before declining to 208,524 on April 12. The total daily BAI showed a similar pattern of change to the total daily posted and forwarded number over time from March 31 to April 12. When the outbreak locations spread, especially into other areas of the same province/city and the capital, Beijing, daily posted and forwarded number and BAI increased again to a peak at 368,500 and 116,911, respectively. The median daily BAI during the studied 25 days was significantly higher among the 7 provinces/cities with reported human H7N9 cases than the 2 provinces without any cases (P<.001). So were the median daily posted and forwarded number and daily BAI in each province/city except Anhui province. We retrieved a total of 32 confirmed rumors spread across 19 provinces/cities in China. In all, 84% (27/32) of rumors were disseminated and transmitted by social media. Conclusions: The first 3 days of an epidemic is a critical period for the authorities to take appropriate action through Internet surveillance to prevent and control the epidemic, including preparation of personnel, technology, and other resources; information release; collection of public opinion and reaction; and clarification, prevention, and control of rumors. Internet surveillance can be used as an efficient and economical tool to prevent and control public health emergencies, such as H7N9 outbreaks. %M 24440770 %R 10.2196/jmir.2911 %U http://www.jmir.org/2014/1/e20/ %U https://doi.org/10.2196/jmir.2911 %U http://www.ncbi.nlm.nih.gov/pubmed/24440770 %0 Journal Article %@ 14388871 %I JMIR Publications Inc. %V 15 %N 10 %P e237 %T The Complex Relationship of Realspace Events and Messages in Cyberspace: Case Study of Influenza and Pertussis Using Tweets %A Nagel,Anna C %A Tsou,Ming-Hsiang %A Spitzberg,Brian H %A An,Li %A Gawron,J Mark %A Gupta,Dipak K %A Yang,Jiue-An %A Han,Su %A Peddecord,K Michael %A Lindsay,Suzanne %A Sawyer,Mark H %+ Department of Geography, San Diego State University, Storm Hall #326, 5500 Campanile Dr, San Diego, CA, 92182, United States, 1 619 594 0205, mtsou@mail.sdsu.edu %K Twitter %K infoveillance %K infodemiology %K cyberspace %K syndromic surveillance %K influenza %K pertussis %K whooping cough %D 2013 %7 26.10.2013 %9 Original Paper %J J Med Internet Res %G English %X Background: Surveillance plays a vital role in disease detection, but traditional methods of collecting patient data, reporting to health officials, and compiling reports are costly and time consuming. In recent years, syndromic surveillance tools have expanded and researchers are able to exploit the vast amount of data available in real time on the Internet at minimal cost. Many data sources for infoveillance exist, but this study focuses on status updates (tweets) from the Twitter microblogging website. Objective: The aim of this study was to explore the interaction between cyberspace message activity, measured by keyword-specific tweets, and real world occurrences of influenza and pertussis. Tweets were aggregated by week and compared to weekly influenza-like illness (ILI) and weekly pertussis incidence. The potential effect of tweet type was analyzed by categorizing tweets into 4 categories: nonretweets, retweets, tweets with a URL Web address, and tweets without a URL Web address. Methods: Tweets were collected within a 17-mile radius of 11 US cities chosen on the basis of population size and the availability of disease data. Influenza analysis involved all 11 cities. Pertussis analysis was based on the 2 cities nearest to the Washington State pertussis outbreak (Seattle, WA and Portland, OR). Tweet collection resulted in 161,821 flu, 6174 influenza, 160 pertussis, and 1167 whooping cough tweets. The correlation coefficients between tweets or subgroups of tweets and disease occurrence were calculated and trends were presented graphically. Results: Correlations between weekly aggregated tweets and disease occurrence varied greatly, but were relatively strong in some areas. In general, correlation coefficients were stronger in the flu analysis compared to the pertussis analysis. Within each analysis, flu tweets were more strongly correlated with ILI rates than influenza tweets, and whooping cough tweets correlated more strongly with pertussis incidence than pertussis tweets. Nonretweets correlated more with disease occurrence than retweets, and tweets without a URL Web address correlated better with actual incidence than those with a URL Web address primarily for the flu tweets. Conclusions: This study demonstrates that not only does keyword choice play an important role in how well tweets correlate with disease occurrence, but that the subgroup of tweets used for analysis is also important. This exploratory work shows potential in the use of tweets for infoveillance, but continued efforts are needed to further refine research methods in this field. %M 24158773 %R 10.2196/jmir.2705 %U http://www.jmir.org/2013/10/e237/ %U https://doi.org/10.2196/jmir.2705 %U http://www.ncbi.nlm.nih.gov/pubmed/24158773 %0 Journal Article %@ 1929-073X %I JMIR Publications Inc. %V 1 %N 2 %P e20 %T Issues Regarding the Implementation of eHealth: Preparing for Future Influenza Pandemics %A Li,Junhua %A Seale,Holly %A Ray,Pradeep %A Rawlinson,William %A Lewis,Lundy %A MacIntyre,C. Raina %+ Asia-Pacific Ubiquitous Healthcare Research Centre, The University of New South Wales, APuHC, Room 1039, 1st floor, west wing, Quadrangle Building, kensington Campus, University of New South Wales, Sydney, , Australia, 61 (2) 9931 9308, junhua.li.syd@gmail.com %K eHealth %K influenza pandemic %K preparedness assessment %K case study %D 2012 %7 06.12.2012 %9 Original Paper %J Interact J Med Res %G English %X Background: eHealth is a tool that may be used to facilitate responses to influenza pandemics. Prior to implementation of eHealth in the hospital setting, assessment of the organizational preparedness is an important step in the planning process. Including this step may increase the chance of implementation success. Objective: To identify the preparedness issues in relation to implementation of eHealth for future influenza pandemics. Methods: One hospital was selected in Australia for this study. We conducted 12 individual interviews to gather a rich data set in relation to eHealth preparedness in the context of the 2009 influenza A (H1N1) pandemic at this major teaching hospital. These participants’ views were analyzed according to five main themes: (1) challenges in present practices or circumstances for pandemic responses, which indicates a need for change, (2) healthcare providers’ exposure to eHealth, (3) organizational technological capacity to support an IT innovation for medical practices, (4) resource preparedness, and (5) socio-cultural issues in association with eHealth implementation in response to a pandemic. Results: This article reports a subset of the issues identified during the case study. These issues include, for example, poor sharing of patient health records, poor protection of patient privacy, clinicians’ concerns about IT reliability and dissatisfaction with the software in use, clinicians’ concerns about IT’s impact on professional autonomy versus having inefficient IT support, and inefficient communication across departments in the form of consultation. Conclusions: Based on discussions with the participants and interpretation of their responses, we assessed the hospital’s preparedness status and also identified areas of deficiency. Accordingly, we suggest possible solutions for the areas in need of improvement to facilitate eHealth implementation’s success. The study results will also provide policymakers at national, state and local levels with insights to refine relevant public health policies for the planning and management of pandemics from the eHealth perspective. %M 23611788 %R 10.2196/ijmr.2357 %U http://www.i-jmr.org/2012/2/e20/ %U https://doi.org/10.2196/ijmr.2357 %U http://www.ncbi.nlm.nih.gov/pubmed/23611788 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 14 %N 1 %P e14 %T Real-time Prescription Surveillance and its Application to Monitoring Seasonal Influenza Activity in Japan %A Sugawara,Tamie %A Ohkusa,Yasushi %A Ibuka,Yoko %A Kawanohara,Hirokazu %A Taniguchi,Kiyosu %A Okabe,Nobuhiko %+ National Institute of Infectious Diseases, Infectious Disease Surveillance Center, 1-23-1Toyama, Shinjuku, Tokyo, 162-8640, Japan, 81 3 5285 1111, tammy@nih.go.jp %K Surveillance %K influenza %K real-time surveillance %K prescriptions %K pharmacy %K anti-influenza virus %K automatic surveillance %K early response %D 2012 %7 16.01.2012 %9 Original Paper %J J Med Internet Res %G English %X Background: Real-time surveillance is fundamental for effective control of disease outbreaks, but the official sentinel surveillance in Japan collects information related to disease activity only weekly and updates it with a 1-week time lag. Objective: To report on a prescription surveillance system using electronic records related to prescription drugs that was started in 2008 in Japan, and to evaluate the surveillance system for monitoring influenza activity during the 2009–2010 and 2010–2011 influenza seasons. Methods: We developed an automatic surveillance system using electronic records of prescription drug purchases collected from 5275 pharmacies through the application service provider’s medical claims service. We then applied the system to monitoring influenza activity during the 2009–2010 and 2010–2011 influenza seasons. The surveillance system collected information related to drugs and patients directly and automatically from the electronic prescription record system, and estimated the number of influenza cases based on the number of prescriptions of anti-influenza virus medication. Then it shared the information related to influenza activity through the Internet with the public on a daily basis. Results: During the 2009–2010 influenza season, the number of influenza patients estimated by the prescription surveillance system between the 28th week of 2009 and the 12th week of 2010 was 9,234,289. In the 2010–2011 influenza season, the number of influenza patients between the 36th week of 2010 and the 12th week of 2011 was 7,153,437. The estimated number of influenza cases was highly correlated with that predicted by the official sentinel surveillance (r = .992, P < .001 for 2009–2010; r = .972, P < .001 for 2010–2011), indicating that the prescription surveillance system produced a good approximation of activity patterns. Conclusions: Our prescription surveillance system presents great potential for monitoring influenza activity and for providing early detection of infectious disease outbreaks. %M 22249906 %R 10.2196/jmir.1881 %U http://www.jmir.org/2012/1/e14/ %U https://doi.org/10.2196/jmir.1881 %U http://www.ncbi.nlm.nih.gov/pubmed/22249906 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 4 %P e85 %T Digital Dashboard Design Using Multiple Data Streams for Disease Surveillance With Influenza Surveillance as an Example %A Cheng,Calvin KY %A Ip,Dennis KM %A Cowling,Benjamin J %A Ho,Lai Ming %A Leung,Gabriel M %A Lau,Eric HY %+ School of Public Health, The University of Hong Kong, 5/F William MW Mong Block, Faculty of Medicine Building, 21 Sassoon Road,, Hong Kong, China, 852 3906 2019, ehylau@hku.hk %K Dashboard %K dissemination %K surveillance %K influenza %D 2011 %7 14.10.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: Great strides have been made exploring and exploiting new and different sources of disease surveillance data and developing robust statistical methods for analyzing the collected data. However, there has been less research in the area of dissemination. Proper dissemination of surveillance data can facilitate the end user's taking of appropriate actions, thus maximizing the utility of effort taken from upstream of the surveillance-to-action loop. Objective: The aims of the study were to develop a generic framework for a digital dashboard incorporating features of efficient dashboard design and to demonstrate this framework by specific application to influenza surveillance in Hong Kong. Methods: Based on the merits of the national websites and principles of efficient dashboard design, we designed an automated influenza surveillance digital dashboard as a demonstration of efficient dissemination of surveillance data. We developed the system to synthesize and display multiple sources of influenza surveillance data streams in the dashboard. Different algorithms can be implemented in the dashboard for incorporating all surveillance data streams to describe the overall influenza activity. Results: We designed and implemented an influenza surveillance dashboard that utilized self-explanatory figures to display multiple surveillance data streams in panels. Indicators for individual data streams as well as for overall influenza activity were summarized in the main page, which can be read at a glance. Data retrieval function was also incorporated to allow data sharing in standard format. Conclusions: The influenza surveillance dashboard serves as a template to illustrate the efficient synthesization and dissemination of multiple-source surveillance data, which may also be applied to other diseases. Surveillance data from multiple sources can be disseminated efficiently using a dashboard design that facilitates the translation of surveillance information to public health actions. %M 22001082 %R 10.2196/jmir.1658 %U http://www.jmir.org/2011/4/e85/ %U https://doi.org/10.2196/jmir.1658 %U http://www.ncbi.nlm.nih.gov/pubmed/22001082 %0 Journal Article %@ 1438-8871 %I Gunther Eysenbach %V 13 %N 2 %P e36 %T Natural Supplements for H1N1 Influenza: Retrospective Observational Infodemiology Study of Information and Search Activity on the Internet %A Hill,Shawndra %A Mao,Jun %A Ungar,Lyle %A Hennessy,Sean %A Leonard,Charles E %A Holmes,John %+ Operations and Information Management, The Wharton School, University of Pennsylvania, 3730 Walnut Street, Suite 500, Philadelphia,PA, 19104, United States, 1 2155735677, shawndra@wharton.upenn.edu %K Internet search %K pandemic %K herbal supplements %K H1N1 influenza %D 2011 %7 10.05.2011 %9 Original Paper %J J Med Internet Res %G English %X Background: As the incidence of H1N1 increases, the lay public may turn to the Internet for information about natural supplements for prevention and treatment. Objective: Our objective was to identify and characterize websites that provide information about herbal and natural supplements with information about H1N1 and to examine trends in the public’s behavior in searching for information about supplement use in preventing or treating H1N1. Methods: This was a retrospective observational infodemiology study of indexed websites and Internet search activity over the period January 1, 2009, through November 15, 2009. The setting is the Internet as indexed by Google with aggregated Internet user data. The main outcome measures were the frequency of “hits” or webpages containing terms relating to natural supplements co-occurring with H1N1/swine flu, terms relating to natural supplements co-occurring with H1N1/swine flu proportional to all terms relating to natural supplements, webpage rank, webpage entropy, and temporal trend in search activity. Results: A large number of websites support information about supplements and H1N1. The supplement with the highest proportion of H1N1/swine flu information was a homeopathic remedy known as Oscillococcinum that has no known side effects; supplements with the next highest proportions have known side effects and interactions. Webpages with both supplement and H1N1/swine flu information were less likely to be medically curated or authoritative. Search activity for supplements was temporally related to H1N1/swine flu-related news reports and events. Conclusions: The prevalence of nonauthoritative webpages with information about supplements in the context of H1N1/swine flu and the increasing number of searches for these pages suggest that the public is interested in alternatives to traditional prevention and treatment of H1N1. The quality of this information is often questionable and clinicians should be cognizant that patients may be at risk of adverse events associated with the use of supplements for H1N1. %M 21558062 %R 10.2196/jmir.1722 %U http://www.jmir.org/2011/2/e36/ %U https://doi.org/10.2196/jmir.1722 %U http://www.ncbi.nlm.nih.gov/pubmed/21558062